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May 2008 Issue

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Bullying Threatens Direct Patient Care, Nurses' Careers

Published May 2008

Bullying behavior directed at nurses from physicians and colleagues threatens patient care and is driving much-needed talent out of the profession, according to an article by Dianne Felblinger, EdD, associate professor of nursing.

Felblinger examines the issue of bullying in the March/April 2008 issue of the Journal of Obstetric, Gynecologic & Neonatal Nursing.

In an examination of studies on workplace bullying, Felblinger found that most verbal abuse in cases involving nurses is instigated by physicians, followed second by fellow nurses.

More than half of nurses surveyed by the Joint Commission
on Accreditation of Healthcare Organizations reported that they had been subjected to verbal abuse and more than 90 percent had witnessed disruptive behavior such as verbal abuse or physical and sexual harassment, Felblinger writes.

The adverse affects of such behavior extend to patient care, Felblinger writes, citing a 2005 study in which 25 percent of health care workers saw a strong link between disruptive behaviors and patient mortality, and as many as 75 percent saw a strong link to adverse clinical outcomes.

Many nurses who are targets of bullying suffer from post-traumatic stress disorder with symptoms
that can include low self-esteem,

sleep disturbance and depression, Felblinger writes. Psychological effects may include a shame response, with inner-directed anger that results in revictimization. Or, the bullying target might direct their anger toward co-workers.

To overcome the effects of bullying, Felblinger writes, steps must be taken at both the individual and administrative levels. Boundaries of appropriate behavior must be set, and education is needed to raise awareness of everyone involved.

Its just a matter of how we address it, she says, adding that dialogue and collaboration are important in addition to clear policies and procedures.

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