Preparing Students to Deal with Bullying in Healthcare

Written By Guest User

Author: Maureen Bonatch MSN, RN

Your CNA students may think that once they finish the course and pass the state certification exam, their next challenges will only be dealing with difficult clients. Unfortunately, that’s not always the case. Sometimes, the most difficult people won’t be the clients they care for but those they work with.

CNAs provide care to others, but they may be the recipients of uncaring behavior, harassment, or bullying from their peers or other healthcare staff. Educating your CNA students on identifying and addressing bullying may help them learn how to deal with it without sacrificing quality patient care.

Take the blinders off about bullying

Unfortunately, bullying behaviors aren’t exclusive to children.  A 2021 survey from the Workplace Bullying Institute reported that about 30% of Americans have experienced bullying at work. Bullying can happen in most healthcare settings and even extends to nursing management. That doesn’t make this behavior acceptable. As a CNA instructor, you can teach your students how to understand it and be prepared to address bullying in the workplace. 

The American Nurses Association (ANA) defines bullying as repeated, harmful actions intended to humiliate, offend, and distress the recipient. This behavior can occur over a period of time, is usually meant to cause harm, and is targeted at an individual.

Bullying doesn’t just affect those involved but can also negatively impact the culture and make it an unpleasant place to work. Bullying can infect the workplace by causing fear and humiliation. This negativity can affect positive health and well-being, decrease productivity, and increase absenteeism and employee turnover. 

What is bullying?  

Providing appropriate constructive criticism isn’t bullying. Coworkers behaving unprofessionally or disrespectfully, if it’s an isolated incident or atypical behavior, isn't bullying. Angry or complaining clients aren’t bullying. Their distress may stem from being in pain, or their families may be distraught because they don’t understand what’s medically happening to their loved ones.

So, what is bullying? According to The Joint Commission, bullying can be verbal abuse, threatening, humiliating, or intimidating behaviors, or interference with completing work. Bullying isn’t just verbal abuse. It can even expand outside the workplace to continue in the digital world with social media and text messages. 

Identifying specific bullying behaviors could create an extensive list. This list isn’t all-inclusive, but behaviors could include:

  • Verbal abuse:

    • Including incivility, which is rude or disrespectful actions that may have a negative intent

  • Acts of physical intimidation, humiliation, or threatening behaviors, which may include:

    • Social isolation

    • Exclusion

    • Projecting blame

    • Spreading rumors or gossip

  • Interfering or sabotaging work, which may include:

    • Withholding information

    • Unfair assignments

    • Refusing to work as a team 

    • Extreme micromanaging

Regardless of the reason, unacceptable behaviors shouldn’t be tolerated in the workplace. 

What are the causes of bullying? 

Bullying is more likely to occur in settings with heavy workloads and high stress, which, unfortunately, is often the work environment for healthcare. CNAs frequently work with inadequate staffing and may care for angry or in-pain clients. Conflicts may arise, leaving CNAs feeling overburdened and lacking the necessary support. 

Motivation for bullying behaviors can vary or may be unknown. Behaviors could be due to envy, competition, or stress. Bullies may lack self-confidence and see certain co-workers as a threat. 

Other potential causes of bullying behaviors could include:

  • Fear of the unknown

  • Demands for client care

  • Insufficient staffing

  • Tolerance of negative behaviors

  • Poor conflict resolution tools

  • Learned behaviors from childhood 

  • Working with a supervisor who leads by intimidation and fear 

Long hours, heavy workloads, and emotionally draining tasks create stress and frustration, and in this environment, incivility may escalate into bullying as staff struggle to manage their stress. 

The impact of bullying

Quality patient care is the result of the healthcare professional team working together. However, teamwork may feel impossible if you work in a toxic environment. A toxic environment can drive you out even if you love your job. Some CNAs may leave the healthcare profession, and unhappy staff often create dissatisfied clients for those who stay.

A few potential consequences of bullying may include:

  • Psychological

    • Anxiety or depression

    • Apprehension and even dread about going to work 

  • Physical

    • Sleep disturbances

    • Stress-related illnesses such as headaches 

  • Professional

    • Decreased job satisfaction and productivity

    • Unwillingness to work with others

    • Absenteeism or staff shortages 

    • Increased employee turnover 

  • Client Care

    • Reduced quality of care 

    • Careless mistakes

    • Giving insufficient attention to clients

    • Communication failures

  • Culture

    • Poor morale and damage to the culture

    • An unpleasant or toxic work environment

Confronting bullying 

A healthy, supportive, collaborative work environment is essential in healthcare. Without it, the lines of communication may break, affecting the quality of care provided. Often, the first step to eliminating or reducing bullying is to recognize the behavior as bullying and name it for what it is. Bullying is unlikely to resolve independently. The longer it’s left, the more it becomes part of the culture. 

Encourage your CNA students not to wait until bullying becomes a problem. Bullying may escalate if it’s not addressed. When they start a new role, encourage students to review the policies and procedures so they know the chain of command, how to report an issue, and whether they can do so anonymously if desired. 

Adequate staffing is critical in reducing feelings of overwhelm and stress, but that’s usually not something CNAs can control. Other ways to address bullying can include:

  • Ask for reassignment if there are personality conflicts.

  • Be aware of and support policies and procedures regarding inappropriate behaviors.

  • Follow the chain of command and include management if necessary.

  • Document using an incident report or follow policies and procedures for clients or family members.

  • Model the desired professional behavior by practicing calm, clear communication while being mindful of the volume of your voice and body language.

  • Offer to cover for co-workers if they need a break.

Encourage your students to practice kindness and basic manners and be attentive to their co-workers' needs when they are managing a difficult client or family.

Take a proactive stance against bullying

Your future CNAs are less likely to stay in a toxic workplace. Bullying can impact their well-being and the quality of client care. Helping your students understand the cause and effect of bullying and strategies to address it may help them nip it in the bud, creating a more supportive work environment. 

Caring4Cal is a program by the California Department of Health Care Access and Information (HCAI) to offer licensed or certified in-home or community care providers — and those interested in becoming an in-home care provider.

Do you have other tips for your students to address workplace bullying? Leave a comment below and share your experiences.

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