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Constantly criticised, overruled, undermined, undervalued, humiliated, threatened, intimidated? Read this

Information on bullying and harassment for
UK nurses and healthcare workers

Bullying of nurses, NHS bullying, illegal suspension

On this page
Suspension
Recent press coverage of NHS staffing crisis
Harassment procedures in the NHS

Nurses and healthcare employees account for around 12% of over 10,000 cases of bullying reported to the UK National Workplace Bullying Advice Line between 1996 and 2002. Surveys by Unison, RCN and others suggest that levels of bullying in nursing and healthcare are around 33%.

A review by the Nuffield Trust (1998) found that between 29% and 48% of UK nurses are suffering symptoms of psychological disturbance ranging from depression to suicide. Between 1991 and 1995, emotional exhaustion doubled. The main causes cited were overwork, bullying, staff shortages, unsupportive managers and insufficient time to give patients emotional support. It was noted that where staff were allowed to express their views and management worked with nurses to solve problems jointly, stress levels were lower.

Nursing, healthcare, and the voluntary sector (especially elderly care and childrens' charities) have accounted for the largest growth in Advice Line calls since 1999. In the NHS, high expectations imposed by government have led to patients and their relatives demanding and expecting more and more, understaffing and excessive working hours and regimes are now the norm, and there's been a significant rise in the levels of violence that nurses experience. It's hardly surprising that, as with teaching, more nurses are now leaving the profession than are joining it. The government's answer is to fly in temporary nurses from Australia, South Africa and the Philippines - which neither identifies nor addresses the cause of the nurse shortage problem. In February 1999, the government announced a 4 million nurse recruitment drive. The message? You too can become a nurse and experience the appalling working conditions that cause so many to leave the profession.

In 1998/99, UK spending on the NHS was 46 billion, or 790 per person, around 6.7% of GDP, the lowest in Europe.


Suspension in the NHS

The NHS uses suspension as a means of getting rid of staff who have gone off sick because of bullying and harassment or false allegations made against them. Suspension in the NHS: many people are left so traumatised by the experience that they never return to work in the NHS: http://www.suspension-nhs.org

Suspension Failure in the NHS: http://www.ten-percent.co.uk/Reportonfailure.pdf

The Role of Unions in NHS Suspensions (PDF format): http://www.ten-percent.co.uk/Report_on_the_Role_of_Unions.pdf


NCSC: As research for a forthcoming Court Case and Tribunal I am collating information about inappropriate behaviour by National Care Standards Commission (NCSC) Inspectors towards Nurses in the Private Sector. This may relate to Inspections of Nursing Homes or Private Health Care establishments. If anyone has any evidence of bullying and abuse of nurses or carers by this relatively new body I would be grateful if they emailed me at the below email address. I am specifically looking for evidence of complaints of bullying, harassment or intimidation. I would also like to hear of the manner in which complaints were dealt with by the NCSC. If anyone has any success stories or evidence of good or excellent practice by the NCSC I would also welcome this. Full confidentiality will be guaranteed. I can be reached on timburnes@hotmail.com


Freedom to Nurse is a group run by and for grassroots nurses with the aim of allowing qualified nurses the freedom to practise our skills at the bedside. We offer support to nurses who are bullied when they try and tackle problems at work such as lack of staff, bullying, poor skill mix; or inadequate patient care by support workers in nursing homes. We can be contacted through our new web site at www.freedomtonurse.co.uk where we offer advice about bullying and whistleblowing, as well as news and views, plus our Survival Guide. Or you can contact us by e-mail on freedomtonurse@yahoo.com or by post at Freedom to Nurse, PO Box 37, Worksop, Notts S80 1ZT.


NHS Injury Benefits Scheme
The Injury Benefits Scheme provides benefits for any NHS employee who as a result of an injury, disease or condition caused by their NHS employment: http://www.asu.org.uk/advisor/ibs250300.html


www.StaffNurse.com is the UK's number one place for nurses, midwives, health care assistants and health visitors. We have a growing online community discussing everything from work related issues to family life!


The Campaign for Health Service Democracy is a network of people and groups all over the UK sharing the aim of making health service professionals accountable to local bodies whose members are democratically elected through direct elections.


www.nurses-are-bullied.org describes in detail the bullying that has occurred in one NHS Trust in southeast England.

NHS Exposed exposes various issues within the NHS sector.

Exposing your NHS exposes various issues within the NHS sector.

NHS Expose questions the alleged transparency of whistleblowing in the NHS: http://www.nhsexpose.co.uk/


Contribute to an online survey of nurse-experienced workplace verbal abuse to assess nurses' experiences of verbal abuse in the workplace ... click here.


Fear of a bullying boss, or fear of someone in higher authority who can wreck your career, is a common reason for people refusing to speak out. Disaster and death can result. An article by Olivia Barker in USA Today on 8 December 1999 titled "4 studies aim to reduce, resolve medical mistakes" reports the Institute of Medicine's finding that 98,000 people die each year from medical mistakes caused by cultural and systemic problems. In many cases a junior member of staff saw the error being committed but was too afraid to speak up. Bullying by consultants is rife in health services, many of whom fit the Guru profile. [Examples: #1 #2 #3 #4 #5]


Bullying and harassment are at epidemic levels in the NHS, say the MSF union (NHS News, September 1999, Issue 4). Recognising that there might be a problem, UK government health ministers have set specific targets to be achieved by April 2000 for tackling racial discrimination. The requirements are set out in a booklet Tackling Racial Harassment in the NHS - a plan for action, available free from Department of Health, PO Box 410, Wetherby, Yorkshire LS23 7LN


NurseAdvocate is an international email list about nurse-experienced workplace violence and its underlying causes.

Violence has been defined by the International Council of Nurses as "being destructive towards another person," and abuse as "behavior that humiliates, degrades, or otherwise indicates a lack of respect for the dignity and worth of
an individual."

See Carrie Lybecker's Nurse Advocate: Nurses & Workplace Violence web site at http://www.nurseadvocate.org

For more information and how to join NurseAdvocate, see http://www.nurseadvocate.org/list.htm


The Bullying Culture, Ruth Hadikin and Muriel O'Driscoll, Butterworth-Heinemann, 2000, ISBN 0-7506-5201


Recent press coverage

For news items see the BBC News Online web site and use the Search facility at the bottom of each news page. Search on words like "nurses" and "midwives".

May 2005

NHS needs to tackle soaring levels of workforce stress
"This problem is not about whingers and malingerers," says Professor Cary Cooper, "... the assumption that the employee is at fault, rather than the organisation": http://www.nhsconfed.org/press/releases/workforce_stress.asp

Nurses take more sick time off work
Bullying is a primary cause of stress: http://news.bbc.co.uk/1/hi/health/4619245.stm

UK crippling African healthcare by poaching its staff
http://news.bbc.co.uk/1/hi/health/4582283.stm

April 2005

One third of medical students bullied
http://www.dehavilland.co.uk/webhost.asp?wci=default&wcp=NationalNewsStoryPage&ItemID=8425131&ServiceID=8&filterid=10&searchid=8

March 2004

Commission for Health Improvement (CHI) survey of UK NHS staff
37% of staff experience bullying harassment or abuse: 
http://www.chi.nhs.uk/eng/surveys/nss2003/index.shtml with survey results at http://www.chi.nhs.uk/eng/surveys/nss2003/key_findings.pdf and comment from Amicus-CPHVA at http://www.amicus-cphva.org/pressreleases/pr04/prschisurvey.htm

November 2002

Mental health and Employment in the NHS
Guidance for NHS employers on the recruitment and retention of people who have or have had "mental health problems": http://doh.gov.uk/mentalhealth/mental-health-employ-rep.pdf

Sick culture of NHS
Fiddled figures and fear of reprisals are the order of the day: http://news.bbc.co.uk/1/hi/health/2299291.stm

Scotland faces nursing shortage whilst UK can't even recruit from abroad
Scottish nurses endure some of the highest levels of bullying recorded (nearly 50%, see http://news.scotsman.com/archive.cfm?id=623072002&rware=LCUDPRXJMDMV&CQ_CUR_DOCUMENT=5 and http://news.bbc.co.uk/hi/english/uk/scotland/newsid_1639000/1639176.stm) but now they're being enticed back with golden handshakes - but no mention of the bullying culture: http://news.bbc.co.uk/1/hi/scotland/2335839.stm.

Code of conduct for NHS managers
NHS staff are ... given all reasonable protection from harassment and bullying, allegedly: http://www.doh.gov.uk/nhsmanagerscode/code-code.htm

Government's plan to bolster NHS services with overseas doctors in disarray
Few foreign specialists want to come and work in the UK - perhaps they've heard about the NHS bullying culture: http://news.bbc.co.uk/1/hi/health/2356155.stm

Surgeon struck off for bullying
"Highly-gifted" surgeon struck off by General Medical Council (GMC) after hearing how he bullied and groped staff, reduced patients to tears whilst his attitude left nurses needing counselling: http://news.bbc.co.uk/1/hi/england/2349663.stm

12 May 2002: a survey by psychologist Noreen Tehrani of healthcare and personnel management in the NHS has again revealed high levels of bullying with at least 10% of sufferers exhibiting symptoms of PTSD. 80% of those bullied had not reported bullying because 'the bully is my boss'.

24 April 2002: an article Occupational stress in consultants in accident and emergency medicine: a national survey of levels of stress at work in the Emergency Medicine Journal reveals that 10% of senior casualty doctors feel suicidal because of the workload and stress of the job. Around half report severe stress and 20% suffer depression.

24 April 2002: 29-year-old Lorraine Bowman, described as an "excellent and respected" nurse at the Royal Devon and Exeter Hospital, committed suicide because of the burden of debt. Chancellor Gordon Brown announced new funding for the NHS in the 2002 Budget.

13 April 2002: Lyn Quine, a reader in health psychology at the University of Kent at Canterbury has published the results of her latest survey of bullying of junior doctors. The figures revealed 37% of junior doctors reported being bullied in the previous year with Black and Asian doctors more likely to be bullied than other doctors. See full report in the BMJ with the opportunity to comment. Lyn's 1998 study of bullied nurses is at BMJ.com. Chancellor Gordon Brown recently promised billions of pounds of extra money for the NHS; perhaps dealing with bullying would save more money than Gordon is giving?

15 January 2002: bullying is rife in the NHS with levels of of up to 50% being reported. One site that describes a typical case of bullying in an NHS Trust is at www.nurses-are-bullied.org

5 November 2001: a confidential survey by Grampian University Hospitals Trust reported in The Scotsman reveals that nearly 50% of staff working for a leading hospitals trust have been bullied at work "Undue pressure to produce work" was the largest single cause of bullying. [More]  In June 2005 NHS Grampian had an outstanding debt of just under 11m and were ordered to cut their budget by 20 million. [More]

21 March 2001: a survey by the Royal College of Nursing (RCN) has revealed that 1 in 6 nurses has experienced bullying and a third of these are planning to leave the profession. Nurses with a disability fared worst (41%) followed by ethnic minorities (33%) and agency nurses (30%). Over 50% of nurses who said they'd been bullied were unhappy with the way management responded whilst more than a third said that no action had been taken in their case. These figures are in line with another study published in the BMJ.

4 October 2000: a new survey by public sector union Unison reveals that 4 out of 5 nurses have considered quitting their profession due to poor pay, low morale, and feeling undervalued. Staff shortages and increased patient expectations also feature. A third of nurses have a second job to bring their income up to acceptable levels. Less than 1 in 3 nurses would recommend nursing as a profession.

7 January 2000: A study by the Royal College of Nursing in Scotland found that one third would leave the profession if they could, one fifth thought they were in a dead-end job, and one fifth had a second job to make ends meet. 58% said their workloads were too high. 91% felt they were poorly paid compared to other professions. Over two thirds felt they would earn more for less work if they left the job.

15 February 1999: Poor pay in the NHS is under the spotlight again The MSF union has published figures which suggest that many NHS staff can earn more money by working at a supermarket checkout than in their chosen profession within the NHS. The union found that 65,000 graduate health service scientists earned around 7476 a year, compared to over 9000 for a checkout operator. A 16% rise in NHS pharmacist vacancies has also been reported at a time when recruitment levels of NHS nurses have fallen below the rate of nurses leaving the profession.

10 February 1999: the Royal College of Nursing was criticised by its members for paying 72 of its own staff more than 40,000 a year each. The RCN defended the high salaries saying that they had to reward staff working in a big and complex organisation. (Not as big and as complex of the NHS, though?) The salaries brought criticism from health chiefs who pointed out than the figures are more than double what most nurses earn. The average annual salary for a nurse is around 16,000. Nurses and healthcare workers are the second largest group of callers to the UK National Workplace Bullying Advice Line, with many saying that the RCN have not helped their cases.

29 January 1999: the results of a staff survey at Berkshire Health Authority leaked to the Reading Chronicle (29 January 1999) reveal that health staff are at breaking point, with insecurity and uncertainty rife. Comments included "I am looking for other employment" and "The authority does not value its staff" and "I can see no way forward", with many staff also critical of senior management. Chief executive Crispin Kirkman was singled out for particular criticism.

23 January 1999: a staff questionnaire survey by Lyn Quine in the BMJ Volume 318, 23 January 1999 reports that bullying is a serious problem in the NHS and is experienced by more than one in three staff. Two thirds of those bullied had tried to take action against the bullying, but most were dissatisfied with the outcome. The bullying had resulted in significantly lower levels of job satisfaction, higher levels of job induced stress and anxiety, with an increased intention to leave the job.

21 October 1998: the Royal College of Midwives (RCM) claim today that there at least 1000 vacancies in the profession. Delivering a 90,000 signature protest to 10 Downing Street, Karlene Davis, RCM General Secretary reported "Conditions are at crisis point, that's why we're out here today". Midwives currently number 32,000, the lowest figure for a decade with the figure falling by 7% annually. The average starting wage for midwives is 14,000. Since 1995 the profession has lost over 2500 nurses, mainly, it is claimed, because they are "stressed out, burnt out and badly paid". The government's solution is to employ more and more midwives from overseas.

20 October 1998: shortage of nurses compromises quality of care and puts patients at risk, a survey by the RCN has shown. Shortages of staff across the country - currently 8000 nursing vacancies - has resulted in the NHS spending 192 million each year on agency nurses. In many cases nurses are only able to provide minimum nursing care and 10% of nurses felt there often weren't enough staff to provide even that. The survey also showed, amongst other things, that 71% of wards had nursing vacancies and over 10% of wards were understaffed by a fifth or more. The RCN believes a pay rise of 17% to bring nurses into line with newly qualified teachers is necessary; the government is considering 2.5%.

10 October 1998: medical experts warn that hundreds of babies die unnecessarily each year because of poor training and overwork. Clinical errors account for approximately one death in 1000 cases, new research shows. Reduced workloads and better training standards for midwives and could cut this death rate by half it is claimed.

8 October 1998: a survey commissioned by the public sector union Unison shows that 70% of nurses are considering leaving the profession, and 20% have a second job to make ends meet. Three quarters of nurses say they would not recommend a career in nursing, compared to only 60% the previous year.

17 September 1998: a report by the NHS Confederation indicates that 75% of all hospitals are having difficulty retaining nurses and midwives. The main problems were understaffing and work overload, lack of career opportunities, constant change, difficult working conditions, and a feeling of not being valued.

28 March 1998: the Guardian newspaper reports that sickness absence within the NHS costs around 700 million a year. This works out at about 5% compared to the industry average of 3.7%.

25 March 1998: a Nuffield Trust report blames management failings and poor management style for a "profession in crisis" and "worrying levels" of sickness and psychological disturbance.


Harassment procedure in the NHS

The following information is taken from Section 8 of Whitley which determines the terms and conditions of employment of nurses and many healthcare workers in the UK. If anyone has a later version, please let me know of any changes.

SECTION 8

HARASSMENT AT WORK

1. The General Whitley Council affirms that harassment at work in any form is wholly unacceptable and expects employing authorities to ensure that employees enjoy a working environment in which the dignity of individuals is respected. Harassment at work is contrary to the Council's declaration on equal opportunities in employment (Section 51).

2. Harassment can take many forms and may be directed in particular against women and ethnic minorities or towards people because of their age, sexual orientation, physical or mental disability, or some other characteristic [eg being competent and popular - TF]. It may involve action, behaviour, comment or physical contact which is found objectionable or which causes offence; it can result in the recipient feeling threatened, humiliated or patronised, and it can create an intimidating work environment.

3. To help with the important task of ensuring that all staff enjoy a working environment in which the dignity of individuals is respected, the General Whitley Council recommends that each authority publish a clear statement on harassment as part of their resource management and equal opportunities policy and establish clear procedures for handling complaints.

4. While it will be for each individual employing authority, in consultation with staff and local staff representatives to determine precise details, the General Whitley Council recommends that the policy statement includes the points set out below. Where authorities already have a policy they should ensure that it addresses each of the points:-

POLICY STATEMENT ON HARASSMENT

5. A policy statement should make plain that employees have the right to be treated with consideration, dignity and respect and that harassment at work is unacceptable. It should also:

GUIDELINES

6. By its nature harassment may make the normal channels for handling grievance complaints difficult to use. The General Whitley Council believes that employees subject to harassment should be able to seek advice, support and counselling in confidence and without obligation to take a complaint further. A complainant should be able to discuss the grievances in a confidential and initially informal manner with a specially nominated officer. It may be helpful for the complainant to bring the grievance in the first instance to someone of their own sex or ethnic background, should they wish. Investigation of the complaint should be handled with sensitivity and due respect for the rights of both the complainant and the accused. Throughout the process the complainant may be supported by any person of his or her choice, including a trade union or staff representative or friend.

PROCEDURE

7. If it is not possible to resolve the complaint informally the employee may wish to bring a formal complaint. Employing authorities will need to consider whether the grievance and disciplinary procedures are flexible enough to cope with complaints related to harassment issues, and, in particular to cover the situation where the complaint concerns a line manager.

8. The General Whitley Council recommends that a nominated officer for the informal procedure (paragraph 6 above) should receive training in counselling skills. Management courses should include training to help Managers identify factors which could cause complaints of harassment and how to respond to complaints.

9. The employing authority's policy statement, guidelines and complaint procedures should be made available to employees on appointment and be included in the induction training of all staff. The statement, guidelines and procedures should also be regularly reviewed, in consultation with staff and local staff representatives, to see how effective they are and whether improvements are needed. In particular, where complaints have been upheld, authorities should confirm that harassment has ceased.

10. Employing authorities may wish to refer in their policy statement to harassment caused by patients or other members of the public and whether the guidelines in paragraph 8 above should be available to staff so affected.


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The answer to Why don't you stand up for yourself?
Bullying and vulnerability
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Why grievance procedures are inappropriate for dealing with bullying
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