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The support NHS staff can get and what regulators and managers can do to address a toxic culture that is damaging to nurses and poses a risk to patients
There is no denying that there is a chronic bullying culture in the NHS. Over the past decade, NHS staff surveys have continued to show that at least one quarter of nurses have experienced bullying from colleagues, patients or relatives.
Nursing Standard. 37, 7, 35-38. doi: 10.7748/ns.37.7.35.s19
Published: 06 July 2022
Harassment and bullying among members of staff can have a hugely negative effect on individuals and a team.
As the COVID-19 pandemic hit the UK in early 2020, did the fight against COVID-19 bring staff together, or deepen divides?
For staff on the front line stress factors were abundant. Long hours, inadequate personal protective equipment (PPE) and putting themselves at risk of an unknown disease, along with watching patients die, were just a few of the terrifying challenges nurses faced daily.
With stress can come burnout, hostility and toxic behaviours. And while many teams found strength by pulling together, many other nurses encountered bullying or abuse from colleagues for the first time.
According to the latest NHS staff survey, bullying and harassment by colleagues increased between 2019 and 2021.
In England, the number of registered nurses who experienced bullying by other staff members was 166,100, or 22.1% of the nursing workforce. This was up from 146,272 (21.6%) in 2019. The average across all staff was 18.9%, meaning nurses reported more bullying than other groups.
The RCN’s 2021 employment survey of more than 9,500 nurses, support workers, students and nursing associates found just over one third of respondents had experienced bullying or harassment from colleagues in the previous 12 months. The figure rises to 51.5% for respondents who stated they had a disability.
‘People should be able to call out bad practice in their workplace without fear of being ostracised’
Andrew Pepper-Parsons, head of policy at the charity Protect
Fallout from bullying can be huge. One nurse told Nursing Standard she experienced panic attacks and depression after being abused by a manager at work.
The latest Workforce Race Equality Standard (WRES) report, published by NHS England, shows female nurses from ethnic minority backgrounds as most likely to have experienced harassment, bullying or abuse from other staff in 2020, with 32% reporting it. Almost 30% of male nurses from ethnic minority backgrounds reported the same.
Meanwhile 27% of white male nurses and 25.5% of white female nurses said they had experienced bullying in 2020.
Anna*, a former surgery nurse, has dyslexia and is on the autistic spectrum, and says she started experiencing bullying at work in 2015.
Colleagues would belittle and berate her, saying she was unable to do her job because of her disability, and she was told she could not be promoted.
‘I was targeted because of my disability. Managers would speculate about whether “working is in your best interests”, not to mention the classic “people like you can’t empathise”. It has destroyed my mental and physical health as a result,’ she told Nursing Standard.
Anna says her protected characteristics were not honoured by her managers, and instead she was moved into an office role as they refused to support her to work on the ward. She believes it was easier for them to move her than to address the bullying.
‘I know of others who have experienced sexism (male nurses), homophobia, ageism, racism and religious bigotry, and I’ve seen staff bully or discriminate against patients, again on racist, religious or other grounds, such as being drug addicts or prisoners,’ she adds.
Anna is now working with her union to raise a grievance about the individual who, she says, orchestrated the bullying.
But she adds that without serious intervention and ramifications for ringleaders, the culture cannot be broken.
*Not her real name
In the 2019 Sturrock report into bullying culture at NHS Highland, a senior staff member sums up bullying and abuse experienced by staff.
The staff member says bullying was rife among all levels of staff and included ‘ignoring people, belittling them, treating their ideas with contempt and talking about them negatively to other members of staff’.
They added: ‘Often when staff have spoken out against this, they are taken aside and interviewed by two or more senior managers and cautioned or threatened with disciplinary action.’
Although referring to a specific trust, it is a picture that will be familiar to other nurses across the UK.
Kirsty* was working as a nurse in an intensive care unit at a hospital in Scotland when the pandemic hit.
She says she had witnessed or experienced a bullying culture in the past, but bullying became so intense in her department during the COVID-19 pandemic she was forced to quit. She spoke to her manager but her concerns were dismissed.
‘I remember feeling that the entire shift would be dictated by the mood of one or two individuals – usually those in charge,’ she says.
Kirsty recalled one occasion when she defended herself, which resulted in an email to everyone in her department saying in was unacceptable to ‘talk back’ to senior staff.
‘After that I asked to meet with the charge nurse to discuss the fact I felt there was a bullying culture in the unit, to which I was told nursing always has and always will be a bitchy profession and that I should pull my big girl pants up,’ she says.
She says she experienced panic attacks and post-traumatic stress disorder from her experience and was so disheartened she considered leaving nursing altogether to become a teacher, until she later took up a research post.
*Not her real name
Charity Protect, which offers confidential whistle-blowing advice to individuals and supports organisations on related policies, says using ‘trumped up charges’ against members of staff who speak up is a typical tactic deployed by bullies to protect themselves.
Protect head of policy Andrew Pepper-Parsons, often encounters bullying in the NHS in association with whistle-blowing. He warns that fear of speaking up can lead to fatal results.
He points to the Ockenden review into maternity services at Shrewsbury and Telford Hospital NHS Trust, which found a bullying culture led to poor outcomes and even deaths, as nurses and other staff felt unable to raise concerns.
Mr Pepper-Parsons says: ‘One of the problems is that, unlike other businesses such as the financial industry, there aren’t expectations of how managers across all trusts should deal with allegations of bullying or how boards should put an anti-bullying framework in place.’
Former emergency department nurse Helené Donnelly, a whistle-blower at the Mid Staffordshire NHS Foundation Trust, where serious failings in care were found to have taken place, is now a Freedom to Speak Up Guardian and is helping to tackle the toxic culture among staff in the NHS.
‘To say that nursing has always been and always will be a nasty or bitchy profession is a sad indictment’
Helené Donnelly, pictured right, Freedom to Speak Up Guardian
She likened Kirsty’s experience (see box, above) to being in a domestic abuse relationship, where your day can be dictated by the mood of your partner and dominated by verbal abuse.
‘To say that nursing has always been and always will be a nasty or bitchy profession is a sad indictment. That attitude from a nurse and a manager is totally unacceptable’ says Ms Donnelly.
» Being ignored or ostracised by other members of staff
» A colleague physically turning their back on you or walking away during a conversation
» Racist, homophobic or sexist language – this may be disguised as ‘banter’
» Speaking in a hostile or confrontational tone
» Swearing and aggression
» Persistent and frequent negative comments about colleagues
» Physical violence
» Intimidation or threats
The Nursing and Midwifery Council’s latest leaver’s survey, published in May, reveals that 5% of respondents described their work environment as toxic and said bullying in the workplace was a reason for them leaving.
In a section on workplace culture, the report includes this quote from a nurse in Wales: ‘I was working in a community mental health team. A social worker joined the team as the integrated team manager and within 18 months the entire team of nurses and social workers had left due to her bullying and lack of compassion for patients.
‘I was the last to leave but had to after the stress resulted in me collapsing at work.’
Ms Donnelly says that with the number of nurses leaving the register up 13% this year, along with 40,000 nursing vacancies, tackling bullying culture in the nursing workforce is now more important than ever.
‘When people are saying that nurses are leaving because of the pressure – lack of staff, pressure to hit targets, lack of resources, waiting lists – of course they are relevant, especially as we face the backlog,’ she adds.
‘But ultimately people don’t leave because of those reasons. People leave if they don’t have support, care and compassion from colleagues.
‘Being a nurse is a hard job. If you are doing the job alongside colleagues who are being bitchy, who are talking down to you – to your face or behind your back – it has a really negative impact. That is what ultimately gets people down.’
Protect and Ms Donnelly agree that only top-down change will make a difference to the work culture in the NHS.
» Openly encourage staff to report instances of harassment at the earliest opportunity to their line manager, Freedom to Speak up Guardian or union rep
» Are you the problem? Ask yourself whether you are being respectful and inclusive to colleagues
» Introduce a signal word in the team for when you witness bullying or incivility
» Challenge sexist, racist or abusive language or behaviour you witness as soon as possible. Instances may be resolved quickly with a conversation
» Team leaders should identify persistent offenders and discuss how to challenge their behaviour
» Consider speaking to the person directly It can be effective to tell the person to stop and explain why they are causing you distress
» Do (and promote) the Freedom to Speak up Guardian e-training
» Try reverse mentoring – senior people in the team taking time to hear feedback from the most junior members
» Keep a detailed written record of incidents If behaviour continues after informal action, keep notes and escalate it with your manager or union rep
RCN: Bullying and Harassment tinyurl.com/rcn-bullying-harassment
Royal College of Emergency Medicine: RCEM launches anti-bullying campaign to challenge toxic behaviour in EDs tinyurl.com/rcem-anti-bullying
Unilateral regulation or stronger guidance on bullying needs to be implemented across the NHS, as well as training for people moving into manager positions and sanctions for serial bullies.
Ms Donnelly says: ‘People leaving might resolve the problem personally, but it doesn’t get rid of the bully or the culture. We need more being done by the regulators and by the unions to call it out.’
RCN national officer Leona Cameron says the college is ready to stand with all members against discrimination and abuse.
‘People leaving might resolve the problem personally, but it doesn’t get rid of the bully or the culture’
Helené Donnelly, Freedom to Speak Up Guardian
‘Employers have a duty of care to all of their staff, not only to provide a safe working environment but to act on any forms of bullying or discrimination, and our Nursing Workforce Standards make it clear staff should be treated with dignity and respect,’ she says.
But Mr Pepper-Parsons says there must be more urgency for change.
‘People should be able to call out bad practice in their workplace without fear of being ostracised. It’s a problem across society, not just across the NHS, but the difference is that in the NHS it can mean the difference between good or poor care, or indeed the life and death of a patient,’ he says.
Nurses more likely to be bullied by colleagues since pandemic rcni.com/bullied-by-colleagues
Department of Health and Social Care (2022) Final Report of the Ockenden Review tinyurl.com/ockenden-final
National Guardian’s Office nationalguardian.org.uk