Bullying in the workplace is a nation-wide problem in the US. According to the statistics, around 75% of workers experience workplace bullying at least once a year. At the same time, over 80% of bullying is conducted by less than 6% of the total workforce (Wright & Khatri, 2015). Workplace bullying affects nearly every domain of labor activity, including the healthcare system. Despite being an industry founded on holistic principles of kindness, compassion, and care, the healthcare industry shows a persistent dynamic in workplace bullying across all specialties and designations (Blackstock, Harlos, Macleod, & Hardy, 2014).
Bullying in nursing has very strong connections to the turnover rate, effectively increasing it. The costs of turnover in medicine are among the highest in the world, ranging from 22,000 to 65,000 dollars per employee, excluding the associated expenses for university studies (Blackstock et al., 2014). Overall, the healthcare industry loses more than 300 billion dollars worldwide because of turnover based on mundane slights (Wright & Khatri, 2015). In addition to making people lose their jobs and causing additional expenses, nurse turnover is associated with various psycho-emotional issues and an overall decrease in the quality of care. The purpose of this paper is to analyze the issue of workplace bullying in healthcare through the lens of mathematical and scientific analysis.
The research questions for this paper are as follows:
- What are the psychological effects of nurse bullying in the workplace?
- What is the connection between nurse bullying and the development of psychological diseases in the workplace?
- What are the economic consequences of bullying in healthcare institutions?
- What is the connection between nurse bullying, turnover rates, and loss of profit?
The Psychological Effects of Nurse Bullying
Nurse bullying has profound psychological effects both on the victims and the perpetrators. For the victims, bullying is one of the primary sources of stress and anxiety. They do not feel safe, threatened and fearful of both physical and emotional bullying. Their self-esteem decreases and they start feeling less competent than they actually are. Attempts to stand up to organized groups of perpetrators often result in failure, which only magnifies the impact of further bullying attempts.
According to Wright and Khatri (2015), many bullied nurses acquire bullying as a coping mechanism and learned behavior, exuding it on those who have even less power than they have. Thus, to summarize, the psychological effects of nurse bullying include a negative outlook on oneself, stress and anxiety, uneven sleeping patterns, and a plethora of unhealthy coping behaviors, some of which are learned (Wright & Khatri, 2015).
As for the nurses who participate in bullying or witness it as bystanders, they are more likely to develop emotional detachment from their job and antisocial behavior tendencies. They are typically desensitized towards patients and their suffering and are more likely to be fired for the poor quality of care (Wright & Khatri, 2015). They are aware of this fact, which leads to stress and a desire to supplant others to make themselves look competent.
Nurse Bullying and the Development of Psychological Disorders
Some of the most common psychological disorders found among victims of bullying in the workplace are depression, anxiety, and borderline personality disorder. Depression is a common psychological illness that can have severe consequences on a person’s life. It causes sadness and a lack of pleasure in activities that used to bring enjoyment and satisfaction. This is directly related to nursing turnover. When faced with constant abuse from workplace colleagues while suffering from depression, nurses are far more likely to drop out of the job. Anxiety is often accompanied by depression and has a person suffering from panic attacks, jitteriness, and a loss of confidence (Chang et al., 2017).
Low self-esteem is connected with the bipolar personality disorder, which is often represented by mood swings, bouts of indecisiveness, apathy, and fear as well as the polar opposites of these symptoms, such as hyperactivity, desire for conflict, and violence. Bullies, on the other hand, tend to suffer from the development of antisocial personality disorder, which is characterized by a complete disregard for conventions, morals, and feelings of others (Wright & Khatri, 2015). It leads to social isolation and ostracizing, making them more likely to quit.
Economic Consequences of Bullying in Healthcare
As it was already mentioned, mundane slights cause over 300 billion dollars of deficit in healthcare institutions worldwide. The majority of these expenses arise from the need to recruit and train new staff. As it stands, the US hospital system experiences a shortage of nurses. According to Duffield, Roche, Homer, Buchan, and Dimitrelis, (2014), the US healthcare market will require additional 1.1 million nurses by 2022, increasing the overall body of nurses in the country by about 20-25%. Because of shortages, time, and effort required to educate professional doctors and nurses, the costs of healthcare for the end users are increased.
US healthcare department reports that an average family of four (mother, father, two children) spend roughly 20% of their yearly income (Duffield et al., 2014), which is around 10,000 dollars, assuming the family receives government aid, which covers for half of the expenses. Otherwise, the expenses may rise to 20,000-25,000 dollars a year, depending on the insurance plan. Since bullying directly affects nurse turnover rates, it also sends a ripple effect throughout the entire system, affecting the economic well-being of all individuals and stakeholders involved, including the nurses, the hospitals, the patients, and the governments, who are forced to pay for these expenses.
Nurse Bullying, Turnover Rates, and Loss of Profit
Nurse bullying is directly related to the profitability of healthcare ventures. Duffield et al. (2014) highlight the three important ways of how harassment creates a budget deficit in hospitals. First, it creates a shortage of nurses, doctors, and employees. US hospitals on average have a job vacancy rate of about 14-16%. It means that the majority of healthcare facilities are, on average, understaffed. Seeking out, hiring, and training nurses cost around 20,000-60,000 dollars (Blackstock et al., 2014). Every time a nurse quits because of workplace harassment, the hospital suffers a direct loss of investment equal to a half of a nurse’s yearly pay.
Loss of profit is exacerbated by the fact that most hospitals cannot deal with the imposed workload during seasonal peaks. Chang et al. (2017) report that hospitals are forced to hire temporary staff to be able to manage their patients at a basic level. Hospitals that cannot deal with extra patients simply lose them, which results in a loss of profit and reputation, as the patients the hospitals failed do serve are unlikely to recommend the facility to their friends and family.
Lastly, fewer nurses mean higher chances of clinical mistakes. Wright and Khatri mention that patients in understaffed nursing settings are more likely to contract hospital-related diseases, which would result in long, expensive, and potentially dangerous treatments. Ulcers, blood contamination, as well as bacterial and viral infections contracted by patients are usually paid for by the hospitals.
Nurse bullying is a complex and dangerous issue that affects the entirety of the healthcare system. It causes higher levels of stress, nurse burnout, and nurse turnover, in turn affecting all the related stakeholders in the equation, including the hospitals, the governments, the patients, and the nurses themselves. As it was proven in this paper, nurse burnout and turnover caused by bullying leaves severe psychological scars on both the victims and the perpetrators.
The economic aftereffects of bullying-induced turnover affect the cost and quality of healthcare. Piecemeal solutions implemented in singular healthcare facilities will not change the situation for the better. A state-wide solution backed by laws and policies is required.
Blackstock, S., Harlos, K., Macleod, M. L. P., & Hardy, C. L. (2014). The impact of organisational factors on horizontal bullying and turnover intentions in the nursing workplace. Journal of Nursing Management, 23(8), 1106-1114.
Chang, H. Y., Shyu, Y. I. L., Wong, M. K., Chu, T. L., Lo, Y. Y., & Teng, C. I. (2017). How does burnout impact the three components of nursing professional commitment? Scandinavian Journal of Caring Sciences, 31(4), 1003-1011.
Duffield, C. M., Roche, M. A., Homer, C., Buchan, J., & Dimitrelis, S. (2014). A comparative review of nurse turnover rates and costs across countries. Journal of Advanced Nursing, 70(12), 2703-2712.
Wright, W., & Khatri, N. (2015). Bullying among nursing staff. Health Care Management Review, 40(2), 139-147.