Occupational health practitioners have a role in implementing workplace bullying and harassment policies, research suggests. Felicity Fleming looks at the evidence.
The CIPD (2015), Acas (2014), and the Health and Safety Executive (HSE) (2009) all provide comprehensive advice for employers and managers regarding policies to address work-based bullying and harassment. Research has identified that some organisations have constructed policies by means of “imitation” (copy and paste), and that these documents have tended to be unsuccessful when implemented (Salin, 2008).
This recognises that policies need to be tailored to the needs of individual organisations, and Acas (2014), recommends that staff are actively involved in the development of these documents.
Acknowledging that policies in themselves do not eradicate negative behaviours, the CIPD (2015) stresses the importance of additionally creating a positive organisational culture regarding acceptable conduct, and ensuring that this is embedded within these policies. It is also recommended that the effectiveness of policies is regularly monitored through the collection of data on the number of grievances raised (CIPD 2015; Acas 2014), and organisational attitude surveys (Salin, 2008).
Prevalence of workplace bullying and harassment
A survey of 217,000 NHS staff in the UK revealed that 10% of employees reported having been bullied or harassed by colleagues within the preceding 12 months, and that this figure increased to 37% if abuse from relatives, visitors or patients was included (Bloom and Farragher, 2010). Just under half (42%) of workers declared that they would not report instances of workplace bullying or harassment.
Under-reporting of workplace bullying and harassment is not restricted to nurses. Research indicates that doctors, particularly trainees, are deterred from raising grievances due to beliefs that their actions will not result in improved outcomes for patient care, and, worse still, that they will be victimised and this will have a negative impact on their career prospects (Quine, 2002).
In research, 19,764 NHS employees responded to a request for information about their experiences of workplace bullying and harassment. Just under one-third (30%) of them reported that they had felt unsafe after raising a concern. Of those who had not felt sufficiently safe to speak out, 18% said that this was due to a lack of trust in their organisation, and 15% stated that they feared subsequent victimisation (Francis, 2015).
This level of staff intimidation arising out of bullying and harassment behaviours in NHS healthcare workplaces has serious implications and consequences, both for the health and wellbeing of staff and for patient safety.
Government statistics are based on officially reported grievances and cannot reflect instances of bullying that have not been reported (LaVan and Martin, 2008). This can result in under-reporting, eg if endemic bullying exists within an organisation, whereby no employee feels sufficiently safe to raise a grievance (Beaumont, 2010). Conversely, as identified by Francis, a very small number of individuals may make fraudulent claims to gain financial compensation, or raise a grievance in retaliation to disciplinary action regarding their performance (Francis, 2015).
Causes of harassment
Much of the data derived from research into the prevalence of workplace bullying and harassment is based on surveys. Where the results produced are grounded on the perceptions and opinions of victims, caution is needed when interpreting the findings (Vartia, 1996). Individuals who are depressed, for example, may perceive situations differently (Atkinson, 2014).
Conflicting views may arise, eg in differentiating between abusive supervision and firm management (Einarsen, Raknes and Matthiessen, 1994). The wording of questions and personal experiences of bullying can also influence feedback given in these surveys (Vartia, 1996).
Equally, when individuals have been subjected to long-term bullying in the past, they may continue to have a very negative attitude about their organisation, which may be reflected in their responses to survey questions. To gain an accurate assessment into the prevalence of work-based bullying and harassment, it is therefore very important to take the views of observers into consideration (Vartia, 1996).
In Quine’s survey (1999), 42% of respondents reported having observed colleagues being bullied, while many had not been bullied themselves, indicating that this is not a purely subjective phenomena.
Research findings can also be affected by volunteer bias. As identified by Vartia (1996), it is possible that individuals responding to questionnaires regarding workplace bullying and harassment did so because the issue was personally relevant to them due to current issues at work, or past experiences about which they had not yet reached closure.
Conversely, employees may have chosen not to participate because they did not consider the topic pertinent to them or their organisation. Both these possibilities have the potential to skew results (Vartia, 1996).
Effects of organisational culture and individual personality traits
Research indicates that bullying begins with conflict (Leymann, 1992), and that organisational culture plays a part in the prevalence of workplace bullying and harassment (Vartia, 2008; Salin, 2008). Key factors contributing to unacceptable behaviour include:
- leadership;
- unclear goals;
- organisational constraints, eg finance; and
- lack of control/ambiguity regarding job role.
However, not all employees experiencing these stressors become perpetrators or victims of bullying behaviour, which suggests that other factors need to be considered, such as individual personality traits and social learning theory. One aim behind this research is to create supportive interventions to curb the development of bullying behaviour, and to enable potentially vulnerable employees to become more resilient when faced with challenging situations (Etienne, 2014).
Certain aspects are of particular relevance in relation to workplace bullying. Tyrannical leadership for example, whereby an individual is excessively disrespectful towards staff, and abuses their position of authority (Bloom and Farragher, 2010), can result in unachievable expectations being placed on employees and abusive supervision. This behaviour may occur where there is pressure to meet service delivery targets, and may be unintentional. Conversely, it can be based on a desire for personal gain and advancement (Bloom and Farragher, 2010).
The bullying behaviours implicit in tyrannical leadership can result in employees developing “learned helplessness” (Bloom and Farragher, 2010). Constant exposure to excessive criticism, unachievable targets and a loss of control can cause staff to feel that their attempts to perform well are futile, diminish their critical thinking skills and undermine their performance (Bloom and Farragher, 2010).
Further dangers arising from this style of leadership are identified within social learning theory (Bandura, 1973), suggesting that individuals model their behaviours on those of colleagues in an attempt to be accepted (Restubog and Bordia, 2006). Research indicates that if a culture of bullying is seen as the accepted norm, employees will adopt these behaviours in order to “fit in” and conform with their working environment (Bommer, Miles and Grover, 2003; Zagenczyk et al, 2008).
Additional concerns regarding workplace bullying stem from the transactional theory of stress (Lazarus and Folkman, 1984). This theory asserts that individuals experiencing stressors such as workplace bullying will attempt to ameliorate their negative feelings, either by taking direct action and retaliating against the perpetrator, or by resorting to emotion-based coping strategies.
Importantly, individuals feeling unable to confront perpetrators directly due to fear of negative consequences, eg disciplinary action, are more likely to utilise emotion-based coping strategies in which they displace their aggression away from the perpetrator, and redirect it towards an alternative target (Marcus-Newhall et al, 2000). Research suggests that this is most likely to be a spouse or partner (Hoobler and Brass 2006). This can lead to the development of abusive relationships and domestic violence (Restubog and Bordia, 2006).
In contrast, inappropriately passive leadership may be equally damaging. It can result in unacceptable behaviour not being challenged and allow a bullying culture to develop and escalate (Salin, 2008).
In recognition of the importance of good leadership, increasing attention is now being given to the concept of emotional intelligence (Etienne, 2014). Bennett and Sawatzky (2013) describe this as “the ability to accurately perceive, appraise and express emotions”, thereby assisting in the creation of a positive work environment.
Training and development
Research has highlighted the need for employers, managers and employees to be better trained in the management of workplace bullying and harassment in order to eradicate unacceptable behaviours (Etienne, 2014). However, training has generally not been forthcoming. In recognition of this, Francis (2015), makes a number of recommendations, including:
- regular training for employers and managers;
- regular training for all employees in relation to their organisation’s policies and procedures;
- routine use of reflective practice to improve future performance; and
- the introduction of a standardised training component in all education courses for healthcare professionals.
Francis has also recommended that where training establishments do not comply with these regulations, the validation status of their course should be revoked (Francis, 2015).
With more attention currently being given to the benefits of assertiveness and aggression training (Etienne, 2014), arguably this should be included within the training of all healthcare staff to make them more effective/resilient in resolving work-based conflict.
Implications for OH practitioners
The Black (2008) and Boorman (2009) reports both identify the need for OH departments to become more proactive in maintaining the health and wellbeing of employees. This message is re-emphasised by Francis (2015).
Stress caused by bullying can result in profound damage to an individual’s psychological health and wellbeing (Restubog and Bordia 2006), highlighting the need for effective OH involvement in helping employers to eradicate unacceptable workplace behaviours.
However, OH practitioners cannot do this alone. As identified by Francis (2015), and earlier research (Etienne, 2014), success will be dependent on well-conducted collaborative partnership working.
OH nurses need to be involved in the development and review of local and national policies and legislation (Etienne, 2014). Indeed, they have a professional duty to do so (International Commission on Occupational Health (ICOH), 2012; and the Nursing and Midwifery Council (NMC), 2015), in terms of acting as advocates in promoting the needs of their clients. This involvement includes the need for them to assist in reviewing and evaluating the effectiveness of policies, support measures and interventions (Salin, 2008).
Following recommendations by Francis (2015), procedures regarding work-based bullying and harassment are likely to change. For example, the proposed appointment of a new Independent National Officer, and the possibility that responsibility for the management of grievances will be removed from HR, and instead be processed by an executive board member, in order to emphasise that bullying is a safety issue.
Due to the complexity of issues surrounding work-based bullying and harassment, it has been suggested that OH practitioners may benefit from additional training to assist them in developing specialised interventions to target unacceptable behaviour (Etienne, 2014). This is in accord with their professional duty to engage in life-long learning (ICOH, 2012: NMC, 2015).
This, in turn, would enhance OH practitioners’ ability to provide effective, appropriate advice to staff and managers. Additionally, it would enable them to work collaboratively with employers to identify appropriate training support structures for colleagues, managers and employees (Etienne, 2014).
Acas (2014) recommends that staff are provided with appropriate support to protect their health and welfare. However, details as to what constitutes “appropriate support” remains vague.
While many organisations provide counselling services, it is not uncommon for this to be limited to a minimal number of sessions. In the light of research highlighting the profound levels of psychological distress that victims of bullying can experience (Restubog and Bordia, 2006), and the effect that this can have on their health and wellbeing, it may be appropriate for OH practitioners to act as advocates for improved support services and interventions.
OH practitioners also need to develop a comprehensive range of contact details in order to signpost individuals to specialist support services, including those for domestic violence, crisis teams for mental health conditions, and addiction services. They must also have sound knowledge of their local safeguarding procedures.
It may also be helpful for OH practitioners to reevaluate and reflect on their existing skills, either at an individual level, or as part of a team exercise, in order to improve future practice. The benefits of using the biopsychosocial model of questioning during consultations are well recognised (Thornbory, 2014).
In view of the far-reaching effects that bullying can have on the health and wellbeing of employees, OH practitioners may benefit from expanding their enquiries during consultations to gain a better understanding of the impact of bullying. They should include this information in the support strategies that they put in place for individuals and the recommendations that they make to employers.
Recommendations
Workplace bullying, particularly within the NHS, is a complex issue. To date, government recommendations, legislation and national and local policies have not been successful in eradicating these behaviours. This failure has largely been attributed to organisational factors, poor leadership, insufficient collaborative partnership working, inadequacies regarding the education and training of healthcare workers, and poor implementation of recommendations based on current research.
Francis (2015) emphasised the need for significant improvement in each of these areas, together with increased involvement from OH. Although this expansion in the role of OH will undoubtedly be challenging for many practitioners, potentially it will result in more robust interventions, and a more positive working environment, thereby improving patient safety and the health and wellbeing of staff.
References
Acas (2013). Bullying and harassment at work: guidance for employees. London: Acas.
Acas (2014). Bullying and harassment at work: a guide for managers and employers. Advisory booklet. London: Acas.
Bandura A (1973). “Aggression: a social learning analysis”. Englewood Cliffs. NJ: Prentice Hall.
Bennett K, Sawatzky J (2013). “Building emotional intelligence: a strategy for emerging nurse leaders to reduce workplace bullying”. Nursing Administration Quarterly; 37(2), pp.144-151.
Black C (2008). Working for a healthier tomorrow: Dame Carol Black’s review of the health of Britain’s working age population. London: TSO.
Bloom SL, Farragher B, (2010). “Destroying sanctuary: the crisis in human service delivery systems”. Oxford: OUP.
Bommer WH, Miles EW, Grover SL (2003). “Does one good turn deserve another? Co-workers influences on employee citizenship”. Journal of Organisational Behaviour; 24, pp.181-196.
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Etienne E (2014). “Exploring workplace bullying in nursing”. Workplace Health and Safety; 62(1), pp.6-11.
Francis R (2015). “Sir Robert Francis: review of whistleblowing processes in the NHS”. Leeds: NHS Employers.
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HSE (2009). Dignity at Work Policy (HSE Ireland). Dublin: HSE.
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Lazarus RS, Folkman S (1984). “Stress, appraisal and coping”. New York: Springer.
Leymann H (1992). “From bullying to exclusion from working life”. Stockholm: Publica.
Marcus-Newhall A (2000). “Displaced aggression is alive and well: a meta-analytic review”. Journal of Personality and Psychological Psychology; vol.78(4), pp.670-689.
NMC (2008). “The Code: Standards of conduct, performance and ethics for nurses and midwives”. London: NMC.
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Salin D (2008). “The prevention of workplace bullying as a question of human resource management: measures adopted and underlying organisational factors”. Scandinavian Journal of Management; 24(3), pp.221-231.
Thornbory G (2014). “Contemporary occupational health nursing”. Oxford: Routledge.
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Vartia M, (1996). “The sources of bullying-psychological work environment and organisational climate”. European Journal of Work and Organisational Psychology; 5(2), pp.203-214.
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