Last week, we explored the troubling issue of nurse bullying, also known as lateral and horizontal aggression or violence.  After our Mother's Milk show on breastfeeding, which aired last season, this program has generated the second highest number of emails, as well as posts to our blog and to our Facebook page.  It's a difficult subject; one that generates reactions that range from anger to despair.  Click on the link to read a sample of the many emails we received from you.

Agnes Riediger of Whitehorse, NWT, contributed this email:  "I am an R.N. at the hospital here in Whitehorse, and I had not experienced bullying till my latest job.  The previous person in the job was being bullied and as I was working casual with her I would tell her to confront the manager and not let herself be bullied.  My co-worker left and I got her position and the bullying started.  I would wait a few days and organize my thoughts and confront my manager.  Each time she backed down and apologized but this probably happened four or five times.  Eventually a group of us organized a meetingg with our hospital CEO and aired our views.  All he said he could tell us was that this wasn't going to happen again and basically it hasn't so we knew she was spoken to."

Kim Tomsich of Vancouver writes:  "I have worked in a Vancouver hospital for over twenty years. I love nursing and like to think of myself as a consciensious nurse.  Does bullying exist?  Overwhelmingly yes.  Of the many head nurse-managers I have worked with, they have been all across the spectrum.  The head nurse that hired me ran a tight ship, stood up for her staff, would not tolerate bullying from anyone to anyone, I could go on about her many attributes -  standing at the desk tapping her watch when tardiness occurred on a regular basis, paging doctors to return to the unit to complete a task, be it return the chart wheel to the desk or finish a converstion with a patient, sitting and consoling a new nurse and encouraging her not to give up."

Liisa Toner-Lindsay of Sudbury, Ontario, writes:  "Having just retired as a Nurse Consultant and prior to that a cardiac nurse, etc., I have observed that bullying is just one part of the continuum in making war.   Regarding your program one might add that many managers use bullying among employees as a managerial strategy.  And this is part of upper management philosophy of maintaining hierarchial power.  Fortunately, there are evolutionary developments that admit to this hitherto denial and look beyond this primitive way of relating to others.  This advancement is a result of the perseverance of many including mine, as well recent legislation as was noted on your program."

Luella Gilchrist of Kingston, Ontario, sent us this:  "You were dead on.  I've been a nurse since 1989 and found it pretty horrible a lot of the time because of bullying.  Especially when you are new and they give you only part of the information you request, holding back info and then indicating how stupid you are when you can't succeed.  That one is typical.  You are right about another thing.  I worked in the US and found nurses there so much kinder and helpful to each other there.  I worked in five states so it was not just a lucky placement.  Bullying in Canada is a huge problem in nursing...thanks for pointing it out."

Trevor Johnson of Markdale, Ontario, sent us this:  "It was nice to hear someone speak a bit of reality on the subject of bullying.  It's a result of how someone is treated.  Not just nurses.  I think the biggest problem with bullying is the hypocrisy surrounding the subject in our society.  North American Corporate culture is somewhat basted on bullying.  That's how you form monopolies and build empires.  It is unfortunate but I think the anti bullying battle is a losing one for now."

Corinne Hart if Toronto writes:  "Thank you again for an excellent show. As a nursing prof I have posted the link to my third and fourth year nursing students.  Of interest, I am in the midst of a study at a Toronto hospital. The intent was to explore interprofessional collaboration; it ended up with a strong focus on nurses, nursing and issues of real and perceived power. This arose from what many nurses described as passive aggressive behaviour, power struggles, etc. Underlying some of issues of bullying is the notion of real, (and often even more important), perceived power. A discussion that nurses both intra-professionally, and inter-professionally, need to have more explicitly than is the current practice!"

Jason Pedersen, a nurse from Terrace, B.C., sent this email:  "Finally a voice. This problem is bigger that ever thought. Students are being bullied daily and told to keep thier mouths shut for fear of losing their education. We are teaching our future nurses that this behaviour is acceptable and potentiating an wave of new nurses with aquired skills in bulling. There are more stories out there other than mine, I'm sure that more students would speak out if they new that they were not alone and they didn't have the fear of losing thier education."

Karen Bonham of Welland, Ontario, writes:  "Thank you for bringing this topic forward.  Keep up the important work you are doing at White Coat Black Art."

Alison Washington sent this email all the way from Canberra, Australia.  She writes:  "I live in Australia and have just read and listened to you article regarding workplace bullying amongst  nurse's and thought is was brilliant. I have share this everywhere on Facebook . I am an administrator on "Beyond Bullying Australia".  After suffering severe workplace abuse, I am now an advocate for others  to educate and support people that go through this.  I have known some that have committed suicide as a direct result of workplace abuse. Thank you so much for doing the program and highlighting this about nurses. I was a highly qualified nurse and have left my profession due to this and it grieved me greatly to have to do so."

We received many emails from insiders to the health care system. Pam Makeiff, who works for the Interior Health Authority in Salmon Arm, B.C., sent us this: "I'm not glad to hear about nurse bullying, but I was glad to have heard your program.  I couldn't believe I tuned it when I did.  I had such a sad week last week due to bullying towards my child.  After helping him and having his wonderful teacher help out, it's such a shame that I had to tell him that there are bullies at most stages of our lives in some shape, way or form and even into adulthood but we have more tools to handle it and navigate around it.  It's darn unfortunate.   I want to say I work with a pile of nurses and all are absolutely wonderful and loving, but that's a health unit.   It sounds like it's really nasty in some parts of the (hospital) nursing world and that's just so unfortunate.  We must change this and one person at a time can.    I just wanted to say I loved what you said at the end of your program  - Get help and/or find another job."

Pam Marshall, Executive Director of Patient Relations and Legal Affairs for The Scarborough Hospital, sent us this note regarding our guest, former nurse manager and author on nurse bullying Kathleen Bartholomew:  "Her books are an excellent resource on this topic and I look forward to listening to the program. As an ED physician I am sure you know that bullying in nursing is also an issue in Canada. I have done a number of training sessions in our facility as well as for other nursing groups, including the Registered Nurses Association of Ontario on this very topic entitled "Mean Girls is Not Just a Movie" .  Bullying or horizontal violence continues to be an issue throughout all areas within the profession and one which does not have easy answers. Thanks for bringing attention to the issue through your show."

Vivian Cruise of Fanny Bay, B.B., writes:  "What an amazing thing to hear and yes it is true.  I think that some nurses bully because they do know a lot about medicine and the human body therefore they think that they are knowledgeable about all else in the world and that their knowledge entitles them to be in charge.  Their resentment that they probably know as much as many doctors might have some bearing on it too.  I know a fair number of nurses and there are lots of wonderful, caring and compassionate ones but there are a few that are bullies, arrogant, cruel and dangerous.  I wonder if the number of  "medical errors" has a correlation with nurses that bully on that ward or floor of that hospital the experienced the problem.  One nurse I have to deal with in a non medical situation is a bully about everything else in life.  We are on a Board of Directors together and she just argues and belittles people down into where she thinks they should be.  More and more of us are standing up to her but her actions may have repercussions and destroy the organization if she isn't stopped."

 Marion Jurrjens of Pomeroy Ridge, New Brunswick, sent us this:  "I am an RN in my 40th year on the floors, having moved from the Netherlands to Canada in 2003.  My psychiatric background served me well to cope with the bullying so prevalent here when I became a Canadian RN in a rural hospital. From working in Holland with a mix of fifty percent male colleagues in psychiatry, I suddenly found myseld working exclusively with female colleagues that had worked there for twenty years or more. Some had not talked directly to each other in many years although at the same ward and were using the charge nurse as a go between. No yearly evaluations, only remarks on paper for everyone when it really only concerned 'the bad apples" in the bunch.  What a difference to go from an open culture to such a closed one. I had never experienced such a work environment before. Thanks for a great program, will certainly become a regular listener to your show."

We received this email from a listener in Winnipeg whose name is witheld because of a confidentiality agreement she had to sign.  She writes:  "Dear Dr Goldman,  Your show, White Coat, Black Art, plus your other radio pieces, are of great national importance and I thank you for them.  Having said that, I was dismayed to hear in the last few minutes of the show that bullies are insecure cowards and that victims need to report them and stand up to them.  That classic understanding of bullies and their nature is simply wrong, and following that advice can often ruin the victim's life even more thoroughly than the bully can.  An innocent victim will often not realize what is being done to them, will try various good-faith strategies to satisfy the bully, and will eventually be so demoralized that their performance is affected.  Until we become fully aware of what it looks like and its effects, we will pay for it without knowing those costs, in money and heartache; costs that could have been avoided completely"

More than one listener wanted to talk about patients being bullied.  Eleanor Jackson of Vancouver sent us this:  "Listening to your program this morning brought back a flood of memories of my experience as a patient in hospital in August 2007.  I was a senior in hospital following surgery for a broken leg.  The third night I was incontinent and suggested they leave me on a pad and no diapers.  They did, but I spent the whole night in a wet bed.  When I rang the bell, one of them reluctantly came, and I asked for a dry pad.  I always got one, but it was put on top of the wet pad and bed, so the dry one didn't give me much relief.  At five a.m., I rang and said I wanted to get up and washed and dressed.  I was informed by one of the nurses that they had already just started on the other side, so I would have to wait.  In another five minutes or so, she came back and through a damp cloth and towel.  So I got myself up  and dressed  and eventually got a dry bed, except one corner was wet.  However, the day nurse informed me it couldn't be wet, because it was just freshly made.  After fifteen minutes of insisting it wasn't wet, I pulled that part of the bed apart and discovered a wet towel.  Even before this, I had decided that I was going to sign myself out.  I called my own GP and told her what I was going to do,  and, eventually, I did go home that day."

Marsha Cannon of Swift Current, Saskatchewan writes:  "I was disappointed that the episode only addressed bullying amongst nurses and not as it may relate to patients. My husband was buried in a trench and luckily escaped with a severely broken pelvis and two broken collar bones. As you may be able to appreciate, the broken collar bones complicated moving him with regard to the pelvis. To make matters worse he had been buried in very sandy soil and for three days lay on his back on sand before they figured out how to lift him and clean it off properly.  The skin on his back was rapidly breaking down as a result of this and we knew it was imperative that he roll over - it just was incredibly difficult to achieve.  I arrived at the hospital the morning of day three to find my forty year old fiercely independent farmer/rancher husband in tears and frightened.  Since he was admitted the nurse manager had informed him that he had to roll over and would come in regularly and harangue him to do so or to let her do so.  On day three, she had proceeded to attempt log roll him over his protests causing excruciating pain and moving the broken collar bone ends on both sides out of alignment necessitating them being reset.  This happened twice and then she gave up in frustration and informed me that he was a difficult patient who was not taking steps on his own to get well.  She advised me to take him in hand and explain that this was necessary for his own good.  After banishing her from the room and calming him down I had him tell me what he felt would be required in order to get him rolled onto his stomach.  My sister and I then spent an hour and a half carefully moving him bit by bit and taking cues from him. Using piliiows and sheets, we managed to get him on his stomach and give him some relief.  We pulled the curtain back once we had him settled to discover three nurses quietly standing there trying to figure out what we had done so they could help him.  He was in hospital for four weeks and in recovery much longer but the experience stays with him to this day.  The nurse manager avoided him for the rest of the month that he was hospitalized and on the last day came and apologized for the pain she had caused.  We have nothing but praise for the rest of the nursing and medical staff that cared for him during that time but unfortunately, what sticks is the bad experience.  Your program revealed some reasons whay such events occur - a healt professional unhappy in the workplace is likely to take out that unhappiness on co-workers or patients creating an environment less than conducive to quick and successful recovery.  Thanks for a fascinating program and continued insight into life on both sides of the gurney."

Ruth Slater thought we should have spent more time addressing the systemic issues that contribute to bullying.  She writes:  "I would like to suggest that, as your guest indicated, it would be more helpful to identify and address systemic issues involved in the whole health care field that contribute to power imbalances and tremendous stress than to focus on one discipline in particular and perpetuate stereotypes about them.  After your guest identified these factors, your response, I believe, was to ask essentially  "how can the manager catch the (nurse) bully?" rather than to acknowledge what she said about how people treat others the way they have been treated themselves.  I am not a nurse but I have worked, and still work, closely with many nurses and I continue to be struck by the herculean tasks they face and the huge discrepancies in power and status that exist between them and the physicians they work with.  Your cavalier suggestion that bullies just "get another job" or just "stop" their behaviour completely misses the crucial point that most bullies, regardless of their profession, are very unhappy themselves and do not feel they have options other than lashing out.  Although you made passing references to the fact that bullying behaviour can happen between members of other disciplines, and although we do, indeed, need to support nurses who are bullied, I am concerned that your piece has done more to contribute to a negative perception of nurses than to work towards any kind of solution.  You could have interviewed people from other disciplines.  You could have interviewed people who have expertise in team building.  You could have interviewed nurses who work very well with each other and asked them how they do it under such adverse circumstances.  Any of these would have identified the issue and not been at risk of doing more harm than good."

Some were disappointed we didn't talk at length about bullying in other health professions.  Britt Santowski of Sooke, B.C., writes:  "I kept on waiting for the veil to be lifted, but it never was. The reason why you never hear that doctors eat their young, and why it's narrowly associated with nurses is an issue of gender, not profession. It has to do with the power imbalances between men and women. In any female-dominated profession, women can only step on the broken bodies of other women, which they break through bullying. The prevalence of passive-aggressive bullying is also a female domain. It begins in the public schools (and sadly, sometimes even earlier). Boys typically use violent contact; girls avoid contact at all costs, and employ gossip, rumour and exclusion to do their damage. Sound familiar? As a woman, mother of a school-age daughter, I am all to familiar with this silent female bullying. I'm sad, but not at all surprised to hear that it is very prevalent in the nursing profession. I agree that the answer lies in confronting the bully.  It also lies in breaking the tradition of female bullying, and start working in collaboration with, and to the advantage of, other women. It begins, and ends, with women."

Some of you took issue with some of the comments Kathleen Bartholomew made.  Kathleen Crone of London, Ontario writes:  "I have great respect for your program and thank you for stimulating my thinking about medical issues. I have always felt trust in what you present. 
To explain my viewpoint, I started my nursing career over 51 years ago and last worked at one a.m. this morning.  A few weeks ago I had a discussion with my superiors that bullying is not and acceptable term within the profession of nursing.  Each utterance erodes the public perception of what nurses do.  Bully may be a buzzword of this decade but should not enter the medical domain.  Perhaps incivility and bad mannered would be more appropriate.
I question Kathleen Bartholomew's righteous statement that nurses are passive aggressive do not have communication skills.  She is indicating that nurses come from a common   mold with uniform personality traits.  I always think of nurses as being educated human beings who have joined the nursing profession.  My major concern is that you have said, "You know you're doing it. Get therapy!"  I take this as a cheerleader mentality of jumping on the bandwagon and agreeing with these utterly foolish statements from Kathleen Bartholomew."

Jacqueline Power, Assitant Professor of Management at the University of Windsor, also took issue with my comments at the end of the program.  She writes:  Dear Brian, I was concerned that you recommended that bullying nurses stand up for themselves and about your statement that bullies will back down if victims confront them.  Actually, workplace bullies escalate if you confront them.  Bullying researchers recommend that victims become passive and that victims look for other jobs.  The ongoing stress of working with a bully - more stressful than being a peacekeeper in a warzone - leads to ongoing physical problems.  I am currently anayzing the personality of workplace bullies and bullying amongst nurses.  Bullies do not suffer from low self-esteem and... confronting them makes things worse."

Heather Woodbeck of Thunder Bay, Ontario, writes:  "I am a long time listener of your show. In general, I think you do an excellent job at portraying health care issues in a balanced way.  While I agree there is definitely bullying in health care, to be perfectly honest, as a nurse, I was not very impressed with how you honed in on nurse bullying as if that was the only kind of bullying that is occurring.  Most of the nurses I know have many stories of physician-nurse bullying everything from being sworn at by physicians to being humiliated when questioning an order. I've personally witnessed more than a few physician tantrums when things were not done in a way that the physician demanded.  The roots of our health care system are in a male dominated hierarchical system in which physicians gave the orders and nurses carried them out. In the past, both nurses and physicians were trained in an apprenticeship system.  In Ontario, it is only in the 1970's when the last hospital schools of nursing were closed. I would suggest to you that there are deeply imbedded traditions in both medicine and nursing of treating the newest members of the profession in a condescending manner.  With the current focus on rights, interprofessional care and healthy work place environments, I personally think things are getting a bit better in health care."

Some of your wrote about the positive work experiences you have had. Pat Morris of Kelwona, B.C., sent us this:  "I listened with interest to your broadcast about bullying in the workplace for nurses.  I was a nurse for thirty-six years before retiring in 2008. For the last twenty-seven years of my career, I had the great fortune to work as a home care Nurse in Kelwona, B.C.. I say that because during most of those years, I had two nurse managers whose philosophy was "Caring Leadership" in the truest sense.  Our fundamental core values were that of respect for one another, trust in our abilities, celebration of our differences and provision of an atmosphere and tools for each of us to explore our particular passion in nursing thus becoming leaders as well.  Because of this, the culture amongst us was always positive, stimulating and fun. It was always a safe environment to admit our shortcomings and seek help from our co-workers.  There was always a listening ear or a helping hand for support when dealing with complex patient care.  I saw first hand how our young bright new graduates blossomed in this environment and were an integral part of our being able to adapt to the health care system as it is today.  Finally I believe that this philosophy and culture in our organization translated into excellence in patient care and a healthy staff. How lucky I was to have nursed in this environment for so long."

And finally, Tina Hahn said my personal experience of being bullied as a child touched a nerve with her.  She writes:  "Dear Dr. Goldman, I'm writing because my personal history echoes yours. I too "accelerated" through elementary school doing grades three and four together. I found myself sitting outside the principal's office in Grade five because of stomach cramps because someone in the "slow class" had threatened to punch me. And while I did not reach my parent's goal of becoming a doctor, I have devoted my life to telling the stories of people with special needs. I've made films with strong anti-bullying messages, and am now working on a web-site for youth to help build their self-esteem and independence skills.  I had forgotten about that Grade five bully and now am watching my daughter (now ten) deal with the sometime aggressive and hurtful behaviour of her classmates. Thank you for giving me an "ah-ha" moment today."

And thanks to all of you for bringing your thoughts to a powerful discussion.