WHO
Kathleen Bartholomew, R.N., was the featured speaker at the Feb. 29 medical center's Leadership Development Institute. She has been a national speaker for the nursing profession for the past nine years and author of several books, including "Ending Nurse to Nurse Hostility: Why Nurses Eat Their Young and Each Other." In 2010 she was nominated by Health Leaders Media as one of the top 20 people changing health care in America. Bartholomew first encountered physician bad behavior as a new nurse in the early 1990s. Bartholomew said it's more critical than ever to teach managers and employees how to create a culture of understanding and security in the work place, especially given statistics that show the huge costs of bullying and aggression in health care.

Tribal Formations
Bartholomew recommended switching from a hierarchical way of managing to a tribal one where employees feel safe and valued.

HIERARCHY
--Staff complain to manager or each other
--Boss solves problems
--People know their place
--No feedback sought
--Secrecy and blame
--Control as key
--Different rules for different roles

TRIBE
--Staff take accountability
--Staff seek resolution
--People know their value
--Peer evaluations
--Just culture – open sharing
--Relationships as key
--100 percent of staff held to same standard

The consequences
Rude behaviors left unchecked can lead to high turnover, low morale and medical errors. One study found the verbal abuse from physicians was reported at 90 to 97 percent; 76 percent witnessed negative nurse-to-nurse behaviors and 67 percent saw a link between those behaviors and medical errors. (Rosenstein).

Among a survey of Washington state ER nurses, it led to:

• Withholding information, 45 percent
  
• Ordered to do work below competence, 40 percent
• Opinions and views ignored, 33 percent
  
• Pressure not to claim something, 28 percent
  
• Key areas of responsibility removed, 27 percent
• Being ignored or excluded, 25 percent (JONA Vol. 39 No. 2)
  
  

Strategies to Cope
There are many strategies that can help reduce the amount of bullying happening in the work place. Managers can decrease negativity, gossip and a culture of blame by maintaining a zero tolerance for communication that is unhealthy, she said. The following is a questionnaire designed to open up a dialogue.

Sample questionnaire managers can use:
I am respected by my peers 1 2 3 4 5
I feel supported by my peers 1 2 3 4 5
I can safely express my opinions 1 2 3 4 5
I feel a strong sense of belonging 1 2 3 4 5
What I like the most about my team is:
What I need more from this team is:

Behaviors to Seek
Professional behaviors include: Accept one's fair share of the workload, keep confidences; work cooperatively, despite feelings of dislike; look co-workers in the eye; don't engage in conversation about a coworker; stand up for an "absent member" in conversations so you don't become a silent witness; don't be overly inquisitive about each other's lives; and do repay debts, favors and compliments.

Contact Info
Dowload handouts at http://mcintranet.musc.edu/muscexcellence/LDI/LDI21.htm.
For more information, visit http://www.kathleenbartholomew.com.