Changing workplace culture: What would it take to speak up? Changing workplace culture: What would it take to speak up?

Bullying in the health care environment historically has been tolerated and, in many cases, expected. The Health and Safety at Work Act 2015 has provided the necessary legislation to stimulate a move toward addressing the bullying culture within New Zealand hospitals. This article takes a reflective look at how speaking up about bullying, although difficult, is important in order to change workplace culture.


Introduction
What would it take to speak up?
This was the sole question on a survey in the tearoom at work and I picked it up to respond.But the question was too complex.I was unable to articulate the multiple answers in my head, so I placed the blank piece of paper back on the coffee table and headed back to work.
Bullying behaviours in the health care setting have been well documented and have become ingrained in the hierarchical culture of health care.These behaviours negatively affect productivity, job satisfaction and staff retention which can hinder safe patient care.We could all probably give examples where workplace interactions are inappropriate, but these behaviours have become so common that they are often overlooked.We instead move on through our busy day without giving them another thought.Within the last few years targets of bullying behaviours have begun to speak up.There is a greater awareness and understanding around the subject of bullying.This article, based on a Surgicosponsored free paper presentation at the 43 rd Perioperative Nurses Conference, explores the process of personal reflection alongside recent research literature, legislation and guidelines.

Background
Perioperative nursing has been my career for more than 20 years.Early on in my working life in theatre, the senior staff nurses that I most remember were terrifying, unapproachable and grumpy.They tolerated surgeons yelling and ranting at them just because that was how it was!They treated the junior nurses the way they did because these negative interactions had been normalised.
Horizontal violence has been well documented in the literature and is only now beginning to be addressed.Professor Jenny Carryer from Massey University believes that bullying between nursing colleagues is undoubtedly an oppressed group behaviour.She also maintains that when nurses feel valued and hold appropriate power and control over their own destiny, horizontal bullying will decrease markedly 1 .These experiences early on in my perioperative career have highlighted the importance of providing junior nurses with positive role models and encouraging them to achieve and know the feeling of success.
In my current position I am respected by my colleagues, both medical and nursing, and my opinion is valued.This, for me, is key to my job satisfaction.However, it hasn't always been so positive.I have worked in environments for years where bullying behaviours were common with many subtle instances leaving me feeling overwhelmed and frustrated.It was only when someone showed me an employment relations website that listed seven bullying behaviours that I realised what I was experiencing had a name, was wrong and was not my fault.
The difficulty in identifying bullying behaviours is due to their sometimes subtle nature and in some cases the perpetrator may have little insight into how their behaviour impacts on others 2 .
To deal with the situation I chose to change jobs.This approach to dealing with bullying was a significant finding in Dr Kate Blackwood's PhD research 3 .Dr Blackwood's participants included 34 nurses who met the study's bullying definition.Interestingly, 28 of the 34 nurses acknowledged being bullied.Fifteen reported action was taken but only one indicated the bullying was successfully stopped.The other 13 nurses said that no action had been taken.Leaving their

Sandra Millis
Originally published in The Dissector, Volume 46, Issue 2 (September 2018).Reprinted with the permission of the Perioperative Nurses College of the New Zealand Nurses Organisation.
job was the most commonly reported way the bullying was stopped.

Definitions
There are numerous online bullying resources available, including from the New Zealand Nurses Organisation (NZNO), Worksafe New Zealand, Health Quality and Safety Commission and Employment New Zealand.They all provide definitions of bullying.Key words in these definitions include: persistent, misuse of power, systematic, interpersonal, unreasonable, intimidating, malicious, insulting, undermining, humiliating, abusive behaviour.
[Bullying] may cause social, psychological harm, loss of dignity and respect and compromise the target's safety and well-being.
The Health Research Council of New Zealand released a report in 2009 titled 'Understanding stress and bullying in New Zealand workplaces' 4 which took a comprehensive look at bullying across the health sector, education and hospitality.It found that bullying was more likely to occur in the following situations: • in the absence of strong effective leadership • when the organisation is of a hierarchical nature • when there were staffing shortages and a general lack of resources • when there was a lack of bullying reporting systems 4 .
NZNO also has a definition of what is not bullying.This is important to note as sometimes the word bullying can be used when it is not appropriate to do so.It is worth checking this at www.nzno.org.nz/bullyfree.

Royal Australasian College of Surgeons acknowledges bullying
In  We are also bound by the following Nursing Council competencies:

What triggered my selfreflection
• accepts responsibility for ensuring that his/her nursing practice and conduct meet the standards of the professional, ethical and relevant legislated requirements (Competency 1. 1) • communicates effectively with health consumers and members of the health care team (Competency 3.3) • collaborates and participates with colleagues and members of the health care team to facilitate and coordinate care (Competency 4. 1) • recognises and values the roles and skills of all members of the health care team in the delivery of care (Competency 4.2) 10 .
Therefore, all nurses have a personal and professional responsibility to work towards a change in workplace culture.

Conclusion
The focus of workplace bullying research has moved on from looking at the personality traits to seeing bullying as a product of the work environment and placing the onus on organisations to do something about it.Even with all of the available resources, policies, templates, guidelines and toolboxes, our standard approach to dealing with bullying is not working, and the focus is moving to changing institutional culture.
By taking a moment to reflect on a situation in the workplace I have been able to explore the complex issue of bullying and have developed a greater understanding of strategies and processes.For changes to be made, a major shift in behaviour across all disciplines and management levels is required.With large professional bodies now acknowledging the problem exists and the appearance of personal accounts in the media, I am confident bullying cultures in our hospitals will begin to change.This change will be accelerated with strong leadership, breaking down the hierarchical structure in health care, increased resources and robust reporting systems.
By speaking up about bullying and presenting this paper I hope to have stimulated conversations and maybe encouraged people to reflect on the way they treat others.By being aware of others and caring for others you can create a much safer, comfortable, positive and productive work environment which in turn can only enhance outcomes for your patients.
We all deserve to be treated with respect, to be valued, to be treated as a professional and to work in a safe, healthy environment.

About the author
Sandra Millis completed her Diploma and Bachelor of Nursing at Otago Polytechnic and her Postgraduate Certificate in Health Sciences pilot RNFSA course at Auckland University in 2011.She has worked in perioperative nursing for 24 years and is currently self employed as a surgical assistant in orthopaedics in the private setting.Sandra has held positions on both the National PNC Committee and The Dissector.