By Rasa Kabaila (Mental Health Nurse Practitioner)
Illustration by Suhani Kapadia
‘Men are like fish; the great ones devour the small’ is an old Lithuanian proverb that anyone working in the caring professions, understand better than most.
Bitter irony for so many of us committed to improving the mental health outcomes of our clients, however, is the prevalence of workplace bullying in these very same medical institutions.
The truth is, that while we are charged with supporting life’s difficult journey for others, we are often — due to work stress; rigid, uncaring, and inflexible bureaucracies; and a tendency to cover-up unacceptable work behaviour — on that same journey ourselves.
Public mental health services in the nursing sector loudly proclaim themselves defenders of an important set of values. These differ slightly from service-to-service, but often entail worthy concepts such as: “kindness”, “care”, “innovation”, “professionalism”, and “stewardship”.
While these principles guide how we are, ideally, to treat our clients and patients, these same values unfortunately seem to fall by the wayside in how many mental health professionals working for the service themselves are treated.
In 2022, for instance, “The International Journal of Environmental Research and Public Health” released an extensive body of systematic reviews that were published between 2013 and 2021. The findings were sobering; systemic workplace bullying was found to negatively impact at least one-quarter of the working nursing population. From the experiences of myself and many colleagues, this sounds scarily-high, but it is not surprising.
Now an independent clinician, I’m so very grateful for the decade that I worked as a nurse at various hospitals and other health facilities. From that time, I’ve maintained some beautiful friendships with colleagues from these workplaces, with some wonderful managers who offered and encouraged me to take incredible opportunities for training and mentorship. I wouldn’t be where I am today, without those unique and enriching experiences, and still work as a subcontractor under some fantastic government pathways.
Unfortunately, though, the problem with bullying in the nursing profession, has led me to prematurely remove myself from a number of government health care systems. It’s not just me, more and more of my colleagues, are moving away from the public sector to work on their own, not because of the patients, but because of an insidious and ultimately-debilitating work culture.
The final result of bullying, and a lack of an effective managerial and organisational response is, sometimes unfortunately, suicide, the final act of despair of an old colleague and friend of mine.
There are obviously complex reasons behind the causes of bullying and how to deal with bullies themselves. However, I’ve found that, over my career as I’ve moved up in seniority as a Nurse and after becoming a Nurse Practitioner, that ego, a tall poppy syndrome, and a lack of suitable and committed staff in leadership and management positions — due partly to a workforce shortage of nurses — are contributing factors to this commonplace work problem.
Of course, like most problems, there are solutions.
When I became a Nurse Practitioner, I always thought it was the lofty doctors that I’d have to convert and cajole into understanding and appreciating my role. It really wasn’t. Largely, the medicos really supported me and, instead, I was surprised and saddened to find that it was many of my fellow nurses in leadership positions and management, who didn’t care.
When I shared this observation with a dear mentor of mine, a nurse practitioner, he said that it had happened to him too. He talked about how, as a gay man, he had experienced so much hate by strangers because of his sexuality, which obviously hurt him. I had tears well up when he told me that even though that hurt, nothing hurt him more than when his nursing colleagues turned against him. This story seems to be the case for a lot of my nurse practitioner mentees too.
I never really understood what the tally poppy syndrome meant, until I started to progress in my career. I didn’t understand it because I was always happy for my nursing colleagues when they would be promoted, especially when they were taking-up positions that I could never imagine doing myself.
When I became a nurse practitioner, things changed again. Of course, aspects of my role changed as my scope of practice widened, my pay went up a bit but, regardless I was still a nurse, and am still a nurse, and I will always be a nurse.
However, it was at that point when I felt things change, I’d moved to a new area, people didn’t know who I was, and they weren’t familiar with the role. All they really seemed to know is that I was paid a bit more than them. I had people constantly reference my pay in open office conversations and then mock my abilities behind my back. It was lonely, confusing, and it hurt.
What I always wanted to bite back with was “I’ve been doing nursing work since I was 15, I have two masters’ degrees, and I prescribe and diagnose, which is a huge responsibility. I broke my back to get here, and you could do it too, but you didn’t, so why are you complaining?” But I never said that because it’s not in my nature.
Meanwhile management would make references to me “being on a good wicket”, as if I had simply fallen on my feet as a random act of providence, while constantly devaluing and invalidating my work, regardless of the positive outcomes I was producing. Amongst a lot of disfunction in that workplace, I left to work on my own. By that time, I was so lacking in confidence, that I wasn’t sure if I even liked my profession anymore or even if I was any good at it.
I realised since working on my own, that I am good at my job, and I love it. I just needed to get away from that toxicity. Unfortunately, those tall poppy-bashers and negative egos still turn-up from time-to-time.
While working on my own, I ended-up sub-contracting for a range of government pathways, one of which, I saw majority of my clients through. I was passionate about the work and all of my clients gave highly-positive feedback about how they had progressed in their recovery in our time working together.
Unfortunately, one particular colleague who I dealt with, seemed very upset that a client of theirs, wanted to see me too, and after that made it their mission to try and put me down at every opportunity possible, regardless of my kindness towards them. Management sided with them, regardless of their poor interactions with numerous other female health staff in the community, and so I resigned under duress.
There’s an old saying in the Public Service, which is half-true even today. “To be sacked, you have to either murder someone, or steal one cent”. I think this is often true, I’m afraid.
I’m an individual who was taught to have a strong moral compass. It’s in my DNA, and I’m not the kind of person who won’t speak-up when there is an opportunity for positive change in a workplace. Too often, I think nurses are often punished for this outspokenness, at least I have often been. Health services will say they value innovation, but really most of them want you to just keep your mouth shut and do as you are told.
In a world where nurses need to work together to care for community in need, bullying just means that the good nurses are leaving, and the toxic ones stay where they are.
In what has become a vicious cycle, chronic staff shortages in nursing, often leads to people with the wrong personalities moving into leadership roles for the wrong reasons. It’s hard to get rid of a staff member if there is no one available to replace them and, when someone applies enough times, (even if they are inappropriate for the role), they will likely go up in the ranks. People with big egos and narcissistic traits in leadership roles, are reinforcing a bullying culture in health care.
The terms “Non-Maleficence” (Do No Harm) and “Beneficence” (the act of charity, mercy, and kindness with a strong connotation of doing good to others including moral obligation) are indoctrinated into nurses regarding the way they treat their patients. These terms should be applied to our colleagues too.
To retain and recruit good nurses in an under resourced profession, bullying needs to be taken seriously by management through being actioned and mitigated quickly. There are so many wonderful new nurses coming into the field who would thrive as nursing leaders in mental health, but they don’t have the experience in the field. The mental health field should be picking up these nurses based on personalities that are kind and collegial; train them up and nurture them. Don’t eat them alive. Let these people become our future leaders… and push the nasty ones out!
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