Effects of a Hostile Work Environment in Healthcare
Tiffiny K Sweet
February 6, 2022
Hostile work environments affect many people in the workforce across America. It affects the morale and work-space atmosphere. This, in turn, affects job satisfaction leading to decreased job productivity and employee retention. There are different views on how to handle hostile work environments to include policies and training. A hostile work environment can affect so many things for that one person that is being attacked. If this issue is not dealt with expediently, this opens the door to many negative effects of the workplace. This affects employee satisfaction in their job, turn-over rates, the mental health of that nurse, and ultimately can affect patient care. With COVID and all the shortages everywhere, people that are still able to work are over-worked. Due to the shortages, the remaining workforce is exhausted and stressed. A study by Leodoro Labrague et al. concluded: “Nurses who work for a manager exhibiting toxic leadership behaviours demonstrated lower job contentment, higher stress levels, frequent absenteeism and higher intent to leave the nursing profession.” These behaviors need to be addressed and handled in a professional manner before it causes a mass-exodus of the remaining hard-working nurses that continue to show up to care for their patients. Rasool et al. (2021) “The feelings that come with a toxic workplace environment, i.e., harassment, bullying, and ostracism, can be detrimental and lead to unnecessary stress, burnout, depression, and anxiety among the workers.” I believe work toxicity affects every job field across the board no matter the business. This is currently happening right now, and it is widespread, nondiscriminatory, and it is a real problem in the world.
You walk into the Emergency Room for work today. This is your second extra shift this week due to being short staffed. The patient board is full. Half of them have COVID symptoms. One of your co-workers is home on quarantine due to an exposure last week. You didn’t sleep well last night because yesterday’s workday weighs heavy on your mind. It was much like today is looking like. So here you are, over-worked, tired, stressing. Pretty ugly picture to imagine, however, these are true everyday occurrences for nurses these days. Now, let’s throw in a bullying co-worker or abusive manager. The horrible, although manageable, day just became worse. Unfortunately, this is happening across many hospitals, and it is taking a toll on the nurses. As stated by Labrague et al. (2020) “Reed (2004) identified the criteria of a toxic leader, such as neglect of employees’ well-being, the existence of a negative personality that influences organisational climate and the presence of self-driven motivation.” Nurses have enough stress in their everyday work life. Everyone, at some point, has had to work with someone that they didn’t like. As adults, we go to work, we do our job, and come home. Everyone’s job is different, carries different stresses, different requirements, and different settings. One thing that is the same is that if you throw in that one hostile co-worker, your job/work environment just became toxic, and overtime can become unbearable. It is never expected that everyone at one workplace will be best friends. There are too many different personality types to have that dream come true. It is expected, that as all adults, we would all be respectful of each other and get along with each other. That is not always the case.
If everyone has worked in this situation and it is so widespread, what’s the big deal, right? The effects of this type of work habitat are detrimental. Cole Edmonson et al. referenced a study by K. Stevenson et al. showing that “Within the first 6 months, 60% of nurses leave their first job due to the behavior of their coworkers” (Our Own Worst Enemies: The Nurse Bullying Epidemic. 2019). This is a staggering amount. Edmonson (2019) reported that “A bullying culture contributes to a poor nurse work environment, increased risk to patients, lower Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient satisfaction scores, and greater nurse turnover, which costs the average hospital $4 million to $7 million a year.”
What exactly is “nurse bullying”? Every person has their own definition of bullying, however, per Edmonson (2019) “The American Nurses Association defines nurse bullying as “repeated, unwanted harmful actions intended to humiliate, offend and cause distress in the recipient,” calling it “a very serious issue that threatens patient safety, RN safety and the nursing profession as a whole.”” Labrague et al. (2020) reports in a study “After controlling for the nurse/unit/hospital characteristics, our findings revealed a strong and significant association between toxic leadership behaviours and nurse-reported adverse patient events and care quality.” This is unsatisfactory. Examples of bullying can be talking down to a coworker in a condescending manner, ignoring or not including someone on purpose, verbal threats, and worse case actual violence. As nurses, we are here to provide excellent care for our patients. We should not tolerate anything that causes a negative outcome for our patients. Labrague et al. (2020) “In particular, higher perceptions of toxic leadership behaviours in NMs significantly increased the reporting of poor care quality and nurse-reported adverse events including verbal abuse and complaints from patients and their families, patient falls, health care-acquired infections and errors in drug administration.” This is possible because nursing communication is hindered when there is hostility in the environment. One nurse may fail to relay important information strictly because she does not want to communicate with hostile employee. “Communicating thoughts and feelings about bullying and interpersonal hostility can be challenging” (Howard & Embree, 2020). Even worse, one nurse may turn a blind eye to a nurse making a medication error because they fear retaliation or an attack for pointing out an error to the bully, they have problems with. In the end, the patient is the one who suffers.
How do we fix this growing problem?
One solution is there needs to be a clear zero-tolerance policy that is enforced. Another solution is training employees how to handle and cope with the hostile work environment. Ideally, it would be nice if both were used across the board. Unfortunately, that is not the case many times. I feel the zero-tolerance policy put in place and enforced to the full extent is the best choice if you could only use one. Crawford et al. (2019) “The American Nurses Association recommends zero tolerance for any form of violence from any source and adopting evidence- based strategies to mitigate incivility and bullying.” With any misconduct in the workplace, there are consequences for your actions. If there was a clear policy with disciplinary action, there would be support for the bullied nurse. A place with no policy in place has no consistency. This leaves room for favoritism or the victimized nurse’s problems not being resolved or “swept under a rug”. A nurse manager may listen to the complaint but the say “oh that is just how she is” and encourage her to brush it off. If this happens repeatedly this nurse will feel like there is no point in reporting the abuse as nothing is being done. Crawford et al. (2019) “Inappropriate actions and behaviors are accepted as “That’s Just How S/he Is.” The Nurse Manager is supposed to be your refuge and safe place to go to. Crawford et al. (2019) “The NM must explore the “Three Sides to a Story” to investigate the bullied nurse’s story and the bully’s story to determine the story that exists between the two. The NM then has an organizational and ethical obligation to follow policy, procedures, and guidelines to correct inappropriate behaviors.” For this to be effective, there must be a written standard. Once there is a dedicated policy, the next step is education.
Another way to help with hostile work environments is educating/training nurses how to deal with the situation. A study by Ann Stalter et al. (2020) discusses evidence-based teaching strategies and evaluation methods using the seven steps for civility awareness. “The overall education goal is to promote discussion about experiences with incivility so that learners can recognize incivility as a social justice issue, call it what it is, and think about responsibility for overcoming and dealing directly with incivility” (Stalter et al. 2020). The second step is cognitive restructuring toward civility. Stalter et al. (2020) “Cognitive restructuring is the introduction of new ideas to change previous thoughts about civility and incivility.” The third step is “critical reasoning of today’s challenges to educate civility awareness” (Stalter et al. 2020). Step four “reinforces quality and safety competencies as a foundation for civility in practice” (Stalter et al. 2020). The fifth step “emphasizes ways that learners can discuss and interpret professional standards of conduct as they relate to civility” (Stalter et al. 2020). The fifth step “emphasizes ways that learners can discuss and interpret professional standards of conduct as they relate to civility” (Stalter et al. 2020). The sixth step “applies high standards of ethical conduct according to eh ANA Code of Ethics” (Stalter et al. 2020). Step seven “leads civility cultures within complex practice systems (Stalter et al. 2020). Having a standard to follow allows for consistency across the board. It eliminates the room for favoritism or any missed steps. This type of training empowers the targeted nurse against the bully. It allows them to have some control of the situation.
Unfortunately, workplace hostility is something that occurs, however, there is also ways to handle it. There is no reason anyone should go to work with dread and fear. There is no one in the world that has a right to do this to someone on a regular basis. Our patients deserve top-rated care that is not tainted by a hostile work environment. We must educate and empower our fellow nurses. Do not let them think they are alone. We also need to set in place a disciplinary action plan for the offenders and let them know this behavior is not acceptable. Nurse managers must step up and enforce set policies. Nurses work too many hours, usually with the same people, to not feel safe and comfortable at their job. We are already overworked, tired, and stressed, even more so with the COVID crisis. A bully at work is the last thing we should have to worry about.
Crawford, C. L., Chu, F., Judson, L. H., Cuenca, E., Jadalla, A. A., Tze-Polo, L., Kawar, L. N., Runnels, C., & Garvida, R. (2019). An integrative review of nurse-to-nurse incivility, hostility, and workplace violence. Nursing Administration Quarterly, 43(2), 138–156. https://doi.org/10.1097/naq.0000000000000338
Howard, M. S., & Embree, J. L. (2020). Educational intervention improves communication abilities of nurses encountering workplace incivility. The Journal of Continuing Education in Nursing, 51(3), 138–144. https://doi.org/10.3928/00220124-20200216-09
Labrague, L. J. (2020). Influence of Nurse Managers’ toxic leadership behaviours on nurse‐reported adverse events and quality of care. Journal of Nursing Management, 29(4), 855–863. https://doi.org/10.1111/jonm.13228
Labrague, L. J., Nwafor, C. E., & Tsaras, K. (2020). Influence of toxic and transformational leadership practices on nurses’ job satisfaction, job stress, absenteeism and turnover intention: A cross‐sectional study. Journal of Nursing Management, 28(5), 1104–1113. https://doi.org/10.1111/jonm.13053
Rasool, S. F., Wang, M., Tang, M., Saeed, A., & Iqbal, J. (2021). How toxic workplace environment effects the employee engagement: The mediating role of organizational support and employee wellbeing. International Journal of Environmental Research and Public Health, 18(5), 2294. https://doi.org/10.3390/ijerph18052294
Stalter, A. M., Phillips, J. M., Goldschmidt, K. A., Brodhead, J., Ruggiero, J. S., Scardaville, D. L., McKay, M., Bonnett, P. L., & Merriam, D. (2020). Promoting civility in nursing practice using systems thinking: Evidence‐based teaching strategies for nurse educators. Nursing Forum, 55(4), 754–762. https://doi.org/10.1111/nuf.12493