Staying Below "Red Line": Bullying Students in Workplace

Friday, 20 July 2018

Dalit Wilhelm, MA, RN
Cheryl Spencer Department of Nursing, University of Haifa, Mt Carmel, Haifa, Israel


Bullying in the workplace may have negative influences on nurses' health, and this may impact the quality of care that they provide. Nursing students are particularly vulnerable to bullying behaviors as they are often younger, have less clinical and life experience, fewer acquired adapting and coping skills, and minimal understanding and power in the workplace (Mabrouk & Rahman, 2014). When students have negative experiences in the workplace, this influences their perspectives on the nursing profession. Student nurses who have experienced or witnessed bullying behaviors in their clinical placements have reported being adamant about not wanting to work in similar areas upon graduation (Tee, Özçetin & Russell-Westhead, 2016). Moreover bullying and incivility is strongly correlated to an increased intent to leave the institution (and even the profession) for both experienced and novice nurses (Laschinger et al., 2010). Many studies on bullying and incivility of nursing students in practice settings have exposed the presence of this phenomena, and how widespread it has become (Birks, Cant, Budden, Russell-Westhead, Özçetin & Tee, 2017; Budden, Birks, Cant, Bagley & Park, 2017; Tee et al., 2016). Unfortunately, bullying is carried out by staff in different positions along the institutional hierarchy. As a result, it is clear that nursing education must address these phenomena in a proactive manner.

Simultaneously, newly graduated nurses continue to report the ongoing struggle and stress with their transition to working nurses (Edwards et al., 2015). Many nursing students experience reality shock and are anxious that they are not able to ‘fit in’ to their new roles (Malouf & West, 2011). Between the environmental challenges presented by bullying and the difficulty that student nurses face entering their work role, educators must help students develop skills to work in complicated social work environments. These skills cannot be developed by solely a didactic course.


For the past three years, the university's Department of Nursing has launched a preparation program for the final semester of the fourth year. This program includes both an academic course and human simulation (with actors) component. The academic course strives to improve individual skills including communication, self-reflection, conflict resolution, and awareness of organizational environments and standards. The nursing students already have gained awareness of these topics in a patient-nurse situation; this course focuses on their role as a staff member within an organization. For example, communication skills are examined through the context of the student as a nurse with a peer or with another staff member. The simulation component is an exercise on how to cope with different situations. Students narrate through text or description about difficult scenarios, such as nurse bullying, and the student plays the part of the nurse with actors, who play the parts of the other staff members. The course and simulation are assessed by the students, actors and instructors.


Three years including four to five groups (n=20) or a total of 100 students have undergone this course and simulation each year. Their first assignment is to about a situation crossing the "red line" (the subjective feeling that an incivility, disrespectful incident or bullying has been witnessed or experienced – and that the student feels disrespected or that something is "really wrong"). Their initial reaction is surprise – many students are completely unaware or do not remember the occurrence of nurse bullying in the hospital or clinic departments. After they write about a situation, they are amazed to realize the extent of the bullying – and that they were largely unaware. Often they become angry or frustrated, and that gives them the motivation for the second assignment, to further describe and analyze the actions and context. They are then invited to have the event presented in a simulation with actors depicting the roles of the staff members or student in the situation. They are like directors in a play showing their experience on the unit.


Students encounter many difficult events with other staff and repress their emotions. The emphasis of the thoughts and work is on patient care and so they dismiss negative experiences and events with staff as unimportant or as a one-time occurrence. They are unaware of the context and the patterns that recur. Only through the stages of awareness that come with the program, do they understand their defense mechanisms and learn effective responses.