By Catherine Conlan

Nurses have a tough job, no matter where they work.

Yet a toxic workplace culture can make it especially difficult for nurses to provide top-level care.

A recent survey from the American Nurses Association found that up to half of nurses said they had been bullied in some manner, either by a peer (50 percent) or a person in a higher level of authority (42 percent).

The issue is so important that the ANA included workplace bullying in its 2015 position statement, says Holly Carpenter, a policy associate for nursing practice and work environment at the ANA. As the position statement says, “the nursing profession will no longer tolerate violence of any kind from any source.”

These expert tips can help you create a better workplace culture for every nurse at your health care organization.

Get Buy-In from All Leaders

Change starts at the top, so make the case to department and organizational leaders about the importance of a more supportive work culture. Enlist respected nurses who might be willing to share their stories about what they’ve experienced in the workplace.

Leaders must communicate, model and enforce desired behaviors, says Addam Marcotte, vice president of organization development for San Diego-based FMG Leading, a human capital strategy advisory company. That includes everyone from the chief medical officer to physicians to charge nurses, Marcotte says. “People must see that those with supportive behavior are the ones who get promoted, and those who poison the well get let go,” he says.

Create and Communicate Policies

Nursing is a high-stress profession where workplace violence, inadequate staffing levels, fatigue, heavy workload and other unhealthy risk factors are not uncommon, Carpenter says.

These issues can lead to abusive behavior, nepotism and opportunism. To avoid these issues employers and nurses must work together to develop appropriate bullying-prevention policies and programs.

Even if an organization has policies in place to prevent workplace bullying, they may not be clear or enforced, Carpenter says. Make sure you communicate your anti-bullying policies clearly, consistently and frequently.

“Employers must create and enforce a zero-tolerance policy and program regarding bullying that is transparent, applicable to all cases of bullying and allows for corrective actions,” she says.

Include Staff in Decisions

People who feel like they aren’t heard may act out in an effort to gain some control over their work. On the other hand, staff who are heard and included in decisions about their work and patient care are less likely to be bullies, says Marilyn Stoner, professor emeritus at California State University, San Bernardino. In addition, they are likely to have happier patients and fewer occupational issues such as compassion fatigue.

One way to combat this is to create teams or panels. Include rank-and-file nurses to address workplace issues and find solutions, says Stoner. While you’re not obliged to adopt every suggestion, try to find ways to make changes that help everyone.

“The most important aspect of building a healthy workplace culture is the inclusion of staff in organizational decisions,” Stoner says.

Instill Core Values during Onboarding

Marcotte points out that the tone of your workplace culture is often established during orientation and onboarding. Remember that each new hire is an opportunity to shape the desired culture.

“The way new nurses are brought into a healthcare system will greatly influence the way they show up and treat other staff,” Marcotte says. “Messaging about core values and ‘how we work around here’ are vital at the very beginning.”

Throughout the application and onboarding process, be sure to highlight information about your company’s core values; be sure that current employees are able to articulate and display them as well. Include information about your workplace bullying policies during orientation and during the training process, Carpenter says.

Neutralize Scheduling

The work schedule is a significant symbol of power in nursing culture and should not be underestimated, Marcotte says. When done poorly, it can become a tool to punish or bully outsiders or reward those who are in favor, leading to factions and resentment. He recommends that the person responsible for the monthly schedule be someone who is seen as neutral in the department, with no allegiances, preferential treatment or agendas.

Mentor Young Nurses

Mentoring new nurses is a great way to ensure your workplace culture for nurses is passed on to new employees. “An ideal mentor will instill confidence and respect in and for the new nurse, providing all relevant information on bullying-prevention policies, programs, training and reporting processes,” Carpenter says.

Sharing stories about workplace bullying and how it was resolved can be particularly helpful for new nurses. Train mentors to be aware of their interactions and communications with others, recommends Carpenter, particularly when mentoring new nurses, so they can serve as effective leaders who model the organization’s culture.