Abstract

This article provides an overview of workplace bullying in midwifery and how it may be addressed. Typical bullying behaviour, the effects and implications for individuals and employers are discussed together with the unsavoury topic of bullying of a client by a midwife, and what to do about it.     

Workplace bullying is responsible for an increase in stress and stress-related illness in the workplace. It can cause or exacerbate conditions such as hypertension, anxiety disorders, alcoholism, gastrointestinal disorders, depression, post-traumatic stress disorder (PTSD) and suicide. For employers it leads to high rates of absenteeism, under-performance and can cost financially in the settlement of litigation claims. yet it is often ignored because colleagues and managers  alike are unsure how to handle it.     

The law is very clear that bullying and harassment are illegal. Seven separate Acts of Parliament are cited in this article which are designed to protect individuals from various forms of bullying and harassment.

This article also provides practical solutions, with action checklists, for both managers and the targets or workplace bullying, whilst emphasising the fact that to ignore bullying is to condone it. The employer's responsibility is highlighted simply because the employer hads a legal responsibility to prevent workplace bullying and is also in the best position to address it.

The section subtitled 'What to do if you are being bullied' provides practical suggestions for those individuals who find themselves targeted by a bully. These can be followed in order of priority.

Introduction

Workplace bullying is a collective term for inappropriate behaviour in the workplace. Typical bullying behaviours include:

During the early 1990s, a bullying management style was often condoned and bullying managers were often praised for running a 'tight ship'. It is still a common management myth that strict, authoritarian managers get better results. In fact, the reverse is true: performance improves in a climate of trust and respect (a high-trust culture) where employees feel nurtured, appreciated and valued. Performance declines in low-trust cultures where employees feel undervalued, overworked and taken for granted.

Culture is defined by sociologists as: 'The values, beliefs, customs, rules and regulations of a group or society'.¹ A bullying culture in the workplace creates an unhealthy, negative, working environment where trust is low or non-existent and employees contribute little for fear of ridicule. Fear of having their ideas (intellectual property) 'stolen', of not being given credit, not being appreciated, acknowledged and valued, leads to less creativity. Employees are more likely to 'dump' problems on the manager's desk rather than try to come up with creative solutions themselves. In this low-trust climate employees are suspicious. They withdraw good will, are unwilling to contribute and they look around for another job -

"I would leave tomorrow if I could find another job."²

Many workplace bullies would not think of themselves as bullies or even admit that they intend any harm. The fact is that if they adopt a bullying approach in their interactions with their colleagues they must at least have intended to control, coerce and/or humiliate.

"...she stood and humiliated me so much in front of a lady we were looking after that the client told her there was no need to be so horrible".²

The effects of bullying

The effects of bullying are devastating for individuals, their families, our working environments and organisations. Bullying is a stressor, that is: a factor which causes stress.

On a personal level, bullying will either induce stress-related disorders or exacerbate exisiting symptoms.

Stress related disorders include hypertension, anxiety disorders, alcoholism, gastrointestinal disorders, depression, PTSD and suicide.

Those targeted by workplace bullies will be familiar with the above list of symptoms. Employers can recognise a bullying culture within a NHS Trust or a department by high staff turnover or high sickness levels. However, it must be noted that in times of recession, turnover decreases as jobs become hard to find and it must not be assumed that a bullying culture does not exist. During such times sickness levels are the better indicators that bullying could be a problem.

Bullying is illegal and costs employers dearly. For employers, bullying will (at best) result in high staff turnover, increased absenteeism and under performance. At worst, it could result in a lawsuit where the employer is sued for a failure in their duty to care for an employee and is forced to pay up to £ 200,000 in compensation (see: http://www.bullyeq.com/bol/action/caselaw.htm )

Workplace Bullying: an action checklist for proactive midwifery managers

The implications for professional practice are that workplace bullying leads to under-performance; poor concentration; low esteem; lack of confidence and increased alcoholism. This puts women and colleagues at risk and forces experienced people to leave the profession at a time when we are desperately short of midwives.

The employer's responsibility

It is the midwifery manager, as agent for the employer, who has the primary responsibility for addressing a workplace bullying situation within a midwifery team, unit or department.

Under the Health and Safety at Work Act 1974³ employers have a legal responsibility to protect the health and safety of their employees whilst at work. The Sex Discrimination Act 1975,⁴ the Race Relations Act 1976⁵ and the Disability Discrimination Act 1995⁶ make any form of bullying which involves gender, race or disability an offence. Persistent harassment and stalking are offences under the Protection from harassment Act 1997⁷ and the Criminal Justice and public order Act 1994.⁸

'The Employment Rights Act 1996 gives protection to employees with qualifying service by allowing them to claim 'unfair constructive dismissal' if they are forced to leave their job because of the actions of their employer. Such actions might include failure by the employer to deal with any complaint of bullying or harassment, or failure to protect their employees from bullying or harassing behaviour.'⁹

In the event that it causes a recognised mental illness, bullying or harassment could be considered assault and/or grievous bodily harm carrying a maximum sentence of five years or life imprisonment respectively.¹⁰

Where bullying is suspected this should be assessed and monitored within the context of a risk assessment strategy, where any risk to clients' (and other employees') health, safety and well being should be regularly monitored.

The Advisory, Conciliation and Arbitration Service (ACAS) (www.acas.org.uk) recommend that 'dignity at work' policies should be developed to establish frameworks for employees to maintain their dignity, well being and integrity. These policies can allow grievances to be aired without the target having to directly address specific line managers who may be bullying them. Circulars can be sent to staff informing them:

Midwifery managers must act proactively (Figure 1). Midwives invariably do not want to create bad feeling, however, by the time a midwife is forced to seek redress through an organisation's grievance procedure, a bullying situation is usually prolonged and serious. Even at the first level of a grievance procedure, most midwives simply want an apology from the bully, the bullying to stop and to be reassured that management are taking action to prevent a re-occurence.

Midwifery managers can conduct confidential enquiries that assess bullying within NHS Trusts or departments. Performance reviews such as 360-degree feedback¹¹ which take interpersonal skills into account, and allow for assessment by peers and subordinates, may highlight a bullying style before any harm is done. Where bullying styles are identified managers can arrange for the individual(s) concerned to be coached on improving their interpersonal skills. Coaching is believed to be more effective than counselling because it calls for action and measurable behaviour change.¹² Performance objectives can be set which the coachee is required to meet. Following a period of coaching the performance review should always be repeated and performance improvements measured and monitored.

Bullying of a client by a midwife

This is fortunately a rare occurrence but as long as it remains a possibility everyone involved in the care of clients must remain vigilant. Practising midwives have statutory responsibilities relating to the Nurses, Midwives and health Visitors Act 1979¹³ - these are outlined in the United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC) Code of Professional Conduct.

Fig 2. Action checklist for targets of workplace bullying

A. It is essential for your safety, health and well-being that you first:

• record everything
• cultivate a personal support network
• avail yourself of training and/or coaching in assertiveness skills and personal stress management
• seek appropriate medical advice for stress related illness
• tell the bully what they are doing and ask them to stop

B. You may then choose the following (in this order):

The UKCC has produced guidance for managers and employers¹⁵ on reporting fitness to practise, and for all practitioners on practitioner-client relationships and the prevention of abuse.¹⁶ Abuse can be physical, psychological, verbal, sexual, financial and/or neglect. According to the UKCC, psychological abuse involves any verbal or non-verbal behaviour which demonstrates disrespect for the client and which could be emotionally or psychologically damaging. Verbal abuse is any remark 'made to or about the client which may reasonably be percieved to be demeaning, disrespectful, humiliating, intimidating, racist, sexist, homophobic, ageist or blasphemous'.¹⁶ The examples given include the use of sarcasm and a condescending tone of voice. The responsibility of colleagues is explicit:

'Zero tolerance of abuse is the only philosophy consistent with protecting the public'.¹⁶

Any midwife who witnesses such abuse, verbal or otherwise, of a client is required to 'report it as soon as practical to a person of appropriate authority'.¹⁶

In this instance the appropriate person of authority would be the statutory supervisor of midwives and the midwifery manager.

What to do if you are being bullied

The single most important thing you can do is to record everything. Even if you never intend doing anything about it simply record the facts to the best of your recollection, sign and date it.

Develop a support network for yourself which could include friends, family, colleagues, a personal coach, counsellor, and/or your manager. If you choose to tell your manager take someone else with you. There are support groups where you can talk to others who are going through the same experience and enlist their support also. (see: www.workplacebullying.co.uk). Whether or not you decide to take a case forward, you will still need people to talk to who can provide ongoing support for you.

Make sure you are well trained and skilled in the practice of personal stress management techniques and that you have a mastery of assertiveness skills. A personal coach can help you with these.

If you are experiencing stress-related symptoms you must see your doctor and have your condition diagnosed formally. it will help a future court case if your doctor can record that your symptoms are caused or linked to workplace stress.

Let the bully know what they are doing is wrong, how you feel about it and ask them to stop. If you do not feel strong enough to confront the bully alone take a friend or union representative with you. Alternatively write to them, keeping a copy of your letter together with any reply. It is important that the bully knows what they are doing is harmful to you. In the event that you do decide to pursue your case through the legal route this also prevents the bully from denying their actions, claiming they didn't know how you felt or that it was 'harmless fun'. Consider your options (Figure 2). When you have informed the bully that may be the last you hear of it. Unfortunately, the bullying may continue and you may feel you want to take it further. Maintain strong links with your support network.

Never meet with management alone. Involve a trade union or professional association. if you are not currently a member, join one. Whether you believe they can help or not they will have experienced workplace bullying before and in many NHS Trusts will have been involved in policy making. They will also know the grievance procedure in your workplace.

If you decide to take action use the grievance procedure. Follow every stage of the grievance procedure as laid out by your employer. This is important should your case go to court. Even if you think it is ineffective, and believe your employer is not doing anything to address the problem, it is important that you at least give them the opportunity. If it gets as far as an industrial tribunal, you could be criticised for not using a grievance procedure if there was one there for you to use.

You may also wish to seek independent legal advice. You could contact ACAS for advice or the Law Society (see websites at end of article) who can let you know of solicitors who specialise in employment law. If you believe you have suffered a recognisable mental illness (such as depression) as a result of bulying or harassment at work, it may be a personal injury solicitor you seek. If you have to leave your employment because the situation becomes intolerable, it may be an unfair constructive dismissal route you pursue. It is important to seek the appropriate professional advice for your particular case.

Assertiveness coaching

When confronted with a bullying situation for the first time most of us are unprepared. We often don't know what to do and think of dozens of things later which we could or should have said or done. Sometimes we criticise ourselves for handling it badly yet we are unaware that we could have been prepared. It is important to be coached on your assertiveness skills so that you become adept at putting them into practice rather than just having knowledge of the theory. This will enable you to develop a strong foundation, high personal standards and set strong personal boundaries.

'Boundaries are invisible lines we draw around ourselves to protect us from the ill effects of other people. Having strong boundaries doesn't mean you build a wall around yourself and become an island in which you are isolated from others... [boundaries] do the opposite - they enable you to be with others without having to suffer them.'¹⁷

Conclusion

Adams A. Bullying at work: how to confront and overcome it. London: Virago, 1992.

Hadikin R, O'Driscoll M. The bullying culture: cause, effect and harm reduction. Oxford: Books For Midwives Press, 2000.

Randall P. Adult bullying: perpetrators and victims. London: Routledge, 1997

Useful contacts:

ACAS: Tel: 0207 396 5100; Website: http://www.acas.org.uk

Law Society: Tel: 0207 242 1222; Website: http://www.lawsociety.org.uk

Access Employment Law A UK firm of solicitors specialising in workplace bullying. They represent targets of bullying and offer advice on prevention to employers. Call 01772 792777 for advice and information.

(update Nov 2009 The UK National Workplace Bullying Advice Line has evolved into "Bully Online")

Websites: :

http://www.dreamcoach.co.uk

http://www.workplacebullying.co.uk

Access Employment Law A UK firm of solicitors specialising in workplace bullying. They represent targets of bullying and offer advice on employment law to employers. Call 01772 792777 for information.