AACN's national office will be closed for a summer pause from July 15-19, 2024.

Strategies to Improve Retention by Reducing Bullying

By Renee Thompson, DNP, RN Oct 05, 2022

Added to Collection

High levels of stress and burnout coupled with the unpredictable nature of a prolonged pandemic have created an environment that is ripe for bullying and incivility.

High levels of stress and burnout coupled with the unpredictable nature of a prolonged pandemic have created an environment that is ripe for bullying and incivility. When ignored, they may affect morale, retention and patient outcomes. Healthcare professionals do not always act to recognize and address disruptive behaviors, especially when the person being uncivil is clinically competent. Further contributing to the problem is that most of us in healthcare feel we cannot add one more thing to our plates. We may think that leaders will be reluctant to take action when an individual demonstrates disruptive behaviors, especially during the continuing Great Resignation because a “bad nurse” is better than no nurse.

Therefore, we often do what’s comfortable – nothing. As a result, we may lose great colleagues and harm our patients.

We cannot use silence as a strategy.

Among the reasons that nurses leave a position or leave nursing is because they are no longer willing to work in a culture or an environment where they feel nobody cares or supports them, and they see bullying and incivility being tolerated.

Recent studies show that an unhealthy work environment is strongly correlated with high turnover and poor patient outcomes. Here are just a few studies:

  • AACN’s 2021 National Nurse Work Environments report reveals that 72% of RNs have experienced at least one incident of incivility within the past year.
  • Almost half (49%) of direct patient care nurses are currently planning to leave or considering leaving their position within the next six months due to unhealthy work environments, according to American Nurses Foundation’s 2022 Workplace Survey.
  • According to the Patient Safety Network, 71% of hospital staff surveyed in 2019 indicated disruptive behaviors were linked to medical errors.
  • A 2022 McKinsey report shows that employees who experience high levels of toxic behavior at work are eight times more likely to experience burnout symptoms. These employees are six times more likely to leave their organization within the next three to six months.

With evidence showing the negative effects of incivility and bullying on nurses and patients, we have an ethical responsibility to stop these behaviors.

What can nurses do to address bullying and incivility?

Here are two strategies:

  • 1Heighten awareness

    Often, we find that some people do not even realize their behavior is uncivil or that their stress has caused them to lash out at their co-workers. It may be the “elephant in the room” that nobody talks about directly but becomes the whispered breakroom conversation.

    Therefore, we need to heighten awareness of behaviors that undermine a culture of safety by infusing content related to workplace bullying everywhere: orientations, nurse and physician residency programs, preceptor programs, leader orientations, ongoing leadership development, staff meetings, leadership meetings, performance reviews, annual competencies, etc. We should not address appropriate conduct only when employees are hired. Every team member should know they matter, and the way they treat each other matters too.

    After all, you can’t expect people to adapt their behavior if they’re not aware their behavior needs to change.

  • 2Don’t ignore bad behavior

    Everyone can misbehave under stress. However, ignoring bad behavior normalizes it. What you ignore now, regardless of the stressors that may be triggering it, becomes the norm for the team in the future. Even if bad behavior seems understandable, don’t ignore it.

    Whenever someone acts out, say, “You can be angry, frustrated, stressed or scared, but you can’t be cruel – not today.”

    As investor Perry Belcher said, “Nothing will kill a great employee faster than watching you tolerate a bad one.”

    The same is true for negativity. When anyone on the team is negative, they spread that attitude to others. When we ignore or tolerate negative team members, they cause more stress on the entire team. Mirror neurons in our brains mimic what we see and hear. We unknowingly absorb and then allow others to influence our attitudes and behaviors. Therefore, we need to start a conversation with any negative team member aside and say something like one of the following suggestions:

    • “I’m not sure you realize that you come across as very negative (add specific examples). I’d like to talk to you about this.” [Be honest and respectful].
    • “When you spend time complaining about or criticizing ______, it influences the entire team and brings morale down.” [Address the impact]
    • “I’d like you to spend less time complaining/criticizing in front of the team and more time complimenting/praising.” [Redirect]

    Stop tolerating or ignoring negativity.

It is time to identify and address the “why” our colleagues are leaving their work environment. It takes courage to actively participate, manage and sustain a healthy environment, especially when faced with massive staffing shortages. Taking the time to focus on our colleagues and team to ensure they feel valued, cared for and recognized is critical for retention. Culture and the way people treat each other at work is important!

What will you do to create a healthy culture in your department today?