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Bullying at work: does it happen in primary care?

Thelma Sackman
RN RHV ONC DipMS
Consultant in Primary Care and Nursing

Defining bullying is difficult as the effect of one person's behaviour on another will be perceived differently between individuals, and how each person responds to individuals can also be different.
Tim Field states that bullying occurs when one person, typically (but not necessarily) in a position of power, authority, trust, responsibility, management etc, feels threatened by another person, usually (but not always) a subordinate who is displaying qualities of ability, popularity, knowledge skill strength, drive, determination, tenacity and successes.(1)
The Andrea Adams Trust has defined workplace bullying in four statements:(2)

  • The unwarranted humiliating, offensive behaviour towards an individual or groups of employees.
  • Such persistently negative malicious attacks on personal or professional performance are typically unpredictable, unfair, irrational and often unseen.
  • An abuse of power or position that can cause such anxiety that people gradually lose all self-belief in themselves, suffering physical ill-health and mental distress as a direct result.
  • Bullying can be regarded as the use of position or power to coerce others by fear, and persecution or to oppress them by force or threat. It has been identified as a more crippling and devastating problem for both employees and employers than all other related stresses put together.

The Community Practitioners and Health Visitors Association (CPHVA) and the trade union Amicus carried out a survey of community nurses to establish what level of bullying occurred in PCTs.(3) The results showed that, out of the 537 community nurses surveyed across the UK, half had been bullied in their current workplace, mainly by their managers. To cope with the clinical pressures, many community staff stated in the survey that they did not complain as they thought this would make the situation worse. 
The extent of bullying in general practice is unknown. However, there will be a number of people working in this field who are the daily victims of bullies. How do you identify a bully? What are their behaviours? Are these behaviours deliberate and planned, or do they arise from the bully's own lack of confidence, poor interpersonal skills and personal and organisational stress? There are three types of workplace bullies:(4)

The person who does it out of habit
They can derive great satisfaction from the effect they have on their victims. Some may lack insight into the impact their behaviour has on others, and others may not care what they do or the effect they have.

The person who bullies under pressure
They will return to being a relatively good colleague when things have calmed down again. This type of bully is difficult to deal with and can cause even greater confusion for the victim(s).

The person who does it to go along with others
This bully is often weak, wanting to be part of a wider group and fit in with their norms. They are often afraid to change, and they do not want to consider the impact of their behaviour.

Table 1, while not exhaustive, gives the reader an insight into the behaviours of a bully. Many of these behaviours on their own would not necessarily constitute bullying, but it is the application of them to an individual or a group that is of concern.

[[NIP17_table1_49]]
 
Under pressure?
In the primary care setting there is an opportunity for a bully to be present in your team. The pressure to meet national targets, local implementation plans and patients' expectations are increasing. This causes stress, anger and job dissatisfaction, which can unfortunately bring out the worst in some people. The way a bully survives is by using some of the behaviours listed in Table 1.
 
What can you do about it?
You first need to acknowledge that you are being bullied and that it is having an effect on you. Then talk to colleagues and check whether anyone else is experiencing the same as you. The more people who are experiencing this, the less likely it will be seen as a personality clash. They may also be willing to provide some support. Talk to a representative from your union or professional organisation: they will be able to support you and help you formulate your evidence should you wish to pursue a grievance against the bully.
Begin to collect the evidence about how the bully behaves towards you and record this. Accurate notes are essential; note the date, time, who was present, what happened, what was said and how it was said, including the nonverbal clues. It is important to write down how you felt at the time and how you responded. Keep relevant correspondence and copies of appraisal reports as these may provide further evidence. Try not to be alone with the bully. At all times try and stay calm, remain assertive, remain objective and refute disparaging remarks. Seek training in stress management and assertiveness, and where possible, ask occupational health for counselling and strategies to deal with the situation. 
Find out if your employer or the PCT has a policy on harassment, bullying and/or unacceptable behaviour.(6) Also, the local grievance procedure may give a pathway to tackle the situation. 
Look after yourself, eat a well- balanced diet, take moderate exercise, relax, do not overindulge on the alcohol, have treats and make time for those friends who will understand and support you. Taking time out - sick leave, a course or annual leave - may give you the opportunity to reflect on what is happening and enable you to formulate a plan.(1) 
Remember, it is not your fault, but you will have to be the one who deals with the situation to ensure that things improve for you and others that you are unaware of. If all else fails, you may have to leave, but inform your employer of why you are leaving as you may want to pursue a constructive dismissal claim.
 
Conclusion
The impact that bullying can have on the individual is far-reaching. The bullied person can become physically ill, mentally stressed and adopt a changed personality. All these can inadvertently reinforce any work performance issue that the bully has tackled. In extreme cases, a downward spiral of poor self-worth and ill-health makes it extremely hard for the bullied person to do something positive and remove themselves from the situation. Sick leave and alternative employment become the only solution. The impact can also affect friendships, marriages and family networks, which change and, in severe cases, can break down. 
Finally, if you feel you are being bullied, act as soon as possible. The longer you leave it, the worse it is likely to become for you and your family.

References

  1. Field T. Bully in sight. How to predict, resist, challenge and combat workplace bullying. Wantage, Oxford: Wessex Press; 1996. 
  2. The Andrea Adams Trust. Factsheet on workplace bullying.
  3. CPHVA. Press release. Call For Ombudsmen to eradicate bullying in the NHS. October 2003.
  4. Braithwaite R. Managing aggression. New York: Routledge; 2001.
  5. Ishmael A, Alemoru B. Harassment, bullying and violence at work, A practical guide to combating employee abuse. The Industrial Society; 1999.
  6. Amicus. Ban bullying at work. Action pack. 2002/3.

Resources
The Andrea Adams Trust
A national charity devoted to raising awareness of and tackling bullying Hove Place
1 Hove Villas Hove, East Sussex
W:www.andreaadamstrust.org
T:01273 704 900
CPHVA
W:www.cphva.org.uk

Further Reading
Linkemer B. Working with difficult people (a self-development programme). London: Marshall; 1999.
Love C. Dealing with difficult and aggressive behaviour -19 tried and tested activities for tackling conflict. Ely: Fenman; 1999.