Lana Brown
Donna Middaugh
Nurse Hazing: A Costly Reality
L
aura began college at age 17
with the career goal of becoming a registered nurse. She discovered horizontal hostility within the
nursing profession early in her
nursing curriculum. After completing the prerequisites for nursing
school, Laura began her first
course in pediatric nursing. Being
young and naïve, Laura unexpectedly walked onto a pediatric oncology unit unprepared to deal with
the negative attitude and disrespect of her preceptor. Laura’s preceptor referred to her as, “Hey, student!” throughout the 2-day clinical
activity while continually rolling
her eyes each time Laura presented her with a patient care question.
This is just one example of
many situations that Laura and
other new nurses experience daily.
Fortunately, Laura chose to continue in the nursing profession and,
learning from this incident, always
has tried to treat others the way
she would want to be treated as a
student, co-worker, patient, or family member.
Hazing Definition and
Examples
Nursing management is stressful, with patient safety and excellent care at the forefront of deciLana Brown, MNSc, RN, BC, is Patient
Education Coordinator, University of
Arkansas for Medical Sciences, Little
Rock, AR.
Donna Middaugh, PhD, RN, is Associate Dean for Service and Coordinator,
Masters in Nursing Administration,
University of Arkansas for Medical
Sciences, College of Nursing in Little
Rock, AR. She is a member of the
Editorial Board for MEDSURG Nursing.
sion making when overseeing and
managing staff and staff interactions. The role of the nurse manager
in dealing with horizontal violence
in the workplace has received
increased attention over the last
few decades. Horizontal violence or
horizontal hostility can be defined
as “a consistent pattern of behavior
designed to control, diminish, or
devalue a peer (or group) that creates a risk to health and/or safety”
(Bartholomew, 2006, p. 4). Horizontal violence in nursing is comparable to hazing in the university or
college setting, and is described by
Longo and Sherman (2007) as “an
act of aggression that is perpetrated by one colleague toward another colleague” (p. 35). The descriptions of hazing in education settings and horizontal violence in
nursing have many similarities.
While nurses don’t require new coworkers to eat live goldfish, they
frequently engage in irritating
actions or behaviors to see how
new nurses can tolerate or fit into
the unit. The continual nursing
s h o rtage does not allow for the
costly loss of nursing staff due to
unnecessary disrespect in the
workplace.
Hazing in the school setting is
described as “a complex social
problem that is shaped by power
dynamics” within a group or organization (Kleim, 2005, para. 2). There
are varying degrees of hazing in the
education setting. Hazing can
range from subtle hazing to harassment hazing or violent hazing.
Kleim described subtle hazing as
hazing accepted among the group
as harmless. Examples included
assigning demerits with loss of
group privileges, using social isola-
MEDSURG Nursing—September/October 2009—Vol. 18/No. 5
tion, silence, or name calling, or
assigning rookies tasks that other
group members are not expected to
perform. Kleim also discussed
harassment hazing as behaviors
that cause a group member anxiety
or physical discomfort. They
encompass verbal abuse, threats,
humiliation, degradation, sleep
deprivation, sexual simulations,
and harassment. Lastly, violent hazing has the potential to cause physical, emotional, or psychological
harm to the individual being hazed.
Examples consist of insistence of
drug or alcohol consumption, assault, branding, water intoxication,
public nudity, illegal activities, bondage, or exposure to extreme elements.
Numerous examples of nurse
hazing appear in the literature,
encompassing verbal and nonverbal behaviors and activities.
According to one study, 30%-50%
of all U.S. workers report experiencing bullying on a weekly basis
(Craig & Kupperschmidt, 2008).
Purpora (2005) provided the hazing examples of “criticizing, undermining, discouraging, or scapegoating” (p. 35). Other forms include gossiping, eye rolling, sighing, humiliation, silence, or sabotage through withholding inform ation or peer support (Simpson,
2008). Further behaviors consist of
intimidation, negative innuendos,
revelation of personal inform a t i o n ,
consistent criticism, or exclusion
f rom nursing cliques (Craig &
Kupperschmidt, 2008). Do any of
these sound familiar to your work
setting?
Hazing is a violation of university policy and an illegal activity
under state laws, and is considered
305
to be a felony in many states
( C o rnell University, 2007). Even college fraternities realize hazing causes a loss of trust, confidence, and
reputation among the fraternity
brotherhood. The consequences of
being found guilty of hazing in the
college setting may be monetary
fines, suspension for a minimum of
3 months, expulsion from the university, or jail time (Kappa Alpha
Order, 2004). If university policies
and state laws mandate no-tolerance for hazing, why would nursing
allow hazing to continue?
Nurse Hazing: Influences and
Outcomes
Sociology literature explains that
individuals within a group act against
one another when they feel they have
no power or control in the work environment (Bartholomew, 2009).
Oppressive conditions already exist
in nursing, including the inability to
have uninterrupted meals or restroom breaks, no time to schedule
personal appointments (Thomas,
2003), inadequate staffing ratios, or
limited resources to provide quality
patient care (Baltimore, 2006). Oppressed individuals tend not to verbalize frustrations to administration for fear of punishment. Many
health care settings continue to
have a hierarchal structure that
lacks support and recognition of
nurses’ ability to think critically.
Frequently, this structure does not
allow or provide significant clinical
recommendations for improved
patient outcomes or organizational
change (Purpora, 2005).
Nursing re s e a rch indicates
horizontal violence diminishes
nursing enthusiasm and creates
dissatisfaction in the work setting
(Longo & Sherman, 2007). A disagreeable work setting may slow
productivity and clinical effectiveness (Purpora, 2005). Nurses who
bully colleagues are described as
having low-self esteem, feelings of
powerlessness, and feelings of disrespect from others (Longo &
S h e rman, 2007). Typically, university hazing also is associated with
low self-esteem (Kappa Alpha
Order, 2004). Hazing becomes the
n o rm in nursing and university settings if the behavior is allowed
(Longo & Sherman, 2007).
306
Figure 1.
Manager Steps for Change
Evaluate your wo rk culture.
Monitor for nurse hazing in your area.
Educate staff by providing examples of nurse hazing.
Take staff complaints seri o u s l y.
Mentor your staff in crucial conversations and conflict management.
Empower staff to change.
Allow staff input into a plan for discipline for nurse hazing.
Nurse managers and staff nurses must realize horizontal violence
not only affects nursing satisfaction, but also ultimately places
patient safety at risk (Simpson,
2008). Nurses who experience bullying are less likely to ask for help
or ask questions, increasing the
likelihood of errors in patient care
(Longo & Sherman, 2007). According to Longo and Sherman, the
ability to recruit new nurses is limited when horizontal violence
occurs, which leads to unsafe conditions from inadequate staff i n g
ratios. The Joint Commission’s
Sentinel Event Alert titled “Behaviors That Undermine a Culture
of Safety” (Simpson, 2008, p. 328)
includes hazing if a sentinel event
occurs in relation to the behavior.
Nurse Manager’s Role
Gaining knowledge about the
common types of nurse-on-nurse
bullying behaviors and causes for
these behaviors is a nurse leader’s
responsibility (Longo & Sherman,
2007). Additionally, administrative
awareness and understanding
necessitate intolerance for negative
treatment among peer groups and
support for staff willing to speak
against bullying or hazing. Zero tolerance of horizontal hostility in
nursing is beneficial, leading to
improved staff satisfaction and
morale and resulting in lower nurse
turnover rates (Mehallow, n.d.).
Changing the Culture
The majority of nurses desire a
manager who responds to staff concerns, encourages shared governance or participative decision
making, and acknowledges staff
contributions to the organization
(Thomas, 2003). Nurse managers
can take several steps to make a
positive change in nursing culture
(Longo & Sherman, 2007) (see
Figure 1). Managers also should
provide staff with a copy of the
position statement “Lateral
Violence and Bullying in the
Workplace” from The Center for
American Nurses as a reference
(Simpson, 2008). This position
statement provides suggestions for
developing a no-tolerance policy in
the health care setting.
Once a unit culture has been
evaluated for hazing, the manager
should confront hazing behavior
immediately (Bartholomew, 2009).
Confrontations always should
occur in private. The manager
should monitor his or her behavior
to avoid becoming part of the hazing problem (Mehallow, n.d.). The
manager should maintain an open
environment for sharing complaints
and concerns involving hazing incidents (Craig & Kupperschmidt,
2008), engaging staff in the process
of change for zero-tolerance for
nurse hazing (Longo & Sherman,
2007). Lastly, the manager should
be equipped and provide staff with
the tools for crucial conversations
to stop nurse hazing in the workplace (Patterson, Grenny, McMillan,
& Switzer, 2002).
Conclusion
The controversial issue of
nurse hazing is detrimental to the
health care culture and is quite
expensive for an org a n i z a t i o n
(Longo & Sherman, 2007). Because
nursing’s journey toward achieving respect as a profession among
members and other disciplines is
diminished by horizontal hostility,
nurses and nurse managers must
undertake an era of change.
MEDSURG Nursing—September/October 2009—Vol. 18/No. 5
Nurses are caring, compassionate
individuals with the ability to think
critically and make changes for the
greater good of the profession and
patient safety. Is it asking too much
to demand professional treatment
of co-workers as well?
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