Doc­tors seek cure for bul­lies

The Weekend Australian - Travel - - Health - From Health cover

re­buked the paint would be peel­ing off the walls.’’

How­ever, un­ac­cept­able ag­gres­sive be­hav­iour is still a re­al­ity, he ac­knowl­edges, and has partly been fu­elled by the dis­ap­pear­ance of down-time — which used to give op­por­tu­ni­ties for nurses and doc­tors to have morn­ing tea, cel­e­brate a birth­day or have an un­rushed train­ing ses­sion.

‘‘ Twenty years ago hos­pi­tals would run at 80 per cent oc­cu­pancy so there were slow pe­ri­ods. Now we are at 100 per cent oc­cu­pancy most of the time, and ev­ery day is a hard day,’’ he says.

A 2007 Aus­tralian Royal Col­lege of Nurs­ing re­port, Na­tional Over­view of Vi­o­lence in the Work­place, in­cluded the fol­low­ing def­i­ni­tion of bul­ly­ing: ‘‘ co­er­cive, un­eth­i­cal ac­tiv­i­ties which cre­ate an en­vi­ron­ment of fear through acts of: cru­elty, be­lit­tle­ment/ degra­da­tion, pub­lic rep­ri­mand, ridicule, in­sult, sar­casm, de­struc­tive crit­i­cism, per­sis­tent nit­pick­ing or de­val­u­a­tion of a per­son’s work ef­forts, triv­i­al­i­sa­tion of views and opin­ions and un­sub­stan­ti­ated al­le­ga­tions of mis­con­duct’’.

Lyn Tur­ney, se­nior lec­turer in so­ci­ol­ogy at Melbourne’s Swin­burne Univer­sity of Tech­nol­ogy, says th­ese less overt forms are the hall­mark of bul­ly­ing among the pro­fes­sions, whereas of­ten bul­ly­ing in the trades, for ex­am­ple, is more ob­vi­ous — and eas­ier to deal with.

A num­ber of fac­tors in pro­fes­sional work­places com­bine to cre­ate a toxic at­mos­phere ripe for bul­ly­ing: highly com­pet­i­tive, high-achiev­ing peo­ple with a mas­ter­ap­pren­tice power re­la­tion­ship built into the train­ing process, says Tur­ney. ‘‘ High achiev­ers are very vul­ner­a­ble to bul­ly­ing be­cause they have so much to lose — you may have spent half your life train­ing to be­come a sur­geon, and then you find your­self at the mercy of the more se­nior sur­geon who has supreme power over your marks and re­ports.’’

Bul­ly­ing of­ten de­stroys self-con­fi­dence, says Tur­ney. This of­ten re­sults in the vic­tim be­com­ing com­pli­ant and ac­cept­ing of the be­hav­iour, as one nurse in an Aus­tralian study tells: af­ter many episodes of be­ing di­rected with a point of the fin­ger to stand silently in the cor­ner while the more se­nior nurse took over the care of pa­tients, she would ‘‘ au­to­mat­i­cally fol­low the fin­ger’’ in ‘‘ non-think­ing ro­botic mode’’ ( Con­tem­po­raryNurse 2006;21:228-23).

Bul­ly­ing is not con­fined to the health sys­tem, says Ju­dith Meppem, for­mer chief nurs­ing of­fi­cer of NSW, now in­ves­ti­gat­ing bul­ly­ing at Syd­ney’s Royal North Shore Hospi­tal at the re­quest of the Area Health Ser­vice.

How­ever, the re­cent tu­mul­tuous times in the man­age­ment of hos­pi­tals have a lot to do with cre­at­ing a stress­ful en­vi­ron­ment that en­cour­ages bul­ly­ing. ‘‘ The hos­pi­tals have had con­stant change over the last 15 years, and the staff at the grass­roots level are af­fected by it.’’ Strong, con­sis­tent lead­er­ship that has the con­fi­dence to al­low staff to dis­agree is what is needed, she says.

‘‘ All staff need to ac­knowl­edge that bul­ly­ing is un­ac­cept­able, and that no one is ex­empt — in­clud­ing se­nior peo­ple,’’ says Meppem.

And un­less all staff are on board noth­ing will change, she says. If some­one is ben­e­fit­ing from the cur­rent sit­u­a­tion, they will sabotage any ef­forts to get rid of bul­ly­ing.

As­so­ci­ate pro­fes­sor Stephen Bolsin, anaes­thetist at Gee­long Hospi­tal, says the cur­rent train­ing sys­tem seems to teach ju­nior doc­tors a ‘‘ hid­den cur­ricu­lum’’ of keep­ing quiet if they see more se­nior staff com­mit­ting un­safe prac­tices.

Bolsin him­self re­ported a higher than usual death rate of ba­bies un­der­go­ing car­diac surgery at the Royal Bris­tol In­fir­mary in the UK in the 1990s — then found him­self un­able to get a job any­where in the UK and so re­lo­cated to Aus­tralia.

Bul­ly­ing has been a prob­lem in medicine for a long time, he says. ‘‘ I re­mem­ber train­ing with a sur­geon who did not con­sider his day com­plete un­less he had re­duced a nurse to tears, and an­other who threat­ened fe­male med­i­cal stu­dents and ju­nior doc­tors with a neg­a­tive ref­er­ence if they wore trousers to work.’’

Ex­po­sure to bad role mod­els per­pet­u­ates the prob­lem, he says. ‘‘ Some of the med­i­cal schools are repos­i­to­ries of the worst be­hav­iour, but they don’t sub­scribe to the view that they are bad role mod­els,’’ says Bolsin.

How­ever, there are some strate­gies to help the pro­fes­sion break out of the cur­rent cy­cle. For ex­am­ple, mak­ing the re­port­ing process eas­ier greatly in­creases the like­li­hood of ju­nior staff speak­ing up, he says.

‘‘ We also need to eval­u­ate the be­hav­iour of teach­ing staff and re­duce stu­dents’ ex­po­sure to bad role mod­els and in­crease their ex­po­sure to good role mod­els,’’ says Bolsin.

Newspapers in English

Newspapers from Australia

© PressReader. All rights reserved.