Midwifery clique: was it bullying or cultural control?

Midwifery clique: was it bullying or cultural control?

Midwifery clique: was it bullying or cultural control?

As part of my research for a webinar looking at nursing culture I read an article from the UK about a report: A cultural review of maternity services at Wirral University Teaching Hospital NHS Foundation Trust.

The author Shaun Lintern, never used the term “bullying” yet the behaviours and management responses to the existence of a clique of midwives and the effects on other staff did appear to be a clear example of a culture that “while creating a strong and supportive in-group, also resulted in the exclusion, and at times, ostracism of others”.

I have investigated complaints of bullying in the workplace, especially from students on clinical placement where the interpretation of directives, identification of mistakes and correction by staff has been interpreted as bullying by the student.  Sometimes there was no doubt that clinical staff were demonstrating hostility and aggression, often as a consequence of frustration with the demands of students. Sometimes the student’s sensitivity and lack of experience with the clinical culture and nursing communication patterns led to these accusations.    Other times it was because this was the first time the student has ever been corrected through the use of short, sharp words.

The issue with the midwifery clique being investigated in this report was “the climate, culture and tone that this creates for others in the working environment which needs to be acknowledged.”   While there were positives identified; the way clinical information was shared and openness to clinical questions, these were at the expense of other staff being shut out or devalued.  Staff who raised issues about behaviours were disregarded.

The report identified that management had ignored complaints from those staff who were outside the clique.  In fact the report has since given direction for the facility to implement changes.  Change in staffing, rostering and organisation of staff being key aspects.  This correction and intervention is both expensive and time consuming no doubt.  Not to mention the embarrassment.

What interested me was the fact that here was a unit problem that needed an investigation by outside management consultants and resulted in a formal report that publicised a negative pattern and management failures to deal with complaints about that behaviour.  How had this situation developed?  Was it because the staff had simply decided “this is just the way it is?” or “this is the way we do things here” or a development of negative behaviours that were seen as normal and reasonable to all except recent recruits and outsiders?

Were they simply discounting complaints waiting for these new staff to grow into the culture and adopt the patterns in place?   There is no doubt in my mind that staff do this.  We don’t see things the same way as an outsider and there is pressure on the outsider to conform.  If they don’t these folk are labelled as troublemakers.  It is hard to see our own culture.  We live it, it is normal and usually from the inside, it works well.  We don’t need to be questioned, insulted or doubted. 

Being accountable and an ethically valid nurse means we do need to be on our toes and prepared to analyse and evaluate our own patterns.  If we are confronted by an accusation we need the resilience to be able to listen and weigh up the facts.  Some people accuse colleagues of bullying as a control strategy.  They use it to defend themselves from findings of fault.  It is a powerful weapon as the person accused can be devastated and shocked.  The way to defend yourself, your unit, the organisation is to be proactive and insightful.  Develop awareness and willingness to recognise when and if a negative pattern has developed.  To be self-aware and prepared to discuss and monitor ourselves and our habits of speech and practices.  We have to take responsibility for the culture we create in our workplace and be critical of it.  It isn’t enough to recognise bad behaviour we need to be professionally active in working to develop strategies to promote and maintain the ideal culture and behaviour.

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There are 5 comments for this article
  1. Samantha Day at 1:06 pm

    Upon reading this article on Clique. I just wanted to say that it is in every hospital I have worked. It is a real shame that management don’t see this happening and it is really frustrating when management is involved. It is bullying. It is very harmful to all that is targeted. I don’t know how they are ever going to change this form of bullying but it needs to stop.

    • BOB at 11:17 pm

      I couldn’t agree more. Too many nurses have experienced broken sleep, a mind that won’t slow down, feelings of guilt, and remorse, the experience of jumping at shadows, low confidence and self-esteem, breathlessness, feelings of panic and over-whelming dread. Relatonships have been adversely affected, some have left the profession, some have taken their own life. Drugs, alcohol and gambling are also part of the narrative. All this occurs in the prescence of a profound and shocking silence from those who are positions of power and authority and do nothing. Do nothing in the face of misery, unhappiness and a sickening sadness.

      Unfortunately, there is neither the capacity ( let alone the political will), either at the managerial or the industrial level, to address this issue adequtely. However, I am sure there is the will for nurses collectively to address the issue. It should be possible to create a web-site or establish a Facebook page where nurses can rate their work-sites in terms of an adverse work-place culture. That is, a work-place culture marked by bullying and harrassment. Not to offer some meaningful way to address this issue, is to do compound the psychological and emotional harm. Harm that is compounded by the indifference, at both the industrial and managerial level, to the suffering that nurses experience on an hourly, daily weekly basis as an out-come of work-place bullying and harrassment. An out-come that is so profound that nursing work-place cultures are used when ever there is a reseach into horizontal violence. Don’t look towards established structrues to address this issue: their failure to address well-documented incidents of suffering can only lead to tears (or worse).

      If there is a web-based means of rating nursing work-sites in terms of their work-place cultures (both the humane and the inhumane)t hen at least our colleagues will be better equipped to make choices as to where they want to work. Though there is nothing that can be done to stop work-place bullying and harrassment, (or make the perpetrators face the consequences of their behaviours) at least we can minimise its impact by helping our colleagues make informed decisions as to where they want to work.

      What do others think? Is it possible to set up such a web based rating system? if so, How do we go about it? It is well-beyond time that this matter is addressed.

  2. bob at 7:25 pm

    ‘….We have to take responsibility for the culture we create in our workplace and be critical of it…’ And what do we do when the work-place culture, by comparison, makes Australia’s system of gulags on Manaus Island and Nauru a poster child for the UNHCR?

    I speak, of course, of the nursing work-place cultures of mental health facilities across Australia. Work-place cultures that have a centuries old history of denigration, abuse, violence and unlawful incarceration of people, who, like the people in Australia’s off-shore detention centres, are seen as beyond society’s purview of care. Society both in general and in the particular: the nursing ‘society’ that is in day to day contact with people with a mental illness, the nursing ‘society’ that on a daily, sometimes hourly, basis across Australia, inflicts violence (across many domains) on those who seek help from the public mental health system.

    A violence that is sometimes unconscious, sometimes systemic. When one or other of the Accreditation Authorities did its rounds of a hospital, so as to ensure that the red coloured forms where all in the red covered folder, that the green coloured forms were all in the green coloured folders and the Q and A Co-ordinator had given out the cheat-sheets to staff (of questions that the members of the Accreditation Authority would ask individual staff and what the answers to those questions were), nursing staff in the mental health facility would be abusing clients. And when the Accreditation Authority gave both that facility and the hospital more generally a tick of approval, and thereby all were Accredited for the next three or five years, t nurses would be yelling at clients ‘….Listen! you f****ing PD! Next time you try and kill yourself, do it properly and stop wasting our bloody time….’ Or, to another client, ‘….will you just shut the f***** – up! The doctor is talking to you!…’ An unconscious violence towards the nature of the Accreditation process (how are the members of the accreditation committees to know what happens in mental health facilities?) and a systemic violence, as the abuse of people with a mental illness is part of the warp and weave of Australian psychiatric care.

    This ‘warp and weave’ creates ‘ ‘….a strong and supportive in-group, (that) result(s) in the exclusion, and at times, ostracism of others….”. An ostracism, that in my case generated an attempt by management to have me classified as mentally ill (and thereby have me admitted to a psychiatric in-patient unit), and have me suspended from work while I had to have an examination by both a psychiatrist and a general practitioner —- both of whom had no qualms regarding my mental and physical health. At least I remain alive. A colleague of mine who also stood out-side the ‘….in-group…’, who also did not conform to the in-groups norms of abuse, denigration and other forms of violence and spoke out, suicided.

    Yes, we need to take responsibility for the cultures that we create in our work-places and be critical of it, however we must also speak out against the prevailing work-place cultures that establish norms of violence (violence across many domains) with-in psychiatric facilities across Australia. Client’s need a voice, though the cost of speaking out will be high. Expect the violence that is directed at clients, to be also directed at the ‘…out-sider…’ who does not ‘…conform…’ A violence that I gained insights into, both its workings and its causation, (apart from person experience) when I studied a couple of subjects in psychology. Subjects that considered the work of Miller, Zimbardo and others at Stanford University in the 1960’s and 1970’s.

    I remain alive, and a bit of mental wreck, but sufficiently engaged with the world to hire a firm of lawyers with a national profile. They would not do anything until I had paid an upfront fee of $7,000.00 dollars. I paid and then was told that nothing could be done. That was after speaking with the Work-place Health and Safety Officer who advised me against commencing a Grievance Dispute, as the dispute would be facilitated by my manager and would only subject me to further abuse. Thus the other cost of speaking out against work-place cultural norms of abuse and aggression, bullying and harassment, in the Australian context, is that nothing can be done to address the inhumanity generated by mental health nursing work-place cultures.

    In conclusion then, to answer the question with which I started this piece, despite the awareness that ‘….nothing can be done…’ we must speak out. Our clients not only need us to, but it is part of our nursing ethos, to be advocates for our clients. Florence Nightingale created the idea of nurses as agents of change: she changed the way that health care was delivered, she changed the way that a health care work-force (nurses) was educated. In advocating for our clients, we follow in that tradition of change. We advocate for our clients in seeking to change work-place cultures that are antithetical to the best that is in us and the best that nursing practices and procedures can provide. Thus, I agree that it is not ‘….enough to recognise bad behaviour we (also) need to be professionally active in working to develop strategies to promote and maintain the ideal culture and behaviour….’ Particularly in those nursing work-place cultures (such as those found in Australian mental health facilities) where the abuse of basic human rights is blatant (as I know from personal and professional experience) Though the out-comes from such ‘…(professional) activity …’ may ultimately be disappointing, though we may be ostracised, devalued, shut-out, disregarded (or worse) through our attempts at implementing best practice when it comes to client care, the alternative, silence towards and conformity with, norms of abuse and aggression, is never an option. Thus the answer we always speak out as we owe clients at least that minimum, that very minimum, of involvement in their care.

    • Pam Savage at 12:31 pm

      I felt sad and horrified at the suffering and experiences of respondents. However I was not surprised as these cultures and behaviours have been entrenched. I do believe it can be changed but yes it will be slow and not without pain. There are islands of hope where managers have looked hard at themselves and their strategies. I would hope that the UK experiences can teach us just how terrible the consequences can be for failing to address these issues. Having reread the Morcambe Report recently and these posts it does seem we have an ongoing battle.

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