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Study: Bullying linked to decline in patient safety


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Not only does bullying and aggressive behavior create a difficult and hostile work environment, but a new study links bad behavior with compromised patient safety in healthcare.

The study, released by the Pennsylvania Patient Safety Authority in June, reviewed almost 6,000 reports with keywords that suggested bullying or aggressive behavior in healthcare in the Pennsylvania Patient Safety Reporting System over a two year period between 2014-2016, and identified 44 events that described bullying in healthcare facilities. While bullying is characterized by repetitive aggressive behavior over time, the examples consisted of behavior that repeated over time would suggest bullying.

A majority of the events included verbal abuse and intimidating behavior, and other issues reported were work interference and humiliating and threatening behavior. The events occurred in many areas of care, especially in perioperative care, medical/surgical units, and emergency departments, and were often prompted by procedural errors and complications.

While most of the events described overt bullying with no direct patient-care consequences, bullying behavior can threaten patient safety in many subversive ways. The study authors found that bullying behavior inhibited teamwork, obstructed communication, and delayed new practices from being implemented. Disruptive behavior can affect the healthcare provider’s ability to think clearly and focus on the patient, which can lead to an increase in errors. Additionally, bullying decreases staff morale and can increased absenteeism and turnover of qualified staff.

Bullying in healthcare has become a major issue over the past decade, prompted by the Joint Commission’s recommendation of a zero-tolerance policy towards bullying behavior in 2008. The American Nurses Association and the Lucian Leape Institute for Patient Safety Foundation are among the institutions that have an official position on the subject of bullying in healthcare, and states across the country have introduced bills that address workplace bullying.

Patient-care facilities are encouraged to take bullying behavior seriously, by evaluating the behavior and workplace culture in their facility, and effecting zero-tolerance policies against bullying. Leadership support in this area is crucial, as they will be involved in introducing and maintaining successful anti-bullying programs. Educate staff and managers to recognize and handle bullying behavior in their unit; there are many approaches that have proven effective, such as scripting techniques to diffuse bullying encounters like D.E.S.C. (describe, express, suggest, consequences) or role-play simulation to practice confronting a bully in an assertive manner.

For more information on preventing bullying, particularly on the nursing unit, check out Kathleen Bartholomew’s landmark book, Ending Nurse-to-Nurse Hostility, which is recommended by the American Nursing Association in their position statement against workplace bullying. You can read an excerpt here.