Bullying: When Words Get in the Way

    • September 9, 2013

Verbal abuse of nurses by their colleagues in health care settings is an ongoing and well-documented problem. Now two studies published by the Robert Wood Johnson Foundation (RWJF) RN Work Project demonstrate that high levels of such abuse have a significant negative effect on victims.  The studies reveal that newly-licensed registered nurses (NLRNs) who are on the receiving end of verbal abuse have lower job satisfaction, greater intent to leave their jobs, and more negative perceptions of their work environments.

The study examining verbal abuse of nurses by nurses found that only about five percent of NLRNs had experienced high levels of abuse (defined as having been verbally abused more than five times in the previous three months). The most common forms of abuse were experiencing condescension or being ignored.

“The verbal abuse we found to be most common is best characterized as passive-aggressive,” said Wendy Budin, RN-BC, PhD, FAAN, adjunct professor at the College of Nursing, New York University, and a lead investigator for the nurses’ study. “Rather than yelling, swearing, insulting, or humiliating behavior, most early career RNs reported that the abuse they experienced involved condescension or lack of acknowledgement. This kind of subtle abuse is less likely to be reported and more likely to be overlooked as a problem, which makes it all the more insidious and it is all the more important that hospital administrators work to confront and prevent it.”

The study examining physician abuse of nurses revealed that high levels of verbal abuse from physicians correlate with high levels of abuse from nurse colleagues. They also correlate with negative work environments, but the researchers pointed out that it was not possible to determine whether the abuse created the negative work environment or being in a negative work environment engendered the verbal abuse.

“One of the most striking findings is that higher levels of verbal abuse by physicians are correlated with poorer perceptions of the work environment across the board,” said Carol Brewer, RN, FAAN, professor at the School of Nursing, University at Buffalo, who co-directs the RN Work Project. “It also seems that verbal abuse is contagious. One potential explanation is that negative behavior exhibited by one member of a group spills over to other members of the group and hurts the group dynamic. We also see that in a stressful environment, including one in which there is physician to RN abuse, there is more likely to be RN to RN abuse, as well.”

For both sources of verbal abuse, higher levels were associated with working day shifts and working on units that were short-staffed. Nurses participating in the studies who worked in Magnet hospitals reported lower levels of verbal abuse by physicians and by other nurses. 

The researchers recommend mandatory hospital-wide programs for all employees about the impact of verbal abuse and other disruptive behaviors, and zero-tolerance policies. They note that a variety of methods have been proposed to prevent verbal abuse but suggest that a holistic approach to improving the work environment is best. They also recommend that policies be developed in cooperation with nursing leaders, key physicians, and administrators.

“Physicians’ verbal abuse of nurses is a long-standing problem and one we need to do much more to address,” said Christine T. Kovner, PhD, RN, FAAN, professor at the College of Nursing, New York University, who directs the RN Work Project with Brewer. “It hurts morale, breeds further verbal abuse, and is associated with nurse intention to leave, particularly among younger nurses. All of these things ultimately reduce the quality of patient care. Health care organizations need to do much more to create positive, healthy work environments”

The researchers also cited a need for evidence-based strategies to decrease and eliminate verbal abuse and to help new nurses cope with abuse, including structured interventions. They suggest that therapeutic communication, assertiveness training, and conflict management strategies may help new nurses cope with perceived abuse.

The RN Work Project is a 10-year study of NLRNs that began in 2006. It is the only multi-state, longitudinal study of new nurses’ turnover rates, intentions and attitudes—including intent, satisfaction, organizational commitment, and preferences about work. The study draws on data from nurses in 34 states, covering 51 metropolitan areas and nine rural areas.

The study on abuse by physicians was published online in Nursing Outlook. The RN Work Project team surveyed 1,328 NLRNs about how often they were verbally abused by physicians, the nature of the abuse, and its effect on their perceptions of work environment and their jobs. The study on abuse by other nurses was published online in the Journal of Nursing Scholarship. The researchers surveyed 1,407 NLRNs about how often they were verbally abused by nurse colleagues, the nature of the abuse, and the impact.