Original Article Featured in OR Today Magazine, November 2016 Edition
Do you believe that workplace bullying and incivility are the same?
No. Workplace incivility can best be defined as low-intensity unpleasant behavior that is rude, impolite, or inconsiderate. While the target can feel insulted or angry; an actual desire or intent to harm the other person is ambiguous. Anyone has the potential to behave inappropriately towards a coworker given the right circumstances coupled with a lack of self-management.
Workplace bullying however, is ongoing, offensive, abusive, intimidating or insulting behavior or actions directed at a person(s), causing the target to feel threatened, abused, humiliated or vulnerable. The person experiencing prolonged bullying can feel a range of psychological and physiological symptoms. The research supports that, those who bully, are very aware of their behavior and its effect on the others; even though they may deny that there is intent. Fortunately, there is only a very small percentage of the workforce that is capable of such sustained disregard for another individual.
So these behaviors are very different. Should the management be different as well?
Yes, they should and I want to be clear as to why. The two keys here are insight and sustainability. The person who behaves in an uncivil manner has the ability to self-reflect on that indiscretion, feel remorse or regret and make the active choice to work on their self-management skills and achieve personal growth. A bully does not have this ability.
It is vital that we understand and accept that a nurse bully is a narcissist with a license. A narcissist lacks the capacity for empathy. The ability to reflect empathically on the consequence that one’s poor behavior has on another is vital for driving the desire to change. Bullies (narcissists) are incapable of this.
An uncivil staff member can gain insight though coaching and training. Positive, sustained changes in behavior can be noted within six to twelve weeks of working a clear emotional intelligence improvement action plan. A narcissist typically reacts in one of two ways to someone attempting to hold them accountable. They may escalate their behavior and retaliate or they will tell you what you want to hear and vow to reform. However, they cannot sustain any improvement because they lack a connection with the need to improve.
So why is managing bullying behavior in nursing so challenging?
This is a complex issue but one reason is that nurses are professional caregivers. Nursing leaders have a good deal of difficulty coming to terms with the fact that a bully/narcissist cannot be fixed. It is not a part of our caregiver DNA to “give-up” on someone. We talk ourselves into believing that if we just try a little harder that this individual will have an epiphany and the problem will be resolved.
The bully/narcissist is hoping that you will react exactly in this manner. They are experts at taking your wonderful qualities of empathy, patience and the need to heal and use them against you to achieve their goal of never being held accountable to sustained improvement. Essentially, we need to get out of our own way in order to take charge of this situation. Nurse leaders must try to accept that once someone shows you their true colors, you need to resist repainting them.
The only performance improvement plan for a bully/narcissist is a collaborative effort put forth by administration, human resources and the nurse leader that is time sensitive and rich with mandatory training. The documentation should discuss the need for improvement to be demonstrated within three to six months then sustained for six months as well.
Most bully/narcissists will not be able to withstand this type of scrutiny and may decide to move on. The others may stay but will find it very challenging to sustain the improvement. Should termination be the only option left, you can have the peace of mind that a sincere effort was made on your part; and twelve months’ worth of documentation to support your action.
Originally featured in Women of Distinction Magazine: September 8, 2016
Q: A good deal of your coaching practice is centered on working with family caregivers. What are some of the challenges facing family caregivers today?
A: Their biggest challenge is to have a life of their own while caring full time for their loved one and not self-destruct in the process. I think it is so important to remember that in most cases, family caregivers never saw this responsibility coming. They didn’t go to school to learn how to be caregivers. They did not make a conscious decision to make a career in caregiving. They responded to a life-changing event, which usually involved a spouse, parent or child. They made the significant changes necessary to be fully present and care for that person. That is not only love and loyalty in action; it is the highest form of generosity. By in large, family caregivers go it alone. What community resources were available are now all but gone since the economic downturn of 2007. So my work with these clients is centered on finding ways to meet their self-care needs and in identifying ways to seek assistance. I am a huge proponent of the care model put forth by The Share the Care Organization. This not-for-profit organization conducts training programs to teach professional and family caregivers how to set up care circles. We usually have a group of friends and neighbors who would like to help but are not capable of rendering physical care. This care model focuses on what people can do. Perhaps you can help with marketing, lawn care, driving to doctor appointments, etc. Creating care circles allow others to help you and your loved one so that the responsibilities of your life do not become overwhelming.
Q: What is your approach to coaching?
A: My approach to coaching is to view my client as whole, competent and capable. I understand how challenging it can be to remain clear and authentic about ones goals and one self as you try to navigate your life. Responsibilities, setbacks and the demands of an adult life can overshadow a person’s understanding of the present and cloud his or her vision for the future. Our very human nature creates blind spots to options and solutions. My goal is to empower my client to access their own innate knowing and personal wisdom. I can support them as they explore where they are now, guide them in clarifying where they want to be, assist them in setting up a timeline, and support them efforts to attain their goals in a nonjudgmental manner.
Q: What is compassion fatigue?
A: It is a condition characterized by a gradual lessening of your ability to render empathic care over time. Those at risk for the development of compassion fatigue include: nurses, social workers, first responders, special education teachers, and the family caregivers of those with chronic illnesses. Symptoms include but are not limited to, a decrease in experiences of pleasure practicing a profession you once loved, a sense of relentless stress, anxiety over the thought of going to work, and a pervasive negative attitude that creeps into all areas of your life. Long term, this can have devastating effects on your work performance and relationships and life.
Q: How can you start a person along the process of recovery from compassion fatigue?
A: Caregivers have a difficult time with the idea of receiving care therefore, acknowledging that you may be experiencing compassion fatigue and seeking help is a healthy first step. Everyone’s journey to the development of the syndrome is unique so there is no such thing as one approach fits all. However, the biggest hurdle to get over is to embrace the fact that you must take just as good care of yourself as you do others. It is vital to approach caregiving from a place of fullness and not try to render care when you are fueling yourself from the fumes of your compassionate nature. The airline industry really gives the best advice. Put your own oxygen on first, and then help the other person. A big part of recovery is to incorporate an adequate rest and self-care regimen into your life. This adaptation should be seen as a treatment for compassion fatigue and as a vaccination against developing the syndrome again.
Q: Why do you recommend a regular mindful practice for caregivers?
A: People who are drawn to human services are perpetual doers. They start doing from the minute they wake up and don’t stop until they fall asleep. They only way to add a sense of balance to that approach to life is to incorporate regularly scheduled times when we are just still and breathing. Doers are always in their head thinking about what they need to do and whom they need to do it for. So taking time to just sit and breathe, so that you are more aware of being in your body rather than stuck in the endless loop of thinking, can offer a much needed break from perpetual doing.
Q: What inspired you to write your book; Rediscover the Joy of Being a Nurse?
A: As I was crisscrossing the country speaking and coaching at various nursing events, I was deeply saddened by the degree of personal pain these nurses were struggling with every day. I felt the need to try to offer some guidance to those who felt so disconnected from something that meant so much to them. The insight the book offers is not centered on anything that we learned in nursing school. Rather, it is focused on the development of three vital life skills: the ability to adapt, the ability to make and sustain relationships and the ability to be resilient. I believe that cultivating these three life skills can help nurses refocus their attention on themselves and what they need to have a content professional and personal life for the long term.
Q: What has been the most successful marketing strategy for you?
A: Developing my relationship within the social networks on LinkedIn. I have found LinkedIn to be the most professional and powerful networking medium. Everyone using this platform is serious and looking to connect with other serious individuals. Engaging on LinkedIn is a commitment of time and effort but the return on my investment has been worth it. Many of my most important opportunities have been offered to me through LinkedIn.
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.”
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.
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.”
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.
The Mission of Share the Care is to improve the quality of life for anyone who needs support and to reduce the stress, depression, isolation and economic hardship of their caregivers
When I was 22, I scored what I thought was my dream job. I moved from the snowy Midwest to sunny Florida with a group of fellow former college athletes to help a global athletic brand launch a sports academy. But within two years I and many of my peers had left our jobs.
We had fallen victim to a work culture rife with bullying, rudeness, and other incivility that was set by a dictatorial head of the organization and had trickled down through the ranks. Employees were at best disengaged; at worst they undertook acts of sabotage or released their frustration on family members and friends. By the time I left, many of us were husks of our former selves.
That experience was so formative that I decided to spend my professional life studying workplace incivility—and its costs and remedies. My research has shown that it is almost impossible to be untouched by incivility during one’s career. Over the past 20 years I’ve polled thousands of workers and found that 98% have experienced uncivil behavior and 99% have witnessed it. In 2011 half said they were treated badly at least once a week—up from a quarter in 1998. Rude behavior ranged from outright nastiness and intentional undermining to ignoring people’s opinions to checking e-mail during meetings.
As I and my colleagues at the sports academy discovered, incivility in the workplace drags down performance and takes a personal toll. In laboratory settings I’ve found that simply observing it makes people far less likely to absorb information. Seeing or experiencing rude behavior impairs working (short-term) memory and thus cognitive ability. It has been shown to damage the immune system, put a strain on families, and produce other deleterious effects.
Unfortunately, people’s resilience to incivility is partly out of their control. Research has shown that responses to threat, humiliation, loss, or defeat—all commonly associated with incivility—are significantly influenced by genetic makeup. Perhaps as a result, the most effective way to reduce the costs of incivility in the workplace is to build a culture that rejects it—to adopt “the no asshole rule,” as Robert Sutton calls it in his best-selling book by that name. But very few organizations can comprehensively enforce this rule. So when individuals encounter incivility, what should they do?
My research has uncovered some tactics that anyone can use to minimize the effects of rudeness on performance and well-being. I wish I could have shared these with my younger self as she floundered in a hostile work environment many years ago.
Many people decide to tackle incivility head-on—through either retaliation or direct discussion. Another common response is to try to work around the problem by avoiding the perpetrator as much as possible. Although these approaches can help in certain situations, I don’t usually advise people to take them. Avoidance often falls apart, because sometimes you have no choice but to collaborate with discourteous colleagues. Confrontation can make the dynamic worse. In my surveys I’ve found that more than 85% of people who chose to avoid or confront perpetrators were unsatisfied with how the situation ended or how they handled it, and those who attempted confrontation were no more satisfied than those who didn’t respond. Relying on institutional remedies rarely works either—a mere 15% report being satisfied with how their employers handle incivility. In fairness, organizations often have no opportunity to act: More than half of survey respondents say they don’t report rudeness, largely out of fear or a sense of helplessness.
Just as medicine is shifting from a focus on fighting illness to one on promoting wellness, research in my field—organizational behavior—has begun to discover that working to improve your well-being in the office, rather than trying to change the offender or the corrosive working relationship, is the most effective remedy for incivility.
That’s not to say you shouldn’t report a rude or bullying colleague to HR, or try to manage conflict directly. But a more sustainable way to deal with bad behavior is to make yourself impervious to it—or at least a lot less vulnerable. To do that, it’s helpful to look at what we know about thriving—the psychological state in which a sense of vitality and self-improvement fortifies people against the vicissitudes of life.
Few people are satisfied with how their employers handle incivility.
In my research I have found that thriving people are healthier, more resilient, and better able to focus on their work. They are buffered against distraction, stress, and negativity. In a study of six organizations across industries, employees characterized as high thrivers burned out less than half as often as their peers. They were 52% more confident in themselves and their ability to take control of a situation, and their performance suffered 34% less after an unpleasant incident.
If you’re thriving, you’re less likely to worry about a hit or take it as a personal affront, more immune to the waves of emotion that follow, and more focused on navigating toward your goal. Yet despite these obvious advantages, fewer than half the people I’ve surveyed focus on themselves and work to foster a thriving mentality after a brush with incivility. Rarely do they consider that the antidote might be totally disconnected from the incident at hand.
How can you help yourself thrive? I suggest a two-pronged approach: Take steps to thrive cognitively, which includes growth, momentum, and continual learning; and take steps to thrive affectively, by which I mean feeling healthy and experiencing passion and excitement at work and outside it. These two tactics are often mutually reinforcing—if you have energy, you’re more likely to be motivated to learn, and a sense of growth fuels your vitality. But distinguishing between them can help people recognize in which area they may be lagging and take steps to bolster their defenses for the next hostile encounter.
If you’ve dealt with a rude colleague, you probably know how hard it can be to get over it. Perhaps no feeling is more difficult to overcome than a sense of injustice. Neuroscientists have shown that memories attached to strong emotions are easier to access and more likely to be replayed, and ruminating on an incident prevents you from putting it behind you. This can cause greater insecurity, lower self-esteem, and a heightened sense of helplessness.
I encourage people to shift their focus to cognitive growth instead. Your conscious brain can think about only so many things at once—far better that it keep busy building new neural connections and laying down new memories.
You can allow yourself to feel hurt or outraged—but for a limited time only. Tina Sung, a vice president at the nonprofit Partnership for Public Service, shared with me a saying that captures this advice: “You can visit Pity City, but you can’t live there.” I might add that Pity City is a good place to drop off your baggage.
Journaling and other rituals can help bring closure. As David Brooks documents in his new book, The Road to Character,Dwight D. Eisenhower often wrote furious invective in his journal to release negative emotions related to colleagues. He started the habit while working as an aide to the famously tyrannical General Douglas MacArthur.
Once your attention has shifted to more-productive avenues, several steps can help you focus on cognitive growth. First, identify areas for development and actively pursue learning opportunities in them. Teresa Amabile and Steven Kramer have shown that progress is a more powerful motivator in the workplace than even recognition or pay. It can be equally effective in helping employees bounce back from incivility. One young woman working in marketing told me, “A toxic environment was chipping away at my soul.” She saw no quick or easy path out of her position, so she decided to pursue an MBA at night. Events along the way, such as achieving a great GMAT score, provided excitement and confidence. Although her future remained unclear, she became more resilient to her corrosive workplace.
It’s worth noting that these development efforts need not be linked directly to your job. Taking on a new skill, hobby, or sport can have a similar effect. It’s simply harder to be dragged down when you feel on the upswing.
Another way to promote cognitive growth is to work closely with a mentor. Mentors have a knack for helping their protégés thrive by challenging them and ensuring that they don’t stagnate or get caught in an unproductive churn. For example, Lynne, a consultant working in an uncivil environment, built a close relationship with a mentor who urged her to steer clear of any unnecessary drama and focus on her own performance. When Lynne felt that she was slipping into rumination, recrimination, and anger, her mentor reminded her of the toll on her happiness and productivity and pointed her in more-fruitful directions. Following the advice, Lynne was able to dramatically improve her well-being—and her performance, which scored her a promotion.
I find it useful to think of rude behavior in the workplace as an infectious pathogen, like a virus. Your defense against it depends in good measure on how well you are able to manage your energy. In fact, my research suggests that many of the factors that help prevent illness—such as good nutrition, sleep, and stress management—can also help ward off the noxious effects of incivility.
Sleep is particularly important: A lack of it increases your susceptibility to distraction and robs you of self-control; makes you feel less trusting, more hostile, more aggressive, and more threatened even by weak stimuli; and can induce unethical behavior. In short, sleep deprivation (usually defined as getting less than five hours a night) is a recipe for responding poorly to incivility and perhaps even damaging your career.
Exercise is another surefire way to protect yourself against the negative emotions, such as anger, fear, and sadness, that are typically brought on by rude behavior. It enhances both cognitive firepower and mood, distracts you from your concerns, reduces muscle tension, and improves resilience. It has been shown to slash symptoms of anxiety by more than 50%, and in one study it even proved to be more effective at treating depression than sertraline, a leading prescription for the illness. Those who exercise regularly are far less likely to sulk and better able to rebound in the wake of negative interactions.
Maintaining your energy in other ways, such as eating healthfully, will also help put you in top form to respond smoothly to an uncivil encounter. When famished, most people tend to respond to frustration by lashing out.
But it’s not just about caring for your body. Mindfulness—shifting your consciousness to process situations more slowly and thoughtfully and to respond with greater premeditation—can help you maintain your equilibrium in a difficult environment, as can finding a sense of purpose in your job. I and other researchers have discovered that when people are engaged in work they consider meaningful, they are more productive in uncivil teams than their colleagues are. Reminding yourself of nonmonetary attributes that attracted you to your work in the first place may foster gratitude and satisfaction.
Positive relationships within and outside the office also provide an emotional uplift that can directly counterbalance the effects of incivility. Research I conducted with Andrew Parker and Alexandra Gerbasi shows that across industries, organizations, and levels, “de-energizing,” negative relationships have four to seven times as much impact on an employee’s sense of thriving as do energizing, positive ones. In other words, you need a small group of energizers to offset the effects of each jerk. So think about the people in your life who make you laugh and who lift your spirits. Spend more time with them, and ask to be introduced to their friends.
Finally, in studies of MBAs, executive MBAs, and employees, I have found a consistently strong correlation between thriving outside work and resilience to incivility. In a study of people who experienced rudeness, those who flourished in nonwork activities reported 80% better health, 89% greater thriving at work, and 38% more satisfaction with how they had handled the encounter. Seeking leadership roles in the community—particularly if you have no immediate opportunity within your organization—bolsters both cognitive and affective thriving. One executive I interviewed decided to join the board of a nonprofit dedicated to improving the lives of patients with dup15q, a condition his daughter had inherited. He spearheaded fundraising efforts, helped build scientific interest, and stewarded the group’s finances. These experiences and rewards, he told me, made him feel nearly bulletproof at work.
Incivility exacts a steep price. In extreme cases a job change or relocation may be needed to avoid burnout and to preserve your health and well-being. My research shows that for every eight people who report working in an uncivil environment, approximately one ultimately leaves as a direct result, and, looking back, I know I was right to exit the Florida sports academy. However, when I encounter rude behavior now, I’m better armed to offset its effects. Like everyone else, I’m still a work in progress, and my response is rarely perfect. But I can say with confidence that focusing on a sense of thriving has made me a more engaged, productive, and happy professional. You can be too.
I will fearlessly assess my personal strengths and weaknesses, work diligently to bolster my weaknesses and to graciously recognize my strengths.
I will fearlessly make my voice be heard with regard to my loved ones care and be a strong ally to those professional caregivers committed to caring for my loved one and a fearless shield against those not committed to caring for my loved one.
I will fearlessly not sign or approve anything I do not understand, and will steadfastedly request the information I need until I am satisfied with the explanations.
I will fearlessly ensure that all of the necessary documents are in place in order for my wishes and my loved ones wishes to be met in case of a medical emergency. These will include Durable Medical Powers of Attorney, Wills, Trusts and Living Wills.
I will fearlessly learn all I can about my loved one’s healthcare needs and become an integral member of his or her medical care team.
I will fearlessly seek out other caregivers or care organizations and join an appropriate support group; I realize that there is strength in numbers and will not isolate myself from those who are also caring for their loved ones.
I will fearlessly care for my physical and emotional health as well as I care for my loved one’s, I will recognize the signs of my own exhaustion and depression, and I will allow myself to take respite breaks and to care for myself on a regular basis.
I will fearlessly develop a personal support system of friends and family and remember that others also love my loved one and are willing to help if I let them know what they can do to support my caregiving.
I will fearlessly honor my loved one’s wishes, as I know them to be, unless these wishes endanger their health or mine.
I will fearlessly acknowledge when providing appropriate care for my loved one becomes impossible either because of his or her condition or my own and seek other solutions for my loved one’s caregiving needs.