3 Apr 2018

Nursing can’t shake its bullying problem

3:24 pm on 3 April 2018

New Zealand's nurses are belittled, humiliated and pushed to their limits. Mava Enoka reports.  

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Photo: Illustration: Celia Jacobs

Lily Carter* is losing chunks of her hair. The 24-year-old pulls back a section revealing a bald patch just above her right ear.  

Lily is a registered nurse in one of New Zealand’s busiest hospitals. She works in the paediatrics ward taking care of the country’s sickest children. It’s a demanding job, both rewarding and heartbreaking, and Lily was prepared for that. She wasn’t prepared for the bullying.

“I had no idea this was what nursing would be like,” she says. “I’ve never experienced something so fucked up in my life. It is soul crushing.

“I went into the job so bright-eyed and bushy-tailed. I love everything about holistic care for the entire whanau.”

Lily landed the job at the beginning of last year. A few weeks in, her optimism began to erode. She noticed chronic understaffing, stressed workers, insufficient resources, and a toxic culture among some of the nurses.

Lily sent The Wireless five pages of her accounts. Her stories are sobering and at times difficult to believe. They include being yelled at in front of patients, belittled and demeaned by nurses, purposely being given difficult rosters, and being left with unsafe workloads.

She recently developed alopecia - an autoimmune disease that causes her hair to fall out  - due to the stress of the job.

Bullying is a well-known and thoroughly-researched phenomenon in healthcare. It’s been described by the Emergency Medicine Australasia journal as the most “destructive phenomenon plaguing medical culture”.

It seems like an anomaly that an inherently nurturing profession like nursing produces particularly high levels of bullying. In fact, it’s so common that it has its own catchphrase: "nurses eat their young".

Bullying in nursing is still a major issue. The nurses we spoke to say while the majority of nurses are wonderful colleagues, a small number are making the job unbearable.

In a Facebook group with over 44,000 members, many nurses have pointed to bullying on the job. The group was set up last month for Kiwi nurses to share their experiences and campaign for better pay. Those who are bullied say it’s often from those in senior positions but also includes peer-to-peer and patient-to-nurse bullying.

The Wireless invited nurses who wanted to share their experiences of bullying to get in touch and we interviewed five of the seven who reached out. All the nurses we spoke to wanted to remain anonymous as they feared speaking out would increase the bullying or affect their chances of getting future work.

Rates of workplace bullying in New Zealand are high by international standards and healthcare is especially bad, with 18.4 percent of people saying they’d been bullied in the past six months. It’s been attributed to the hierarchical culture of medicine, high levels of stress, poor resourcing, and long working hours. It all leads to an environment that breeds bullies.

Nursing is particularly affected, with research suggesting 65-80 percent of nurses having either experienced or witnessed bullying in the workplace.

All 1169 nurses who responded to a New Zealand study had experienced bullying. Over half reported being undervalued by other nurses. Over a third had had learning opportunities blocked, and had been distressed by conflict between others. Although the study was carried out over a decade ago, nurses say the issue of bullying is as pressing as ever.

The consequences can be huge. A study by the UK Office for National Statistics found nurses are more at risk of suicide than any other health professional. Female health workers are 23 percent more likely to kill themselves than any other women. Also, patient care and safety can be seriously compromised when nurses are dealing with conflict.

Dr Kate Blackwood, lecturer in management at Massey University, studied 34 cases of bullying in three different hospitals across New Zealand and found just one was completely resolved.

“One nurse I spoke to said ‘you go into nursing and you experience bullying and earn your stars and stripes. That then gives you the right to go on and do it to others coming through.’ It’s almost like an induction process.”

Some DHBs are trying to address it, she says, but it’s no easy feat. “It’s embedded, it’s endemic and it’s been going on for a very long time. It’s almost ingrained in the culture and the way nurses and doctors operate.

“One of the DHBs I worked with said they’d received nine formal complaints in the last year. Only one had been upheld as bullying”, Dr Blackwood says.

Nurses all over the country are right in the middle of a pay battle with DHBs after rejecting a 2 percent pay rise offer. Dr Blackwood says while pay is important, she doesn’t think it will have much of an impact on bullying.

“Don’t get me wrong, I definitely believe nurses should be paid better. However, pay may have a minimal impact… it’s certainly not the solution. If you want to be happy at work, it’s not just about pay.”

"... you experience bullying and earn your stars and stripes. That then gives you the right to go on and do it to others coming through."

"... you experience bullying and earn your stars and stripes. That then gives you the right to go on and do it to others coming through." Photo: Illustration: Celia Jacobs

Lily’s five-week orientation in her ward was cut down to just two. She was left to look after four children on her own, some of them complex cases, while the senior nurses cared for critical patients. On her eighth shift, a child stopped breathing and she resuscitated the patient with no prior training.

“I was getting shitty remarks because now the child would have to be put on respiratory supports and that created paperwork and unbalanced workloads for the senior nurses … I was scolded for doing what I was told to. Keeping children alive.”

Lily says she was once yelled at in the hallway of the hospital for not taking a child’s temperature when there were no working thermometers on the ward. She was told she “wasn’t a team player” when a family member was critically-ill in hospital and she didn’t come to work.

“I remember having a gnarly flu and was told to come into work anyway,” she says. “During my next shift, the charge nurse humiliated me in handover in front of everyone for being ‘irresponsible’ enough to come to work since one of the babies had caught an adult strain of influenza.”

Most of the people she works with are wonderful, says Lily, but a handful of bullies hold the positions of power. 

“There is a scary and corrupt power trip happening in the highest ranks of nursing.”

Lily and several other new graduates tried to talk to management about the bullying and unsafe workloads. She ended up being rostered on night shifts and weekends for two months straight.

She took her concerns higher. A group of nurses told the head of the department, director of nursing, and CEO’s second in charge of the conditions in the ward.

“We were told to look within ourselves and ask if we are the problem. If you can’t go to these people, who the fuck can you turn to?” says Lily

Experiencing bullying is associated with a 2.2-fold increase in intent to leave the profession, and a New Zealand study found 34 percent of registered nurses in their first year of practice had considered leaving nursing because of bullying.

This can result in huge costs for the country’s DHBs with conservative figures showing it costs $20,000 to $48,000 to replace a nurse. The Ministry of Health estimated that the cost of nurse turnover is $100 million each year.

Lily says her department has an incredibly high turnover of nurses.

“We lose nurses due to the bullshit politics of the higher management and the incredibly unsafe and stress-ridden environment we work under,” says Lily.

In Yvette Norris’* family there is a long line of nurses, including both of her parents. The 22-year-old felt drawn to the profession.

But the bullying she experienced in her first job affected her practice and her mental health so badly, she no longer wants to nurse. She was made to feel like everything she was doing was wrong, and was humiliated by her senior mentors.

“There is a long-standing culture and history of bullying on this ward and they're not welcoming to newcomers,” says Yvette.

“Basically, one of the senior nurses is kind of like the alpha female that decides whether she likes you or not. If she doesn't like you, then they push you out.”

Yvette says she’d always done well during her studies but was sometimes given patients with needs she didn’t feel qualified to treat as a recent grad.

“I'd tell them I'm not comfortable and they’d tell me I’d be fine but never gave me the support. Of course, I missed things you know?”

“A couple of nurses would, actually in front of patients, have goes at me. That's horrible for the patients as well.”

About two months into her job, Yvette found out the nurse in charge of overseeing her work had told other nurses on the ward not to approach her with feedback because she had a mental illness and was “mentally unstable”.

“It's shit because I do [have a mental illness]. Not that they knew. I live with depression. You get through it because that's how it is.

“It made me feel like ‘oh my god, maybe people actually see it? How do these people know?’ I hadn’t actually told anyone so [the nurse] had just picked something and gone with it, and it just so happened that it’s something real.”

Yvette went to management about the bullying. “They said to me that it’s well known and they've had their suspicions for some time … I was the first one, first new grad to come forward about it.”

She was told last year a meeting would be set up between her and the nurse to go over the problems. That meeting has yet to be organised.

Yvette was kept on the ward for two more months after she spoke up about the bullying and was then moved to another part of the hospital.

“They're dealing with the problem that's easier to remove; the complainant. That's putting the blame on the victim. They've put the ward culture in the ‘too hard’ basket,” she says.

“I don't think there's anything that can be done until those nurses retire.”

Yvette is currently on sick leave due, in part, to the stress of the job. “I want to quit nursing. It's not something I want to be part of, I don't enjoy the politics of it.”

Dr Kate Blackwood says it’s normal for the victim to be moved, rather than the bullier.

“That’s what happens the majority of the time. It’ll be that the focus is on the victim; removing them and providing coping strategies for them rather than dealing with the perpetrator.

“Often the perpetrator is in a position of power or perhaps the way they’re behaving is actually helping to get the job done in a high-paced and under-resourced working environment.”

As part of an Australian study in 2006, researchers found that bullies controlled work roles, tasks, and status in the nursing hierarchy through enforcing their “rules”. Bullies enforced these rules through a process of “ritual indoctrination”, destroying the self-confidence and self-image of those targeted.

But the acts of bullying are not always obvious or easily described so victims may not seek help.

“Often the behaviours are ongoing, subtle and contextualised - it’s hard to hang it off one incident. Victims may not have sufficient evidence to substantiate a claim,” says Dr Blackwood.

“And witnesses don’t want to stand up for fear of being victimised themselves. The majority of the complaints just go under the radar.”

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Photo: Illustration: Celia Jacobs

It’s not always nurse-to-nurse bullying. Rebecca Hart* found the caregivers in her job refused to take her seriously.

“The caregivers were experienced, I'll give them that. But they decided that they didn’t want to follow my care plans for patients that I was writing. As a registered nurse, caregivers are actually working under your order.”

The 26-year-old found a job at a spinal and head trauma rehabilitation unit in the North Island after graduating from nursing in 2016.

“I went in there, I was 25, I was young, enthusiastic, all this fresh, new knowledge and they just don't want to listen to someone who's only been in the job for a short while,” she says.  

The caregivers weren’t following Rebecca’s medical instruction which sometimes affected patients badly. “I would argue my clinical judgement from just little things to big things. And every day there would be something new.

“The worst thing that happened to me was I had a patient that was deteriorating so fast that I decided he needed to be seen by the hospice,” she says.

The hospice doctors agreed with Rebecca that he was dying and needed to be on a syringe driver - a device used to administer medication to help control pain towards the end of someone's life.

“I came back to work and apparently, according to the caregivers, I'm euthanising him...” Rebecca’s voice starts to crack.

“They said they know that he's not dying and that I'm euthanising him. And that was the final straw for me. To hear that I had potentially euthanised someone … you know … I still get really upset about it, sorry. It's actually quite traumatic for me.”

Rebecca considered leaving nursing.

“I just thought, ‘is this what my life is gonna be like?’ I was so down. I was never happy, it was starting to affect my private life.”

She left after eight months and luckily found a new job which she enjoys.

“My job is amazing. I love being a nurse. I have a supportive manager, all the nurses around me are supportive, and I'm really, really lucky.”

Although junior nurses are particularly susceptible to bullying, nurses across the experience spectrum can encounter it.

Senior nurse Leigh Rowe* says the bullying she experienced at Waikato Hospital was so bad, she no longer works in New Zealand.

“I’m petrified of taking a job in New Zealand again. I really am. The idea that I'm going to get stuck in an environment like that again really does scare me.”

When she complained to management about the bullying, they suggested she get counselling.

“[The counsellor’s] advice to me was ‘get out now’. She said she sees lots of nurses from Waikato with so many stories similar to mine and it won't change, so get out.”

The Wireless has contacted Waikato DHB and is awaiting a response about the number of bullying complaints received over the past few years, and what has been done about them.

Leigh had nine years experience under her belt when she landed a job in Waikato’s emergency department but was made to feel like she was “very junior.”

“I felt like no way I could prove myself. I just got on and did my job but, then it just seemed like nothing was ever friggin’ good enough.”

Leigh had a review with her supervising nurse who she said made a point of focusing on her small mistakes, like tissues on the floor in her bed space.

"I said, ‘Okay that's fine. I'll take that onboard but, can you tell me any of the positives that I'm doing?’ She couldn't say anything. She was gobsmacked I questioned her.”

Leigh moved from the emergency department to the intensive care unit. But she found a fellow nurse on the ward continued the bullying. At one stage she yelled at Leigh in front of patients.

“She was reprimanded because there were witnesses and she had a patient who was awake who obviously felt quite intimidated by the language she was spewing.

“The two years I was in Waikato, I was the most miserable I had ever been.”

Since leaving, Leigh has been working contracts in Australian hospitals and loves her work.

She doesn’t think she’ll work in New Zealand anytime soon.

*Some names have been changed as interviewees feared speaking out would affect their work life and future employment