Creating a Healthy Workforce by Implementing a Unit-Based Intervention to Address Bullying and Incivility

The act of “Bullying” is not new to the nursing profession as the “Nurses eat their young”, adage has survived many generations. According to the “Incivility and Bully Fact Sheet”(Pacers, 2015), 21 percent of nursing turnover rates are related to bullying, and 60 percent of new graduate nurses cite “Bullying” as their reason for resignation within the first six (6) months of employment, (Townsend, 2012). Disruptive behaviors in healthcare institutions result in the financial forfeiture of an average cost of $88,000.00 to onboard a new nurse for each resignation (Jones, 2012). The greater detriment, is the loss of nursing experts, jeopardizing patient safety, and the inability to develop aspiring nurse leaders.

The Chief Nursing Officer (CNO) and the leadership team at this 640-bed facility, recognized the negative impact that uncivil occurrences had on their new nurse retention rate and consulted an internationally known expert. A professional collaboration was formed to create a “Healthy Workforce” culture.

A focused assessment was completed in the fall of 2016 to determine if bullying and incivility was a wide spread concern or isolated to specific nursing specialties. 173 face-to-face interviews, and 169 anonymous staff survey completions, validated the need for a house-wide intervention to address disruptive behaviors and establish a healthy workforce culture.

Intervention

The consultant, the CNO, and the Director of Nursing Clinical Excellence developed a strategic plan to create and sustain a healthy workforce culture by addressing incidents of disruptive behaviors. The immediate priority was to heighten awareness of what is and what is not workplace bullying and incivility. The Nurse Residency and Clinical Coach programs underwent curriculum enhancements to set behavioral expectations with the guidance of the consultant. Education and training was provided through a series of half day workshops, by the consultant, to all levels of nursing leadership, including front line nursing staff, shared governance leaders, and human resource representatives. The intent of the workshop was to equip front line managers and employees with the education, training, tools, and resources that cultivate a culture of safety, professionalism and respect by recognizing, addressing and eliminating disruptive behaviors that undermine a culture of safety. The education and training empowered employees to participate in the cultural shift that promoted peer-to-peer accountability. This strategy focused on the emphasis of professional practice expectations while clearly articulating elements of a healthy, professional, and supportive work environment.

These workshops were presented between March 2017 and November 2017.

• 280 employees and leaders attended 9 half-day workshops
• 100% of the 280 attendees said they felt more confident addressing bullying and incivility after the workshop
• The most common action attendees planned to take was to speak up and be more aware of their behaviors and the behaviors of their coworkers

A Healthy Workforce (HWF) committee was created to support the organizational goal by providing structure and oversight to ensure congruence with organizational standards. Policies and processes were augmented to support a healthy workforce culture and relationships were strengthened between leaders and human resource representatives. Front line leaders were equipped with essential skills required to set behavioral expectations and the ability to hold employees accountable for their professional behavior. Healthy workforce is now a standing agenda item for all leadership and shared governance meetings.

Three units were selected to participate as the initial pilot: a critical care, a medical surgical unit, and a surgical services specialty unit. All staff members from the pilot units were requested to complete an initial anonymous survey to provide baseline data regarding the frequency of experienced and witnessed incidents of disruptive behaviors prior to the intervention. Ongoing education and training and individual coaching, related to addressing disruptive behaviors was provided to these unit leaders with support from the executive leadership team and the human resource department.

Strategies to involve and engage front line staff were incorporated to successfully create a professional, nurturing, and supportive work culture; unit leaders included their employees when developing unit-based behavioral expectations.

Heightened awareness of disruptive behavior has empowered staff to support a zero tolerance for bullying and incivility. The number of experienced and witnessed disruptive behaviors decreased following implementation of the pilot unit interventions. People Survey results revealed a 3.6 percentage point increase over the previous year’s results with over 1600 participants. Scores increased from 81% the previous year, considered to be a strong score according to the vendor, to 84.6% indicating highly engaged employees.

While there was evidence of decreased disruptive behaviors, the success of this work is supported by anecdotal stories collected by the staff and leaders of these departments.

The organizational commitment to a Healthy workforce culture through the elimination of nurse bullying and incivility has had a positive impact. Cultural shifts occur slowly and require commitment and dedication to the goal by the CNO, unit leaders, healthy workforce committee, and frontline leaders and staff. The success on these units is a tribute to the unit leader’s commitment to holding staff accountable through conversations, counseling, and staff engagement.

Fostering awareness, empowering staff, and leadership development through education, training, and support, has prompted a cultural shift that supports and sustains a healthy workforce.