The existence of bullying in the nursing profession is not a new phenomenon. Nursing students are particularly vulnerable in their role as students and are often on the receiving end of bullying behaviour (Sauer, 2017; Clarke, Kane, Rajacich, & Lafreniere, 2012). Bullying of nursing students within the clinical setting has numerous effects on students, including negatively impacting their self-esteem, self-confidence, mental and physical health (Birks, Budden, Biedermann, Park, & Chapman, 2019), as well as making them reconsider their decision to enter the nursing profession (Rawlins, 2017; Smith, Gillespie, Brown, & Grubb, 2016). Strategies for recognizing and responding effectively to bullying behaviours should be addressed as soon as students begin their nursing education. Without educating and supporting nursing students to cope with bullying behaviours, these effects will carry on to future generations. Cognitive Rehearsal Training (CRT) is a strategy that helps people reduce impulsive actions through training/education (Griffin & Clark, 2014). The purpose of this research was to provide CRT to second year baccalaureate nursing students so that they would feel more confident to effectively respond to bullying behaviour in the clinical setting.
Methodology
A CRT workshop (Fehr & Seibel, 2016; Griffin & Clark, 2014) was included in the orientation program for second year nursing students (N=90) prior to beginning their summer clinical practicum. The content included a definition of bullying and the impact it has on nurses and the quality of care being delivered. Following this, senior nursing students’ role-played scenarios of bullying interactions which included student to faculty member, student to registered nurse, and student to student. While the scenarios were being performed, students were asked to raise their hand when they recognized the bullying and how they would address this behaviour. The students were then placed into their clinical groups to answer six questions regarding bullying behaviours within the nursing profession. At the end of the workshop they received lanyard cards that outlined how to respond to bullying. At the completion of their clinical experience two focus groups (N=23) were conducted at a University in South-Western Ontario asking students about their experiences implementing the strategies taught during the workshop.
Findings
The majority of students voiced that the CRT workshop helped them to recognize bullying situations, however, they did not have the confidence to respond to the behaviour when actually experienced in the clinical setting. Students indicated that they now recognize why they do not speak up and related this to the power differential in the workplace between nurses and students. Both focus groups suggested that more nursing education is needed to teach students how to realistically, effectively, and confidently respond to bullying behaviours between nurse and student.
Conclusion
The CRT workshop was successful in teaching nursing students to recognize bullying behaviours. However, more education is required in guiding our future nurses to properly respond to such incivility during their clinical rotations. This in turn, may increase the quality of patient care provided and strengthen healthy work environments.