In nursing school, the same murse said that his conspicuousness led instructors to have higher expectations of him than his female classmates. “My successes were highlighted in front of everyone, as were my failures. It’s like when the instructors were looking for an example, they picked the person who stood out the most, because I’m a guy,” he said. Now, at work among his colleagues, other nurses are more likely to “think I have a stick up my ass when I question anything,” and socially, “I usually end up feeling like the little brother, big brother, or comic relief, not part of the actual clan.”
The workplace “can be challenging” socially for male nurses, a New York City murse admitted. “I’m not really involved in my colleagues’ social functions outside work. Baby showers, wine tastings, bachelorette parties . . . Sounds fun, and while I do consider many coworkers my friends, a lone married man in his early thirties with a bunch of young women at these events would just be awkward.” Even when nurses like him don’t rely on their coworkers for socializing, nursing is such a team-oriented profession that bonding outside of the hospital can easily affect the working relationships within it.
Cliques
It would be shortsighted to dismiss Juliette’s complaints about her coworkers’ social exclusivity as trivial or irrelevant. Much of any workplace bullying comes from cliques, which both galvanize and hide the perpetrators. In material about workplace bullying, the American Nurses Association specifically stated, “Misuse of power can also occur when a nurse who, acting as charge nurse, shows favoritism toward friends or those in a personal clique while treating others poorly by assigning them more difficult assignments or by not offering to help. This misuse of power is done without regard for the nurse and the patient, and it exposes the vulnerability of both.” It is this sort of treatment that distressed Juliette.
Nurses spend long hours together and are dependent on coworkers both professionally and personally. Many studies have found that nurses have higher job satisfaction when they have positive relationships with colleagues. Of course, benign work relationships can form that leave some nurses feeling devalued or left out. A Louisiana pediatric nurse explained, “Some places have set weekends, so when you work full-time you always work with the same crew. Sometimes if you get switched or request the opposite weekend, it’s like you’re not a part of the team because you never worked with them, so they don’t help you like they help the others.”
More trouble comes when a nurse’s standing devolves from not quite fitting in to being alienated. A Michigan ICU nurse was tormented by a nurse practitioner who tried to rally other coworkers to “take her down.” The nurses tried to sabotage the ICU nurse, refusing to answer her questions and to teach her the electronic health record system. The nurse left the hospital because of this treatment.
A 21-year-old Southern ER nurse described a clique of supervisors as “something straight out of Mean Girls. They make each other stronger, like female bullies in high school.” Without the pack, these nurses seem socially needy and insecure, but “when they’re together, they go around wreaking havoc. While you’re running around frantically trying to take care of five patients, they’re sitting at the desk reading People, and looking at you, laughing, ‘Looks like you’re having fun over there.’”
Mean girls. Humiliation. Sabotage. Why is there such a strong bullying culture in a profession known for its empathy and compassion, and a profession in which even bullying victims enthusiastically gush about how much they love their job?
Oppression causes in-fighting
In 1909, Dr. Leon Harris told The New York Times that nurses were “subjected to a despotic set of rules and regulations which in their stringency and utter lack of justice compare favorably with Siberian prison rules.” The head nurses, whom Harris called “tyrants,” regularly fired young, pretty nurses in favor of less attractive women, and “abuse their position of power. Like many of their sex, their inclination to be petty and mean and small in their dealings with other women comes out strong.”
Harris went on to inform the Times that “the abominable outrages practiced on our young women at these institutions in the name of ‘hospital discipline’ ” included hazing young nurses, disgracing them for trivial reasons, micromanaging their lives outside of the hospital, forcing them to work when they were sick, ordering them to do kitchen work or scrub floors if the head nurse didn’t like them, and stripping nurses of the two hours of “off time” they were supposed to have during their twelve-hour shifts (a break that will have disappeared a century later). Certainly, nursing has changed since then, but Harris’s description illuminates the roots from which nursing grew.
Many people insultingly believe, like Harris, that nurses catfight because it’s women’s nature to, and the vast majority of nurses are female. Australian researcher Elaine Duffy has observed that people dismiss bullying “with statements like, ‘This is typical of bitchy females working together,’ implying that such behaviors are typically female.” That rationale is far too simplistic, but is related to a more plausible explanation.
In 1970, Brazilian philosopher Paulo Freire theorized that when a dominant group forces its own values and norms upon a less influential group, the oppressed group develops low self-esteem and becomes angry and aggressive as it tries to internalize those standards. As group members are made to feel inferior, they begin to disdain their own culture. Because the oppressed group won’t engage in violence against the more powerful dominators, its members turn on each other, dividing and infighting, sabotaging each other. Freire called this conduct “oppressed group behavior.”
Some nurse scholars contend that nurses are an oppressed population because of a history of submissiveness to mostly male physicians and administrators. In the early 1900s, doctors controlled nursing school curricula, steering programs to instruct nurses primarily on how to support physicians. Without autonomy or control over their occupation and treated by medical professionals as subordinates, nurses took on the characteristics of an oppressed group. As the Center for American Nurses reported, “The culture of the healthcare setting has been historically populated by images of the nurse as a ‘handmaiden’ in a patriarchal environment. The balance of power has not been in the nurse’s favor. . . . Too often, nurses have acquiesced to a victim mentality that only facilitates a sense of powerlessness.”
Browbeaten by doctors, administrators, patients, and patients’ families, nurses also came to accept bullying as an inevitable part of the job. “Unfortunately, many nurses have been taught to simply ‘grin and bear it,’ and as a result of prolonged abuse, nurses have become an oppressed group with nowhere to channel anger but at other nurses,” according to St. Joseph’s University researchers.
Venting to doctors or administrators could jeopardize nurses’ jobs, so they redirect their rage, frustration, or fear against each other, for which there are few repercussions. Interestingly, studies have found that when nurses are empowered at work, bullying occurs less frequently. This correlation supports the idea that when oppressed group members gain influence, they are less likely to lash out at each other.
Stress and burnout lead to bullying
When a healthcare organization does not empower employees—or when it restructures, downsizes, or keeps nurses short-staffed—nurse bullying increases. Studies have found that environments with volatile workloads, degenerating patient health, and increasingly confrontational patients and visitors create “a perfect storm for workplace bullying.”