Written by Dr. Kathleen Thimsen, AFN Treasurer

Amanda Flynn, DNP, APRN, FNP-BC, is a nurse who looks at obstacles as opportunities. Flynn began her career as an associate-degree prepared nurse after a year in business school. She used her business skills to analyze her potential and realized that nursing would provide her independence and stability in her career and also as an individual. Flynn had grown up in a family where everyday life was uncertain due to both of her parents having addiction issues.

As an associate-degree graduate, she took on a new nursing role in the ICU. She was well suited for dealing with chaos, multi-tasking, and uncertainty that fed her adrenaline-surging needs as well as her persona of being a peacekeeper and problem solver. Her journey, though, was one of the challenges as the culture of that ICU unit was one that many of us can relate to: the “eat your young” environment. She was relentlessly bullied and treated in a derogatory manner. However, because Flynn turned obstacles into opportunities and focused on her quest to address and solve problems, she earned respect and was valued by her peers. As a result, she was appointed to a charge nurse position within six months of being a new hire.

During this time, things were equally challenging at home. Her middle daughter faced serious health challenges. Flynn made the tough decision of changing jobs to attend to her family’s needs and the extra time necessary for her daughter’s medical needs. To prepare for that transition, she received advice to return to school to get her BSN so that she could gain a better nursing position and be valued and respected for her educational attainment. As her daughter’s condition improved, Flynn embarked on her BSN and completed an RN to BSN program in just 10 months. This was with three children in school, one who still need some medical follow-up but with less severity and frequency of appointments and treatments.

Flynn then returned to school yet again for her MSN and FNP degrees and aced her licensing exam for her FNP. Shortly thereafter she joined academic nursing as a faculty member, while maintaining her FNP practice. As an academic faculty member, she identified the need to return to school for her doctorate. Again, taking on challenges, she entered an accelerated DNP program and achieved her Doctorate in Nursing Practice degree in one year. This was an incredible accomplishment for a doctoral student who also worked full-time as a professor while also maintaining her clinical practice.

Facing Bullying Head-On

During this phase of Flynn’s professional development, her middle child experienced increasing bouts of anxiety as she navigated her teenage years. It was identified that her daughter suffered from anxiety because she was the focus of significant bullying at her high school due to having to wear glasses while also navigating her gender identity.

Flynn met with the school, but sadly – as many schools do – they took no action to intervene in the matter despite the bullying being perpetrated on school grounds and during school hours. The events of the bullying included social media contacts, comments, as well as the group mentality that often occurs with bullying: large groups of kids join the bullying actions, thus isolating the bullied party even more. Add to this the presence and contributions of the parents of the bullying kids, which reinforced the issue and further created disharmony.

Again, the school did nothing to address the issues despite the fact that school faculty and staff witnessed bullying events. This practice, sadly, is not an isolated event; rather, it is the norm. Flynn and her husband took action to protect their daughter and remove her from the situation.

Bullying in the Nursing Profession

This very personal experience created motivation for Flynn to look at this social and public health problem through an evidence-based lens that led to her doctoral research and now the trajectory of that work into the healthcare arena.

Some facts that Flynn shared are important for forensic nurses to be aware of when considering interventions and education for our patient population and their families:

• Ninety percent of students in nursing school are bullied. This occurs via text messaging and social media by peer students as well as faculty.

• There is an increase in the rate of suicide related to bullying, as one can read about frequently in the news media.

• Of social media users who reported being bullied, 60% of them were bullied by a total stranger.

• Bullies hide. In social settings (at school or the mall, for example), restrooms are prime for a bullying encounter.

• Bullying may be experienced in a single encounter, but the impact of bullying stays with a person. It does not disappear after the experience ends.

Flynn’s work was conducted as a quasi-experimental study in a Midwestern nursing school. She recruited 100 subjects and consented them prior to enrolling them in her study. Her work included a pre/post-test design. She offered as her intervention a video demonstrating how bullying is perpetrated. The pre-test of subjects showed 0% reported experiencing bullying. The post-test results demonstrated significance in reports of having been bullied after viewing how bullying is actually carried out and experienced. Her results are submitted for publication in the near future.

Some takeaways from work done in the United Kingdom showed that the impact of bullying could be minimized when awareness of the bullying activities is known. The work also shows that people who bully must be held accountable. In instances when there is no accountability, events and episodes increase in frequency and severity, with a significant increase in violence, trauma, and death.

As the work Flynn started in the nursing school environment shows, the translational association to long-term impact can be seen and also explains issues in social as well as workplace violence. The implications to healthcare are documented in patient safety literature. The literature cites instances when nurses are afraid to ask for clarification, or even to question mistakes in ordering. As a result of this hesitancy, patient care suffers. One example Flynn gave was a nurse who was afraid to question an order to hang a bag of hypertonic fluids on a patient. The order read for a 1000cc (not the appropriate 250cc) bag. The direct and almost immediate result was that the patient died of a brain herniation. This is not an isolated event. People who have been or who are being bullied suffer in silence. They manifest depression and aggression. We are seeing an alarming increase in bullied individuals turning to suicide or even becoming active shooters.

Flynn contributed to the AFN’s position statement on bullying several years ago. Her work focuses on cyberbullying and cybercrimes, and she actively looks for opportunities to enhance interventions to protect clinicians from the harmful effects and impacts of bullying in all its forms.

A recent study of emergency department professionals (MDs and RNs) showed that 100% reported being bullied or had been a victim of assault or battery within the last six months. The extent of violence being committed against healthcare professionals is at the highest rate in history. Sadly, the healthcare industry takes on the same approach to bullying and violence as schools: inaction. This only propagates the issue.

The takeaway from Flynn is that we as individuals, communities, and society must stand up against bullying and be prepared to address these events and behaviors. While it may be daunting, together we can make a difference. The epidemic of bullying has far-reaching consequences even after the bullying ceases. The adage of “see something, say something” is ever so important to each of us to not be complicit bystanders! Be part of the solution.