Originally published in the AORN Periop Insider Weekly Newsletter July 28, 2016. Authored by Carina Stanton
The term “bully” is often used incorrectly to classify both bullies and those expressing incivility. Understanding the distinction between the two can help to put structure around communication and action in attempts to weed out bad behavior in perioperative nursing care, according to nursing Career Coach Phyllis Quinlan, PhD, RN-BC.
“The 10% of nurses who are true bullies have a personality defect,” Quinlan says. “Knowing the distinction is key to protecting your staff and deciding whether to develop a plan of remediation or to get rid of a toxic staff member.”
Understanding Incivility vs. Bullying
Quinlan describes bullying as a threatening behavior based in intimidation that stems from the bully’s issue with personal power. “For a bully, their personal power is far more important than the other person’s needs—if the other person needs to feel supported, a bully says ‘tough.’”
A person who indulges in bullying is very egocentric and has far more limited opportunity for personal growth, introspection and a commitment to change.
In the practice setting, a bully will intimate to someone that “you are on your own, if you don’t do what I want I have the power to isolate you,” Quinlan explains. She says bullying is not distinct to one professional level because this bad behavior knows no direction. It can be top down (leadership to staff), down up (staff to leadership) or lateral (peer to peer).
Although incivility is also bad behavior, it stems more from not being fully respectful of the other person’s perspective. Incivility is commonly seen by Quinlan during patient hand-offs or when a patient is transferred to a different area of care, such as from the OR to PACU. “As the nurse is explaining the patient’s state and previous care, an uncivil reaction by the nurse listening is to act as though they are being inconvenienced or worse to provide negative judgment about the previous care, making the nurse handing off the patient feel as though they must justify themselves and their actions.
With 80% of communication being non-verbal, much uncivil behavior is expressed with a less-than-polite facial expression or a toe-tapping type of stance indicating the nurse talking should speed it up and finish what they are saying.
Seeing Bad Behavior as Neurotic Need
One common thread between incivility and bullying is denial of wrongdoing. “If you ask an uncivil or bullying nurse to assess their behavior, they will report they were unaware of wrong doing and may say the nurse who reported their behavior was ‘too sensitive’ or ‘took it the wrong way.’”
Yet research indicates that both uncivil and bullying nurses essentially know exactly what they are doing because it fills a neurotic need.
Quinlan recalls the words of Abraham Lincoln, in which he suggested you can see the character of a person when you give them power. “Someone with good character will take a role in power and be collegial, find common ground and be generous enough to give praise for a job well done. On the flip side, someone with problematic character will use a power role to offer criticism and make remarks that are self-serving.”
Catching It Early
For new employees, Quinlan recommends a set time frame for a probationary period in which the hire is observed for both clinical and behavioral performance. Quinlan says nurses who are good clinically but lacking in collegial behavior are often kept on staff to work on the behavior piece, what she hears nurses refer to as the “soft stuff.”
“Nonsense, behavior is the tough stuff and should be viewed as equally important to clinical skills,” Quinlan stresses. She advises a strong collaboration between nursing, hospital administration and human resources to establish strict behavioral boundaries that are reviewed wisely through the probationary period to measure knowledge, skills and behavioral benchmarks that are demonstrative of culture.
“Make sure everyone is on same sheet of music with clear descriptives of bullying and incivility weaved into your code of conduct and stand behind a zero-tolerance approach to toxic behavior,” she suggests. “If a true bully is identified, cut your losses quickly, otherwise you will lose good staff members.”
Register now to attend “Bringing Shadow Behavior into the Light of Day: Understanding and Addressing Incivility and Bullying Behavior,” AORN’s Nurse Executive Leadership Seminar with Phyllis Quinlan, and get the skills to build your own zero-tolerance policies and practices against bullying and incivility.