“Physician, Heel Thyself”

By Theresa Brown, Op-Ed Contributor, The New York Times, May 7, 2011,

It was morning rounds in the hospital and the entire medical team stood in the patient’s room. A test result was late, and the patient, a friendly, middle-aged man, jokingly asked his doctor whom he should yell at.

Turning and pointing at the patient’s nurse, the doctor replied, “If you want to scream at anyone, scream at her.”

This vignette is not a scene from the medical drama “House,” nor did it take place 30 years ago, when nurses were considered subservient to doctors. Rather, it happened just a few months ago, at my hospital, to me.

As we walked out of the patient’s room I asked the doctor if I could quote him in an article. “Sure,” he answered. “It’s a time-honored tradition — blame the nurse whenever anything goes wrong.”

I felt stunned and insulted. But my own feelings are one thing; more important is the problem such attitudes pose to patient health. They reinforce the stereotype of nurses as little more than candy stripers, creating a hostile and even dangerous environment in a setting where close cooperation can make the difference between life and death. And while many hospitals have anti-bullying policies on the books, too few see it as a serious issue.

Today nurses are highly trained professionals, and in the best situations we form a team with the hospital’s doctors. If doctors are generals, nurses are a combination of infantry and aides-de-camp.

After all, patients are admitted to hospitals because they need round-the-clock nursing care. We administer medications, prep patients for tests, interpret medical jargon for family members and double-check treatment decisions with the patient’s primary team. Nurses are also the hospital’s front line: we sound the alert if a patient takes a serious turn for the worse.

But while most doctors clearly respect their colleagues on the nursing staff, every nurse knows at least one, if not many, who don’t.

Indeed, every nurse has a story like mine, and most of us have several. A nurse I know, attempting to clarify an order, was told, “When you have ‘M.D.’ after your name, then you can talk to me.” A doctor dismissed another’s complaint by simply saying, “I’m important.”

When a doctor thoughtlessly dresses down a nurse in front of patients or their families, it’s not just a personal affront, it’s an incredible distraction, taking our minds away from our patients, focusing them instead on how powerless we are.

That said, the most damaging bullying is not flagrant and does not fit the stereotype of a surgeon having a tantrum in the operating room. It is passive, like not answering pages or phone calls, and tends toward the subtle: condescension rather than outright abuse, and aggressive or sarcastic remarks rather than straightforward insults.

And because doctors are at the top of the food chain, the bad behavior of even a few of them can set a corrosive tone for the whole organization. Nurses in turn bully other nurses, attending physicians bully doctors-in-training, and experienced nurses sometimes bully the newest doctors.

Such an uncomfortable workplace can have a chilling effect on communication among staff. A 2004 survey by the Institute for Safe Medication Practices found that workplace bullying posed a critical problem for patient safety: rather than bring their questions about medication orders to a difficult doctor, almost half the health care personnel surveyed said they would rather keep silent. Furthermore, 7 percent of the respondents said that in the past year they had been involved in a medication error in which intimidation was at least partly responsible.

The result, not surprisingly, is a rise in avoidable medical errors, the cause of perhaps 200,000 deaths a year.

Concerned about the role of bullying in medical errors, the Joint Commission, the primary accrediting body for American health care organizations, has warned of a distressing decline in trust among hospital employees and, with it, a decline in the quality of medical outcomes.

What can be done to counter hospital bullying? For one thing, hospitals should adopt standards of professional behavior and apply them uniformly, from the housekeepers to nurses to the president of the hospital. And nurses and other employees need to know they can report incidents confidentially.

Offending parties, whether doctors or nurses, would be required to undergo civility training, and particularly intransigent doctors might even have their hospital privileges — that is, their right to admit patients — revoked.

But to be truly effective, such change can’t be simply imposed bureaucratically. It has to start at the top. Because hospitals tend to be extremely hierarchical, even well-meaning doctors tend to respond much better to suggestions and criticisms from people they consider their equals or superiors. I’ve noticed that doctors otherwise prone to bullying will tend to become models of civility when other doctors are around.

In other words, alongside uniform, well-enforced rules, doctors themselves need to set a new tone in the hospital corridors, policing their colleagues and letting new doctors know what kind of behavior is expected of them.

This shouldn’t be hard: most doctors are kind, well-intentioned professionals, and I rarely have a problem talking openly with them. But unless we can change the overall tone of the workplace, doctors like the one who insulted me in front of my patient will continue to act with impunity.

I wish I could say otherwise, but after being publicly slapped down, I will think twice before speaking up around him again. Whether that was his intention, or whether he was just being thoughtlessly callous, it’s definitely not in my patients’ best interest.

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Theresa Brown, an oncology nurse, is a contributor to The Times’s Well blog and the author of “Critical Care: A New Nurse Faces Death, Life and Everything in Between.”

A version of this op-ed appeared in print on May 8, 2011, on page WK8 of the New York edition with the headline: Physician, Heel Thyself.

Just like the workplace, it’s the exposure to unremitting stress that injures. Writer Joshua Kors has been reporting since 2007 on the military psychologists’ reluctance to diagnosis PTSD, many electing to prostitute themselves by deceitfully employing the Chapter 5-13 discharge for having a “personality disorder.” A PD diagnosis deprives the warrior vet of post-discharge treatment and medical coverage by the Veterans Administration (VA) earned by her or his service to country.

Michael Wolcoff, VA acting undersecretary for benefits told the Washington Post, “We are acknowledging the inherently stressful nature of the places and circumstances of military service, in which the reality and fear of hostile or terrorist activities is always present.”

More good news:  the change in rules apply to claims that are new or pending and previously denied claimants are invited to re-apply.

More than 400,000 veterans of all military operations receive benefits for the disorder, of which about 19,000 are women, according to the VA. VA compensation is about $27,000 per year.

What could possibly be wrong with the rule change? The private mental health clinicians who treat and diagnosis vets are excluded.  The Army is confident that their clinicians are good (but read the Kors series about psychologists willing to lie when the lies and coverup go all the way up the ladder to Army surgeon general Gale Pollock).

Offering a warning is Richard Cohen, executive director of the National Organization of Veterans’ Advocates. In his legal advocacy role for vets, he has seen federal clinicians with minimal experience with PTSD who had rejected legitimate claims.  Paul Sullivan, executive director of Veterans for Common Sense, a nonprofit group, said that federal clinicians and claims adjudicators were often adversarial in dealing with veterans seeking benefits. “V.A. needs to train their examination staff so that they understand that P.T.S.D. is associated with deployment,” Mr. Sullivan said. “It’s a cultural thing.”

The other shortcoming of the new regulation is its temporary status. An enacted law, however, would lock in the spirit of helping combat vets and the diagnosis of PTSD. Rep. John Hall (D-NY-19th District ) (and 17 co-sponsors) introduced HR 952 in the current Congress. Passing the bill would also allow non-military clinicians to diagnose.

Read the official VA memo announcing the new regulation. Turns out the start date announced was wrong and could screw up the filing process for some vets. Tip o’ the hat to VA Watchdog for catching the error.

What has this got to do with workplace bullying? Because any progress in recognizing traumatization from work could eventually make it easier for bullied individuals at work to be believed and taken seriously when their injuries interfere with living and working through PTSD’s debilitating emotional consequences.

Elizabeth Blackburn won the 2009 Nobel prize for Medicine and Physiology. I previously wrote about her work. Briefly, she discovered 20 years ago the telomere, chromosome-protecting caps at the end of strands of DNA. Telomere damage or shortening translates to advanced cellular aging.

Telomere = Greek for "end" (telos) and "part" (meros)

Research by Elissa Epel and Blackburn and others measured telomere length and telomerase enzyme levels to show that mothers who raise special needs children may have their lives shortened by between 9 and 12 years from the stress that they reported.

Now comes news that Epel and Blackburn at the University of California, San Francisco, are soliciting women ages 50 to 65 to volunteer for a study beginning August, 2010. The purposes are to develop a test for telomere length, to assess the correlation with lifestyle behaviors, and the reaction to learning how likely you are to live a long (or stress-shortened) life.

Here is an application of basic science to the real world. Is the telomere a predictor of longevity or overall health? Older genetic tests can predict one’s risk for cancer or Alzheimer’s. This may be the next big breakthrough.

To volunteer, women must be in good health and between ages 50-65. Call 415-476-7634 or e-mail  knowyourtelomeres@ucsf.edu

Also read the July 5, 2010 article by Erin Allday in the San Francisco Chronicle

Worklessness and health – what do we know about the causal

For an easy download of this document, go here.

But for individuals overwhelmed by the emotional morass of early-stage bullying or the effects of prolonged exposure to workplace stress, we offer telephone coaching/counseling by Jessi Brown, MS, LMHC, LPC. We plan to offer her telephone services one day per week starting in December. That day has not been determined yet. You can request a 55 min. session with Ms. Brown via e-mail (info at workplacebullying dot org)  and we will contact you to select a convenient time.

INTRODUCTORY RATE of $50 (US) per hour.

Historically, committee chairs of the majority party can pass legislation out of committee whenever they want with strict majority votes (13 Democrats, 10 Republicans). However, Baucus chose a select group, which he dubbed the “coalition of the willing,” to craft new legislation. It included only 3 Democrats, including himself, and 3 Republicans and met in his office without public scrutiny. The result is a draft without a public insurance option designed to compete with the private plans. The House versions (e.g., HR 3200) contain this provision. This was President Obama’s original goal.

The Center for Responsive Politics compiled health industry lobbying and campaign contribution expenditures through June, 2009. The figures are staggering and help explain Congressional reluctance to adopt either single payer or public insurance options as part of any final “reform” package. Industry giving has been split nearly evenly between parties.

Pharmaceutical firms have spent $370.4 million on lobbying and $33.6 million on campaign contributions, with 51% going to Democrats, 49% to Republicans. Health insurers’ lobbying costs — $144.7 million — $22.8 million in contributions. Health professionals (physicians, dentists, nurses) spent $117.2 million lobbying and $105 million in contributions. Hospitals and nursing homes spent $151 million lobbying and gave $26.6 million to campaigns with 63% going to Democrats. Business PACs (tilting toward Republicans) spent $2.8 billion on lobbying and $433 million in contributions to oppose employer mandates.

Who supports the public insurance option? Unions (with Democrats as 92% of recipients) with $53.6 million spent on lobbying and $92.8 million in contributions. Nurses were the only health professionals to support a single payer plan ($1.9 million in lobbying, $866,891 in contributions with 79% going to Democrats). The AARP with its $37 million in lobbying is ambivalent about supporting the public option.

Industry opponents have outspent reform proponents approximately 43 to 1. Advocates for a public health insurance plan option spent $96.7 million, normally a large sum, but pale in comparison to the industry’s $4.2 billion. But does all that giving produce desired results?

Mike Dennison, writing for the Montana Standard discovered that one-fourth of Baucus’ campaign funds from 2003 through 2008, totaling $3.4 million (the most of any Congressman), came from drug companies, health insurers, hospitals, medical supply firms, and other health professionals. Sen. Grassley (R-IA) who stated publicly that people had reason to fear the so-called death panels, received a higher percentage 23.5% from the industry but a lower amount.

Forget baseball, bullying, it seems, is fast becoming the national pasttime.

Bullying involves intimidation by one side over another acting with unshakeable confidence — whether real or faked. It’s about the unilateral exercise of power — real or imagined. Republican party power comes from its minority role and ability to block bills in the Senate. Republican unity often convinces Democratic leaders to not bother to move bills not certain to garner 60 or more votes. Minorities can bully despite their numerical disadvantage.

Bullies love to claim they are victims. They are whiners, projecting their weaknesses onto others. For example, Grover Norquist of Americans for Tax Reform famous for calling bipartisanship "date rape" claims that (1) there is a left wing political handbook, and (2) it dictates the use of lies, harassment and violence at Town Hall meetings to silence meeting disrupters. 

However, it’s the vociferous minority at Town Halls who are the harassers. Their startling misconduct paralyzes attendees who are there to get genuine questions answered or to have a reasonable dialogue as a voting constituent. Just like in bullying situations in families, classrooms and workplaces, witnesses tend to stand idly by with a deer-in-the-headlights powerlessness.

Civility and respectful disagreements are quickly becoming a thing of the past. Watch how Rep. Kathy Castor of Tampa tries valiantly to talk through the noise.

Town Hall bullies are the ones with simple-to-follow guidelines for those unwilling to think for themselves. Nothing could be farther from courteous civility in public settings necessary to discuss something as important as whether or not the health insurance industry will change. Changes proposed, but far from finalized, may create new opportunities for coverage for people previously blocked by the industry’s historical habits — rescissions (policy cancellations for dubious reasons), exclusion of pre-existing conditions (rendering the personal insurance game a "Catch 22" in which the only ones eligible for coverage are the ones who least need it), and unconscionably high COBRA rates after separation from employer-purchased group coverage.

Tea-bagger and relative unknown Bob Macguffie of the Rights Principles.com  wrote the recipe for incitement and chaos at Town Hall meetings. He directed attendees to be disruptive early and often, shout out a particular vote by the Rep then "freeze it, attack it, personalize it, and polarize it." Disrupters are to use intermittent shout outs by different people spread out across the room to make the Rep "uneasy early on .. goal is to rattle" the member of Congress. Macguffie tells people to be angry about "the socialist agenda, infringement of our liberties, and profligate spending."

 Bullies are bullies because they target others with hateful attacks. The real targets of bullying in all settings, for a variety of reasons, cannot or will not defend themselves. The presumed bully in Congress could be the Dems, based on their numerical superiority, but they behave more like targets, victims, and let the minority determine the legislative agenda.

Said one Washington State Democratic representative, "we dare not push the other party around or we will be mistreated when they next come to power and can control us." Make no mistake, this sheepish view is not shared by Republicans who historically intimidate their colleagues when in power. (Can you say Clinton impeachment?)

The rowdy folks in Castor’s Tampa meeting identified themselves afterwards as Glenn Beck fans. If they had studied the language crafted by the House Ways and Means Committee (HR 3200), the first of three House bills which will require melding in September, they could have rationally discussed provisions of the current drafts with which they disagree.

It’s a world turned upside down when the mock-"grassroots" message from the shouters is actually pro-corporate. They want to derail any changes to the current patchwork system that leaves millions of Americans uninsured or underinsured so as to risk dying in the world’s richest country for no other reason than they could not afford access to doctors and hospitals. 

And based on the film footage of some Town Halls, the screamers are unsure of what angers them — "socialism," having a Black President, government in their lives. The Town Hall I attended personally introduced me to a group of about 10 rabblerousers in a group of about 60 people who naively followed Macguffie’s script. 

The Town Hall was held in an American Legion hall with the stated purpose to discuss veterans’ matters. So many of the screamers seemed to be vets — of Medicare-eligibility age and many with VA benefits. Despite the involvement of government in their lives, they stood on cue, clapping, exhorting others in the room to stop the slippery slide into government involvement in healthcare!

To his credit, Congressman Rick Larsen (WA-2)  scheduled subsequent Town Halls to focus on health reform right after the events for veterans.  He also firmly countered the misconceptions and lies about the reform legislation at the meeting I attended. The faux-angry grumblers did not stay around to have an intelligent discussion with the Congressman afterwards.

So not only do bullies lie, they are whining cowards who have no intention of being reasonable. Stay tuned to see how aggression and conduct at Town Halls further impacts progress toward solving the myriad of societal problems.

Gary Namie

1-800-273-TALK  / 1-800-273-8255

Article features the brave and bullied target Julie Soderstrom. As well as ridiculous notions from employer attorney Karen Buesing that corporations facing cutbacks are less likely to tolerate the antics of an employee who is perceived to be a bully and “There are too many great people out there who are not abusive.”

And the comment “Could you be a whinier baby? Blame a bully for everything. Perhaps you are just mentally weak…” from Keith. Yeh, right! The pro-corporate mindset has blinded workers to their ability to feel compassion for other workers.

Read the article

Romanow writes eloquently

GDP (gross domestic product) makes no distinction between economic activities that are good for our wellbeing and those that are harmful. Spending on tobacco, natural and human-made disasters, crime and accidents, all make GDP go up. Conversely, the value of unpaid housework, child care, volunteer work and leisure time are not included in GDP because they take place outside of the formal marketplace.

Even the “father of the GDP,” Nobel laureate Simon Kuznets, recognized that “the welfare of a nation can scarcely be inferred from a measurement of national income as defined by the GDP.”

(the late) Senator Robert Kennedy noted that GDP “measures neither our wit nor our courage, neither our wisdom nor our learning, neither our compassion nor our devotion to our country. It measures everything, in short, except that which makes life worthwhile.”

The Institute of Wellbeing has created the Canadian Index of Wellbeing (CIW). The CIW is rooted in Canadian values.

 It begins with the belief that our cornerstone value as Canadians is the principle of “shared destiny”: that our society is often best shaped through collective action; that there is a limit to how much can be achieved by individuals acting alone; that the sum of a good society and what it can achieve is greater than the remarkably diverse parts which constitute it …

our standard of living, our health, the quality of our environment, our education and skill levels, the way we use our time, the vitality of our communities, our participation in the democratic process, and the state of our arts, culture and recreation.

Good public policies can improve wellbeing, bad ones can harm it. Three examples. Reductions in Employment Insurance (unemployment benefits in the U.S. which several governors have proudly refused to extend despite additional federal funding) increase financial risks and hamper economic wellbeing for people — a negative. Denial of medical services (even in Canada) causes a rise in a family’s health care expenses leading to poorer health for low-income citizens — a negative from the Canadian CIW perspective (as U.S. lawmakers consider taxing workers’ health care benefits and fight over people’s right to care). Significant cuts in welfare benefits increase income inequality (the rich getting richer) — something that impairs Canadians’ wellbeing.

Wellbeing in the U.S. Starting to Get Noticed

The only diectly comparable US counterpart to the Canadian CIW is the Foundation for Child Development (FCD).

The Child Well-Being Index (CWI) is a national, research-based composite measure  updated annually that describes how young people in the United States have fared since 1975.  It combines national data from 28 indicators across seven domains into a single number that reflects overall child well-being.  The seven quality-of-life domains are family economic well-being, health, safety/behavioral concerns, educational attainment, community connectedness, social relationships, and emotional and spiritual well being.

The FCD 2009 Report warned that the recession adversely impacts child wellbeing.

The percentage of children in poverty will rise to 21 percent in 2010, up from about 17 percent in 2006 primarily because of drops in family income from two incomes to one or none. Estimates of the recession’s effects reduce median family incomes to $55,700 by 2010, down from $59,200 in 2007. Single women household incomes fall to $23,000 in 2010, down from $24,950 in 2007. Single households headed by men income is expected to drop to $33,300 in 2010, from $38,100 in 2007.

As a social scientist-turned-advocate, I’ve seen firsthand how science is ignored by public policy decision makers (legislators) and by courts (and lawyers). Mostly it’s science’s fault by being too obscure, incremental, coupled with the common problem that scientists vary greatly in their ability to translate basic science into information relevant to societal problems. A recent (July 9 released) Pew Research Center survey of scientists found that only 3% of scientists are contacted by the media to describe their work; only 8% of scientists believe that public media exposure is important.

However, the library of relevant articles is growing with respect to workplace bullying. (For a sample, consult the WBI Research section.) And the media have been quite kind to WBI.

Lawmakers nearly always respond predictably to the demands of business lobbyists (no regulation, no enforcement, no accountablity, no new worker protections that interfere with absolute control over employees’ lives). Left out of the process is how laws affect real people living real lives, regardless of what’s good for business. Science about the impact of inhumane business practices should inform compassionate policy developers.

That same Pew survey also asked Americans how much various groups contributed to the “well-being of society.” The group credited as the most contributory: members of the military (84%), teachers (77%), scientists (70%), while lawyers (23%) and business executives (21%) contributed the least. In addition, 53% of the public (and only 33% of scientists) agreed that the best way to ensure peace is through military strength. Militarism is a key cultural ingredient in America. Militarism, all about the business of death, certainly undermines attention to wellbeing.

Rugged individualism, another American trait, sabotages the collective nature of society. It coarsens the regard we Americans have for one another. “To hell with him, let him fend for himself” is often the operating creed.

Both militarism and individualism run counter to genuine human altruistic impulses. Elsewhere, we cited the neuroscience of compassion. In America, showing concern for a fellow human’s wellbeing is frequently mocked as being “wimpy” or a “bleeding heart.” It is a challenge to American exceptionalism (the belief that the nation is the best and most advanced in all endeavors) to compare ourselves to European or Canadian progress on a topic like wellbeing. We clearly lag behind.

However, there is a bold new movement called Therapeutic Jurisprudence (TJ). WBI colleague and law professor David Yamada introduced TJ in his July 2 blog. He reports that a recent conference of the International Academy of Law and Mental Health included panels on mental health law and family law.

Mental health and law professionals are beginning to see the utility of “connecting the dots” (the CIW description of the process) to make the causal connection between social policy and impact on individual lives (as the CIW and FCD already know). These connections come naturally to social scientists, but the barons of the marketplace, businesses, lawmakers, and obviously do not share the same perspective. The TJ movement is bridging that gap in knowledge.

Finally, theologians can soften American attitudes toward defining success. Rabbi Michael Lerner, in his book The Politics of Meaning (1997), wrote:

The goal of the economy should be to help produce and sustain humans who are capable of realizing their highest capacities for love; creativity; intelligence; mutual recognition; solidarity; productive work; freedom; caring and nurturing; intimacy; commitment; trust; vitality; and aesthetic, ethical, spiritual, and ecological sensitivity. The materialist conception that promoting these capacities is difficult when people face material deprivation is correct, but needs to be qualified. There are, and have been throughout human history, societies that more successfully actualize these capacities than some of our contemporary advanced industrial societies, even though these others produce less, materially speaking. In my view, these societies have had a stronger economy-one that we ought to deem more productive and generating a higher standard of living.

Here’s hoping that the public dialogue started in Canada and the rest of the world enthuses America. Taking into account citizens’ wellbeing is one sign of an enlightened society. America needs to catch up. We need only to look north for a model.

UPDATE: 7/15 Public Policy and Health Impact
Los Angeles has an estimated 40,000 homeless people. The city’s policy (called Safer City which spends $6 million to pay for extra 50 police to patrol the downtown 50-block skid row) is to criminalize the destitute (for example, giving harassing tickets for not obeying crossing signals). The city spends only $5.7 million for homeless services at a time when more people, including working people, are living in their cars stripped of their foreclosed homes. Contrasted with LA is New York City with half the homeless population in large part due to a “right to shelter” policy and an investment of $200 million for housing and services for the needy. Read the Reuters report. Policies affect human wellbeing.

Gary Namie

Recall the fact reported in a story at this website that 62% of all individual bankruptcies by Americans were due to medical costs that overwhelmed families. In other words, while Congress plays political games with health care reform, and the president refuses to design a new system “from scratch,” people are DYING. Underinsurance or the lack of insurance compounds the problems of bullied individuals driven from their jobs. Just when they are the sickest, they cannot get much-needed care. This is an unconscionable uniquely American disgrace.

Compounding the problem is that the poor are sliding into even greater depths of poverty. Barbara Ehrenreich wrote in her blog (and published in the NY Times on 6/14/09) the rate of blue collar unemployment is 3 times higher than the white collar variety.

People are doubling and tripling up and couch-renting after losing their houses. The overcrowding may be causing a spike in domestic violence. Women are turning to stripping. People are urban hunting — squirrels, rabbits, raccoons — and eating food past their sell-by dates acquired at “food auctions.”

All of this at the same time that Goldman Sachs in 2009 is paying the largest bonuses to its richest employees in its history thanks to largesse from the US Treasury engineered by Paulson and now Geithner. (Originally reported by the way in a British newspaper, not a US one.)

Why does this country not understand an obligation to take care of its own people? As Katrina Vanden Heuvel wrote, can we please stop the illusion of bipartisanship that prevents the federal government from being a problem solver?

The folks at MomsRising.org want you to sign their petition alerting your U.S. Rep and Senators to support the respective bills. The U.S. Chamber of Commerce will certainly fight this pro-employee health bill. They will claim it interferes with employers’ ability to “compete.”

Read the related report exposing America’s dismal denial of paid sick leave.

Stay tuned.

On the morning of June 2, 2009, a city letter carrier went to work and reportedly fatally shot himself in the head in the locker room at a postal facility in Gastonia, North Carolina. The Gaston Gazette online news report stated that the “Gastonia Police are investigating an apparent suicide this morning at the post office. . . . One of the employees is inside dead from a gunshot wound.”

Prior to my retirement from the USPS, at a former district I worked for, there were three suicides within a two year period that I concluded were contributed to in significant part by how these employees were treated in the workplace. The third employee, a city letter carrier, fatally shot himself in a postal jeep and left a letter stating that he could no longer take the job. The suicide at the Gastonia postal facility was the second since December 2005.

Many people have asked: Why is there so much stress and workplace tragedies in the U.S. Postal Service? The answer to these questions is because the postal culture embraces and reflects core values that center on achieving bottom-line results with little or no regard for employee participation, respect, dignity, or fairness. Additionally, there is little or no accountability for the actions of top management in the Postal Service. Many postal facilities consequently have toxic work environments, and they can be a catalyst or trigger for serious acts of workplace violence, including homicide and suicide. The associated rewards system for behavior consistent with the postal culture core values, moreover, enables systemic organizational and individual bullying of employees at all levels of the organization.

I define a toxic workplace environment as a workplace where there is a high incidence of stress-related illnesses. These stress-related illnesses are manifested by psychological and physical deterioration. In other words, these types of environments seriously erode employees’ health and well-being. The primary factors contributing to a toxic workplace environment are high job demands, low job control, and low social support. Low social support generally entails a lack of respect and validation of employees’ dignity by their “superiors”. It also oftentimes includes organizational practices and methods that encourage the bullying of employees to meet corporate goals.

The name of the city letter carrier who committed suicide in Gastonia, NC on June 2, 2009 is Steven Spencer age 60. According to his obituary, Steven was married and leaves two daughters and three grandchildren. He was a member of the National Association of Letter Carriers/ and state representative for Muscular Dystrophy Association. He was the founder of the National Association of Letter Carriers Food Drive for Gaston County. He was very active in Scouting, attaining the highest rank of Eagle Scout. He also was a member of the Order of the Arrow. Steven was a veteran of the Vietnam War serving his country proudly in the US Navy.

I find it highly improbable that an employee will kill himself or herself in a postal facility or while on a postal route unless it is to send a clear message that a toxic workplace exists and the person can’t handle it anymore. Sadly, it also may be a tragic attempt to better the lot of one’s fellow coworkers by drawing attention to the tragic event itself.

Prior to Steven’s suicide, I was contacted by a relative of an employee at the Gastonia post office in April of this year. She was concerned because of what she reported as a toxic workplace environment at the Gastonia post office, lack of accountability to address employees’ concerns, and that the situation may lead to another workplace tragedy. Unfortunately, her worst concern became a reality on June 2, 2009. She further indicated several employees have resigned their positions at the office because of the toxic workplace environment and others were suffering from negative psychological and physical effects because of this environment. I was told employees’ attempts, mostly city letter carriers, to have their concerns addressed over a two-year period included: filing of discrimination complaints and grievances, unprofessional workplace assessments, town hall meetings, contacts to congressional representatives both locally and nationally, contacts to the Office of the Inspector General (OIG), and petitions to Charlotte postal District officials and representatives of their national postal union. She further indicated that none of these measures contributed to fully addressing the workplace environment or alleviating its negative impact for the employees at the Gastonia Post Office.

In order for the U.S Postal Service to become a safe and healthy organization and thereby prevent future workplace tragedies, which have been at an endemic level over the past three decades, there is an urgent need for congressional intervention and legislation to address its toxic postal culture. Dr. Gary and his wife, Dr. Ruth Namie, along with their colleague Professor David Yamada, have for years pushed for such legislation at the state level. In order for national legislation for the prevention of workplace bullying to have the intended impact, it would require sanctions to employers or their representatives who are in violation of a new workplace statute that defines workplace bullying as a harmful and illegal activity.

Stephen D. Musacco, Ph.D.

http://goingpostal-beyond.com/

WBI Note: Readers of the comments below will see the pattern of abuse described above repeated at the same postal center with other employees. Sadly, other comments reveal a national pattern within the Postal Service. So, readers may also be interested in:

Details of a bullying-related NALC Arbitration and management’s use of “routine” bullying on the shop floor as a defense! and   The 1992 USPS Joint Statement on Violence (policy that supposedly applies to ALL employees, except when a grievance is filed)

This British article criticizes their government agency HSE. Know that the U.S. OSHA is even less protective of workers.

How realistic are limits when employers want to offer 24/7 operating hours? Nurses are especially vulnerable because patient care requires 24/7 coverage.

No summary can do justice to this detailed article. Read it in its entirety @ Hazards Magazine..

Regardless of personal political leanings, it’s time to form an alliance between the US Workplace Bullying movement which represents 24% of the US workforce who lose jobs due to bullying (64% of the 37%, see the WBI-Zogby statistics) and the Single Payer Health Insurance movement.

The triple whammy: Employer exposes worker to abuse/Worker with declining health loses job for daring to complain/Unemployed, uninsured worker’s health declines further

Good people lose their jobs through no fault of their own. Many suffer stress-related health complications as a result. And in America just when you require urgent medical treatment for those problems, taken away is health insurance tied to the job.

A study of medical bankruptcy published in the American Journal of Medicine (May, 2009) summarized at Single Payer Action is shocking.

The inability of Americans to pay their medical bills led to 62% of all bankruptcies in the US. 78% of those who went bankrupt because of medical problems had “health insurance.” Later we will explore the disconnect between having “health insurance” and getting treatment by a medical provider. And these statistics were gathered prior to the economic downturn. It can only be worse in 2009.

We cannot afford to get sick and not be able to afford care. It is the height of American heartlessness.

We first became aware of single payer advocacy with the Physicians for a National Health Program (PNHP).

Single Payer Action has a list of groups working for single payer plan.

Dear reader: Help us combine forces and make the obvious connection. Comment below with advice and direction. If you are working with any of the groups listed at Single Payer Action, let them know about WBI and our new outreach effort.

The flu scare revealed yet another gap between the myth of American exceptionalism and reality. American employers would have you believe they take seriously the health of their employees. But a study of sick leave policies (called Contagion Nation) from the Center for Economic and Policy Research found that at least 40% of the private-sector US workforce does not have paid sick days or leave.

The rest of the world’s 22 richest economies have taken a legislative approach to ensuring paid sick days or paid sick leave. Only the US does not guarantees some form of paid time off tied specifically to illness (for example, the 5-day flu or a 50-day cancer treatment) and it does not mandate any form of paid sick days or leave on a national level.

However New Jersey, California, Hawaii, New York, Rhode Island, San Francisco, and Milwaukee do mandate sick leave.

Read the report here.

Are you afraid to lose your job if you take time off when sick? And even if you have sick leave, dare you use it? Has your job been threatened if you take paid time off?

Dr. Denise Lopez Haugen, Licensed Clinical Psychologist

Square Peg Psychological

503-723-5053

17998 S Anderson Rd, Oregon City, OR 97045-9001

drhaugen@squarepegpsychological.com

Dr. Denise is a graduate of WBI University and an Oregon licensed clinical psychologist (PsyD) who can help you. Tell her WBI sent you.

If you do not live in the area but want telephone counseling, call her and request an appointment.

Read our advice about Selecting Therapists and what different kinds there are.

If your therapist is interested in learning more about Workplace Bullying dynamics in order to specialize, have him or her attend WBI University.

How have counselors treated you? Have they understood? Have they hurt? Please tell us here so others know who to trust and who to avoid. Make sure you name the city along with the person’s name.

Work, Stress and Health 2009
Global Concerns and Approaches
The 8th International Conference
San Juan, Puerto Rico

Sponsored by the American Psychological Association / National Institute for Occupational Health and Safety / Society for Occupational Health Psychology

The Conference Website

A City (London) worker has won £800,000 in damages from Deutsche Bank in a landmark workplace bullying case. The award is said by legal experts to be particularly high and likely to be appealed.

High Court judge Justice Owen said that the campaign at the secretariat division of the international banking firm Deutsche Bank Group Services (UK) Ltd. against Helen Green involved a “relentless campaign of mean and spiteful behaviour designed to cause her distress” that left Green on some occasions crying silently at her desk. She worked there from 1997 to 2001.

Owen awarded her a total of $1.5 million for pain and suffering and loss of past and future earnings. He also ordered the bank to pay her legal costs, beginning with an interim payment of $650,000.

The largest part of the award is the £640,000 awarded for future loss of earnings and a pension, and it is this portion which marks the case out as unusual.

“We have seen cases like this before a number of times but the court has awarded such a large amount because it took the view that this person would not be able to work at this salary level for a long time in the future,” said Tom Potbury, a lawyer specialising in employment law at Pinsent Masons.

Green, 36, had said she was subjected to “offensive, abusive, intimidating, denigrating, bullying, humiliating, patronizing, infantile and insulting words and behavior” and subjected to crude and lewd comments from her former colleagues. Her colleagues would move her papers, hide her post and remove her from document circulation lists. She alleged that some of the colleagues had ignored and excluded her, that her personal and professional authority was undermined, and her workload increased to unreasonable and arbitrary levels.

Her lawyer said medical experts on both sides of the case agreed that Green developed a major depressive disorder, but there was disagreement about its cause.

Deutsche Bank said it had not breached its duties to Green and denied that she was bullied, saying she had had a predisposition to mental illness. Deutsche Bank paid for stress counselling and assertiveness training for Green but she had a nervous breakdown before returning to work and suffering a relapse.

“The best way for companies to deal with workplace bullying is to have a clear policy in place and to make sure that employees know about it,” said Potbury. “The policy then has to be enforced. If someone complains it is important that the employer does not sweep it under the carpet,” he said. “That is the best way of protecting yourself against claims. You can better defend yourself if you can show that you have done everything you can.”

Green said she was delighted by the ruling, adding that she had learned bullying was a problem throughout London’s financial world. “My case was not an isolated one,” she said. “At the trial the court heard evidence about other victims. Not only does Deutsche Bank have to put its house in order, but all City (finance) businesses will have to do more than pay lip-service to this hidden menace.”

A Deutsche Bank statement said that “No decision about whether to appeal has been made at this stage”.

Part of Green’s case was argued under the Protection from Harassment Act, a 1997 anti-stalker law that is beginning to be used in employment cases. A House of Lords ruling last month permitted its use in employment cases, and the law differs substantially from existing employment legislation.

“I don’t think anyone imagined when the law was made that it would be used against employers,” said Potbury. “Employers have no real defence against this law. If an employee is harassed at work on more than one occasion they can be liable and there is nothing they can do about it.”

In the case on which the Lords ruled, the NHS (National Health Service) was vicariously liable for the harassment of employee William Majrowski, even though it was not guilty of causing the behaviour or of failing to prevent it. Previously, employees had to prove that the employer had been negligent in preventing bullying, but that is no longer the case.

Though the award will concern other City financial institutions, Potbury said that the problem of bullying at work was very real but very widespread. “It is a problem, but it is not confined to City firms. People get bullied at work everywhere, though the City is a higher stress culture than other workplaces,” he said. “This will make other City firms make sure they are doing everything they can to avoid this.”

This type of conduct is what I read as an expert witness in court cases involving bullying physicians. Similar things happened in the trial dubbed the “first bullying trial” in Indianapolis, IN in March, 2005 in which I testified.

How rare were angry, hostile, bullying rants by Castro-Moure? Was this the first and only time that an otherwise respectful, gentle man exploded? Not likely. The statement by the chief medical officer about Castro-Moure’s normalcy means little. He probably never works directly with him in the OR, the workplace that bully surgeons terrorize. He only sees him through an administrative lens and as a fellow physician, a club member deserving protection.

The aftermath will be worth tracking. Will the Medical Board do anything since they rarely strip licenses? Will the chief of staff, Altman, have the guts to sanction Castro-Moure or will that be seen as capitulation to nurses? Will Highland Hospital, the county government employer, implement a policy to prevent this from happening again? [We do work with motivated hospitals but eventually they balk at applying anti-bullying policies to the docs.] Will the nurses union demand action to make them safe? Will the patient’s family sue for the involuntary delay?

Bullying in hospitals jeopardizes patient care and staff safety. But most administrators are too timid to confront and constrain thugs like Castro-Moure. This unfortunate incident gives the public and bully sympathizers a rare peek behind the hospital door to show what nonsense is tolerated on a daily basis by nurses.

Highland (Hospital, Oakland, CA) Surgeon Suspended
Drunken Altercation Reported in Hospital’s Operating Room

By Jim Herron Zamora
San Francisco Chronicle
Thursday, March 9, 2006

OAKLAND — The top neurosurgeon at Highland Hospital has been suspended and may be charged with a misdemeanor after what authorities called a drunken altercation with sheriff’s deputies in an operating room, officials said today.

Deputies believe Dr. Federico Castro-Moure, 45, was intoxicated during the scuffle and prosecutors may charge him with public drunkenness and interfering with a peace officer.

“The deputies felt that he was behaving in an aggressive manner,” Alameda County Sheriff’s Capt. William Eskridge said. “He was yelling and put a fist in the face of a deputy in a threatening manner.”

Neither Castro-Moure nor his attorney could be reached for comment.

The incident began about 8:30 p.m. Monday when Castro-Moure argued with nurses recommending that he wait several hours for sterile equipment to arrive before operating on a spinal patient.

Although Castro-Moure wanted to operate immediately, other hospital personnel believed the surgery could be delayed because the patient was stable enough to wait, said Dr. David Altman, the hospital’s chief medical officer.

In such cases, it is the hospital’s policy to wait. But Castro-Moure became angry and physically and verbally abusive, officials said. A nurse summoned deputies to the foyer outside the fifth-floor operating room.

When deputies attempted to intervene, Castro-Moure allegedly shouted obscenities and used his arm and clenched fist to keep them at bay, officials said.

Although the deputies arrested Castro-Moure on suspicion of public intoxication — based upon both his behavior and the smell of alcohol on his breath — Eskridge said the doctor was so uncooperative that deputies could not adequately test him for intoxication.

“He compromised the test by not blowing the amount of time the test needs to get an accurate reading, but the device did indicate there was some alcohol in his system,” Eskridge said.

The unidentified patient was in the emergency room at the time and remained there throughout the incident, officials said. His spinal operation occurred Tuesday morning, and he is recovering satisfactorily, Altman said.

Altman announced Thursday that Castro-Moure has been suspended without pay. Castro-Moure, Highland’s head of neurosurgery since 2003, will be barred indefinitely from practicing at the hospital pending several investigations by the hospital and county health officials, Altman said.

The California Medical Board, which holds licensing power over all doctors in the state, is expected to launch its own investigation of Castro-Moure. The board could potentially strip him of the ability to practice medicine in the state.

“I cannot confirm or deny that we have an investigation because that is not a public record,” said Erlinda Suarez, analyst California Medical Board. “But I can tell you that in any case like this with wide media coverage we would probably initiate an investigation based on media reports,” Suarez said.

Altman said Alameda County Medical Center officials are “very concerned.” Although there is no specific policy banning alcohol consumption by doctors before surgery, Altman said doctors and other employees are barred from working when “impaired in any way by drugs or alcohol.” He also said it is hospital policy to immediately report any person with alcohol on their breath.

“We will not tolerate unprofessional conduct that could endanger our patients,” Altman sad. “That is unacceptable.”

Castro-Moure has been at Highland Hospital since November 1999 and had no history of misconduct, Altman said. Castro-Moure received his medical degree from Collegio Mayor de Nuestra Senora del Rosario in Bogota, Colombia, and his doctorate from Wayne State University in Detroit.

“He is a well-respected neurosurgeon, well respected in his field,” Altman said.

Targets of bullying experience rejection by cowardly co-workers, indifference from HR and senior management, and limited tolerance by friends and family. Why aren’t people more compassionate? Why don’t they see the pain and help more? Brand new research suggests that we humans are wired to quickly and empathically react to the physical pain of others. For example, watching someone break an ankle and step on it triggers pain centers in our own brains nearly immediately.

However, social pain or the mental anguish of others takes longer to trigger a response and that reaction requires much more brain work. For example, when a woman with cerebral palsy laments that she has never been kissed and probably will never have a romantic relationship, it should trigger a compassionate response. It does, but it takes time. The latency and location of neurological responses are tracked by fMRI. The research was done by Mary Helen Immordino-Yang and Antonio Damasio at USC’s Brain and Creativity Institute. (Paper published in Proceedings of the National Academy of Sciences)

I extrapolate the findings to the real world of workplace bullying. Effortful cognitions, hard mental work, is nearly always avoided. Most people seek low challenge activity that sustains comfort and predictability. The vicarious experiencing of the pain of others can be circumvented if the witnessed events pass quickly by, preventing the time it takes for our brains to adequately process the mental pain witnessed. Averting eye contact and turning or walking away allows witnesses to skip the mental work and the discomfort that would result if they stayed long enough to notice the undeniable pain. Disengagement from the target blocks compassion. It makes it easier to side with the bullying abuser. Another layer of denial may even come into play. By refusing to acknowledge what was seen or heard, not only does the pain not get through, but the witness convinces him- or herself that nothing was actually heard or seen (that’s the rationalization driven by cognitive dissonance).

At the broadest level, the lack of compassion by lawmakers is simple to understand. They delve deeply into nothing; they skim everything due to overload from so many people seeking their attention. I’m not letting them off the hook, but clearly attention spread too thin undermines compassion. Most lawmaker sponsors of our bills are people with direct or family experience with bullying. They do not need to be convinced. Their experience is deep and undeniable. They have seen the pain bullying causes.

Brain science is fascinating because it shows how social/environmental factors are filtered through our personal biological lenses often in interaction with learned social ways of coping with stress and interacting with others.

Stress & the Economic Crisis

The Dark Side of the World of Work

First official WBI podcast

A welcome and warning about the stress-related pressures the economic crisis brings.

You can either..

Download Podcast 1 (in .mp3 format)

By Julie Steenhuysen

Fri Nov 7, 2008 

CHICAGO (Reuters) – Brain scans of teens with a history of aggressive bullying behavior suggest that they may actually get pleasure out of seeing someone else in pain, U.S. researchers said on Friday.

While this may come as little surprise to those who have been victimized by bullies, it is not what the researchers expected, Benjamin Lahey of the University of Chicago, who worked on the study, said in a telephone interview.

“The reason we were surprised is the prevailing view is these kids are cold and unemotional in their aggression,” said Lahey, whose study appears in the journal Biological Psychology (the abstract from the article and MRI picture can be read here).

“This is looking like maybe they care very much,” said Lahey, who worked on the study with Jean Decety, also of the University of Chicago.

The researchers compared eight boys ages 16 to 18 with aggressive conduct disorder to a group of eight adolescent boys with no unusual signs of aggression.

The boys with the conduct disorder had exhibited disruptive behavior such as starting a fight, using a weapon and stealing after confronting a victim.

They showed both groups video clips of someone inflicting pain on another person and tracked brain activity with a type of imaging called functional magnetic resonance imaging, or fMRI.

In the aggressive teens, areas of the brain linked with feeling rewarded — the amygdala and ventral striatum — became very active when they observed pain being inflicted on others.

But they showed little activity in an area of the brain involved in self-regulation — the medial prefrontal cortex and the temporoparietal junction — as was seen in the control group.

“It is entirely possible their brains are lighting in the way they are because they experience seeing pain in others as exciting and fun and pleasurable,” Lahey said.

“We need to test that hypothesis more, but that is what it looks like,” he said.

Lahey said the differences between the two groups were strong and striking, but cautioned that the study was small and needs to be confirmed by a larger study.

(Editing by Will Dunham)

The scientific article abstract:

Atypical empathic responses in adolescents with aggressive conduct disorder: A functional MRI investigation

Jean Decety, Kalina J. Michalska, Yuko Akitsuki, Benjamin B. Lahey

Biological Psychology, 80 (2), 203-211

Abstract

Because youth with aggressive conduct disorder (CD) often inflict pain on others, it is important to determine if they exhibit atypical empathic responses to viewing others in pain. In this initial functional magnetic resonance imaging (fMRI) study, eight adolescents with aggressive CD and eight matched controls with no CD symptoms were scanned while watching animated visual stimuli depicting other people experiencing pain or not experiencing pain. Furthermore, these situations involved either an individual whose pain was caused by accident or an individual whose pain was inflicted on purpose by another person. After scanning, participants rated how painful the situations were. In both groups the perception of others in pain was associated with activation of the pain matrix, including the ACC, insula, somatosensory cortex, supplementary motor area and periaqueductal gray. The pain matrix was activated to a specific extent in participants with CD, who also showed significantly greater amygdala, striatal, and temporal pole activation. When watching situations in which pain was intentionally inflicted, control youth exhibited signal increase in the medial prefrontal cortex, lateral orbitofrontal cortex, and right temporo-parietal junction, whereas youth with CD only exhibited activation in the insula and precentral gyrus. Furthermore, connectivity analyses demonstrated that youth with CD exhibited less amygdala/prefrontal coupling when watching pain inflicted by another than did control youth. These preliminary findings suggest that youth with aggressive CD exhibit an atypical pattern of neural response to viewing others in pain that should be explored in further studies.

fMRI images

I have written previously on workplace violence; this time, I am going to offer a few thoughts on bullying in the workplace, which a number of experts see as a form of workplace violence. Dr. Gary Namie has described bullying as “psychological violence,” and I think that is a very good description. The article will also touch on cyber-bullying, a new form of bullying that is as current as today’s headlines. (See, also, Pondering the Impact of Workplace Violence.)

You may have read the very recent – and profoundly disturbing – headline about a Missouri woman who was found guilty of misdemeanor crimes in a “MySpace” cyber-bullying case linked to a 13-year-old girl’s suicide. According to prosecutors, the woman conspired with her young daughter and a business associate to create a fictitious profile of a 16-year-old boy on MySpace to harass Megan Meier, apparently in an effort to humiliate Megan for saying mean things about her daughter.

The “boy” sent flirtatious messages to Megan, but then abruptly changed to a very harsh tone, telling her “The world would be a better place without you.” After receiving that message, Megan hanged herself with a belt in her bedroom closet. According to prosecutors, the woman knew that Megan suffered from depression and was emotionally fragile.

A major USA Today article dated November 19, 2008, entitled “Bullying devastates lives,” and chronicled the sad stories of three women who experienced constant bullying in school – one for having red hair, one for being shy, and one for being “different.”

The three women, now ranging in age from 28 to 52, continue to be affected by the bullying that they suffered in school. According to Daniel Nelson, medical director of the Child Psychology Unit at the Cincinnati Children’s Hospital Medical Center, “…there’s no question that ‘unrelenting,’ daily hostilities that maybe escalate to threats or actual aggression can be on par with torture…,” or that ” repeated and severe bullying can cause psychological trauma.” Nelson went on to observe that “There’s no question that bullying in certain instances can be absolutely devastating.”

A companion article talked about a high school girl whose epileptic seizures – of all things! – had made her a target in three different schools. She was so traumatized by the tormenting that she dropped out of school and is now pursuing independent study; the young woman “suffers so much that she could not be interviewed” for the article. Sisters Emily and Sarah Buder, appalled by the news, wrote letters to the girl and asked friends to do so as well. They hoped for 50 letters; the current total is 6,500, and counting!

I also ran across a November 7 Reuters article entitled “Bullies may get kick out of seeing others in pain.” In this one, University of Chicago “researchers compared eight boys ages 16 to 18 with aggressive conduct disorder to a group of eight adolescent boys with no unusual signs of aggression.” The article went on to state that, in the “aggressive teens, areas of the brain linked with feeling rewarded…became very active when they observed video clips of pain being inflicted on others. But they showed little activity in an area of the brain involved in self-regulation…as was seen in the control group.”

Researcher Benjamin Lahey noted that “It is entirely possible their brains are lighting in the way they are because they experience seeing pain in others as exciting and fun and pleasurable.” Lahey went on to say that “the differences between the two groups were strong and striking, but cautioned that the study was small and needs to be confirmed by a larger study.”

How does all of this relate to the Federal workplace?

Bullying, whether via the latest technologies or by more traditional means, is a growing problem in American workplaces of all kinds, and I don’t see why Federal agencies would be exceptions.

In fact, I just received an e-mail from a woman who indicated that she has been bullied so severely in her current job, to include being screamed at in anger by managers and treated with no respect by some of her co-workers, that she felt compelled to tell her story to someone. I have received similar comments from other FedSmith.com readers in the past in response to articles I have written that may have touched on the subject, so I know that there are employees in a number of Federal agencies who feel they are being bullied.

I think the following guidance, adapted from Violence in the Workplace Prevention Guide, published in 2001 by the Canadian Centre for Occupational Health & Safety (CCOHS), is worth a look whether you are a Federal manager, supervisor, or non-supervisory employee.

What is Workplace Bullying?

Bullying is usually seen as acts or verbal comments that could ‘mentally’ hurt or isolate a person in the workplace. Sometimes, bullying can involve negative physical contact as well. Bullying usually involves repeated incidents or a pattern of behavior that is intended to intimidate, offend, degrade or humiliate a particular person or group of people. It has also been described as the assertion of power through aggression.

What are Examples of Bullying?

While bullying is a form of aggression, the actions can be both obvious and subtle. It is important to note that the following is not a checklist, nor does it mention all forms of bullying. This list is included as a way of showing some of the ways bullying may happen in a workplace. Also remember that bullying is usually considered to be a pattern of behavior where one or more incidents will help show that bullying is taking place.

Examples Include:

• Spreading malicious rumors, gossip, or innuendo that is not true
• Excluding or isolating someone socially
• Intimidating a person
• Undermining or deliberately impeding a person’s work
• Physically abusing or threatening abuse
• Removing areas of responsibilities without cause
• Constantly changing work guidelines
• Establishing impossible deadlines that will set up the individual to fail
• Withholding necessary information or purposefully giving the wrong information
• Making jokes that are ‘obviously offensive’ by spoken word or e-mail
• Intruding on a person’s privacy by pestering, spying or stalking
• Assigning unreasonable duties or workload which are unfavorable to one person (in a way that creates unnecessary pressure)
• Under work – creating a feeling of uselessness
• Yelling or using profanity
• Criticizing a person persistently or constantly
• Belittling a person’s opinions
• Unwarranted (or undeserved) punishment
• Blocking applications for training, leave or promotion
• Tampering with a person’s personal belongings or work equipment.

It is sometimes hard to know if bullying is happening at the workplace. Many studies acknowledge that there is a “fine line” between strong management and bullying. Comments that are objective and are intended to provide constructive feedback are not usually considered bullying, but rather are intended to assist the employee with their work.

If you are not sure an action or statement could be considered bullying, you can use the “reasonable person” test. Would most people consider the action unacceptable?

How Can Bullying Affect an Individual?

People who are the targets of bullying may experience a range of effects. These reactions include:

• Shock
• Anger
• Feelings of frustration and/or helplessness
• Increased sense of vulnerability
• Loss of confidence
• Physical symptoms such as:
  • Inability to sleep
  • Loss of appetite
• Psychosomatic symptoms such as:
  • Stomach pains
  • Headaches
• Panic or anxiety, especially about going to work
• Family tension and stress
• Inability to concentrate
• Low morale and productivity

How Can Bullying Affect the Workplace?

Bullying affects the overall “health” of an organization. An “unhealthy” workplace can have many effects. In general these include:

• Increased absenteeism
• Increased turnoverv
• Increased stress
• Increased costs for employee assistance programs (EAPs), recruitment, etc.
• Increased risk for accidents / incidents
• Decreased productivity and motivation
• Decreased morale
• Reduced corporate image and customer confidence
• Poorer customer service

What Can an Employer Do?

The most important component of any workplace prevention program is management commitment. Management commitment is best communicated in a written policy. Since bullying is a form of violence in the workplace, employers may wish to write a comprehensive policy that covers a range of incidents (from bullying and harassment to physical violence).

Final Thoughts: I believe that managers and supervisors are morally responsible for ensuring that employees are not bullied in the workplace, but I also think that it makes good business sense.

For example, I can see real potential for people who feel they are being bullied relentlessly to eventually reach their limit and attempt to hurt either themselves or others. I believe that many of the students who have wreaked violence on their schools, such as Harris and Klebold at Columbine High School, or planned to do so, cited being picked on relentlessly as at least one of the motivating factors for their attacks.

While most employees who are bullied are unlikely to strike out at their perceived tormentors – in fact, they are more likely to absorb the bullying without saying anything to anyone – I can’t imagine anyone doing their best work when they are feeling bullied and humiliated and/or are fearful for their safety. Accordingly, I maintain that it is in management’s interest to maintain a respectful work environment and not to tolerate any bullying behavior.

I would advise managers and supervisors to start by examining their own behavior – soliciting feedback from trusted colleagues might be part of the process – to make sure they are not engaging in any bullying of their own, however inadvertent. I would also suggest that they let employees know that bullying, like workplace violence and threats, will not be tolerated, and tell employees who feel they are being bullied to report it to management immediately.

As always, I welcome the thoughts of FedSmith.com readers.

© 2009 Steve Oppermann. All rights reserved. This article may not be reproduced without express written consent from Steve Oppermann.

Hospitals would become bully-free zones and bad-boss behavior prohibited in state statute under a bill that a legislative review committee on Tuesday earmarked for interim study.

Despite opposition to the bill by the head of the state Division of Risk Management, former district Judge Roger Livingston, counter testimony from disgruntled health-care workers who support HB224 was too compelling for lawmakers to ignore.

They heard and were given written accounts of ostensibly competent, caring medical providers being driven from their jobs and even out of the state by supervisors who induce stress in an already high-stress occupation. The hyper-patrolling and controlling oversight — which included employees having to ask to go the bathroom are far from uncommon and are adding injury to the insult in the form of serious mistakes and harm to patients, committee members were told.

Laura Sorensen, a registered nurse with critical care certification and a former Air-Med flight nurse and a state Emergency Nurse of the Year, said workplace bullying is the not the joke opponents try to make of it. She said that after immediately divulging to a supervisor that she had been diagnosed with multiple sclerosis 15 years ago, the University of Utah began a systematic effort to have her fired, effectively “disabling me well before I had any signs of being ‘crippled up’ by the disease.” She said U. attorneys immediately considered her a potential liability as a flight nurse and proceeded to keep her from working, despite her filing an Americans With Disabilities Act lawsuit and court-directed mediation in which she told U. lawyers all she wanted was her job back until her health literally — not potentially — precluded it.

Nurse Sharlene Watson said she was driven out of her labor and delivery job at the U. for delivering a baby before the attending doctor arrived and to ease an ongoing disagreement between her boss and another nurse. She was immediately placed on leave without pay. She said in subsequent hearings she was verbally and physically abused.

“People think government immunity doesn’t prevent actions in court, but I can tell you they do,” Watson said.

Livingston said if state employees feel aggrieved, “we have methods to ensure that we are as progressive and open and fair.”

He added that he didn’t want to come off as denigrating testimony before the committee, but said “in the strongest possible terms, this would be a giant step backward.”

To illustrate his point, he mentioned a 1977 citizen petition in Arizona against Daylight Savings Time in which a reason cited by signers was that “the extra hour of sunlight would burn their lawns.”

Dave Gessel, vice president of government relations and legal counsel for the Utah Hospital Association, said HB224 is “well-intended but off the mark,” noting that behavior at any workplace has never been made a cause of legal action. “This is a Grand Canyon change. To single out health care or go across that chasm is huge” in part because Utah is a right-to-work state in which 89 percent of all employees can be let go from their job for no good reason.

“Employers would see a problem and think they better fire that person right now,” he added. “This would backfire.”

Joseph Doescher and Daniel Raess worked side by side in the operating room at St. Francis Hospital in Beech Grove, Indiana. Doescher and the other perfusionists often had to put up with yelling, swearing, and belittling comments from Raess, the heart surgeon. Finally, Doescher reported the behavior to his supervisor. Raess got wind of it and retaliated.

In subsequent court proceedings, Doescher described looking up at Raess’ red face and popping veins. He was afraid Raess was going to hit him. In the end, Doescher left his job with a debilitating case of depression. Later, he sued Raess and was awarded $325,000 in compensatory (but not punitive) damages.

Shortly after the Indiana Supreme Court decided this high-profile medical case, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) issued a safety alert, requiring hospitals to adopt a zero-tolerance policy toward workplace bullying.

By January 2009, hospitals must also comply with the new disruptive behavior standard (LD.3.15). They will create new training, post a code of conduct for employees, and set up a mechanism for workers to report inappropriate outbursts.

“It’s been widely recognized that this kind of behavior goes on in health care settings,” says Peter Angood, MD, Chief Patient Safety Officer for JCAHO. “It seemed to be increasing in frequency, so we felt it was important to put standards in place.”

Perfect Targets

Researchers, including Gerald Hickson, MD, at Vanderbilt University, and Alan H. Rosenstein, MD, have shown how inappropriate workplace behavior can lead to increased legal costs and put patient safety at risk. Other studies have shown that clinicians working in a hostile environment make more errors while dispensing medication.

“If there are people in the workplace who don’t play well with others, sometimes they cause other members of the team to lose focus,” Hickson says, “and an error will occur.”

According to Gary Namie, PhD, Co-founder of the Workplace Bullying Institute in Bellingham, Washington, this issue is coming to the forefront, just as sexual harassment did about 20 years ago. Employers are starting to see training programs and prevention as a good investment. And Namie says the need is great — in all sectors of the work world. WBI and Zogby International conducted a survey and found that 37% of American workers say they have been victims of workplace bullying.

Health care, with its hierarchical structure of authority and caste-like training systems, is rife with this type of negative behavior. In part, Namie says, this is because there are so many caring and compassionate people in the field, who make perfect targets: They would rather help people and keep a low profile than fight back.

“It’s the people mix,” Namie says. “You’ve got just enough people with strong egos and narcissistic personalities. Then you’ve got this vast pool of targets who have an altruistic bent–they want to focus on the work itself, and they have a belief in a benevolent world. They don’t respond to aggression with aggression.”

Workplace bullies usually target a person with good social skills who is well liked, as Namie explains: “It’s usually a person with an established record who poses a threat, and the bully wants to take him or her down.”

Nurses at the Forefront

Frequently, physicians are the aggressors and nurses are the targets. In fact, a JCAHO survey found that 50% of nurses had been targets of this kind of intimidation, and 90% of nurses reported having witnessed it.

Dianne Felblinger, EdD, MSN, WHNP-BC, CNS, RN, a nursing instructor at the University of Cincinnati, believes the nursing shortage is driving some of the frustration–but also may hold the key to solving the problem.

First of all, many hospitals do not have optimal nurse-to-patient ratios right now, due to the shortage. That, in turn, leads to high stress and more confrontations. “I have pretty much seen it all,” Felblinger says. “I have seen yelling, screaming, and chart throwing. I once saw a physician throw a needle, and it pierced the nurse’s skin.”

On the other hand, she adds, the nursing shortage has helped nurses find their voices and ask for better treatment. Hospitals know if they don’t retain their nurses and keep them happy, nurses have a lot of career options these days–and they just might walk.

Felblinger worries about NPs who may be the sole nurse in a clinic, surrounded by physicians. Those NPs could become targets, since they don’t have other nurses to turn to for support.

The best prevention, according to Felblinger, is to speak up right away. Unfortunately, most targets of bullying let the problems continue for as long as two years.

“The most civil thing is to always address it with the person,” Felblinger says. “Get it out in the open, and request that the behavior stop.” It’s about learning to set boundaries and deciding you want to be treated with respect, she adds. “Sometimes things can be worked out really well,” Felblinger says. “Sometimes people don’t realize they’re doing this, because nobody ever brought it to their attention.”

Building Momentum for Change

With the new JCAHO standards in place, clinicians should have an easier time reporting negative incidents.

Still, Namie warns, the JCAHO standards really don’t have teeth. Health care workers won’t truly be protected until legislators pass laws that will cause a workplace bully to lose his or her job (just as they did for sexual harassment). That’s still years away, but with two bills in the New York State Legislature and six other active bills in states across the country, Namie says the movement “continues to catch fire.”

Meanwhile, clinicians who do call out a bully may run into resistance at the top. Bullies are often adept at charming and building allies in high places. Felblinger says that some hospital administrators may also value the money top surgeons or physicians are able to attract to the institution–sometimes more than they value their own workers.

One shining star in this area is Vanderbilt University Medical Center, which has adopted effective prevention policies of its own and shared the model with 40 other hospitals around the country. (For details, visit www.mc.vanderbilt.edu/cppa.)

Vanderbilt uses patient surveys, suggestion cards, and waiting room videos to make it clear to patients that their feedback is welcome. Staff members use an online program to report unprofessional behavior, Hickson says. Once the data are there, the hospital searches for recurring names and patterns of negative behavior. Clinicians who are repeatedly mentioned must then go through training programs and, in certain cases, counseling through an employee assistance program.

It’s not as simple as printing up a statement about zero tolerance, Hickson says. “So many people think you can slap a policy on this and make it go away,” he adds. In fact, it can take years to make inroads and establish civil behavior as a core value for a medical institution.

For Patients and Clinicians

Clinical nurse specialist Theresa Mulherin, MSN, RN, CEN, is in charge of implementing the new JCAHO standards for workplace behavior at Sentara Careplex in Hampton, Virginia. At times, she feels as if she is operating in uncharted territory, but she is also honored to do this job.

“I’m excited about this,” Mulherin says. “As nurses, we’ve known for a long time that this needed to be addressed. This is about patient safety, and that’s why it’s so important to me.”

While it may be a far from perfect world for health care workers, it’s important not to lose heart. Clinicians need to stick together, support each other, and really work on this cause, Felblinger says: “We can lose some of our best and brightest if we don’t deal with it.”