By Mackenzie Bean

Ask any healthcare leader to name a point of pride during the pandemic, and many will likely say the immense collaboration, teamwork and support that emerged among front-line caregivers and clinical teams.

Take Winston-Salem, N.C.-based Novant Health, for example. Last winter, the system launched "Operation All In," which invited team members and recent healthcare retirees to volunteer for various roles to support nurses on the pandemic's front lines. In total, 3,500 team members — including 700 nurses and 2,200 clinical staff — signed up for more than 5,000 shifts.

"I'm witnessing a support structure and a bond that — if it was there before — has been absolutely highlighted and accentuated throughout this," Denise Mihal, BSN, RN, Novant's executive vice president, and chief nursing and clinical operations officer, said of the pandemic teamwork.

But most clinical leaders also know the adage, "Nurses eat their young," and in some cases, this still rings true — even during something as unprecedented as the pandemic.

"Unfortunately, I would say yes, nurse bullying is still in place and has been for decades," said Janet Tomcavage, MSN, RN, executive vice president and chief nurse executive at Danville, Pa.-based Geisinger. "In many ways, the pandemic brought team members together. But there is still inappropriate, unwanted behavior that offends nurses and causes distress."

I recently spoke with Ms. Tomcavage and Ms. Mihal to understand what nurse bullying has looked like during the pandemic and how their health systems are working to address this unwanted behavior.

The many forms of nurse bullying

Nurse bullying can appear in many forms and does not solely describe older, more veteran nurses picking on their greener colleagues. The term can apply to any type of bullying, harassment, sexual harassment or workplace violence against nurses by other nurses, clinicians, patients or hospital visitors, according to Ms. Mihal.

She said Novant saw an uptick in inappropriate behaviors such as bullying and name-calling by patients, visitors and family members across all units during COVID-19 surges. Rates of these behaviors are still elevated in the emergency department, behavioral health units and intensive care units compared to previous years. She said lack of communication, miscommunication and limited visiting hours during the pandemic were likely contributing factors to this uptick.

Ms. Tomcavage said nurses were often expected to do things that other team members didn't want to do during the pandemic. For example, there was often an automatic assumption that nurses would be the ones to risk infection by going into a COVID-19 patient's room when hands-on care activities were needed.

"It was never not expected that a nurse should automatically be the person that's in that room," she said. "That's not your normal bullying, but to me it was a form of nonprofessional behavior that rose up a little bit that we needed to address."

Overall, 72 percent of Geisinger nurses reported experiencing unprofessional behavior from a provider in the last year. Of these, 25 percent said they tolerated the behavior; 40 percent said they requested the behavior to stop; and 35 percent went to their supervisor, according to a recent internal nursing survey.

5 core tenets of a workplace anti-bullying initiative

Geisinger and Novant both launched comprehensive efforts to address workplace bullying and harassment in 2019, which they are now working to get back on track.

Here are five strategies Ms. Mihal and Ms. Tomcavage identified to combat workplace bullying and harassment toward nurses or other staff.

1. Update definitions of workplace bullying and harassment. Geisinger and Novant both revisited and updated their system's workplace harassment policies to provide a clear definition of professional and unprofessional behavior. Ms. Mihal said Novant added wording specific to social media after the system started receiving complaints from its own team members and consumers about staff members' social media posts that were considered offensive or inappropriate.

2. Form a designated committee/team to oversee improvement efforts. In 2019, Geisinger convened a small, multidisciplinary team known as the Center for Professionalism and Well-Being to oversee its workplace anti-bullying initiative and develop education programs to share with staff. The system also created a Committee on Standards of Professionalism during the pandemic, which reviews harassment reports and works to resolve inappropriate or unprofessional behavior, according to Ms. Tomcavage.

3. Educate team members, leaders and the public. Before workplace bullying can be reported and addressed, it has to be recognized. That's why Novant and Geisinger have doubled down on education efforts so staff knows what bullying looks like and how their organizations address it.

Novant's educational efforts include webinars, open forums and role-playing activities, so staff members learn how to have difficult conversations about bullying and harassment. Early on in the pandemic, Novant also placed posters in its elevators that outlined expectations for patients and visitors to treat care teams with respect and dignity.

"Our team felt so supported that we were willing to put that message out that we were not going to tolerate this," Ms. Mihal said of the posters.

To ensure leadership stays informed, Geisinger is planning to perform regular staff surveys on workplace bullying and report the findings during monthly meetings with clinical operations team leaders, Ms. Tomcavage said.

4. Make reporting easier. Novant has seen a 51 percent increase in the daily rate of reported bullying events since unveiling its workplace harassment initiative in 2019.

"The impetus of this increase is that one, we made the reporting process easier. You don't even have to fill out a piece of paper; you can just pick up the phone and call it in," Ms. Mihal said. "And two, we did much more education that when you are verbally dressed down, that is still abuse and won't be tolerated."

At Geisinger, team members can report bullying by calling a confidential phone line or emailing an account that goes to a small, core group of leaders. Since this process has been in effect — for just under a year — the system has received 40 reported concerns, all of which were substantiated.

"Unfortunately, only 3 percent of those 40 reported concerns came from nursing, which is eye-opening to me," Ms. Tomcavage said, adding that Geisinger is now on a mission to encourage more nurses to report unprofessional behavior.

5. Investigate all reports and implement necessary coaching or disciplinary action. Of the 28 percent of Geisinger nurses who said they'd tolerate inappropriate behavior from a provider, at least 35 percent said they felt nothing would be done if they reported it, Ms. Tomcavage said.

This mindset is often pervasive in nursing culture, according to Ms. Mihal.

"I think there is a form of bullying and harassment that nurses tend to expect and not report," she said. "It's sort of expected that you have to pay your dues."

To combat this thinking, health systems must clarify that such behaviors are unacceptable, encourage nurses to report and then act on these concerns when raised. When Geisinger receives a concern, its Committee on Standards of Professionalism investigates by talking to the alleged offender and his or her supervisor and then recommends any necessary coaching or training. The health system is also going to start tracking staff members who have repeat complaints against them, instead of relying on one-off reports, to escalate interventions as needed, Ms. Tomcavage said.

Why should stopping workplace bullying be a priority?

Addressing unwanted behaviors in the workplace is about more than just professionalism. These behaviors can have detrimental effects on team members' psychological safety and care quality, according to Ms. Tomcavage.

"When nurses are bullied, they may not bring forward quality concerns," she said. "We also know the personal toll that this takes can lead to depression and nurse suicide."

These behaviors can also contribute to nurse burnout and turnover, which is problematic considering the health system is already facing a nursing shortage.

"If we can eradicate unprofessional behavior, we should see a significant increase in our quality and safety for patients," Ms. Tomcavage said. "We should also see a significant impact on turnover and retention and professional and personal fulfillment in a job that is demanding but also so rewarding."