Analysis and Promotion of Psychological Safety in the Healthcare Setting

Lateral violence and workplace bullying are endemic in the workplace.  Both lateral violence and workplace bullying can be defined as covert or overt acts of verbal or non-verbal aggression that causes psychological distress (The Healthy Workplace Campaign, 2011). While bullying occurs when someone of higher position in the workplace perpetrates this behavior, lateral violence is perpetrated amongst peers.

The healthcare workplace is well entrenched in this plague. In the United States of America 35% of all workers report being bullied at work (The Workplace Bullying Institute, 2011).

Related to Nursing in the United States over half of all nurses are victims and >90% of nurses report witnessing bullying and lateral violence (Jacobs & Kyzer, 2010).  The nursing culture has seen these behaviors become the norm and can be considered even an expected “rite of passage”.

Things as simple and seemingly as innocuous as gossiping and eye rolling, when done deliberately and repeated will over time serve to marginalize and eventually ostracize the targeted employee.  The result is impact on several levels. 

On the personal level the targeted person can develop stress related complications.  These can include hypertension, autoimmune disorders, and depression.  At the organizational level the intimidation can negatively impact the concentration of employees, as well as communication between staff which raises patient safety concerns.

Workplace bullies can be considered to arise from two mechanisms alone or in combination.  In an environment where bulling is the norm employees can model that behavior as a survival strategy.  The other way is someone who has sociopathic tendencies can become influential in an organization and their social pathology can directly manifest as bullying behavior.  Since sociopaths can exhibit a superficially charming personality, are often intelligent, and often very successful regardless of how unscrupulous their methods, the success they achieve is valued by the organization.

The U.S. Department of Veterans Affairs (VA) publication titled “Canary in a Coal Mine” discusses how any indication of bullying behavior in the workplace will suggest the possibility of an endemic issue.  As such interventions need to take place at a systems level for that organization.  Any framework for intervention strategies must target the full scope of the workplace environment.

Albert Bandura’s Social Cognitive Theory supplies such a framework.  Reciprocal Determinism and the concept that a person, their behavior, and the environment all cause and effect each other allows for the possibility that intervening at any point of the chain can positively impact this issue. Such is the case at the VA, the national leader in many medical innovations, is also leading its way to promote psychological safety. The VA Boston Healthcare System is gaining momentum in identifying and preventing bullying. This identification process is the first and most important step in influencing the factors that allow bullying to exist.  Once exposed bullies lose their base of support and the chain is broken.  The leadership involvement at the systems level at the VA to support programs aimed at preventing bullying is rapidly influencing the behavior of its employees. New bullies are not created through modeling of bad behavior and the organization as a whole is improving and making room for employee engagement.