Women and working in healthcare during the Covid-19 pandemic in Brazil: bullying of colleagues

These data allow us to point out that the daily experiences of the health professionals was strongly marked by moral harassment.The environment was characterized by precarisation and conflict that inflicted psychological consequences and even injury.

Mental harassment at work is defined as a series of intentionally abusive behaviors, repeated in time, to humiliate and socially exclude a person in the workplace. The consequences of bullying, such as self-degradation and weakening of identity, are increasingly reported by healthcare professionals, with nurses being the most affected [28, 49]. Within these teams, women are the primary victims of this type of psychosocial violence, given the feminization of healthcare professions [50]. It should also be notedthat the chain of command within hospitals is doctors, nurses, and nursing assistants/orderlies, with the last two categories being responsible for carrying out orders [51, 52].

In this regard, rigid and vertical hierarchical relations - often predominant in the majority of hospitals [53] - are favorable to the transformation of conflicts inherent to the work organization into situations of mental harassment, which results in psychosocial degradation of workers by making them doubt themselves as professionals, request transfer to other sectors, or resign. This rigidly hierarchical context in the health field is associated with reducing professional teams, material precariousness, intensifying work with long and exhaustive shifts, and the requirement for a polymorphous professional profile of multiple skills. The Covid-19 pandemic has greatly aggravated this situation.

Thus, this scenario configures what has been called “distressing work” [22] within the context of bullying. “Distressing work” is work that is impossible to complete adequately, or truncated work, against a backdrop of contradictions and constraints that materialize in organizations, making workers susceptible to bullying. The interviewees pointed out several experiences related to this: obligations that could not be fulfilled, lack of material conditions to carry out the tasks, mismatched information.

The new cycle of increased precariousness of working conditions in the area of health, associated with the overload of the health system and impending risk of collapse of health services in the context of Covid-19, has contributed to intensifying workplace bullying, as in the case of a group of 67 resident health multi-professionals (51 women and 16 men) of a large university hospital in the state of Rio Grande do Norte, of whom 44.8% reported suffering bullying during their residency [54]. In the nursing area, another case is emblematic by revealing exponential growth of the phenomenon among female professionals in the context of the Covid-19 pandemic, with the significant presence of situations of physical, verbal, and psychological aggression [55].

The reports of our respondents depicted a wider context of distressing work, with situations such as lack of personal protective equipment (PPE), need to purchase their own PPE, deviation of job duties, lack of information and training, low salaries, excessive work demands, disrespect for working hours, forced transfer of sectors, denial of added pay for unhealthy working conditions, absence of assistance from supervisors, and fear of contamination by the coronavirus.

As a manifestation of distressing work caused by the exploitation of the workforce in the capitalist context, such as long and exhausting work shifts, reduction of salaries, diminished worker protection, greater precariousness, imposition of unreasonable goals, increase of informal labor, growing extraction of surplus value and individualization of problems [25], bullying requires a level of comprehension that places the contemporary capitalist mode of production and its socio-metabolic effects as central elements, thus displacing analyses seeking individual responses and even leading to solutions through judicialization of the phenomenon. That analysis also requires understanding that the conflicts managed in the workplace become personal dilemmas and experiences of suffering and humiliation. Health professionals therefore took upon themselves a responsibility, an impossible workload, which they should not have, and this produced an excessive burden on them.

Studies of healthcare teams have shown that excessive delegation of activities, supply of confusing and imprecise information, failure to convey information useful for work, giving instructions impossible to carry out, depriving workers of access to work instruments, inducing errors, assigning incompatible tasks, imposing unjustifiable working hours, restricting labor rights such as vacation, and salary discrimination [49] are situations of bullying reported by healthcare professionals, mostly women, in their working routine. This description is very close to that depicted by the quantitative and qualitative data gathered by our survey.

The work of caregiving, as we have argued, involves contact between bodies, relations of proximity and subjective implication of healthcare workers, requiring them to experience moral dilemmas in the context of Covid-19 that involve their own safety and that of others. Health professionals felt responsible for the life and death of patients, something that should be a responsibility of the health service.

The invitation to the accountability of their actions regarding the lives of others [16] thus has become a situation present in the everyday routine of these healthcare professionals in the context of Covid-19, causing transformation of the material and organizational adversities, i.e., distressing work, into psychosocial conflicts, strengthening the subordination and oppression that women experience, outside and within the context of healthcare work. In this sense, we believe that the mental harassment, experienced as psychosocial in nature, is a phenomenon resulting from a distressing and precarious work environment, which demands a degree of knowledge for analysis that encompasses a restructuring of capitalism and its effects on the subjectivity of social relations, especially the effects on women, producing constraints, humiliation, embarrassment or even desire to abandon work, as indicated in the narratives. Thus, women are the main victims of a modus operandi of organizing and managing work, intensified in the context of Covid-19, which has transformed the working environment into a minefield marked by fear, disputes and abuses of power, causing suffering and physical and mental overload of workers [17].

Work in the health area is performed most of the time by multi-professional teams, with rigid vertical organization, carried out under pressure and subject to multiple conflicts arising from the interpersonal relations with workmates, patients and their family members [54]. Therefore, activity in the healthcare area is fertile terrain for transformation of disputes into situations of violence and violation of rights, characterizing bullying, especially in the context of a pandemic in which the novelty of the virus and the risk of death make the working conditions even more precarious. The upshot is a context in which mental harassment passes through processes that are at the same time naturalized and reproduced by healthcare professionals, without critical analysis of the harmful effects.

Against this backdrop of work under pressure, bullying can occur through different routes: vertically descending (from superiors to subordinates), vertically ascending (from subordinates to superiors), or horizontal (between professionals of the same hierarchical level) [51]. As seen in the quantitative data, the healthcare workers in the context of Covid-19 reported harassment by users of the service, supervisors, colleagues and head of State. The health professionals’ reports show the harassment experienced in their relationships with superiors, co-workers, patients and patients’ families, which demanded responsibilities that went beyond the individual sphere.

We have depicted some of the conflicts generated by the routine of the respondents that have put them at jeopardy of suffering gender violence, as in the case of questioning the right to breastfeeding. We consider these to be clear examples of how the Covid-19 context has aggravated the violence routinely suffered by women in the workplace, with mental harassment acting as a springboard of this oppression. Various other situations of perturbation and humiliation were mentioned, such as attacks for becoming sick, accusation of stealing vaccines, accusation of contaminating patients or work mates, doubt regarding pregnancy, demands to do the work of colleagues who do not want to become infected, and reassignment of the work location as punishment. Whether vertical or horizontal, from users, colleagues, supervisors or head of State, what matters is not only to understand the perverse nature in the figure of the aggressors as an explanation for the phenomenon of bullying experienced by healthcare professionals in the context of Covid-19, but also to find in the organization of the world of work, in the processes of restructuring health services, and in the securitization and feminization of health services, the central elements that transform interpersonal relations into relations of violence and denial of others [51], especially violence against women.

It is important to stress that the work of caregiving, or caregiving as work, is the expression of the sexual division of work produced by the capitalist mode of production, which exploits women and does not separate the reproductive from the productive sphere [56,57,58,59]. Therefore, historically men have occupied social positions in the productive sphere, with remunerated work, while women have been assigned to roles in the reproductive sphere, with unpaid tasks, and when they enter the labor market, they are impelled to reproduce the caregiving, based on the symbolism of the maternal metaphor of dedication, abnegation, sacrifice, submission and natural love for the caregiving mission [60]. We consider it important to emphasise that these same demands are never placed on male professionals.

It is not without reason that the two agents of bullying identified the most by the healthcare professionals were supervisors and users. The supervisor (sometimes a physician) is at the top of the line of command of health services, and the users are those who demand that the body, devotion, subjectivity, emotion and negotiation appear in the scene, leading to situations in which the professionals are psychologically exhausted and doubt themselves in the exercise of their profession, as a clear expression of the degradation of their integrity and subjectivity.

Starting from comprehension of bullying as a reflection of sociability based on capital, of a contemporary restructuring of the world of work that produces situations of interpersonal conflicts and professional traumas that are manifested in behaviors such as threats of firing, persecution, strict disciplinary control, insults, accusations and verbal aggression, which gravely injure the subjectivity and mental health of workers [22], we analyzed how these situations produce consequences that affect the self-degradation and self-integrity [61] of the healthcare professionals.

A study of caregiving work [62] showed how the routine of these workers has been invaded by demands expressed by those they care for, the use of the body, emotions, devotion and decisions, causing these healthcare workers, especially in the context of the pandemic, to experience anxiety, depression, anguish, sleep disorders, use of drugs, fear, burnout syndrome, post-traumatic stress disorder (PTSD), negative social behaviors and mental exhaustion, as part of the impacts caused to their mental health.

In the case of the healthcare professionals who took part in this study, the scenario is similar. Their narratives identified painful experiences caused by situations such as: inappropriate criticism, isolation, humiliation, denigration, demands outside work, ridicule, harassment or undue public exposure, threatened dismissal, verbal aggression, physical aggression, threatened dismissal, disregard of opinions, investigation of personal life, persecution, defamation and exposure in work-related message groups.

Situations like these experienced by healthcare professionals were also described in a survey of 259 nurses working at basic health clinics and public hospitals [49] communication by shouting; aggression in private; invasion of private life with phone calls, e-mails and letters; physical aggression; refusal to listen in the presence of others; interruption of comments; threats of transfer to other sectors for the purpose of isolation; communication only in writing; and prohibition of communication by colleagues.

With regard to the subjective experiences, we stress that the healthcare professionals surveyed described sadness, depression, sleep disorders, anxiety, headaches, fear, solitude, symptoms of stress, professional denigration, fear of losing employment, emotional fever and sobbing. These are consequences of mental harassment that cannot be seen as natural phenomena inherent to working conditions. This would make their comprehension more difficult, since naturalization creates a smokescreen that obfuscates the real causes of the phenomena and fails to show their effects, shifting the focus to addressing consequences instead of the causes [25, 28,29,30,31].

Self-degradation thus leads to degradation of physical and mental health of the victims, lack of their possibility of acting, and a situation of confrontation in their personal and professional identities, at the extreme causing them to feel guilty for the situation, as can be seen in the accounts presented. Guilt therefore functions as a mechanism that transfers responsibility and produces damaging psychological effects on these professionals.

The self-blame, anxiety and discomfort experienced are signs of this degradation of mental functioning and psycho-affective balance [63] experienced by the healthcare professionals. This can be blamed on the discredit in the eyes of supervisors, colleagues and users of services; accusations of incompetence; manipulation of colleagues; hindrances to professional growth; humiliation and embarrassment in public, forced transfer to other sectors and isolation at work. The bullying manifested by these situations generates consequences, such as alterations in the capacity for concentration and judgment, sadness, depression, suicidal thoughts and use of psychoactive substances [50], besides stigmatization in the workplace by means of descriptions such as “overly sensitive”, “paranoid” or “victimist” [49].

With the victim discredited in the workplace, she is discouraged from sharing her experiences with others, preferring silence, since she is afraid of losing her job or of being transferred to another sector. Because many companies and institutions do not have institutional ways to resolve situations like this, each victim is harassed by her own suffering [51]. This leads us to question whether these might have been elements prompting so many respondents in our study not to recount their experiences in the open-ended question.

What can be perceived from these narratives is that the experiences of workplace bullying have become unsettling, so people often avoid speaking about them, since this can bring unpleasant memories, thoughts or images of the aggressions suffered [51]. This is a psychosocial phenomenon that produces a type of subjective crisis, a level of mental debility that degrades work relations and the victim herself. And who cares for the caregivers? If a pact of tolerance and silence exists in reaction to situations experienced in the context of work, on whom can the victim rely for help? For this reason, it is necessary to devolve this question to the organizations and seek responses that aim both to denaturalize and make visible the consequences of mental harassment to the victims, organization and society.

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