The cost of bullying in the NHS is astonishing.
For a study published last year, analysts totted up the money spent on sick leave, staff quitting their jobs and reduced productivity as a result of bullying and harassment. They found the total bill for the health service in England alone exceeded £2bn a year.
The NHS in all four countries of the UK has significant levels of bullying behaviour so the overall cost to the taxpayer of bullying is huge. But the financial toll it takes is little compared to the lives and careers ruined.
Maggy Heaton, who led an RCN Congress debate on bullying, says that in her role as a steward she has seen colleagues turned into emotional wrecks by bullying. “It absolutely destroys them. I’ve seen people leave nursing completely because of it.”
It absolutely destroys them. I’ve seen people leave nursing completely because of it
A recent RCN employment survey confirmed that bullying, across both the NHS and independent sector, is widespread. A third of respondents said they had experienced bullying or harassment in the last 12 months, with the figure rising among Black African/Caribbean and disabled staff.
And for an insight into how bullying can affect an NHS organisation, a report published this month into allegations of bullying and harassment at NHS Highland is an illuminating read.
Written by John Sturrock QC, the report explores the complexities involved in understanding workplace bullying.
“It all depends on context and circumstances,” Mr Sturrock writes. “There may be pockets, sub-cultures and hotspots; one department could be perfectly satisfactory while, next door, the situation could be unbearable.”
Maggy says bullying behaviour may come from managers, peers or even more junior staff and can take many forms. “It can be anything from social isolation to being downright nasty,” she says. And she believes health services reflect a problem across wider society.
“We’ve got online bullying, we’ve got children being bullied at school and even teenagers taking their own lives because of bullying, so it’s a really widespread problem.”
Governments must do more
The Congress resolution, which received overwhelming support, condemned UK governments for their failure to introduce laws to prevent workplace bullying and called on RCN Council to ensure new laws are introduced.
Several speakers in the debate recounted their own experiences and the impact of bullying on their professional and personal lives. Graham Revie described the dread he once felt at the sound of the alarm clock signalling another shift, and waking up with “stress, fear and apprehension”.
Stuart Crawford, who has a disability, spoke of the bullying he had experienced since his school days. “And on the wards, if a service user was abusive, the response was ‘Just get on with it’.”
Several students said that on placements the hostile attitudes of some staff amounted to bullying. “Student nurses are made to feel like burdens,” Savannah Crowder told delegates.
Sometimes people are so stressed out, they don't even realise they're bullying somebody else
Changing the culture
But bullying at work is a complicated issue to unravel. It often has multiple causes, at individual, group and organisational levels. Evidence suggests it is more common at times of change, where there are rigid hierarchies, where leadership is poor and where bullying is unchecked by disciplinary action against those responsible.
Pressure may also be a factor. If resources are tight and staff numbers limited, the circumstances are right for bullying to breed, Maggy suggests. “The pressure is coming from the Government to the chief exec, who’s putting pressure on the ones below who puts pressure on the ones below them.
“Eventually, that pressure gets to the very lowest level of the trust. Sometimes people are getting so stressed out, they don’t even realise they’re bullying somebody else.”
And when bullying becomes embedded in an organisation, it can be difficult to shift. “Really it’s about tacking the culture,” Maggy says. “If we can get to that culture and make someone – the chief exec – responsible for tackling bullying in their organisation, that would be a start.”
But reporting bullying behaviour can be extremely difficult, both for victims and those who witness it. Disciplining the perpetrator depends on evidence and by its nature bullying can make both targets and bystanders reluctant to speak out.
“And those people who are brave enough to put forward a claim of bullying often don’t have the back-up they need to prove it’s actually happening,” says Maggy. “We know it’s happening, they know it’s happening, but they can’t get the proof to show it.”
The cycle therefore continues, with serious consequences for victims but also for colleagues and even patients. Bullying can result in a negative working environment, which in turn can lead to poorer patient care. Even witnessing bullying has been associated with negative outcomes, producing high levels of distress, increased job dissatisfaction and increased intention for staff to resign from their posts.
Maggy hopes the Congress resolution will mean a change in legislation and, ultimately, a shift in workplace culture that will bring an end to bullying behaviour. Change is long overdue, she says. “It’s amazing that bullying still continues. But then if nobody speaks up, the powers-that-be will say it doesn’t happen.”
The debate at Congress
'I was miserable'
Bullying behaviour left Harriet* feeling so stressed she had to take three months off work...
When Harriet returned from maternity leave, she started a new job. From the very start she had a personality clash with another nurse. Things escalated when Harriet was asked to fill in an incident form following something that happened to a patient during the other nurses’ shift. The intimidating behaviour stepped up a gear.
“She would keep revisiting the situation,” says Harriet. “Taking me aside in the staff room, questioning me about it and telling me I was wrong. Both she and the ward manager also started to penalise me for small things and openly make derogatory comments about me.
“I’ve been a nurse for 10 years so I’m pretty thick-skinned but it got to the point where I didn’t want to go into work. I was miserable.”
Harriet approached Maggy for support. She advised Harriet to keep a diary logging down everything that happened.
“It was the best advice I could have been given,” says Harriet. “When a patient who had become quite friendly with the other nurse made a complaint about me, we were able to use the diary as evidence to show what had been going on.”
Harriet was eventually cleared of any wrongdoing but had to take three months off work due to stress during the investigation process. “It was really scary,” she says. “I didn’t know what was going to happen.”
Once the investigation was over, Maggy helped Harriet put in a bullying claim. As a result, Harriet has now moved to a different ward.
Harriet says: “I’ve been there six months now and it’s going well but I think my colleagues still have some reservations about me. They don’t know why I was moved because, of course, it’s confidential so I feel like I have to work harder to prove myself.
“I think the pressures nursing staff are under can affect the way people behave. Teams are so stretched right now. People are more likely to display negative behaviour if they’re stressed. But it’s never acceptable to bully or intimidate someone.
“I would never want someone to feel the way I did. I make sure I show appreciation for how hard all my colleagues are working.”