No full-text available
To read the full-text of this research,
you can request a copy directly from the author.
The Dangerous Culture of Silence: Ethical Implications of Bullying in the Health Care Workplace
Abstract
Bullying among the health care workforce has reached alarming proportions. It impacts the quality and safety of patient care, plus has far reaching ethical implications for practitioners. The journal is accessible via the free N21 app download at iTunes! View it on your iPad or iPhone; http://hudsonwhitman.com/n-21/issues/
... Yet that effort was minimal compared with the now virulent epidemic of workplace bullying and lateral violence enacted by those individuals responsible for rendering quality and safe care. This behavior obstructs the care process, puts patients at grave risk, and grossly hinders ethical practice by professionals ( Fink-Samnick, 2014 ). ...
... Other reports cite the number at potentially as high as 200,000 deaths a year ( Brown, 2011 ). Bullying and lateral violence interfere with all that health care strives to be: quality-driven, patientcentered, and an interprofessional team effort marked by respectful communication ( Fink-Samnick, 2014 ). ...
... coordination, and collaboration characterizing the relationships between professions in delivering patientcentered care (Interprofessional Education Collaborative [IPEC], 2011). In the interprofessional context, a new tone for the care team is set: one where practitioner cohesion, rather than continued fragmentation and competition between disciplines, is allowed to fl ourish ( Fink-Samnick, 2014 ). Despite the expanded scope on interprofessional team responsibility, individual team members remain beholden to their distinct professional ethical codes. ...
Purpose and objectives:
This article will discuss new regulations and professional guidance addressing bullying and workplace violence including addressing recent organizational initiatives to support the health care workforce; reviewing how professional education has historically contributed to a culture of bullying across health care; and exploring how academia is shifting the culture of professional practice through innovative education programming.
Primary practice settings(s):
Applicable to all health care sectors where case management is practiced.
Findings/conclusion:
This article is the second of two on this topic. Part 2 focuses on how traditional professional education has been cited as a contributing factor to bullying within and across disciplines. Changes to educational programming will impact the practice culture by enhancing collaboration and meaningful interactions across the workforce. Attention is also given to the latest regulations, professional guidelines, and organizational initiatives.
Implications for case management practice:
Workplace bullying and violence have contributed to health care become the most dangerous workplace sector. This is a concerning issue that warrants serious attention by all industry stakeholders.Traditional professional education models have created a practice culture that promotes more than hinders workplace bullying and violence in the industry. Changes to both academic coursework and curricula have shifted these antiquated practice paradigms across disciplines. New care delivery modes and models have fostered innovative care and treatment perspectives. Case management is poised to facilitate the implementation of these perspectives and further efforts to promote a safe health care workplace for patients and practitioners alike.
... Yet that effort was minimal compared with the now virulent epidemic of workplace bullying and lateral violence enacted by those individuals responsible for rendering quality and safe care. This behavior obstructs the care process, puts patients at grave risk, and grossly hinders ethical practice by professionals ( Fink-Samnick, 2014 ). ...
... Other reports cite the number at potentially as high as 200,000 deaths a year ( Brown, 2011 ). Bullying and lateral violence interfere with all that health care strives to be: quality-driven, patientcentered, and an interprofessional team effort marked by respectful communication ( Fink-Samnick, 2014 ). ...
... coordination, and collaboration characterizing the relationships between professions in delivering patientcentered care (Interprofessional Education Collaborative [IPEC], 2011). In the interprofessional context, a new tone for the care team is set: one where practitioner cohesion, rather than continued fragmentation and competition between disciplines, is allowed to fl ourish ( Fink-Samnick, 2014 ). Despite the expanded scope on interprofessional team responsibility, individual team members remain beholden to their distinct professional ethical codes. ...
This article: PRIMARY PRACTICE SETTINGS(S):: Applicable to all health care sectors where case management is practiced.
Despite glaring improvements in how care is rendered and an enhanced focus on quality delivery of care, a glaring issue has emerged for immediate resolution: the elimination of workplace bullying and violence. The emerging regulatory and organizational initiatives to reframe the delivery of care will become meaningless if the continued level of violence among and against the health care workforce is allowed to continue.
Professionals who hesitate to confront and address incidents of disruptive and oppressive behavior in the health care workplace potentially practice unethically. Bullying has fostered a dangerous culture of silence in the industry, one that impacts patient safety, quality care delivery plus has longer term behavioral health implications for the professionals striving to render care. Add the escalating numbers specific to workplace violence and the trends speak to an atmosphere of safety and quality in the health care workplace, which puts patients and professionals at risk.
... Bullying is now viewed in the context of workplace violence (Fink-Samnick, 2014). Rayner and Hoel's (1997) five categories of workplace violence directly reflect bullying behaviors: ...
... When professionals feel disempowered to address the dynamics of bullying, whether manifesting as insults and/or threats toward them and/or patients and families the outcomes can and will be deadly (Fink-Samnick, 2014 ). The industry continues to reel from research in 2016 that identified medical errors as the third leading cause of death in the United States (Cha, 2016). ...
Workplace bullying has permeated every sector of society, particularly that of health care. The disruptive behaviors associated with bullying pose dramatic consequences for practice settings driven to ensure quality driven, population-focused, patient-centered care by a committed workforce.
This article will provide an overview of workplace bullying in health care including foundational elements, plus current research to denote the issue’s expanding scope. In addition, ethical implications for case management will be addressed, with guidance frameworks to empower the professional case manager’s response to this multi-faceted dynamic. You can access the article at
https://issuu.com/academyccm/docs/cm_apr_may_2017?e=23788880/47517320
There is no way to underestimate the importance of the countless ways that ethics impacts case managers and the patients we serve. In fact, solid ethical decisions are such an integral part of case management practice that the Commission for Case Manager Certification has increased its number of continuing education units required for recertification. Discussion and resources are outlined in the Editorial.
In Part 2 of this article series, Professional Case Management’s Ethical Quartet will focus on two constructs; Technology and Mandated Duty to Warn. These areas have greatly influenced how the case management workforce intervenes with clients, caregivers, and health care industry stakeholders as a whole. In addition, each construct has challenged case management’s ethical tenets of practice; autonomy, beneficence, fidelity, justice, and non-maleficence.
Most professional case managers know that nagging feeling. Something happens on the job; it feels very wrong, to the point of untenable. The clinical gut each practitioner possesses and is warned to heed screams loudly for action to be taken, but exactly what action becomes the larger issue to reconcile. One known fact exists amid the rush of emotion and concerns prompting endless mental calisthenics. Independent of the course of action taken, these situations will impact the quality of care that every case manager advocates diligently to safeguard, with potential ethical, if not also legal consequences
The Ethical Quartet explores four of the toughest societal constructs for case managers moving for 2017. Divided into two parts, each will provide a comprehensive overview of two constructs with respect to the scope, incidence, and considerations for professional case management practice. Part 1 will address workplace bullying and end of life care, with Part 2 to focus on technology and social media, as well as mandated duty to warn.
Abstract: A new era of health care realities transverse the ethical tenets of Case Management practice: • Death with dignity and other revised considerations for end of life care • Quality and safety implications of workplace bullying • Mandatory reporting quandaries involving HIPAA and patient privacy vs. public safety, and • The continued dilemma of interstate practice amid increasing telehealth utilization Each of these situations cause case managers to regularly juggle the Moral Distress balls of personal, clinical and organizational ethics. As a result, the question beckons: What is a case manager’s ethical duty when employer mandates present as counter to the established professional standards, ethical codes, and regulations? Where should and does your ethical compass point? Blending real industry scenarios with the latest professional resources, this presentation will provide case managers strategic guidance to define their ethical practice trajectory. Behavioral Objectives: 1. Identify four new ethical challenges for case managers 2. Discuss three ways Moral Distress impacts case management practice 3. Define the five steps of E-ACTS©-A Framework for Difficult Ethical Decision-Making
The purpose of this study was to examine how violence from patients and visitors is related to emergency department (ED) nurses' work productivity and symptoms of post-traumatic stress disorder (PTSD). Researchers have found ED nurses experience a high prevalence of physical assaults from patients and visitors. Yet, there is little research which examines the effect violent events have on nurses' productivity, particularly their ability to provide safe and compassionate patient care. A cross-sectional design was used to gather data from ED nurses who are members of the Emergency Nurses Association in the United States. Participants were asked to complete the Impact of Events Scale-Revised and Healthcare Productivity Survey in relation to a stressful violent event. Ninety-four percent of nurses experienced at least one posttraumatic stress disorder symptom after a violent event, with 17% having scores high enough to be considered probable for PTSD. In addition, there were significant indirect relationships between stress symptoms and work productivity. Workplace violence is a significant stressor for ED nurses. Results also indicate violence has an impact on the care ED nurses provide. Interventions are needed to prevent the violence and to provide care to the ED nurse after an event.
Workplace violence (WPV) perpetrated by patients and visitors against nurses and physicians is a problem in adult emergency departments (EDs), but largely unrecognized and unreported in pediatric EDs. The purpose of this qualitative study was to describe the WPV that occurred in a pediatric ED and the negative effects on the workers. Data included transcribed interviews with 31 pediatric ED workers, nonparticipant observations, digital photographs, and archival records and were analyzed using a modified constant comparative analysis method. Participants perceived that both genders and all occupational groups were at risk for experiencing verbal and physical WPV. Common perpetrator characteristics were patients receiving a psychiatric evaluation and visitors exhibiting acute anxiety. Effects were experienced by workers, perpetrators, patient bystanders, and healthcare employers. It is concluded that WPV is a problem in this pediatric ED, and interventions need to be implemented to promote the safety of the workers and patients.
1. Violence toward health care workers has only recently been addressed as an occupational health hazard and research in this area is in its infancy. 2. Violent incidents are severely underreported and when studied are usually limited to formal incident reports. 3. Identified environmental risk factors for assaults include staffing patterns, time of day, and containment activities. 4. Health care institutions need to be educated that they have much to gain from efforts to identify and reduce the current epidemic of violence in these settings.
Work-related stress in the emergency department previously has been linked to depression and burnout; however, these findings have not been extended to the development of anxiety disorders, such as posttraumatic stress disorder (PTSD). Three sets of factors have been shown to contribute to stress in ED personnel: organizational characteristics, patient care, and the interpersonal environment. The current study addressed whether an association exists between sources of workplace stress and PTSD symptoms.
Respondents were 51 ED personnel from a hospital in a large Canadian urban center. The majority of respondents were emergency nurses. Respondents completed questionnaires measuring PTSD and sources of work stress and answered a series of questions regarding work-related responses to stress or trauma.
Interpersonal conflict was significantly associated with PTSD symptoms. The majority of respondents (67%) believed they had received inadequate support from hospital administrators following the traumatic incident and 20% considered changing jobs as a result of the trauma. Only 18% attended critical incident stress debriefing and none sought outside help for their distress.
These findings underscore the need for hospital administrations to be aware of the extent of workplace stress and PTSD symptoms in their employees. Improving the interpersonal climate in the workplace may be useful in ameliorating PTSD symptoms.
Nursing assistants (NAs) working in nursing homes are at risk for nonfatal workplace violence. The aims of this study were to describe the context in which assaults occur and to identify characteristics of the NAs related to the incidence of assaults. One hundred and thirty eight subjects participated. NAs completed a demographic and employment survey, the Occupational Stress Inventory and the State Trait Anger Expression Inventory-2, and recorded information on an Assault Log for 80 hours of work. The mean number of assaults per NA was 4.69 (range 0-67). Significant relationships were found among incidence of assaults and staffing ratios, age, occupational strain, occupational role stressors, and anger. Results provide new and useful information when planning violence prevention programs for caregivers in nursing homes.
2011 ANA health and safety survey Workplace violence
- American Nurses Association
American Nurses Association. ( 2015a ). 2011 ANA health and
safety survey. Retrieved February 3, 2015, from http://
www.nursingworld.org/MainMenuCategories/Workplace
Safety/Healthy-Work-Environment/SafeNeedles/2011-
HealthSafetySurvey.html
American Nursing Association. ( 2015b ). Workplace violence.
Retrieved March 8, 2015, from http://nursingworld.org/
MainMenuCategories/Policy-Advocacy/State/Legislative-
Agenda-Reports/State-WorkplaceViolence
American Psychiatric Association. ( 2013 ). Diagnostic
and statistical manual of mental disorders ( 5th ed. ).
Workplace bullying among healthcare workers Kin: Man who killed Brigham doctor had blamed him for his mother's death, WBUR's common health: Reform and reality Violent patients, abusive staff: A summary of unpublished study fi ndings
- A Ariza-Montes
- N Muniz
- M Montero-Simo
- R Araque-Padilla
Ariza-Montes, A., Muniz, N., Montero-Simo, M., &
Araque-Padilla, R. ( 2013 ). Workplace bullying among
healthcare workers. International Journal of Environmental Research and Public Health, 10, 3121 – 3139,
Associated Press. ( 2015, January 22). Kin: Man who killed
Brigham doctor had blamed him for his mother's death,
WBUR's common health: Reform and reality. Retrieved
March 5, 2015, from http://commonhealth.wbur.
org/2015/01/pasceri-davidson-brigham-shooting-motive
Blando, J. ( 2014 ). Violent patients, abusive staff: A summary of unpublished study fi ndings. N21: Nursing in
the Twenty-First Century: A Mobile Journal, 3.
Physician heel thyself New York Times The Opinion Pages
- T Brown
Brown, T. ( 2011 ). Physician heel thyself. New York
Times The Opinion Pages. Retrieved March 8, 2015,
from
http://www.nytimes.com/2011/05/08/opinion/
08Brown.html?partner = rss&emc = rss&_r = 0
CMSA standards of practice for case management Nurses rally against violence from patients, family members . Tampa Bay Times
Case Management Society of America. ( 2010 ). CMSA standards of practice for case management. Revised 2010.
Retrieved March 8, 2015, from http://www.cmsa.org/
portals/0/pdf/memberonly/StandardsOfPractice.pdf
Crosby, R. ( 2015, January 13). Nurses rally against violence from patients, family members. Tampa Bay
Times. Retrieved January 15, 2015, from http://www.
tampabay.com/news/health/nurses-rally-against-
patient-family-violence/2213535
Are workplace bullies rewarded for their behavior? Forbes
- P Drexler
Drexler, P. ( 2013 ). Are workplace bullies rewarded for their
behavior? Forbes. Retrieved April 25, 2014, from http://
www.forbes.com/sites/peggydrexler/2013/07/10/are-
workplace-bullies-rewarded-for-their-behavior/
The impact of bullying in health care . The Quarterly, The Royal Australasian College of Medical Administrators Workplace violence: Issues in response, critical incident response group
- K Farouque
- E Burgio
Farouque, K., & Burgio, E. ( 2013 ). The impact of bullying
in health care. The Quarterly, The Royal Australasian
College of Medical Administrators. Retrieved March 8,
2015, from http://racma.edu.au/index.php?option=com_
content&view=article&id=634&Itemid=362
Federal Bureau of Investigations. ( 2002 ). Workplace violence: Issues in response, critical incident response
group. Quantico, VA : National Center for the Analysis of Violent Crime, FBI Academy.
Johns Hopkins Hospital: Gunman shoots doctor, then kills self and mother
- E Friedman
Friedman, E. ( 2010, September 16). Johns Hopkins Hospital:
Gunman shoots doctor, then kills self and mother. ABC
New/NIGHTLINE. Retrieved March 5, 2015, from
http://abcnews.go.com/US/shooting-inside-baltimoresjohns-hopkins-hospital/story?id = 11654462
OSHA fi nes New York hospital over workplace violence, modern healthcare
- B Herman
Herman, B. ( 2014 ). OSHA fi nes New York hospital over
workplace violence, modern healthcare. Retrieved
February 5, 2015, from http://www.modernhealthcare
.com/article/20140812/NEWS/308129962
Confronting workplace violence in nursing Advance Healthcare Network for Nurses Posttraumatic stress disorder in the emergency room: Exploration of a cognitive model
- J Core Competencies For Interprofessional Collaborative Practice Lagrossa
- J M Laposa
- L E Alden
Core competencies for interprofessional collaborative
practice: Report of an expert panel. Washington, DC:
Author. Retrieval March 10, 2015, from http://www
.aacn.nche.edu/news/articles/2011/ipec
LaGrossa, J. ( 2013 ). Confronting workplace violence in
nursing. Advance Healthcare Network for Nurses.
Retrieved February 4, 2015, from http://nursing.
advanceweb.com/Features/Articles/Confronting-
Workplace-Violence-in-Nursing.aspx
Laposa, J. M., & Alden, L. E. ( 2003 ). Posttraumatic stress disorder in the emergency room: Exploration of a cognitive
model. Behaviour Research and Therapy, 41 ( 1 ), 49 – 65.
When doctors are bullies, patient safety may suffer, USA today States increasingly trying to protect healthcare workers from violence, modern healthcare
- K Painter
Painter, K. ( 2013 ). When doctors are bullies, patient safety
may suffer, USA today. Retrieved April 25, 2014, http://
www.usatoday.com/story/news/nation/2013/04/20/
doctor-bullies-patients/2090995/
Rice, S. ( 2014 ). States increasingly trying to protect
healthcare workers from violence, modern healthcare. Retrieved February 19, 2015, from http://
www.modernhealthcare.com/article/20140214/
NEWS/302149971
Bullying: When words get in the way http://www .rwjf.org/en/about-rwjf/newsroom/newsroom-content/ 2013/09/bullying–when-words-get-in-the-way Patient safety and quality: An evidenced-based handbook for nurses
- Johnson Foundation
Robert Wood Johnson Foundation. ( 2013 ). Bullying: When
words get in the way. Retrieved April 25, 2014, http://www
.rwjf.org/en/about-rwjf/newsroom/newsroom-content/
2013/09/bullying–when-words-get-in-the-way.html
Rosenstein, A., & O'Daniel, M. ( 2008 ). Patient safety and
quality: An evidenced-based handbook for nurses. In
Hughes, R. G. (Ed.), Professional communication and
team collaboration (Chap 33). Rockville, MD: Agency
for Healthcare Research and Quality.
85% of social workers were assaulted, harassed or verbally abused in the past year, community cares: Inspiring excellence in social case
- R Schraer
Schraer, R. ( 2014 ). 85% of social workers were assaulted,
harassed or verbally abused in the past year, community cares: Inspiring excellence in social case. Retrieved
March 3, 2015, from http://www.communitycare
.co.uk/2014/09/16/violence-social-workers-just-part-
job-70-incidents-investigated/
Sentinel event alert, issue 40: Behaviors that undermine a culture of safety from http://www.jointcommission.org/ assets OSHA—workplace violence Defi nition of lateral violence The WBI defi nition of workplace bullying Mental health harm from workplace bullying
The code of ethics and professional conduct for case
managers. Retrieved March 8, 2015, from http://
ccmcertification.org/content/ccm-exam-portal/code-
professional-conduct-case-managers
The Joint Commission. ( 2008 ). Sentinel event alert, issue 40:
Behaviors that undermine a culture of safety. Retrieved
March 8, 2015, from http://www.jointcommission.org/
assets/1/18/SEA_40.PDF
U.S. Department of Labor. ( 2015 ). OSHA—workplace violence. Retrieved February 4, 2015, from https:// www
.osha.gov/SLTC/healthcarefacilities/violence.html
US Legal. ( 2014 ). Defi nition of lateral violence. Retrieved
August 11, 2014, from http://defi nitions.uslegal.com/l/
lateral-violence/
Workplace Bullying Institute. ( 2015a ). The WBI defi nition
of workplace bullying. Retrieved February 17, 2015,
from http://www.workplacebullying.org/individuals/
problem/defi nition/
Workplace Bullying Institute. ( 2015b ). Mental health harm
from workplace bullying. Retrieved March 5, 2015,
from http://www.workplacebullying.org/individuals/
impact/mental-health-harm/