Enabling Solutions: PACERS Toolkit Tackles the Wicked Problems of Bullying in Healthcare

Background: Historically, strategies to eliminate bullying and create respectful, civil, supportive, and safe environments have largely centered on individuals, while ignoring the broader context of its occurrence that includes influences from interpersonal, community, environmental and policy sources.  Theory and research establishes bullying as a complex interplay of influences between individuals and their broader environments. Bullying is a group phenomenon, reciprocally influenced by the individual, peers, the immediate environment/institution, community and /or society. Human behaviors are not isolated events; they are linked with and influenced by other behaviors and social norms. Evidence suggests organizational factors serve as a mechanism through which bullying becomes embedded in the culture. While individual factors may play a major role that contributes to bullying, the environment is a powerful force that consciously or unconsciously enables acts of bullying. Educating individuals to be civil when environments are not supportive can be ineffective, making sustainable behavioral change elusive. Leadership commitment and conscientiousness in implementing comprehensive, cohesive and integrated bullying prevention and intervention programs are critical to promote environments of respect, and enhance sustainability of cultures of civility.

Problem: Mounting evidence indicates that incivility and bullying contribute significantly to the pervasive disrespect in healthcare, limiting clinician’s ability to deliver safe, quality healthcare. Bullying threatens quality healthcare and patient safety because it cuts off communication and inhibits collegiality and cooperation; fundamental concepts to teamwork and high performance in healthcare.  Scholars refer to bullying as a silent crime, because victims and bystanders do not know how to handle the situation.  Victims are afraid to speak out for fear of retribution, believing nothing will change, or they will be labeled as a complainer.  Nurse leaders are also unsure of how to break the cycle of bullying and incivility. 

Solution: Recognizing the opportunity to reduce and eventually eliminate bullying in healthcare through enablement and empowerment of nurse leaders, and with a grounded understanding of the scientific etiologies of bullying and the potential solutions to the issues, a seven member  national team of nurse leaders across the United States, known as the PACERS, designed, developed and launched a readily applicable tool kit (stop bullying tool kit) to support nurse leaders to create and sustain  a culture of civility in their organizations.  Creating a culture of respect has been espoused as the essential first step in a healthcare organization’s journey to becoming a safe, high-reliability organization that provides a supportive and nurturing environment that enables full engagement of all persons.  The PACERS tool kit combines individual, interpersonal, community, environmental, and policy level solutions to address bullying where it starts and to create and sustain environments of respect and civility in healthcare environments and beyond. The tool kit is accessible via www.stopbullyingtoolkit.org and was downloaded by more than 15,000 providers in 125 countries within its first 12 months.  Health leaders, nurses and other members of the interprofessional are team are challenged in their role to cultivate and sustain a positive work environment by preventing, intervening, and/or managing issues of incivility and bullying.