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Bullying among trust’s A&E nurses created ‘tribal culture’


A bullying culture between accident and emergency department nurses at a hospital trust in Merseyside has led to “tribal divisions” between staff and has been perpetuated by bosses failing to intervene, an independent report has found.

The behaviour has been going on for many years and is aimed at newly promoted band 6 sisters, according to the report on Arrowe Park Hospital, which is run by Wirral University Teaching Hospital NHS Foundation Trust.

“Unedifying” comments were made by staff about colleagues”

Independent report

It includes nurses undermining colleagues in front of less experienced staff, “aggressively” challenging their decisions, withholding information, and making comments suggesting they did not deserve the promotion, said the report.

In addition, the way staff are allocated to each area in the emergency department has become a tool to bully colleagues by isolating and punishing people and setting up less experienced staff to fail by putting them in teams with less capacity, said the researchers from management consultants ThinkNow Ltd.

While bullying was regularly happening among a small group, there were also problems more generally among a larger cohort of staff who were thought to be “beyond reproach” and were believed to be working in an unhelpful way.

Staff also often referred to others according to their banding under the NHS Agenda for Change pay system, contributing to problems with hierarchy.

“Unedifying” comments were made by staff about colleagues, which suggested they did not understand one another’s role, expertise or personal circumstances, said the researchers.

They warned that these behaviours had been allowed to persist due to senior staff failing to address the issues.

“By allowing them to go unchallenged, people have at least been given passive permission and at worst, inadvertent encouragement to behave badly.

“An absence of strong leadership, management and support in a very challenged clinical and performance environment has created a vacuum that has been inappropriately filled,” noted the researchers in their report.

More widely, many staff told the report authors they did not feel valued and that they could not remember the last time they were thanked for their efforts and commitments to the department.

This lack of appreciation had contributed to some of the negative behaviours, said the researchers.

The trust’s A&E department was also “operating as an island”, with staff under “huge” pressure to compromise clinical and care standards to meet national NHS waiting targets and then blamed by other departments for shortcuts in care, according to the report.

While the researchers found evidence of ongoing unacceptable behaviour, they highlighted that because a wider group of staff also failed to challenge this the trust should make it clear this would not be tolerated but that disciplinary procedures would apply in the future.

They made a series of other recommendations, including an end to referring to staff by their AfC banding because this practice “promotes hierarchy and division” and the introduction of new ways of working so staff can take part in decisions that affect them.

The report was commissioned by the trust after the organisation’s chief operating officer received an anonymous letter in November suggesting bullying the emergency department was not being addressed.

“We acted immediately and commissioned an independent review”

David Jago

In a statement provided by the trust, David Jago, acting chief executive, said: “As soon as concerns were raised with the executive team, we acted immediately and commissioned an independent review in our emergency department, recognising the current challenges we are facing.

“We are now working with colleagues in our emergency department to address the issues raised and to move forward in a positive way,” said Mr Jago.

“Our senior team are fully supporting colleagues throughout this entire process. We thank staff for their participation in this review as this will help us to identify areas where we need to improve,” he said.

“As always our priority is to ensure safe, high quality patient care is at the heart of everything we do,” he added.


Readers' comments (11)

  • Not just in A &E it’s throughout the NHS. It’s a power game

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  • I am a first year student and will be starting placements soon and this is what I’m worried about.

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  • Bullying is absolutely rif within my NHS the amount of times the perpetrator has been reported to the nursing officer, and nothing has been done. In fact they've been promoted

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  • Yes this is definately happening not just in a& e departments. Jobs being filled that are not advertised & bullying being reported but no confidence in management to investigate & weed these people out. I really can’t believe what is happening within our profession .

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  • For a workforce dedicated to helping others and supposedly endowed with more than its fair share of empathy, it is surprising how many nurses and CSWs have a mean streak. Our job is difficult enough without being made to feel as if we are in a war zone. The Respect Agenda should come with a zero tolerance towards those colleagues who cannot resist stirring things up.

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  • Sad but true. Often those who will do and say anything to keep senior management happy ... which of course suits senior management, and that suits Hunt and his government.

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  • Ellie (Ellen) Phillips

    This is not a new phenomenon in nursing, I have been in nursing for over 30 years and have seen and heard of bullying within the NHS. I have also been at the recieving end and know how the victim can feel isolated and unworthy.
    I was hoping that with the crisis within the NHS would bring the nurses together to concentrate on providing care for their patients and work as a team with respect for the role each member provides. But it seems not in all hospitals and maybe times haven't changed.

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  • Always has happened, is happening and will happen as it’s so ingrained in the NHS culture.
    As a former Regional Officer I was called in to represent a member being bullied, not only by the way she was treated, on one occasion having a hoist run into her deliberately. It was endemic from top management down, I thought I would be just working with this nurse, a year later it was like unpeeling an onion with colleagues also involved. End result? Another traumatised nurse who left the profession, many bullies who escaped by taking early retirement and the same weak manager left to control nursing. In 21/2 years this was repeated again and again, traumatised nurses who left nursing and perpetrators who took early retirement and the top person responsible moved sideways to start again. Senior management must take action and stop supporting rotten colleagues. As for the promised protection offered by the Whistleblowers Charter forger it, staff will never work again.

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  • It is not a new thing, promoting staff without interviews. I was told by that it is not what you know but who you know. The hard working staff do not have time to entertain the management, it is those escapers who seem to be favourable to the hierarchy by gossiping, providing little gifts, time etc who are able to step up. Welcome to the real nursing

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  • In 1987 as a Student Nurse bullying was rifeeling on the students in accident and emergency and being the only one to speak out I got put on cleaning duty more often, repeat dressings and the menial tasks. I was excluded from the Resuscitation Bay and more serious injuries and so were some other students whose face didn't fit and speaking up made it worse. I passed my placement with "has a bad attitude" written on it. Till today I never wanted to work in A & E ever again.

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