Bullying in the nursing profession is a serious and widespread problem, but what is it exactly? When it occurs at the workplace, bullying is defined as the recurrent and persistent negative actions toward one or more individuals involving behavior that humiliates, degrades, or otherwise shows a lack of respect for the dignity and worth of an individual or group of workers. Bullying is not a one-time incident, but a repeated and escalating process in the course of which the person or group confronted ends up in an inferior position and becomes the target of systematic negative social acts.

Research shows that very often, bullying results from power imbalances involving rank or seniority. For example, newer nursing staff members are often bullied by more senior nursing staff. Although bullying can occur among peers, towards superiors or subordinates, in the nursing profession the most common perpetrators are nurse peers, followed by supervisors. A recent survey confirmed and showed that:

⦁ 45% of nurses had been harassed or bullied by other nurses.
⦁ 40% of nurses had been harassed or bullied by administrators.
⦁ 38% of nurses had been harassed or bullied by physicians.

What does bullying look like?

Bullying can take many forms. While it can include physical violence, it is as not common as other forms of bullying such as verbal harassment, threats and “inclivity”. The latter is a more subtle and often invisible form of bullying. Inclivity can include actions such as sabotage, withholding information, excluding others from events, unfair assignments or downplaying accomplishments. Here’s one good example:

Cathy was a new nurse in an ICU unit who, during a busy night, had a question about a drug she was supposed to administer. Seeing that there were three experienced nurses close by she asked them a question about it but instead of helping they huddled together laughing.

“(…) Cathy asked her question again. And outside of her patient’s room, the three nurses started to laugh and talk about her. She heard them say out loud that she was stupid and how ridiculous it was for her to ask that question. That maybe she should take remedial nursing 101.”
“A month passed, where she was shunned and ignored. She heard the nurses talk about upcoming weddings and baby showers and birthday parties of fellow staff members. She knew she wasn’t invited. They basically treated her like she was invisible.”

The bullying continued to the point that Cathy felt she had no choice but to transfer to a different unit. She felt degraded, isolated, lonely and depressed.

Bullying has serious consequences

Bullying can cause serious consequences for nurses, their employers and their patients. Nurses who experience workplace bullying may show high levels of stress, irritability, insomnia, PTSD and suicidal ideation.

At an organizational level, workplace bullying has been found to be associated with lower levels of staff satisfaction and morale, increased absenteeism and attrition rate, and intention to leave one’s job and nursing as a profession. In the aforementioned survey, over half of nurses who had experienced bullying considered leaving the profession.

Finally, workplace bullying also negatively impacts the quality of patients’ care and is correlated with mistakes and adverse events as it disrupts relationships and causes barriers to communication needed to effectively care for patients.

Why does bullying happen?

Durmont et al., (2012) identified three major areas that helps explain why bullying is so common in nursing:

1. By definition, nurses’ work is stressful and complex. Working in such conditions causes nurses to feel powerless, demeaned, and victimized, which in turn contributes to unproductive or negative coping behaviors such as bullying.
2. A type of management and work environment that fosters bullying and disregards bullying reports. Upper management leaders use their power or position to bully and intimidate subordinates. These leaders turn a blind eye to bullying that others or themselves perpetrate, fostering a hostile work environment where there is a lack of respect, support and positive recognition.
3. Fear or retaliation. Victims of bullying refrain for making formal reports or seeking help because they feel they would experience negative repercussions as a result including losing their job.

Preventing bullying in nursing

Given that bullying in nursing is such a serious and widespread problem, what can be done to prevent it? There is not a simple answer. The International Council of Nurses calls for a systems-wide approach that should include:
⦁ Education and training of healthcare professional and staff.
⦁ Leadership that models behaviors and both supports and encourages reporting of incidents of violence and bullying.
⦁ “Facts not faults” focus on investigations.
⦁ Designing integrated person-centered healthcare systems and environments that promote clean and open communication.
⦁ Adopting zero tolerance strategies towards every kind of workplace violence, including bullying.
⦁ Creating open and respectful rights-based organizational cultures.

Bullying is a serious and widespread problem that affects thousands of nurses each year and impacts the quality of care delivered to patients. Although bullying is often ignored, it should be a priority for healthcare system stakeholders. Lastly, the American Nurse Association (ANA) recommends that:

“Best practice strategies based on evidence must be implemented to prevent and mitigate incivility, bullying, and workplace violence; to promote the health, safety, and wellness of registered nurses; and to ensure optimal outcomes across the health care continuum.”