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.



Other Articles


  This week we managed to get in touch with Nejlika (pronounced neh-lika) Confinement Care Centre. They provide confinement services for mothers with newborn babies. Established in 2014, Nejlika is committed to providing the best and safest form of care for the newborns’ first 28 days, and for the mothers’ recoveries.  

  What really got us interested with Nejlika was their practice in bringing confinement, which is a traditional concept in post-natal care, into modern times by using scientific methods of observation and critical analysis.  

  Nejlika is currently hiring for post-natal care nurses.  See the job posting page here for more details .  

 
  Can you describe what your institution provides?  

 Nejlika Confinement Centre provides confinement care for post-natal mothers and newborn babies. 

 We assess the health conditions of the mother and baby, monitoring them daily. We provide professional and scientific feeding, nursing care, and early intellectual development for the baby. For the mother we have uniquely customized meals that are both healthy and delicious. These efforts do a lot to promote healing. 

  How did this place come about?  

 We first saw that there was a market demand for confinement centers in the Klang Valley. We saw that in places like Penang or Johor there are already a substantial amount. But a lot of them are sort of like household business. They hire non-medical professionals for treatment. So we set up this place in 2014. 

 The founders of this centre are all from the healthcare industry. The first 28 days of a newborn will be the most critical stage of a baby’s life. Although confinement is a traditional concept of post-natal care, we bring in present, scientific methods to bring this practice to modern times. 

 New parents or non-professionals are not able to take care of the newborn baby and mother as well as trained nurses and physicians. We aim to provide the best quality service, comfortable living environment, nutritious meals and warm family surroundings to help both the mother and newborn navigate this crucial period of their lives. 

  I saw on your Facebook you have many customers; even non-malaysians. What do you do to attract people to come here?  

 To be honest we don’t really go out to promote the centre. So far it’s all been through word of mouth, maybe a bit of Facebook postings. 

  How do you convince someone who is pregnant to use your services, rather than carry out traditional confinement at home?  

 Usually after the customer knows about us, they will call to inquire. This is before they give birth. So we arrange a 1-to-1 appointment with them. So during this appointment period we explain to them what is the service that we provide, and the philosophy behind our service. 

 Over here, our center advocates breast-feeding, and we have a certified infant massage instructor. We promote early brain development for the baby through the infant massages. 

  What makes you different from the other confinement centres?  

 First of all we are one of the pioneers here, so we are very experienced in specialized confinement care. Also, one of our founders is the only person in Malaysia with twin certificates specialized in confinement care from Taiwan. She purposely went to Taiwan to obtain this certification, not just once but twice. 

 At the same time we engage the service of chinese traditional medicine practitioners. Although we advocate scientific and modern confinement care, we also incorporate the traditional care to bring a well-rounded care to the mother and baby. 

 In Traditional Chinese Medicine, we believe the body constitution of humans can be divided into nine types. Different type of body constitution will require different forms of nutrition or medication. Our chef will prepare the personalized herbal tonic soup for each post-natal mother upon advice by our chinese medicine practitioner for greater rejuvenation.  

 Not many other confinement care provide this service. 

  Can we talk about the food you serve here? They look great! Do you have an in-house cook?  

 We have a special cook. We put out an ad in the newspaper, and managed to get one with training for confinement cooking. We advocate healthy and nourishing foods that aids the mothers’ recovery. 

 Everything that comes into contact with the mothers and babies have to be clean, healthy, and promote recovery. This includes the furniture, beds, food, even the air in the centre as well. 

  How many staff members do you now have?  

 We have 10 nurses, 2 maids, 2 chefs and 1 assistant to help us run the operation. 

 As for now, there are not many customers. It is a bit of a low season. Usually there are more births from late July-early August til the end of the year. 

  To staff: What do you do to make your staff happy and enjoy working here?  

 We feel happy because we enjoy what we do. It’s a slower pace than hospitals, and we love to look after babies. 

  What’s the hiring process like? Who decides on the hire?  

 Advertising on newspaper, platforms online, recommendations of current nurses. More so on the EQ. 

 We advertise in the newspapers, online platforms such as MIMS Career, and word of mouth. Very often we get new hires based on the recommendations of nurses currently working here. 

  What kind of people do you look for when you hire staff?  

 We need staff who are passionate about care for post-natal mothers and infant babies. Post-partum depression is very real, so nurses here have to be very aware of the telltale signs of it. They need to have high EQ to be able to console and advise mothers suffering through post-partum depression and help guide them out of it. 

 We also look out for staff who have high patience levels. Dealing with babies can sometimes prove to be a frustrating task. 

  What cool pieces of technology do you have in this centre?  

 We have a  bilirubinometer ; it is a device that measures the level of bilirubin in the babies to detect jaundice. If jaundice is determined to be present in the baby, we bring in a “jaundice phototherapy” machine and treat the infant until bilirubin levels drop to normal levels. We are the first confinement centre to provide this service. It avoids the hassle of going to the hospital, which can be very strenuous on both mother and newborn. 

 Also, to really avoid cross-contaminations we sterilize the rooms with a  UV light emitter . UV light destroys germs and bacteria. 

 On the other side of the  light spectrum , we use Infrared light emitters to promote healing of mothers’ wounds, especially ones after C-sections. 

 Finally, we have a baby swimming pool! Therapy done in the pool promotes brain development. 

  What does the future look like for Nejlika Confinement Care Centre?  

 Obviously we want to expand. That is the only way a business can grow. 

 We have moved from single storey to double storey within three years. We’re looking to set up branches in other places, in order to provide service to customers not within reach of us right now.

Institution Highlight: Nejlika Confinement Centre

This week we managed to get in touch with Nejlika (pronounced neh-lika) Confinement Care Centre. They provide confinement services for mothers with newborn babies. Established in 2014, Nejlika is committed to providing the best and safest form...

Read More



 Nephrology/Renal Nursing 

 Nephrology is a specialty of medicine and pediatrics that concerns itself with the kidneys:  the study of normal kidney function, kidney problems, kidney health, and the treatment of kidney problems.  It encompasses dietary and medication to replacement forms of treatments. Systemic conditions that affect the kidneys and systemic problems that occur as a result of kidney problems are also studied in nephrology. A physician who has undertaken additional training to become an expert in nephrology may call themselves a nephrologist or a renal physician. 

 A nephrology nurse (or renal nurse - those two terms are used interchangeably) is a nursing practitioner that focuses on kidney health. They treat and care for patients that are suffering from those suffering from kidney problems as well as those that are at risk of developing them. 

 As a renal nurse, one must be prepared to stay on top of current developments, as treatments in this field are accelerating their development at a very rapid pace. This is possible to be done by regular consumption of renal-related literary content such as medical journals. Attending seminars and conference is also a possible method. 
   

 Scope 

 Renal nursing concerns the  diagnosis and treatment of kidney diseases , including electrolyte disturbances and hypertension, and the care of those needing replacement therapy, including dialysis and transplant patients. 

 Many diseases affecting the kidney are systemic disorders not limited to the organ itself. Examples include acquired conditions such as systemic vasculitides and autoimmune diseases, as well as congenital or generic conditions such as polycystic kidney disease. 

 Methodology of nursing 

  History and physical examinations are central to the diagnostic workup in nephrology or renal nursing.   

 This may include inquires regarding family history, general medical history, diet, medication use, drug use and occupation. Examination typically includes an assessment of volume state, blood pressure, skin, joints, abdomen, and flank. 

 Urinary analysis (urinalysis) is an instrumental method in assessing possible kidney problems. Nurses in this specialization are trained to notice the appearance of blood in the urine, protein, pus cells or cancer cells in the urine, often with the help of a urologist or nephrology physician. 

 Basic blood tests can be used to check the concentration of hemoglobin, platelets, sodium, potassium, chloride, or phosphate in the blood. All of these may be affected by kidney problems, and renal nurses are supposed to be well-versed in this area. 

 Under certain circumstances, an invasive test is required for diagnosis. A biopsy of the kidney may be performed. This typically involves the insertion, under local anesthetic and ultrasound or CT guidance, of a core biopsy needle into the kidney to obtain a small sample of kidney tissue. Kidney biopsy is also used to monitor response to treatment and identify early relapse. 

 Training 

 The process differs across countries, but the outcome is indefinitely similar. Nephrology is a subspecialty of general medicine. A nephrology/renal nurse will have to complete nursing school, a minimum of three years of practice as a general nurse, and a BSN (Bachelor’s of Science in Nursing) or post-basic course in renal subjects. Typically this training lasts 1-2 years. 

 Nurses in training for renal nursing often continue in the world of academia to obtain research degrees, putting a temporary halt to their clinical practice. Some also sub-specialize in dialysis, kidney transplantation, CKD, cancer-related kidney diseases, procedural nephrology or other non-nephrology areas. 

 However, only pediatric-trained nurses are allowed to train in pediatric nephrology, due to differences in physiology. 

 Work environment 

 A major task and responsibility for renal nurses are  administering treatments to patients.  Treatments can include medications, blood products, surgical interventions, renal replacement therapy and plasma exchange. Kidney problems can have a significant impact on quality and length of life, and so psychological support, health education and advanced care planning play key roles in nephrology. 

 Renal nurses often find themselves having a better work setting compared to their non-specialized counterparts. Schedules are less erratic, especially for nurses working in dialysis support roles. 

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

 Career opportunities 

 
	 Dialysis centers (out- and in-patient) 
	 Nephrology wards 
	 Transplant units 
	 Home care 
	 Medical device industry 
	 Pharmaceutical industry 
	 Government and nonprofit healthcare settings (eg:  NKF ) 
	 Community clinics 
 

 There is a severe shortage of nephrology nurses in Malaysia. 

 Search for high-paying job in renal nursing at  MIMS Career . MIMS Career is a premier, healthcare-focused job portal site for Malaysia, Singapore, the Philippines and Indonesia. Our simple sign-up process allows you to easily apply for jobs you might be interested in with a single click. Job locations include hospitals, nursing homes, and private practices. It’s free, easy to use, and safe. 

 Can’t find what you’re looking for? Set up a job alert and we’ll notify you by email whenever positions that suit your preferences are available. All of our pages are mobile-responsive, so you can take your applications with you on the go. 
   

 Our Most Popular Articles 

  Think About These 5 Things Before You Decide On A Specialization  

  5 Things Nurses Need To Know To Be Paid More  

  10 Ways Malaysian Nurses Can Increase Their Income

Career Highlight: Specialty in Nephrology/Renal

Nephrology/Renal Nursing Nephrology is a specialty of medicine and pediatrics that concerns itself with the kidneys: the study of normal kidney function, kidney problems, kidney health, and the treatment of kidney problems. It...

Read More