UO Magazine > Mar/Apr 2007

For 10 years, Jane had done everything for the ever-absent Clinical Director, Peter Clark, MD, from creatively balancing his budget to picking up his children and his dry cleaning. She opened his mail, screened his calls, and checked his e-mails. When he announced his plan to hire a development professional to generate support for the Charity AIDS Clinic, Jane had hoped she could take on these responsibilities too.

Instead, Clark hired Sarah, a nurse turned fund-raiser. Sarah was quiet, independent, had a strong fund-raising record, and was passionate about the cause. When writing grants, she kept her office door closed, especially to Jane, who routinely pumped people for gossip. Most days, Sarah ate at her desk and used lunch breaks to train for charity runs. Jane called her “the worm.” One day Sarah overheard Jane tell colleagues Sarah had an eating disorder and serious family problems. The next week, Jane accused her of spreading a computer virus. Jane confiscated Sarah’s computer and assigned her the spare in the break room. Jane demanded Sarah’s documents be submitted to her for final clearance and distribution, declaring it office policy. When Sarah requested the budget for the Charity fund-raiser six months away, Jane said she’d get the numbers if Sarah thought she’d survive that long. Five months and numerous requests later, Sarah still had no budget and no computer. Every time Sarah booked a meeting with Dr. Clark, Jane canceled it. The staff had stopped speaking to Sarah and no one made eye contact. On the rare occasions when Dr. Clark breezed into the office, Jane dominated his time. After one such occasion, Jane told Sarah that Dr. Clark canceled the fund-raiser.

Six months after she was hired, Sarah succeeded in getting one message through to Dr. Clark—her resignation.

Bullying in the workplace—a.k.a., psycho terror, mobbing, psychological violence, neuropsychological compromise, can cause irreparable harm to individuals and pose significant financial burdens for health-care facilities and institutions. The Workplace Bullying Institute (WBI) (www.bullyinginstitute.org) calls it the silent epidemic and defines bullying as “the repeated mistreatment of one employee targeted by one or more employees with a malicious mix of humiliation, intimidation, verbal abuse, and work interference.”

Despite its healing orientation, the health-care field offers no immunity to bullying. Gary Namie, PhD, the director of the Workplace Bullying Institute in Bellingham, Washington, and the co-author of The Bully at Work (Sourcebooks, 2003) believes bullying is endemic in the health-care arena.

Physicians may encounter such abusers of power in any health-care setting. A bully might be the office manager who is always good for a dose of gossip, or the head nurse who just lost the

best half of the staff, or the new center director smiling across the hospital billboard who has turned staff meetings into a stage for his relentless raging criticism.

As with other forms of abuse, victims frequently suffer in silent shame. Human nature moves coworkers to avoid the troubled target, remain on guard, and even befriend the bully out of fear of becoming the next victim. The disorder spreads and the symptoms appear—a decline in work performance, a rise in absenteeism, rapid staff turnover, and the departure of the best and brightest, a prevailing aura of distrust, resentment, and hostility. Pity the patients who seek care within a facility staffed by distracted and bullied professionals. Toxicity in the health-care workplace has the potential to affect patient care and safety. Recognizing and effectively dealing with workplace bullying and backing it up with a code of conduct and zero tolerance for less-than-civil behavior are critical to preventing human and financial harm that can reach devastating levels.

“It’s all about power,” says Judith Glaser, the CEO of Benchmark Communications, Inc., and author of The DNA of Leadership, (Platinum Press, 2006). Leaders who abuse their role and cross the line from boss to bully turn workers into victims, thereby creating a toxic environment for everyone.

A lot of classic social psychology experiments like the Lombardo experiment at Stanford and the Milgram Studies at Yale show that putting people in positions of power over others can lead them to be surprisingly cruel, says Ben Dattner, PhD, a professor at New York University and a principal of Dattner Consulting, LLC, a New York-based organizational consulting and research firm.

Of course, not everyone who is entrusted with power is destined to abuse it. “I wouldn’t say that all narcissists are bullies or that all bullies are narcissists, but there is certainly some overlap conceptually between narcissists [and those] who are exploitative,” says Dattner. “With such personalities, there is an attitude of entitlement that could definitely correlate with being a bully.”

While bullying is often thought of as the bad behavior of bosses, a phenomenon known as “horizontal violence” is a form of bullying that occurs among workers on the same level. Despite a dearth of U.S. statistics, this form of bullying is considered a significant problem in the nursing profession. (Journal of Advanced Nursing, 2003).

A bully’s strategies can range from bold public displays to insidious destructive acts. “[Bullying behavior] could be screaming, cursing, spreading vicious rumors, sabotaging people by destroying their property or their work product. A lot of times, with bosses, it’s excessive criticism,” says Robin Bond, Esq., the managing partner of Transition Strategies, LLC, a workplace law firm in Wayne, Pennsylvania, who served as a hospital counsel for 10 years. Bullying behavior can also lead to hitting, slapping, and shoving.

Bullying that escalates to physical violence among health-care workers only sounds like fiction, but in 1993, the U.S. Bureau of Labor Statistics reported health-care and social service workers as having the highest incidence of occupational assault injuries.

According to WBI, three main workplace factors set the stage for bullying: opportunity—often created by a highly competitive environment; the presence of people willing to exploit others; and an employer who refuses to punish or one who promotes and rewards individuals who bully.

The health-care environment is particularly bully-prone, says Namie. “We get the most complaints from health care.” A 2002 national survey of workplace aggression reported 41 percent of workers experience psychological workplace aggression in a given year. (Handbook of Workplace Violence, Sage 2006). By comparison, a study of 2,884 medical students representing 16 U.S. medical schools from the class of 2003, found that 42 percent reported having experienced harassment and 84 percent experienced belittlement during med school. (BMJ, September 30, 2006).

Health-care work settings tend to be fast-paced and attract a distinct mix of people—a large population of individuals with strong egos and a willingness to exploit others working alongside a large population of people who have a pro-social orientation and want to heal, teach, and help others, says Namie. In addition, bullying behavior often passes as ambition. Ironically, these are the very people who get rewarded and promoted and who have made themselves invaluable to key people. Dattner agrees. “There’s definitely a dynamic where people kiss up and kick down,” he says.

In addition, Namie says, few institutions have an established code of conduct or a policy against bullying. It’s so prevalent in health care that employees often think of bullying as an acceptable occupational hazard. This makes it even more dangerous as people become immune to the consequences, do not challenge the manner of conducting business, and become increasingly suppressed and oppressed.

The WBI describes four common bullying behavior patterns: the screaming, fist-pounding individual who cultivates fear; the friend-to-your-face who stabs in the back; the constant critic; and the gatekeeper who bars access to materials and information. Though their styles may differ, “what all bullies share is that they are Machiavellian,” says Namie. “They are willing to manipulate other people to accomplish their own goals. Everything is driven by their personal agenda.”