OR -Mary Beth – Renee: Video automatically transcribed by Sonix

OR -Mary Beth – Renee: this mp4 video file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

Mary Beth Kingston:
Hello, I’m Mary Beth Kingston, the Chief Nursing Officer for Advocate Health, and your host for this Outcomes Rocket series focused on awareness and solutions for workplace violence in healthcare. My guest today is Dr. Renee Thompson. I could speak about Renee for a long, long, long time. I’ll just hit a few highlights. She’s the CEO and founder of the Healthy Workforce Institute, and she works with healthcare organizations to cultivate a professional workforce by addressing bullying and incivility. In 2018, she was recognized as one of LinkedIn’s Top Ten Voices in Healthcare for her contributions to the global online healthcare community, and again, in 2022 and 2023, was identified as one of the top five nurse influencers on LinkedIn. In 2002, Renee was inducted as a fellow of the American Academy of Nursing for her work to eradicate disruptive behaviors in healthcare. So we are just thrilled that she is with us, and thank you, Renee, for being here today. You know, I think many people may be surprised that we’re discussing bullying and incivility in a series on workplace violence, but we know that these behaviors are perceived as violence, as personal violence, by many in healthcare, and in a lot of work care settings, but for today’s purposes, particularly in healthcare. So let’s begin by discussing, you know, what exactly is bullying and incivility? What does it look like in the healthcare workplace? And what isn’t it? I think is equally important.

Renee Thompson:
You’re right, and thank you so much, Mary Beth, for inviting me to be a guest, to have a conversation about this, because, as you said, there’s workplace violence, and people immediately think workplace violence is just physical violence, but I actually see the term workplace violence as an umbrella term that includes, yes, physical violence, but it also includes bullying, incivility, a lot of those lower-level, I would say disruptive behaviors, especially that we’re seeing in healthcare. So it all fits under that umbrella of workplace violence, and one of the most common misconceptions is really what bullying is and what it’s not. We tend to label all bad behavior as bullying, and it’s not accurate. So when we work with organizations and we work with their teams, especially with their leaders, we get really clear in helping them to understand what bullying is and what it’s not. So the definition of bullying. Well, let me just say there’s not a legal definition in this country. We have a legal definition for harassment and discrimination, but not for bullying. However, people like me and other experts, we’ve identified that bullying is really the repeated patterns of disruptive behaviors with the intentional, Oh, I know I’m doing this to you, or unintentional, I’m not even aware I’m acting this way, intent to do harm. And when we look at specific incidents of disruptive behaviors and whether or not it’s bullying, we look at three things. There has to be a target for it to be considered bullying. So let’s say Mary Beth, you and I work together, and there’s something about you I don’t like. I don’t like what you eat. I don’t like the music you listen to. I don’t like anything about you.

Mary Beth Kingston:
Hold on there.

Renee Thompson:
Well, and it could be anything. You don’t know, it could be anything. And let’s say you and I are nurses, and I’m in charge. So when I have to give assignments to other nurses, I give you the worst assignments because I don’t like you. So there has to be a target. The behavior has to be harmful in some way. If I give you a report and I leave something out because I know it’s going to set you up for failure, and you’re going to look bad in front of the interprofessional team when they round, okay, that’s harmful, or if I, ’cause it could be harmful to the patient, or if I refuse to get report from you, that could be harmful. Or if every time I come in to work and I see I have to work with you, I immediately lose my peripheral vision, you know, I have a surge of hydrochloric acid well up in my stomach, and I can’t focus, that’s harmful too. And then it can’t just be one time I get testy with you in a crisis situation, right? It has to be repeated over time. That’s what bullying is.

Mary Beth Kingston:
So what is it not?

Renee Thompson:
Okay, well, there’s a difference between bullying and incivility. And when we go into organizations, and I always say we pull back the covers and we lift up the gown, you know, we look to see what’s really happening, we actually don’t find a lot of bullying. It’s there, don’t get me wrong, but if you really look at how you defining your target, harmful repeated, it’s not as prevalent as you think. What we find is an awful lot of incivility. It’s the gossip, it’s the favoritism, it’s the, I help the people I like, and I don’t help the people I don’t like. It’s the cliques. It’s mocking. It’s more of that lower-level, rude, inconsiderate behaviors. And, you know, the good news is, if you can actually identify that somebody bullying someone else, that’s almost easy to address because you have policies about that. Incivility, not as easy because incivility is culture. And, you know, your culture didn’t get this way overnight, it won’t change overnight, and that’s what we really work on is culture.

Mary Beth Kingston:
When I speak with people, even across the country, when we talk about bullying and incivility, I get so many responses from not just people in healthcare, but everywhere. It’s almost like that thing where it might be difficult to define, but if you’re the person, if you’re the recipient, you sure know when it’s happening. And again, as in much of workplace violence, it impacts people’s joy in work. It impacts their, you know, just their, the care they provide. So how prevalent do you think this is throughout healthcare in general?

Renee Thompson:
Well, we see more, we’ll just call them disruptive behaviors, whether it’s bullying or incivility. We see more disruptive behaviors in healthcare than in any other industry in the world. And people are shocked by that because, think about it, you know this, Mary Beth, we’re the caring industry. We’re all about caring and making a difference in the lives of our patients, but we see more disruptive behaviors. And some of the reasons are, think about it, we see more stress in healthcare, especially over the last few years. And when people are burned out and stressed out, they lash out. And who do they lash out to? They usually lash out to the people standing next to them. So if you look at the numbers, it varies. We see anywhere from 30% of all people who work in healthcare claim to have been the target of bullying all the way up to 75%. The challenge is when people aren’t clear what bullying is and what it’s not, they may say it’s bullying, and it’s really not, so sometimes that number may be exaggerated, other times, we know people won’t speak up. There was a study that shows 40% of all targets of bullying won’t tell anyone, so it makes me think there may be even more people dealing with this. But then we, you know this, we say this all the time, Well, that’s just the way she is. You know, Don’t let anything she says affect you. You know, She’s a great nurse, or, That’s just his personality. We justify people’s behavior. So then, even though we may become a target, we don’t report it because it’s just the way it is here.

Mary Beth Kingston:
It’s interesting. As I talked with particularly nurses, but others during the pandemic, and I would ask them, What’s your greatest source of support, they would often comment, number one, on their leader, for sure, and then also on their support system, on those, the people they worked with. This is what, so if you don’t have that support there at work, I think what happens is people just end up leaving. They may not bring it forward, but I think they end up leaving. What have you seen the impact of bullying and incivility in the healthcare environment?

Renee Thompson:
Exactly what you said, especially, we’re looking at the new graduate nurse population. So these brand new nurses who just graduated, they come into the workforce, and there are some recent studies that show within one year, 40% of them quit, within two years, 63% of them quit. And Mary Beth, they’re not quitting because they’re going down the street making $2 more an hour. They’re quitting because of how they’re being treated by their coworkers. We do a lot of consulting, and this was towards the, dare I say, end of the pandemic, where the leaders we were working with started telling us that their experienced nurses are getting really angry and they’re frustrated because these new nurses are the least prepared new nurses they have ever experienced. And they, you know, basically complain saying, I’m not their instructor, you know, They should have learned this in school, or, I have to teach them the basics. And we really worked with them on this and basically came up with a plan for this. First of all, they were right. They are the least prepared new nurses we have ever seen, but it’s not their fault. Oh my gosh, they learned how to be nurses during a pandemic.

Mary Beth Kingston:
And then we held off on clinical experiences, yeah.

Renee Thompson:
Yes. So we know, Yes, they are right. They are not as prepared as what we’re used to seeing, but stop being mean to them. It is not their fault. And instead, what can you do to come together as, you know, experienced clinicians? You know, it doesn’t matter, nurse, it could be, it could be any, any role, respiratory therapist, pharmacists and basically say, Alright, what are the critical skills, maybe 2 or 3 that we know are really important in this department. Let’s make sure we teach them these three critical skills, because you’re supporting them and you’re helping yourself because if they have those skills, then that’s less that they’re coming to you for help once they’ve mastered them. But instead, how do you create a welcoming and a nurturing environment for them so that they stay?

Mary Beth Kingston:
Yeah, I mean, I couldn’t agree more. I think that having, we focus many times on bringing people into the healthcare setting, but focusing on having that supportive environment is that, obviously, we will continue to see people leave if we don’t have that. You know, I was struck by the fact that you said something about the intent that someone that’s bullying knows they’re bullying. I’ve often thought that maybe people don’t recognize some of those behaviors. What do you think about that? Do you think sometimes people are, and maybe that’s the incivility part where they’re just, as you said, that’s just the way they are or? But, you know, how do you help people to recognize the behaviors and the impact that they’re having on others?

Renee Thompson:
The good news is, sometimes just by raising awareness, just by talking about disruptive behaviors, you can help people turn the mirror back on themselves. You know, it’s so easy to point fingers at everybody else. If any of you who are listening right now, you go to your department, you gather your entire team and you say, Does gossip happen here? Every one of them will say yes, and they will all point the finger, maybe not literally at this person, that person, but rare will somebody say, Yeah, I, I gossip. It’s so much easier to recognize the disruptive behaviors that other people are displaying and is harder, you know, if I ask you right now, Do you ever roll your eyes? Oh, no, I don’t roll my eyes at people. Ask your coworkers, they’ll tell you if you roll your eyes. So when we, some of our strategies, like we have a whole system that we implement in organizations, the first phase, the first strategy is heightened awareness. You cannot expect somebody to adapt their behavior if they’re not even aware of their behavior needs to be adapted. So there’s ways you can do that. There are different surveys. You know, we have a really great survey. It’s a quick and easy one, it’s titled, What if you’re the bully? Because it can’t be everybody else, yeah.

Mary Beth Kingston:
No one stands up and says, Oh, I’m the one!

Renee Thompson:
Yes. Rare, rare if they ever do that. But yeah, it’s that lack of being able to reflect and look at how you show up every day. It’s easy to complain about other people and how they show up. So we do a lot of engaging your team in conversations. So instead of saying, alright, this gossip happened here, it actually is a great way to open the door to a conversation, not to identify who’s gossiping, but just to say, Hey, I was reading an article about gossip. Let’s talk about this. Is gossip happening here? Where is it happening? How is it happening? Because even just that conversation, without coming and saying, Here are ten ways to, you know, reduce gossip in our place. People say, Yeah, she needs it, he needs it. But just to raise that awareness, people will start paying attention and they’ll start noticing things that they may not have noticed before. But I will tell you, you can spend your whole lifetime helping people to be more self-aware. You, I know people you could show them a video of how they behaved, you know, they don’t like the assignment they get so they’re huffing and puffing down the hallway, okay, and they will deny that that was them. I’m like, That’s your name badge. That’s your ponytail. I see you.

Mary Beth Kingston:
I may have done that once or twice in my early career.

Renee Thompson:
Well, sometimes, you know, we get defensive, we get reactive, but not all of us, you know, act on it. But there are some people you will never help to become self-aware. And the good news is, Mary Beth, that only represents about 3% of any workforce. And those 3% that have no self-awareness, no matter what you do, that will never take responsibility or accountability, you don’t work with them. You actually find a way to therapeutically extract them because they’re toxic in your organization.

Mary Beth Kingston:
Yeah, you know, that brings me to another question I have. You know, the leader, so, and we put, you know, we put a lot on the folks that are very close to the point of care, but what tools do you have or what can leaders do to address this issue in all healthcare environments?

Renee Thompson:
We haven’t found one organization yet that does a good job equipping their leaders, especially that frontline leader, with the skills and tools that they need to recognize disruptive behaviors, set behavioral expectations, confront bad behaviors, and hold people accountable. And I will tell you, I was one of them. Many, many years ago, I was a brand new manager in a very large organization. I was new to leadership, new to the organization, and within a couple of weeks, I found out that I was now the manager in a, of a department who had the worst reputation of any department in the entire 700-bed hospital, and I was the sixth leader in six years.

Mary Beth Kingston:
Oh my.

Renee Thompson:
Yeah. Did they tell me that when they interviewed me? Yeah, that would be no.

Mary Beth Kingston:
No place to go but up now, Renee.

Renee Thompson:
Oh my gosh. Well, I had never seen people behave this way. And yet everything that I received from, you know, the organization was how to do the budget, how to do the staffing, how to do the payroll, how to do the quality audits. There was nothing that taught me how to actually confront my most clinically competent nurses during a nursing shortage, when any time I tried to confront them, they would retaliate against me by calling off. And what I’ve learned over the years is, again, we don’t do a good job teaching leaders the skills and tools that they need to do this, because a lot of times we see them as soft skills. And at our company, the Healthy Workforce Institute, we don’t see them as soft at all, we see them as essential. So that’s what we primarily do is, our first, so if you were to say, Who do you serve more than any other sort of role? It is the leader because they’re the ones who determine the culture, and they’re the ones who need the help the most. So yeah, we really focus on equipping those leaders with the skills and tools that they need to address bad behavior.

Mary Beth Kingston:
Well, when you think about it, if it’s not easy, always easy to define if people don’t always come forward. It’s not always easy for a leader to address. So I think, you know, that to me would be just a key strategy that has to be in place: How to help leaders see that within their unit when they’re not getting necessarily hard data about it. I mean, if you have a quality issue, you’re getting data about the quality. You know, this, this is a little bit less specific, and I think that’s really part of the challenge. What would you suggest for those that are feeling that they are either the target or experiencing bullying or incivility in the workplace?

Renee Thompson:
I’m not going to say every day, but close, people reach out to us saying, I don’t know if I’m being bullied, you know, or what do I do? We first encourage them to get crystal clear on what the behaviors are that they’re experiencing. So, for example, it’s easy to sort of go down that rabbit hole and say things like, They don’t like me. They’re always mean to me. You know, They’ve had me as, you know, I’ve been targeted since I started here. They’re mean to other people, but yet, you know, this is how they treat me. And they go on and on and on. And I say, What are they doing? What’s the behavior? They criticize me in front of other people. When they’re in charge, I get the worst assignment. Okay, How do you know you have the worst assignment? How do you define that? I get all the patients in isolation. Do you know that for sure? So I first start by encouraging them to start a documentation trail of all the incidents where they feel they’re being targeted in whatever, you know, whatever that experience is, the date, the time, the location, any witnesses, and then specifically, What did that person do? I had a brand new nurse share this story with me where she was working with her preceptor in an ICU. The preceptor had to step out for, off the unit for a moment, and told this brand-new nurse, hey, I want you to get the meds prepared for this one patient. When I come back, we’ll go over them, and we’ll give them together. She said, Great. Well, this new nurse had a question about a medication, and she wanted to call the pharmacist. She didn’t know the number. There were a group of nurses sitting at the nurses’ station, and she said, Hey, does anybody know the number for pharmacy? And one of the nurses sitting there said, Yeah, it’s one 1800, go f’ yourself. Said that to her, but said the word, and then the rest of them laughed. And I talked to her about this, and I said, Oh, include, anytime you can include verbatim comments in your documentation, include verbatim comments. It’s harder for people to defend themselves when you’ve got verbatim comments. And then also always consider what I call the so-what factor. So what? Somebody criticized you in front of everyone? Well, they criticized me in front of the patient, you know, and that causes stress and anxiety for the patient. So what is the so-what factor? Start a documentation trail, pay attention for a couple of weeks, get really clear on what the behaviors are, and then tell someone. Tell someone. Now, some people are afraid that, afraid of retaliation. One of the things that it’s like our superpower is we give a lot of confronting tools to people. Whether you’re in a supportive role, whether you’re in an executive role, whether you’re a physician, you’re a nurse, you’re in facilities, we give a lot of scripts because I know myself, in the moment, I don’t always know what to say, and I kind of get tongue-tied and then, you know, say something stupid but then the next day when I’m in the shower, oh, I can think of all sorts of things to say.

Mary Beth Kingston:
That’s in every aspect of life.

Renee Thompson:
Right? I’m always been envious of people who are just so quick.

Mary Beth Kingston:
Quick as can be. Yes.

Renee Thompson:
Yes. I’m like, Uh, uh, uh, you know, I get tongue-tied, and I don’t know what to say. And something like, you know, I’m offended by your comments. You know, I’m not willing to respond to that. Or, we, we’re big on naming it, You’re yelling at me in front of everyone. I just saw you roll your eyes at me. You just called me an idiot in front of our patient, okay? It’s naming the behavior. We give a lot of scripting resources for individuals and for the leaders, too.

Mary Beth Kingston:
You know, when I talk to people that have had microaggressions, for example, they have said it becomes exhausting sometimes to have to constantly point this out. So, I think another strategy is to help that team, that supportive team that’s there to say to someone, Hey, you know, that comment was, was out of line. Not always having to be the person, but to have someone else kind of step up, and that kind of builds that teamwork.

Renee Thompson:
A bystander, yeah. It’s actually more powerful for the witness to speak up on your behalf than for you to speak up.

Mary Beth Kingston:
And we should note that we have tremendously supportive nurses throughout this country as well. We don’t want to put our heads in the sand and say, This is not an issue. Because it is, and many times the issue is, I think people think of it as, you know, a hierarchical type of thing where, you know, you might have a physician and a nurse or a supervisor and a healthcare environment personnel or something like that, that there’s a hierarchy to it. How do you respond in those situations when it’s not a peer?

Renee Thompson:
Yeah, there is a hierarchy, especially in healthcare, it’s very steeped, and it shows up in different ways. You know, you have the C-suite, you have, you know, all the different layers of leadership all the way down to the person at the bedside, you know, the front line. And, but then you also have physicians, nurses, the, you know, therapists, the techs, the support staff, all the way down to the housekeeper. But then you also have a hierarchy as far as tenure, how long someone’s been there. You could be a nursing assistant or PCT and been there for 30 years, and yet you actually can act out towards someone with a higher ranking, I guess, than you, who’s brand new. And having a hierarchy is not the issue, it’s when you use your position, your role, your tenure as sort of justification for squashing someone else, and we see that more so in healthcare, I think, than in a lot of other industries. And that’s why we work with the entire healthcare team, and we call it like, our top-down, bottom-up, and everything-in-between approach. It’s the team, doesn’t matter how long you’ve been here. Although we, that’s a gift, that’s a strength that we want to tap into. But again, when it comes to conduct, it should not play a role on how long you’ve been here or what role you have.

Mary Beth Kingston:
Exactly. So, you know, we’ve talked a lot about what happens maybe at the unit or departmental level. What would you recommend organizations do, or either to begin to tackle this or to continue to address it, as many are?

Renee Thompson:
Yes. Well, it can’t just be something that’s a nice-to-do. It has to be actually hardwired into your strategic plan. So we spend so much time on recruitment right now but the retention strategies that I’m seeing don’t always focus on culture. So we recommend that you look at three areas. How do you strengthen your organization? And those are, you know, related to culture, and those are things like making sure that culture is on your strategic priority list as a need-to-have, not just a nice-to-have. Look at your policies. Look at your processes. Does everybody understand, you know, what bullying is, what it’s not? What are you doing to actually make sure that every single person you hire in your organization right from the beginning knows and understands that the way they treat each other is just as important as the care or services that they’re providing? So you have to build that in right from the beginning and then have ongoing opportunities to engage your entire team, your entire organization, including the C-suite, with ongoing skill development related to behavior. It can’t just be, Oh, we brought a bullying expert in to do a workshop and then check the checkbox. It does not work. So that’s, there are a couple of other things you could do with strengthening your organization surveys. You know, when I say, Pull back the cover and lift up the gown, we actually go in, and we do surveys, and we look at what’s really happening ’cause what’s interesting is, they may not tell you, but they tell us everything. It’s quite shocking sometimes what they, we’ll do focus groups, it’s quite shocking what they share with us. So that’s strengthen your organization. But then, a key next piece is how do you equip your leaders with the skills and tools that they need by giving them, you know, education, training, ongoing support, look at the relationship that they have with your HR partners, you know, what’s that relationship like, how do you come together? And then, finally, can’t just be the leader sitting around the table saying, Okay, how are we going to make things better here? You have to empower your employees to be a part of it, and that starts with making sure that they’re invited to the decision-making table and the conversations about culture. It can’t just be the leader’s responsibility.

Mary Beth Kingston:
Yeah. You know, it’s interesting, to me, it really, it’s encompassed by that whole culture of safety. People feel comfortable speaking up when something’s not going well, not just about patient safety issues, but about their own safety. And many times now, we’ll see people willing to speak up about workplace violence towards them, but maybe not bullying and incivility because it is a little less, you know, direct. But if you, I think it really comes under that whole culture of safety, making this a safe place for everyone and a wonderful place to work and to practice it. Are there any last words of advice you have for any of our listeners?

Renee Thompson:
First of all, it’s understanding that it’s a psychological reality that all human beings avoid pain. We are designed as a human race to avoid pain because pain could potentially affect our survival. Confronting someone about their behavior is painful, and this is where I see leaders, they need to work on this. You know, I teach this, and I am still uncomfortable confronting someone, but I have the conversation anyway, and I’ve gotten better at it because I’ve worked on it. So if you’re listening and you’re in a leadership role, just know that it’s okay to be uncomfortable. It’s okay to not want to confront somebody about their behavior. That’s considered normal. But we need you to, we need you to step up. We need you to start confronting these behaviors. If you’re not in a leadership role and you’re listening, do the same with your coworkers, or even if it’s your leader, be willing to have a conversation, even if it’s uncomfortable. But, you know, prepare and know what you’re going to say so that you can have that conversation and hopefully have a good outcome. But we’ve been using silence as a strategy for so many years. We have to start, you know, speaking up and confronting disruptive behaviors when we see them.

Mary Beth Kingston:
Yeah, that is such a great point. It goes back to just having those conversations. And I think your point about preparing, I mean, if I have to have a conversation like that sometimes I’m not sleeping too well the night before.

Renee Thompson:
Right.

Mary Beth Kingston:
But even just writing it down, and also your point about having that scripting, because you don’t, to just think off the top of your head in the moment is really difficult to do, and it’s difficult to have crucial conversations that way also.

Renee Thompson:
Exactly. I know, I created the scripts initially for myself, because I would get caught off guard and I would share those scripts with other people and they would say, Oh, I tried it and it worked, and, you know, that person stopped treating me like that. I thought, Okay, I’m onto something here because we’re really about the practical, you know, say these words, do these things to really help you to overcome your fears and overcome your discomfort so that you have a plan and that you can finally start addressing these behaviors. Because we have important work to do in healthcare, don’t we?

Mary Beth Kingston:
We do, yeah.

Renee Thompson:
We don’t have, I always say, we don’t have any time for these shenanigans, you know? We have important work to do.

Mary Beth Kingston:
We got to get to work.

Renee Thompson:
I know!

Mary Beth Kingston:
And I think that’s the thing. The work we do is really important and it matters. Yeah, yeah. Well, thank you, Renee, for being with us today to shed light on what I think is a very important and often unrealized aspect of workplace violence in healthcare, and that is bullying and incivility. The work you and your team are doing to bring not only awareness to this issue, but solutions, is really inspiring to all of us.

Renee Thompson:
Thank you.

Mary Beth Kingston:
I’d also like to thank all those who joined us today, as we continue to explore strategies to prevent workplace violence and create a safe and respectful workplace for all. Thank you.

Renee Thompson:
Thank you, Mary Beth.

Mary Beth Kingston:
Take care.

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