INTRODUCTION

Adaptable and flexible nurses are needed to meet the fluctuating demands of healthcare systems. The Canadian Nurses’ Association (CNA) states that the knowledge, skills, and personal attributes required by today’s health system can only be gained through baccalaureate nursing programs (2016). However, despite the changes to nursing education, there has been no change to the persistent culture of bullying within nursing. Bullying of nursing students is not a recent phenomenon. An article published in the New York Times in 1909 documented an example of the bullying experienced by nursing students from a physician’s perspective. The physician witnessed “head nurse despotism” directed towards student nurses and recounted stories of bullying (New York Times, 1909). Biographers have documented Florence Nightingale, the symbolic 19th century nursing icon, as being intimidating and domineering with her peers, behaviors often considered as bullying (Lim & Bernstein, 2014). Today, there is a prevalence of literature documenting bullying of nursing students in the clinical setting. Clarke et al. (2012) found that 88.7% of undergraduate Canadian nursing students from various years (n=674) experienced at least one act of bullying with the main sources of bullying being clinical instructors and staff nurses. Nursing students experience bullying from the 1st year of their nursing education programs (Clarke et al., 2012). It therefore follows that there is an opportunity within nursing education programs to change this experience and break the cycle of bullying. Doing so will lead to a workforce where bullying is not a part of the culture (Pope, 2008; Smith et al., 2016).

BACKGROUND

Bullying among nurses is a persistent, international problem. In Australia, the incidence of nurseto-nurse bullying ranges between 14.7% and 21.7% (Hegney et al., 2010; Roche et al., 2010), while in the USA, rates of 23% were reported (Vessey et al., 2009). A national study in the UK found that 20% of healthcare staff, of which the majority were nurses, experienced bullying (Carter et al., 2013). The evidence is clear, bullying in nursing is prevalent internationally. This prevalence of bullying has several implications for the profession. Much of the concern in the literature is focused on staff retention and burn out (Chachula et al., 2015; Yildrim, 2009). New Canadian graduates who were planning to leave the profession reported horizontal hostility as a factor influencing their decision to leave nursing (Chachula et al., 2015). Impaired wellbeing is another unfortunate consequence of bullying in nursing. Yildirim (2009) found a positive association between workplace bullying and depression (r=0.51, p <0.00). Nurses have reported experiencing stress, anxiety, depression, and posttraumatic stress symptoms after bullying experiences (Berry et al., 2016; Rodwell & Demir, 2012; Yildirim, 2009). The negative effects of bullying on nurses’ physical and mental health can also compromise patient safety. An Australian study (Roche et al., 2010) found delayed delivery of nursing tasks to be a consequence of workplace bullying, Nurses have also reported being unable to concentrate on patient tasks and procedures because of bullying (Carter et al., 2013, Rosenstein & Naylor, 2012). A delay in intervention delivery and an inability to think clearly is concerning in the fast-paced healthcare systems of the 21st Century, where patients have higher acuity, requiring time sensitive interventions.