Bullying in the Workplace: Immature Occurrence, or Symptom of Something Worse?

The noble profession of healthcare; where the work started off from compassion and spirit of alleviating others’ suffering.

It is however, very unfortunate that physicians and nurses are not spared from the issue of bullying. We tend to think that bullying only occurs in schools, and are surprised to hear that it also happens in immature settings.

Bullying is a form of directing the bullies’ dissatisfaction inward or towards each other, themselves, and towards those who are less powerful and influential than themselves.

Examples of bullying in the workplace include being spoken in a belittling manner or being lambasted by the older generation for being weak and spoilt.

Studies show that Asian healthcare workers report the largest quantity of workplace-related bullying. The study was carried out in Singapore, showing abuse by nurse managers and colleagues. It also implies that 70% of the staff choose not to report workplace incidents, suggesting that the number of bullying cases might be even higher.

Bullying cases may not be always obvious. It might not be someone yelling at a poor junior nurse in the OT in front of everyone. Shaming, spreading malicious rumors about a co-worker still is bullying, and so are refraining from promotions or the right to take leave.

Why it happens

As previously mentioned, bullying not only happens at immature settings such as in schools, but also at workplaces all the way up to the higher echelons. A stressful environment, poor working conditions and poor leadership are prime vectors for bullying cases in the workplace.

The perpetrators involved in these cases are usually the ones in power. They exercise their power over helpless individuals, humiliating and belittling them in order to make them feel superior. They are usually authoritative, and oppressive in behavior.

There is also a pattern in the victims of such bullying. Doctors and nurses below the age of 30 reported to be more likely to experience workplace bullying. This is due to their position in the workforce- they are generally the lowest tier amongst everyone else, and are prime candidates to be targeted by perpetrators wanting to flex their authority without much of a pushback.

Another study conducted in Asia showed that nurses with high levels of anxiety were almost five times more likely to experience verbal abuse. Because they are by nature unsure of themselves, they do not have the mental standing to push away from bullies’ abuse. Other personality types that are highly associated with bullying are those who are inexperienced, less assertive with their work, lower confidence, and have vulnerable personalities.

Effects

Decline in productivity and effectiveness of care

The physical and emotional health of the victims decreases, which ultimately leads to worse quality of care for patients.

Victims report headaches, sleeping disorders, and medical errors done, which in turn leads to an increase in absenteeism. An increase in absenteeism due to health issues leads to understaffing of a healthcare institution.

Incur costs

Lower morale from victims results in a higher employee turnover rate. This is costly towards the institution; it is far more expensive to constantly replace employees compared to keeping them and increasing their pay year after year. It just doesn’t make much financial sense.

Higher intetion to quit the job leads to career burnouts whuch are much earlier than normal. Impacting non-workplace relationships as well.

Death

When nurse managers or MOs abuse their co-workers by refusing their right to leave, catastrophic results follow. Malaysian newspaper “The Star” reported in May that concerns have been rising about road accidents among tired and overworked doctors. Not too long ago a houseman in Kota Bharu Hospital hit a cow on the way home and died. Nurul Huda Ahmad, a paediatrician in training, died in a motor vehicle accident after nearly 33 hours on duty.

Ways to Stop It

It is not enough to simply tell the staff to “just stop the bullying.” The superiors of the workplace have to encourage their staff to speak out and report any instances or cases immediately. In addition to promoting a safe environment where employees can do so, employers must train effective communication skills to promote reporting as being viewed as an acceptable and necessary behavior.

Moreover, the training provided must encompass business etiquette that touches upon cultural sensitivity practices, and educate the workforce on negative working behaviors. Sometimes, the bullies may not even know about what they’re doing, until pointed out to them.

In the case of management, policies set in place creates a code of conduct to stop these cases. It is important to enforce it consistently for all staff members. Document any violations. This mitigate behaviors like persistent criticism that has no basis.

The way forwards

The act of bullying in a healthcare settings must not and cannot be left to fester. It creates a lot of damage and losses for both the institution and the people working in them. Most of all, the impact on patient’s safety is hit the hardest.

Patients place their utmost trust in the medical world to help them recover and lead productive lives again. Compromised care can deal potential harm in patients; it can mean the difference between a sound mind and a vegetative state, a living patient or a dead one.

If the medical field is to become the bastion of healing and wellness, then it must address this recalcitrant issue and not let it grow like an unwanted tumor, damaging the whole system in the process.



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 As incidences of chronic kidney disease and other related renal issues continue to rise, the need for adequately trained nurses in those fields continue to grow. Similar conditions are seen in various parts of the world. In 1999, the incidence of patients with kidney conditions requiring long-term care is 340,261. In 2010 it is over 600,000. 

 The diagnosis of renal conditions can be done with a primary care doctor. However, treatment and care of those patients require an understanding of risks, comorbid conditions, complications, and probabilities for loss of kidneys by both physicians and nurses. 

 For nurses, a post-basic renal course can open the doors to working in this area which is sorely lacking in manpower. Here are the reasons why you should consider pursuing a renal post-basic certification. 

 From bedside to business 

 There are a lot of CKD (chronic kidney disease) clinics opening up. Having a renal certification enables you to work at these clinics as your training is aligned with what they have to offer their patients. 

  Pusat Hemodialisis Mawar  is one of them. They are the largest private charity haemodialysis organization in the country. They have 13 centres spread throughout the country. 

 A short search on Google Maps also reveals a lot of haemodialysis centres in Klang Valley. 

 Being a nurse at institutions like those will train your patient management skills as you run the day-to-day administrative tasks in parallel with your nursing duties. 

 Better work setting 

 You’ll have a less erratic schedule than your peers. Dialysis patients require a regular timing on their treatment. Your shifts would be on more regular hours. A more fixed routine can be better for your health and well-being. 

 Better pay 

  On average, renal nurses with post basic certification get about 10% more pay.  

 Hospital dialysis nurses may be offered more pay, but they may also be required for emergency dialysis treatments, making their schedule less average than others in their field of focus. 

 Adjustable pace 

 You can choose to work in smaller dialysis centres for slower pace, or larger nephrology units in hospitals if you wish for a faster paced working environment. Unlike other specialties, you have a choice to work in the kind of environment that suits your working style. 

 Rapid changes in the field 

 Technological advances in the renal treatment field progresses at a rapid pace. Previously, it was slow. Kidney diseases were complex and difficult to study. Therefore treatments were vaguely ineffective. 

 The 21st century brought in upgraded transplantation technologies with breakthroughs in biocompatible materials. 

 As a renal nurse, you will handle the care of post-transplant patients. The tasks and how you perform your duties to these patients have a high probability of changing with the frenetic pace of research. 

 High Demand 

 Renal nurses have good experience in interpreting telemetric data. This makes them efficient at being support units in surgical wards to ensure successful procedures. 

 Dialysis is expensive, costly, and there’re not enough facilities and manpower in public and private hospitals. 

 Conclusion 

 Pursuing a renal post-basic certification is a solid pathway to consider. Nurses with this certification are more in demand, have better pay, and all the listed advantages above. For people who like clinical challenges, treading this path is for you. 

 Already have a post-basic in renal care? Head over to MIMS Career to search and apply for renal care jobs in your area. Just signup and experience our convenient 1-click application process. It’s fast, safe, and easy. MIMS Career also allows you to search in our huge database of employers seeking new staff. You can also save potential jobs for later viewing, and create your own personalized job alert.

Renal Post-Basic, a certification to consider

As incidences of chronic kidney disease and other related renal issues continue to rise, the need for adequately trained nurses in those fields continue to grow. Similar conditions are seen in various parts of the world. In 1999, the incidence...

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  1. Specialization tasks  
 2. Pathway  
 3. Common job scopes  
 4. Common terms  
 5. Career opportunities  

 Cardiology 

 Cardiology is a branch of medicine dealing with disorders of the heart as well as parts of the circulatory system the field includes medical diagnosis and treatment of  congenital heart defects ,  coronary artery disease ,  heart failure ,  valvular heart disease  and  electrophysiology . Physicians who specialize in cardiac surgery are called cardiothoracic surgeons or cardiac surgeons. The supporting role of the surgeons and physicians are  cardiology nurses . 

 Although the cardiovascular system is inextricably linked to blood, cardiology is relatively unconcerned with hematology and its diseases. Some obvious exceptions that affect the function of the heart would be blood tests, decreased oxygen carrying capacity, and  coagulopathies . 

   

  source: Resus.me  

 Specialization Tasks 

 All cardiologists study the disorders of the heart and all cardiology nurses are trained to take care of either adult or children conditions. This is due to differing aspects of training for adult and paediatric physiology. Surgical aspects are not included in cardiology and are in the domain of cardiothoracic surgery. 

 For example, coronary artery bypass surgery and cardiopulmonary bypass are both surgical procedures performed by surgeons, and not cardiologists. As a nurse, your task will be that of assisting the cardiologists in this matter. A properly-trained cardiology nurse would have the necessary critical thinking in order to draw conclusions to make meaningful impact of treatment. 

 Common tasks in the wards that you might have to do include the insertion of stents, pacemakers, and valves. 

 Pathway 

   

  source: verywell  

 Cardiology is a specialty of internal medicine. To be a cardiology nurse, a three-year work experience followed by a post-basic or relevant course is required. It is possible to sub-specialize in Malaysia. Recognized sub-specialties in cardiology for Malaysia are cardiac  electrophysiology ,  echocardiography,  interventional cardiology, and  nuclear cardiology . 

 Currently there is insufficient data for Malaysia, for salary, but it is guaranteed to be higher or on par with other similar nursing specialists. 

 Common job scopes 

 Cardiology is a vast field. Not only does it involve the heart and its systems, it also involves supporting systems such as haematology and its diseases. It is important to know and train for this when pursuing this specialization. 

 Cardiac electrophysiology 

   

  An example of echocardiography  

 This is the science of elucidating, diagnosing, and treating the electrical activities of the heart. The term is usually used to desccribe studies of such phenomena by  invasive catheter recording  of spontaneous activity as well as of cardiac responses to programmed electrical stimulations. These studies are performed to assess complex arrythmias, relieve symptoms, evauate abnormal ECGs, assess risk of developing arrhythmias in the future, and to design treatment. 

 Cardiac examination 

 The cardiology nurse is able to carry out cardiac examinations of patients. It is performed as part of a physical examination, or when a patient presents with chest pain suggestive of a cardiovascular pathology. It would typically be modified depending on the indication and integrated with other examinations especially the respiratory examination. Like all medical examinations, the cardiac examination follows the standard structure of inspection, palpation, and auscultation. 

 Paediatric cardiology 

   

  source  

 Paediatric cardiology is a specialty of paediatrics. To be a paediatric cardiology nurse, one must complete at least three years of registered working experience and pass all the required courses. Adult cardiology certifications are not valid due to differences in physiology in children. 

 Common complications that you will see as a nurse practicing paediatric cardiology are  paediatric hypertension ,  paediatric hyperlipidemia , heart palpitations and arryhthmias. 

 Diagnostic tests 

 Diagnostic tests in cardiology are the methods of identifying heart conditions associated with healthy vs. unhealthy pathology heart function. It is commonly started by obtaining a medical history, followed by auscultation. Blood tests soon precede after, and imaging can be done on a need-to-do basis. 

 Common terms 

 1. Tetralogy of Fallot 

 It is the most common congenital ehart disease arising in 1-3 cases per 1000 births. The cause of this defect is a ventricular septal defect and an overriding aorta. These two defects combined causes deoxygenated blood to bypass the lungs and going right back into the circulatory system. The modified  Blalock-Taussig  is used as a treatment for this condition. 

 2. Pulmonary atresia 

 This happens in 7-8 births per 100,000 and is characterized by the aorta brancing out of the right ventricle. It causes deoxygenated blood to bypass the lungs and enter the circulatory system. Fixing it can by done by a team of cardiologists and nurses by redirecting the aorta and fixing the right ventricle-pulmonary artery connection in surgeries. 

 3. Double Outlet Right Ventricle 

 Double outlet right ventricle is when both great arteries, the pulmonary artery and the aorta, are connected to the right ventricle. There is usually a ventricle in different particular places depending on the variations of DORV, typically 50% are subaortic. A VSD closure is the most common form of treatment for this condition. 

 Career opportunities 

 Search for  high-paying cardiology nursing jobs  on  MIMS Career . Browse, save, and apply for nursing jobs, all in one-click. Take the opportunity for higher pay and better work locations. Our pages are all mobile-responsive, allowing you to take that leap for a better job whenever, wherever you are. All our job postings are heavily screened to  prevent scams and mistrustful behavior . 
   

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Career Highlight: Specialty in Cardiology

1. Specialization tasks 2. Pathway 3. Common job scopes 4. Common terms 5. Career opportunities Cardiology Cardiology is a branch of medicine dealing with disorders of the heart as well as parts of the...

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 Want to work in the United States? Opportunities are aplenty; the American over-65 population is about to triple by the year 2030.  Most of them will suffer from chronic conditions, be obese, and suffer from arthtritis.  This leads to an overwhelming demand for nurses to assist healthcare institutions in providing care to these aging patients. 

 Living in the United States can be an interesting and rewarding period of time. You get great education, infrastructure, and one of the highest standards of living in the world. The  salary  is great too: the median salary for US registered nurses is $60,616, or about RM250,000 per annum. 

 Here’s what you need to do: 



 1. Ensure your academic requirements are met 

 You need to: 

 
 Graduate from a program with accredited Registered Nursing 
 Have a valid RN license 
 Practiced as an RN for not less than two years  
-Some states (like  Texas  or California, for example), require you to complete a Foreign Educated Nurses (FEN) course. It’s a refresher course consisting of 240 hours divided equally into classroom and clinical practice. You will do it under the supervision of a licensed RN. 
 



 2. Pass English proficiency test 

 You need to do this if: 

 
 You graduated from a school not in the UK, Australia, New Zealand, Canada, or Ireland 
 Your school’s spoken language is anything other than English 
 Your school’s textbooks were written in English 
 

 You can take: 

 
 TOEFL (Test of English as a Foreign Language) 
 TOEIC (Test of English for International Communication) 
 IELTS (International English Language Testing System) 
 

 Send the test results directly to the state board you’re applying to. 



 3. Sit and pass your NCLEX-RN (National Council Licensing Examination - Registered Nurse) 

 To take the exam, you have to register with Pearson VUE. The instructions are all on the website. 



 4. Find an employer, or a recruiting agency based in the US 

 A recruiter can also be your employer. They will help you get your immigrant visa. Not only that, but they will also assist you in finding a job at a hospital or institution that they are partnered with. 



 5. Get an RN immigrant visa/green card 

 You are going to need these documents for your visa: 

 
 Visa Screen Certificate (VSC) 
 Evidence of US-based employer who will petition for your visa. As mentioned, a recruiter can also be your petitioner. 
 



 6. Obtain visa and accept job offer 

 You might have to take a medical exam for this. 



 7. Get certified for Resuscitation courses 

 You’ll need to take (depending on the area that you will practice in): 

 
 Advanced Cardiac Life Support (ACLS) course 
 Paediatric Advanced Life Support (PALS) course[10] 
 

 And there you have it! All you have to do next is to emigrate to the US. We’d like to wish you good luck with your endeavours! 

 Great nurses are always on the lookout for new, exciting, and better opportunities to grow their career. Find out your next employment with MIMS Career, a fast, secure, and convenient portal to connect you to top-class healthcare employers in MY, SG, ID, and PH.

How to Work as A Nurse in the USA

Want to work in the United States? Opportunities are aplenty; the American over-65 population is about to triple by the year 2030. Most of them will suffer from chronic conditions, be obese, and suffer from arthtritis. This leads to an...

Read More