I used to work with a male doctor who shouted at the female nurses. No one challenged him and everyone rushed around to do what he required; everyone positively reinforced the unacceptable behaviour, and over time it escalated.
Eventually a nurse complained, and she was asked if perhaps she was being oversensitive. She was told that the doctor is actually a very good doctor who likes things done properly.
“In the NHS, bullying is often excused because of pressure of work”
The doctor was not a good doctor. He was a major patient safety hazard. Everyone was tense and the atmosphere was strained when he was on duty. Everyone was waiting for the next explosion. This was not just bullying: it was misogyny. The doctor was displaying malice and contempt towards the female nursing staff.
This incivility is unacceptable and should not be tolerated in 21st-century Britain.
Incivility is not confined to male medical staff. A female discharge coordinator I once worked with shouted at the nurses. She was feared, and staff members did their best not to provoke her. One said their heart rate sped up when they heard her footsteps on the ward. No one would dare answer her back or complain, because everybody knew what she was like. But management thought she was highly effective and promoted her.
The discharge coordinator was also a major patient safety hazard. She created a culture of fear within the discharge team and on the wards. She also provided junior nurses with a negative role model, demonstrating that it doesn’t matter who you walk on or upset so long as you get the job done.
Managers may think it’s worth turning a blind eye to incivility in ‘effective’ employees. But “bullying and harassment are a significant concern in the NHS”, and this can adversely affect patient care and staff wellbeing. 29% of NHS staff have been bullied at work (NHS, nd). The NHS’s (2020) People Plan aims to reduce levels of bullying and harassment.
In the NHS, bullying is often excused because of pressure of work; the NHS (2020) highlights this “can cause unprofessional behaviours and points of conflict between staff”. But bullying and incivility are not caused by pressure of work. This is a cultural issue, and incivility thrives in cultures where it is tolerated.
Bullying and harassment are common and it’s difficult to speak out, but silence is consent. We need to be able to speak up when someone is about to make an error. Our healthcare system is dependent on teamwork and the commitment and competence of staff. Bullying and incivility inhibit teamwork and undermine staff confidence and commitment. This leads to increased staff turnover and poor quality of care (Fontes et al, 2019).
Civility is a hallmark of professionalism. Oppel and Mohr’s (2020) work involving 6,094 nurses and 38,627 patients demonstrated that nurses who were treated with dignity and respect were kinder to patients. This had a positive impact on all aspects of care.
We need to act now. The first thing is to set clear standards of acceptable behaviour. We need mandatory annual training to educate staff and to ensure they are aware of what is and what is not acceptable. Finally, we need managers to act.
Some people will only require a gentle nudge and positive role models to behave in a decent manner. Some people will require considerable management intervention, as their behaviour has become entrenched. A small number of people will be unwilling or unable to change, and will have to find alternative employment that is better suited to them.
Linda Nazarko is consultant nurse, physical health, West London NHS Trust. The views expressed here are those of the author, not of West London NHS Trust.
Fontes KB et al (2019) Relationship between leadership, bullying in the workplace and turnover intention among nurses. Journal of Nursing Management; 27: 3, 535-542.
NHS (nd) Supporting our Staff. NHS
NHS (2020) We are the NHS: People Plan 2020/21 – Action for Us All. NHS.
Oppel EM, Mohr DC (2020). “Paying it forward”: The link between providers’ civility climate, civility toward patients and patient experience outcomes. Health Care Management Review; 45: 2, 141–150.