From the desk of Adrianne E. Avillion, DEd, RN

Staff Development Weekly: Insight on Evidence-Based Practice in Education, October 28, 2011

Editor's note: This feature is written by nursing professional development expert Adrianne E. Avillion, DEd, RN. Each week, Adrianne writes about an important issue in the area of professional development or answers reader questions. If you have a question for Adrianne, e-mail her at

Professional development's role in stopping the bullying cycle

The topic of bullying in healthcare is receiving more and more attention as its negative impact on patient care and recruitment and retention is recognized. Bullying is not limited to supervisors bullying subordinates or physicians bullying nurses. The effects of horizontal bullying (or horizontal violence) in nursing are both devastating to nurses and the organizations for which they work. Research shows that 60% of newly licensed nurses leave their first positions within six months because they have been bullied by their peers. Research also shows that bullying leads to the following:

  • Increased medication errors and other adverse occurrences
  • Increased turnover
  • Decreased ability of organizations to recruit qualified staff
  • Increased use of sick time by nurses who are bullied
  • Development of post-traumatic stress disorder (PTSD) in persons who have been bullied

What can Nursing Professional Development (NPD) specialists do to decrease the prevalence of bullying? First, investigate what policies and procedures exist within your organization that deal with the subject. There should be a zero tolerance for bullying. Policies should identify, specifically, the consequences for bullying and options for persons who are bullied (e.g., filing a grievance). But it is not enough to have such policies and procedures in place. They must be adhered to. Sadly, administration and management have been known to ignore or even encourage bullying. Excuses such as, "She may be a bully, but she's my best clinical nurse," or "Everyone has to put up with this sort of thing when starting a new job. It's just a sort of initiation," are heard all-too-often.

Bullying prevention should be part of continuing education for all employees. The effects of bullying and how to deal with it should be part of orientation as well as annual training. Role play is an important part of such education endeavors. Persons who are bullying need to recognize their own behavior and its effects on those being bullied and on patients, too. It is also important that administration and managers become aware of the effects of bullying and why it must stop. Finally, persons who are bullied need to empower themselves to put a stop to such behavior. Here are some resources that I have found to be quite helpful when planning anti-bullying education.

  • Bartholomew, K. (2005). Speak Your Truth: Proven Strategies for Effective Nurse-Physician Communication. Danvers, MA: HCPro.
  • Bartholomew, K. (2006). Ending Nurse-To-Nurse Hostility: Why Nurses Eat Their Young and Each Other. Danvers, MA: HCPro.
  • Dellasega, C. (2011). When Nurses Hurt Nurses. Indianapolis, IN: STT.
  • Stagg, S. J., et al. (2011). Evaluation of a workplace bullying cognitive rehearsal program in a hospital setting. The Journal of Continuing Education in Nursing, 42(9), 395-403.

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