Welcome to this episode of NLN podcast Nursing EDge Unscripted. I'm your host, Dr. Steven Palazzo, a member of the editorial board for Nursing Education Perspectives. In this episode, we will discuss how bullying behaviors may contribute to medication administration errors. My guest today is Dr. Donna Rutherford, adjunct clinical instructor at Salem State University in Salem, Massachusetts, although I believe she's actually in Ketchikan right now.
We will discuss their innovation article, Bullying Behaviors in Clinical Settings: Potentially Harmful Distractions. This article can be found in the July-August issue of Nursing Education Perspectives. Well, welcome. How are you today, Dr. Rutherford? I'm well. Thank you for having me. Oh, you're very welcome. Thank you for letting us meet with you and have a discussion
about the work that your team did. If you could start off and just let us kind of define for our audience how you all define bullying behaviors and how they may contribute to distractions in the clinical setting. Okay. Well, bullying itself it kind of encompasses a range of disruptive, repetitive and ineffective behaviors. For example, criticism, humiliation, negative activities, all perpetrated by an individual of supposed
power. There's usually a a power imbalance and it's targeted against some in our instance we were looking at it target was targeting nursing students. So, what's interesting I've had people ask me, it's like, well, you say it's repetitive. Nursing students aren't in the clinical setting...
Right. ...every single day. However, what we did, our team did, we took bullying behaviors which would come comes to like the criticism and things of that nature and took that little snippet and that's what we used to to do our simulation. And I I'm assuming during the pre-brief of the simulation or before students were introduced to the concept of bullying behaviors and what that looked like in the clinical space and what that entailed
definition-wise. And I'm sure some of them have already felt like they witnessed or experienced themselves some of those bullying behaviors. What's actually interesting when I brought them into the simulation that we withheld from them we introduced that we want to see how they would perform u basic medication administration.
We used students that had already successfully passed medication and then we looked and said, "Hey, this is a we're just seeing how you do the how the process is done, how you are doing this." They did not know that we had a an actor or we had several different actors come in and pose as the nursing instructors. Oh, good. So, they weren't prepped beforehand. They were separated. the groups they were separated into,
I think there were three groups, correct? So, the intervention group with the bullying behaviors was the one where they weren't they didn't know they were going to have somebody play a role of a bullying person in the role. Right. Correct. Yeah, that makes sense. Yeah. And we there was one group there was there was no intervention. We just had
someone introducing a distraction. She was my she played a nurse that was like my little chatty Kathy and she just I didn't realize the person could talk so much. She was a wonderful actress and she just would talk. However, the interaction with that type of distraction was entirely different than what transpired when we saw those that were actually experiencing some bullying
behaviors. Yeah. Well, though there were no significant findings between the three groups as far as the distractions or the bullying behavior, what was interesting finding that I thought was that the exposed group to bullying distractions finished their medication administration in a much shorter time than the other groups. What did your team attribute this finding to? Well, that one it was kind of sad and it's just like, oh, it's almost like that fear anxiety. It's like,
well, let's hurry up. let's get out of here, right? That fight or flight. And it's like, oh gosh, it's more of a a flight. And that's where looking at it now and looking at it a little more in depth, it's like, wow, that could be dangerous, you know? Yeah. Oh, for sure. Yeah. I mean, you're rushing through a medication administration, something as quote unquote simple as administering insulin. Insulin's not simple. Giving too much insulin, you could actually harm a patient.
Yeah. You could kill a patient. I mean, so yeah, rushing through a certain task just because it's like, oh goodness, this person's hovering over me. Or they're just like, you're taking so long. You don't know what you're doing. And I even have one one of the participants say, I've done this before. It's like, but I just couldn't think. Right? You lose focus and concentration, especially if you feel you're being intimidated,
right? Exactly. With the distractions. So although you didn't find that the distraction led to a medication error, you did find that those who were in the bullying behaviors, I'm just reiterating finished in a significantly shorter amount of time than the other two arms of the study. And it was a small sample size. So obviously you probably didn't have enough power
to capture something with that small. But that's an that's something interesting to take further with a larger group of of students in multiple settings you know and see if that shows up again which what those findings were. I would be really interested and I think many people would too. So that was a, that was a very interesting point I thought when I was reading the article. Yeah. How would you suggest an instructor build a similar
scenario in their simulation lab? What would you change in the delivery of the distraction or did you feel the distraction was distracting enough which you just kind of mentioned that the actor did a really good job at being very chatty? Well, there in the health care setting there's so many different distractions. It all depends on how you want to educate your population. If you're like, well, on the low end, hey, this is how you deal
with distractions in general. So, you can kind of structure it that way. It's like, okay, yes, we have phones in the hospital. Well, you may need to put that to the side, especially if you're a brand new nurse or if you're just a students cannot have them in the in the clinical area, but sometimes all of a sudden you see this little phone coming out, but training is like, hey, these things need to be put away for a reason, not because we don't want you to have technology.
It can also be structured where the bullying the those that are performing the bullying. Oh goodness. You can have them just kind of be like a little gang. One time I actually described someone as remember the movie Mean Girls. Doesn't necessarily has to be women or men, but mean people where they're just grouping around kind of gossiping. Just even just that chitter chatter. It's like are they talking about me and things of that nature. So it can be introduced that way.
I mean there are so many different ways you can take this. What was the role of the actor playing the bully? Like what what bullying behaviors did they manifest when they were interacting with the students? We had to keep it pretty low-key because we did not want to cause I mean physical harm or anything of that nature. Of course. Of course.
Yeah. So what we did one time the gentleman he's like I described what we needed and he's like I'll just be on the phone pretending that he's on the phone and he's just like oh yeah you know how these students are they just take forever and ever this this one she know doesn't even know what she's doing just those small little zingers, those... Right. ...and that's when it's like is this really happening to me so that's how he introduced it. And there was actually one student who
pushed back. He also... Yeah. ...he had a different he had life experience. Let's just say life experience. I remember. But he pushed back and it's like, "Excuse me, you're supposed to be here to help me." It's like, "Oh, okay. Very good." Okay. So, so there was some built-in resiliency potentially from already previous exposure or life experience that they seem to be a little bit more
equipped to handle the situation. Exactly. So, and this type of simulation I would love to see with
brand new grads. Yeah. due to the fact that okay they have this wealth of knowledge that they've already gotten from school but how are they going to be in able to integrate in the real world with what's really out there I mean it's fortunately right now where I'm at it's a wonderful place but there are some places that are not so wonderful and you're these brand new grads are walking in it's like, oh gosh, what have I gotten myself into?
So. Yeah. Dr. Rutherford, how would you suggest an instructor build a similar scenario in their simulation lab? And also, what would you change in the delivery of the distraction or would you change anything in the delivery of the distraction? Delivery of the distraction to keep it low-key and safe. I probably I personally would not do any changes. They could if they wanted to
have additional people. Okay. Instead of just one because I only had one person who was introducing the distracting behavior slash bullying behavior with one student. I I would love to also see, hey, maybe they could develop it where there is just the instructor or someone who is doing a check off, but have another student like a pair, a buddy with them while they're there because not everybody is outspoken. Maybe having two people there will kind of protect protect each other and
keep them on track. That's another way. and and even if they want to do further research in this, would that make a difference? Especially if they're a brand new new nurse or even just a student nurse, it's a buddy system. I assume there's education around this topic then for these students. It's not an isolated situation where they go into this simulation lab and experience this, but there is education around
it. Correct. Those that had the intervention that was the intervention for those that were in that particular arm of the the right yes yes but I was wondering if these students would also get that same type of education after the fact and be exposed to the same strategies for dealing with those type of behaviors. I personally think that
would be ideal. And I also think that this is this type of education needs to be kind of woven into the curriculum so they have that additional additional information to to kind of armor themselves have a toolbox of of things to go from point A to point B. Right. So, well, well, I want to thank you so much for joining us today in this
conversation. I really appreciate your time and your expertise in broadening our understanding of this work and how we can begin to introduce some of these strategies in our own institutions and programs. To our listeners, if you have not already had the opportunity, please take a look at the author's work, Bullying Behaviors in Clinical Settings Potentially Harmful Distractions. And the article can be found in the July-August issue. And Dr. Rutherford, again, thank you so
much. Thank you for joining us from Ketchikan, Alaska. Appreciate your time. Thank you so much, sir. You have a great day. You, too.