All midwives have the right to work in respectful environments that are free from any form of bullying. In fact, all practice groups have legal obligations under the Occupational Health and Safety Act (OHSA) to protect workers from all forms of violence in the workplace, including bullying. The AOM’s position statement on bullying describes the AOM’s stance and calls upon midwives to denounce bullying. Learn more about the AOM’s work to denounce bullying.
What is Bullying?
Bullying is a form of psychological aggression and intimidation. It is generally associated with a power imbalance between the target and perpetrator in which the target is made to feel inferior. Bullying is repeated, persistent behaviour that may be subtle. It may include, but is not limited to: (1-3)
- excessive or unjustified criticism
- withholding information, support or needed resources
- social isolation or the silent treatment
- spreading rumours, talking behind someone’s back
- personal attacks based on a person’s characteristics, whether these are grounds recognized under the Ontario Human Rights Code or not
- threatening, intimidating or humiliating behaviours
- verbal attacks
- setting unrealistic goals and deadlines or overloading work
- overruling, ignoring, marginalizing or sidelining someone
The person being bullied is sometimes described as the “victim”, but “target” is the preferred term.
Bullying is something that people choose to do, but not something that people choose to have done to them, and so we prefer the term "Target" to describe the person being bullied: Bullying is directed towards, aimed at and sometimes specially tailored for a specific recipient, hence the term. "Victim" is a broader term describing a person who has come to feel helpless and passive in the face of misfortune or ill-treatment. While it is true that bullying can render a person "helpless or passive", it can also inspire an assertive response. The term "Target" covers anyone who is bullied, regardless of its effect on them. (4)
Impacts of Bullying
Bullying has numerous negative impacts at many levels: on the target, on their workplace, and on the broader healthcare system.
The target of bullying may experience: (1-3)
- reduced self esteem
- loss of confidence and continuously double checking one's actions at work
- sleep disorders
- difficulty with emotional control (e.g. bursting into tears or laughter or irritable and angry)
- reduced immunity and frequent infections
- eating disorders, irritable bowel
- low morale
- perpetuation of bullying behaviours
- impaired personal relationships outside of work
- removal of self from workplace – psychologically, physically (sick leave, stress leave, resignation)
In the AOM’s fall 2017 survey on bullying, 52% of midwives who experienced bullying indicated that it impacted their health; 33% indicated that it impacted their relationships with family or friends; 58% indicated that it impacted their career satisfaction.
Practice groups, clients, the profession and the health care system may also experience some of the harms of bullying, including: (1,2)
- difficulty retaining midwives and staff
- client complaints
- legal actions
- clinical errors because the “[f]ear of bullying attacks and intimidating behavior present a barrier to the open communication needed for safe patient care” (2)
- diminished view of the profession in the eyes of the public, government and interprofessional colleagues
Practice groups are required under the Occupational Health and Safety Act (OHSA) to protect workers from all forms of violence in the workplace, including bullying. Practice groups need to have policies on violence and harassment and reporting procedures in place, and regularly conduct violence risk assessments.
Raising awareness is key to preventing bullying and violence in the workplace and promoting a healthy work environment. There are many ways to raise awareness in the workplace:
- Assess what kind of practice culture you have. Establish a supportive practice culture of compassion and empathy to help prevent or lessen psychological distress.
- Role model appropriate behaviour and practice self-reflection to determine if any of your actions or behaviours could be interpreted as bullying.
- Ask practice group members to sign a "statement of commitment to co-workers," such as the one adapted in Hastie's article (see Appendix 1).
- Visually communicate an expectation of respect in the workplace, and visually communicate that there are consequences for inappropriate behaviour. Practices may wish to display the poster developed by the AOM (email firstname.lastname@example.org).
- As a practice, read and discuss Myths and Stereotypes About Workplace Bullying to understand what bullying is and is not, as well as common excuses for bullying behavior.
- Develop and adopt protocols and policies to prevent and respond to workplace violence.
- When recruiting new workers, screen candidates for bullying behaviours and set a tone for acceptable behaviour in the workplace from the beginning (see the AOM’s template Orientation Policy – under human resources).
Responding to Bullying
Stand by your colleagues who are being bullied, don’t be a silent bystander, and let them know that they are not alone.
If concerns about bullying arise, the practice will need to develop a strategy to respond (see the AOM’s template Policy on Harassment and Violence). As noted in Is it Bullying or is it just being Bossy?, it is important to consider the intention behind a behaviour, as there will be a differences in how the practice responds to a "knowing" vs. "unknowing” bully. Effective interpersonal communication is key to identifying and addressing behaviours perceived as harassing.
If the practice group receives allegations of bullying or any form of workplace harassment or violence, consider hiring an external workplace violence and bullying investigator to conduct a third party impartial investigation and report to both parties on their findings. Consider calling AOM On Call for advice and coaching specific to your situation. The AOM does not offer investigation or mediation services as the AOM represents all midwives and the profession. However, the AOM can refer you to third-party independent investigators, mediators and facilitators that other midwives have recommended.
If You are Being Bullied
If you are a target for bullying, know that you are not alone. Seek support or allies. It is important to talk to others about it: family, friends, trusted colleagues, a counselor, your physician, or a member assistance program counselor from an organization such as Optima Global Health (member assistance program replacing HumanaCare).
It is very challenging to confront a bully. Workplace bullying often goes unaddressed for fear that reporting will not improve the situation or will make things worse, that the target will not be taken seriously or that the target will be unfairly judged. A midwife may fear that their contract will be terminated or not renewed if they report or call attention to bullying. However, it is often worth trying to engage in a direct conversation with the bully to let them know how their behaviour is impacting you and give them a chance to respond.
It is also important to make note of bullying-related incidents as soon as possible after they occur, to help track and document the situation in the event that you choose to file a formal internal complaint or pursue legal action. Record the date, location, time and nature of the event, including your response (if any), your feelings, action taken or not taken and the names of any witnesses.
If you decide to leave your practice due to bullying, consider letting the practice know the reason. You can contact AOM On Call to help you navigate your options.
The Public Services Health & Safety Association of Ontario has excellent step by step strategies when confronted by a bully.
There are several excellent articles and resources about bullying in midwifery:
- The Royal College of Midwives and Royal College of Obstetricians and Gynaecologists have a number of resources on Undermining and Bullying in the Workplace
- 10 Things You May Not Know About Midwives in Work-Related Psychological Distress presents some of the work conditions and factors, including bullying, that contribute to stress and psychological distress in midwives.
- Midwifery: Horizontal Violence in the Workplace, in-depth article by Carolyn Hastie in Birth International that defines “horizontal violence,” provides examples of bullying behaviours, outlines the consequences and, most importantly, proposes strategies for promoting a safe, happy workplace and for dealing with instances of horizontal violence.
Numerous other organizations have also developed resources about bullying and bullying prevention:
- Public Services Health & Safety Association of Ontario: A Handbook on Bullying in the Workplace includes definitions, how to set up an educational program and a respectful workplace, tools for recognizing bullying, responding to bullying, establishing a complaints process and creating supports for victims.
- The Canadian Patient Safety Institute has alerted that bullying in healthcare is a disruptive force linked to compromised patient safety and proposes some strategies to denounce bullying in the workplace. .
- Canadian Centre for Occupational Health and Safety (CCOHS): Free courses on bullying and violence in the workplace, including an e-learning module on violence in the workplace and podcasts on violence, harassment and mentally healthy workplaces. While some of these materials refer to managers, employers and employees, the key concepts also pertain to independent contractors.
- Bullyonline.org: Myths and Stereotypes about Workplace Bullying
1. Public Services Health & Safety Association (PSHSA). Bullying in the Workplace: A Handbook for the Workplace. 2 ed. [Internet] Toronto, ON. August 2010. [cited 2018 May 1] Available from: https://www.pshsa.ca/wp-content/uploads/2013/02/BullyWkplace.pdf
2. Joan Porcaro, RN, BSN, MM, CPHRM, American Society for Healthcare Risk Management (ASHRM). Bullying Has No Place. [Internet] Chicago, IL. February 2018. [cited 2018 May 1] Available from: https://forum.ashrm.org/2018/02/14/bullying-has-no-place/
3. Abby Sutcliffe, Birth International. Midwifery: Horizontal Violence in the Workplace. [Internet] [Location unknown] 2018. [cited 2018 May 1] Available from: https://birthinternational.com/article/midwifery/1371/
4. BullyOnline, Tim Field Foundation. Myths and Stereotypes about Workplace Bullying. [Internet] [Location unknown] 2018. [cited 2018 May 1] Available from: https://bullyonline.org/index.php/bullying/134-myths-and-stereotypes-about-workplace-bullying