Stepping Out of the Shadows

We lose ourselves in the pages of comics and graphic novels for escapism and entertainment. Whether fantasy and science fiction, or graphic non-fiction, the stories tell of the fantastic feats of superheroes or the desperation of a zombie apocalypse.

A group of faculty and students at the UBC School of Nursing have given a new reason to explore the graphic novella. Not for escapism, but instead to address a reality we wish were merely a story in a comic – the very real story of bullying in nursing.

Together, the student/faculty partnership authored the digital graphic novella Stepping Out of the Shadows – A Story About Bullying in Nursing. The novella was made possible by the UBC Teaching and Learning Enhancement Fund, created to enrich student learning with innovative educational enhancements. The fund is financed entirely by a portion of tuition paid by UBC Vancouver students. Stepping Out of the Shadows tells the story of student nurse Alex. She is paired with an RN and their worlds collide in a painful way – Alex becomes the direct target of bullying. The novella depicts her experience and offers some coping and response strategies for anyone who may witness or experience bullying.

Workplace bullying is widespread in Canada and is a significant problem for the nursing profession. According to a 2011 CBC News report, 40 percent of Canadians have experienced one or more acts of workplace bullying at least once a week. And a 2010 study on bullying in the nursing profession in the journal Medscape found that that between 21 and 46 percent of nurses experienced or witnessed bullying.

The novella is part of the nursing school's CRAB project, and the latest in a series of student-led initiatives to address bullying in nursing, supported by faculty partners. CRAB stands for Cognitive Rehearsal to Address Bullying, an approach where participants are given scripts to practice in advance of encountering an incidence of bullying. The project's charter is founded on the understanding that, when faced with bullying and harassment, the common strategy of "staying silent" doesn't work.

According to the project, research studies have shown that the likelihood of nurses and nursing students witnessing or experiencing bullying during their careers ranges from 17 percent to over 90 percent.

Indeed, bullying is so prevalent that nurses are often characterized as "eating their young." The CRAB project is also based on the recognition that nursing students may tolerate bullying as a "rite of passage" and may not report it because of fears of increased bullying, negative evaluations or limited professional opportunities. And, sometimes, students are unaware of school policies, unsure how to report bullying, respond to bullying by doing "nothing" and/or believe that nothing would be done if they were to report bullying. 

"We created a guiding, three-prong framework that includes policy, education and clinical practice partnerships."

 

- Kathy O'Flynn-Magee says.

The novella's lead author Kathy O'Flynn-Magee is Associate Professor of Teaching Emerita at the nursing school. She explains how the CRAB project began.

"A group of students surveyed their peers on bullying. It wasn't formal research, but they had some alarming results, so they created a poster and wrote a letter to the School of Nursing asking for a policy so students would know where to go if they witness or experience bullying," she recalls.

"That poster caught my attention so, as BSN associate director, I thought 'I'm going to address that,'" says O'Flynn-Magee. Researchers then conducted a qualitative research study with schools of nursing and other health-care professional schools. "We were wondering what other schools did when their students might experience or witness bullying, how they supported those students, if those students knew where to go, etc.," she explains. The research resulted in a published paper, Interrupting the Cycle of Bullying Witnessed or Experienced by Nursing Students: An Ethical and Relational Action Framework. "From that we created a guiding, three-prong framework that includes policy, education and clinical practice partnerships," O'Flynn-Magee says.

Two of the CRAB project's prongs – policy and clinical practice partnerships – are focused on using research to help develop reporting mechanisms so that students know where to go if they witness or experience bullying, and on working with leaders in health care, education and government to address bullying at the systems level.

On the policy front, O'Flynn-Magee highlights an institutional flaw revealed by the project researchers. "From our interviews, we know that everyone who's a nurse is very familiar with bullying. I haven't met many nurses who said, 'I've never experienced it.' We also learned that, despite policies everywhere, including zero tolerance, it [bullying] is very, very prevalent. So those policies are not working. Sometimes they're pushing it underground and we're left with a false sense of reassurance."

The project's education prong is where arts-based methods are used to address bullying in nursing education. Stepping Out of the Shadows is the CRAB project's latest educational tool, but it is just one of many. 

"We've been doing a lot of forum theatre," says O'Flynn-Magee, explaining that this tool offers participants the opportunity to watch a play and then step up on stage to try out a different way of engaging in a conflict situation.

"We're also working on a 'train the trainer' movie about doing forum theatre. We use bullying as our example but really it's about using forum theatre as a pedagogy," she adds. "This will help people learn how to do that."

Addressing bullying is a major priority for BCNU, and part of the union's long-term goal of achieving positive and supportive workplace cultures that promote psychological health. Every February BCNU encourages members to participate in Pink Shirt Day, a made-in-Canada anti-bullying initiative that began in 2007.

The union's focus on mental health also saw it negotiate the Canadian National Standard on Psychological Health and Safety in the Workplace into the Nurses' Bargaining Association contract in 2015. BCNU was the first union to negotiate this standard, which includes a set of guidelines focused on the development of a system of positive factors that support psychologically healthy and safe workplaces. A workplace free from harassment, and which promotes civility and respect, is one of the 13 healthy workplace factors contained in the standard, and health employers and the ministry of health have agreed that psychologically healthy workplaces are "a vital requirement for a healthy, engaged and productive health-care workforce."

The implementation of the standard will take years and much effort from both the union and employers but, once complete, nurses will be one of the first groups of workers who will able to refer to a normative measure of psychological health if they feel they are being devalued and disrespected by their employer.

In the meantime, new respectful workplace policies created by WorkSafeBC in 2013 are tools that all health-care workers can use to address bullying and harassment in the workplace. Section 5.1(1)(a)(ii) of the Workers Compensation Act requires employers to address bullying and harassment as they would any other hazard in the workplace, by taking all reasonable steps to ensure the health and safety of their workers.

BCNU members are encouraged to review their employer's respectful workplace policy and follow it. If they witness or are a target of bullying and harassment, they should report it to a supervisor and contact a BCNU steward. Members can also reach out to their union steward or email BCNU's Occupational Health & Safety team at healthandsafety@bcnu.org.

As the union strives to support members and students affected by bullying, Stepping Out of the Shadows reminds readers in a traditionally escapist format that when this behaviour exists, escapism is not an option – the problem is real and must be addressed. For someone who is the target of this abusive behaviour, there is hope that resources like Stepping Out of the Shadows can help further union and employer efforts to confront and eliminate bullying and make this behavior a thing of the past. •

Read Stepping Out of the Shadows on www.letsact.ca.

UPDATE (Winter 2020)
 

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