It's Time to Stop Nurse Bullying in Its Tracks

  1. Bullying - unwanted, aggressive behaviors - happen daily on nursing units across the United States. During National Bullying Awareness Month, let's talk about why bullying should be stopped and how to stop it.

    It's Time to Stop Nurse Bullying in Its Tracks

    You might think that bullying only happens inside the walls of schools. We often hear stories about bullying between younger children and even teenagers. But, if you've been a nurse for any amount of time, you've probably experienced nurse bullying yourself or witnessed it on your unit. In fact, one study reported that 45% of nurses have been verbally harassed or bullied by other nurses.

    You might be thinking that you've heard so much about bullying in recent years that you no longer need more education. Renee Thompson, DNP, RN, CMSRN, owner of the Healthy Workforce Institute and bullying subject-matter expert, has this to say about continuing the fight against bullying, "It's just like anything else you want to master - you can't just attend one workshop on a particular topic and then check a box...yep, mastered that! If we really want to eradicate bullying and incivility from the healthcare work culture, we must engage in consistent, ongoing education and training related to disruptive behaviors."

    This is precisely why every October, our nation comes together to recognize bullying across all settings during National Bullying Prevention Month. Organizations such as STOMP Out Bullying and the National Association of People Against Bullying educate others on this community problem in the hope of curing our culture.

    What is Nurse Bullying?

    According to stopbullying.gov, bullying is unwanted, aggressive behavior. Renee has described bullying as having three components: it's targeted, meant to cause harm, and it happens over time.

    Not all unwanted or mean behaviors are considered bullying. Some actions may be classified as incivility. For example, if you've had a particularly bad day at work and get a little testy with a co-worker, this might be incivility. But, if a co-worker continuously yells at you, picks on you, or turns others against you - this could be a classic case of nurse bullying.

    Recognizing the Behavior

    Do you remember the playground bullies you dealt with in elementary school? They would pick on you or others only when the teachers weren't around or paying attention. Bullying in nursing isn't much different.

    There may be times when the bullying is overt, such as another nurse who yells at you, insults you, or lets you know in no uncertain terms that they don't care for you. However, often the bullying is a bit more subtle and may even leave you wondering if you're interpreting the actions by others correctly.

    A few examples of subtle bullying include:

    • Others not helping you, even to the point of putting patients in unsafe situations to avoid lending you a hand
    • Not giving you all of the information you need to perform your duties in hopes that you make a mistake
    • Spreading rumors about others
    • Excluding certain nurses from activities on the unit

    What to do if You're Being Bullied

    If you find yourself in a bullying situation, you need to speak with your nurse manager. Renee offers this advice to anyone breaching this difficult conversation, "The first action is to get clear on the specific behaviors of that nurse. Instead of saying to your manager, "she's bullying me," try saying, "she refused to take report from me, yet she takes report from everyone else." This takes the emphasis off of the person and places it firmly on the behaviors.

    Renee went on to say, "Once you're clear on the behaviors, start a documentation trail. Include date, time, location, an objective account of the incident, and most importantly, link that behavior to a patient safety, quality, or satisfaction concern. If done well, documentation can increase the chance that your manager will take action."

    The last thing to do if you're being bullied is to confront the person. Renee said that she shares many scripting techniques that work well. "Most importantly," she shared, "is that if you're being bullied, you must do SOMETHING about it."

    How to be a Positive Influence

    Even if it's never happened to you, there are things you can do to improve the healthcare culture. Try one of these simple actions that let others know that you support a kind, caring nursing environment:

    • If you witness one nurse bullying another, intervene on the target's behalf. You don't have to get in the middle of the situation, but you can redirect the behavior.
    • Befriend and mentor new nurses on your unit.
    • Notify your supervisor if you witness bullying or incivility.
    • Be kind to others, treating them how you expect to be treated.
    • Be positive. Recognize others for the behaviors you want to see on your unit.

    Have you ever experienced or witnessed bullying? We invite you to share your story to bring more awareness to this problem by placing your thoughts in a comment below.
    Last edit by tnbutterfly on Oct 17
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    Melissa is a Quality Assurance Nurse, professor, writer, and business owner. She has been a nurse for over 20 years and enjoys combining her nursing knowledge and passion for the written word. You can see more of her work at www.melissamills.net or on her blog at www.lifeafterforty.blog.

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    19 Comments

  3. by   Hoosier_RN
    I've been lucky in my 20 years of nursing that I have few incidences of being bullied, but it has always been by management in my case. But I know that myself and countless coworkers, over the years, have been bullied by patients, who are then backed up by management. This, to me, is worse than direct bullying, which can be dealt with. The latter form is allowed due to the almighty dollar, so everyone turns a blind eye. Just my $.02
  4. by   NurseSince2014
    While I agree that bullying is certainly prevalent in the nursing profession, I think it is also important to consider that it may also be overreported. In other words, people perceive actions as being "bullying," but really aren't. One example I can think of is many nursing students or new nurses can sometimes interpret what is meant to be constructive criticism as "bullying." I've noticed that sometimes when those new to the profession do not receive the positive feedback they are looking for, they accuse the person providing the feedback as bullying them. I actually can relate to this, as I remember having some instructors/preceptors give me some feedback that I perceived as being harsh. In reality, they were just giving me the news I needed to hear in order to keep my patients safe.


    Even some of the examples above, such as "others not helping you" and "not giving you all of the information you need," may not necessarily be bullying. For example, sometimes preceptors do not help you out in certain situations, because they are waiting to see how you will respond. They may not always answer your questions directly, as they are hoping you will learn to use resources to look up information on your own. Of course, if patient safety is compromised, then these are not safe behaviors and would constitute behaviors. I'm just concerned that some people could report others for bullying just because they weren't there holding their hand as much as they would like.


    I would also even say that excluding some nurses from activities on the unit may not be bullying. Sometimes these activities may require nurses with more experience. Other times, people simply prefer to do things with certain coworkers. As long as it is not a unit-wide event that everyone is invited to except for two or three people, I don't necessarily think it is a big deal if not everyone is invited to everything.


    This was a well-written article and I'm not trying to downplay the prevalence of bullying in the nursing profession, because it is there. I just think it is important for those who feel they are being bullied to really analyze the situation they are in and what role they may have played, before accusing someone else of bullying.
  5. by   Hoosier_RN
    NurseSince2014, very correct. Also, nursing is not the only career this happens in. If you look to any profession, you will find many incidences of bullying. Nurses have definitely not cornered the market on this phenomenon.
  6. by   KatieMI
    1). to speak with nurse manager about being bullued/witnessing bullying is approximately as effective as to shout toward thunderstorm cloud. Management knows in 110% out of 100% if such "problem"exists in the unit. In >90% of cases, they encourage and perpetuate it.
    "Divide, then govern" principle is still alive and works pretty well.

    2). The majority of bullies are, on average, smarter than a typical rank-and-file staffer in any given place. Being nurses, they hardly ever do anything that can potentially (as far as THEY see it) endanger anyone. In fact, much of bullying in nursing revolves around obsession with "safety".

    Also, recording everything that can be perceived as bullying by a victim is hardly possible in averagely busy unit. And recording something like "Nurse X entered the room 1234 on 10/16/2018 at 2:35 PM to which she was not assigned with prevention to "help me" and then proceeded to verbally abuse me for labeling an IV line "Levophed" instead of "norepinephrine" and with blue ink instead of black one, both actions she claimed as significant policy violation" can easily be made up by the said Nurse X and nurse manager into "reportable offence" in form of HIPAA breach, because it would be easy to figure what patient was in that room at that time.

    3) being smart and devious as they are, bullies have one thing in common. They are, almost with no exclusions, cowardly, very much concerned about THEIR OWN safety, and easy to scare if they met resistance or uncertainty. Therefore, personal, bold, fearless and unpredictable actions are the best weapons against them. Personal confrontation is rarely successful simply because victims usually are not able to clearly state where things are standing at. But bold, personal and completely unpredictable actions hit the bullies' soft underbelly.

    Refusal of nursing school to send students where their new grad(s) are eaten alive or personal call to facility administration from a local political/religious/economic leader are examples of relatively "soft" actions which usually bring the problem to at least closer point of view.
  7. by   melissa.mills1117
    NurseSince2014 -
    Thanks so much for your thoughts. I agree that every situation must be taken individually. The thing that Renee Thompson, subject matter expert, points out is that the actions must be done repeatedly over time. It's not just a one-time incident. I think this does help differentiate those "learning" experiences you pointed out above and a few of your other examples. If someone is trying to help a nurse learn, this shouldn't be a pattern of behavior. Thoughts?

    Thanks for your comments. It's great to have conversations about these issues and shed some light!

    Melissa
  8. by   aniretake
    Quote from KatieMI
    3) being smart and devious as they are, bullies have one thing in common. They are, almost with no exclusio.................. But bold, personal and completely unpredictable actions hit the bullies' soft underbelly.
    Would you give an example of such actions?
  9. by   KatieMI
    Quote from aniretake
    Would you give an example of such actions?
    Please read just below. I gave two "soft" examples.
  10. by   Truth66
    I applaud the above article with regards to stopping bullying. Bullying is a significant problem in all aspects of society, whether it be in schools, workplaces, etc.

    Based on the research that I've done, both in and out of nursing, as well as when I was taking my courses in Forensics, bullying for the most part is not taken seriously in any setting. Bullying often leads to homicides and suicides if not properly dealt with. For example, In 1999 in Ottawa Canada, Pierre Lebrun shot and killed four of his co-workers. When reading through the subsequent Coroner's Inquest, Lebrun was regularly harassed by his fellow co-workers because of his facial tic and of the way that he talked. The major warning that was mentioned in that inquest was that Lebrun often complained about the behavior of his co-workers and nothing was ever done.

    When one reads incidents of school shootings, a similar pattern arises. The target who is often bullied ends up either committing suicide and/or kills others. If a bully targets numerous people and the bully's behavior is not dealt with, the targets have a potential of banning together and start collectively targeting the bully. At that point you have what's called Mobbing. The best description I've ever read about Mobbing is that it's bullying on steroids. I witnessed mobbing first hand in my workplace and it is really bad. It was all because the bully's behavior was never dealt with.

    I don't want to monopolize this thread, but will say that bullying/mobbing has no place in any setting. Constructive criticism is always welcomed, especially in a health care setting. However, it's my hope that health care professionals act like just that "professional". Toxic environments does no one any good, and in a health care setting, only impedes quality care.

    Bullying unsafe Patient : Residential Wellness
  11. by   HomeBound
    Quote from KatieMI
    1). to speak with nurse manager about being bullued/witnessing bullying is approximately as effective as to shout toward thunderstorm cloud. Management knows in 110% out of 100% if such "problem"exists in the unit. In >90% of cases, they encourage and perpetuate it.
    "Divide, then govern" principle is still alive and works pretty well.

    2). The majority of bullies are, on average, smarter than a typical rank-and-file staffer in any given place. Being nurses, they hardly ever do anything that can potentially (as far as THEY see it) endanger anyone. In fact, much of bullying in nursing revolves around obsession with "safety".

    Also, recording everything that can be perceived as bullying by a victim is hardly possible in averagely busy unit. And recording something like "Nurse X entered the room 1234 on 10/16/2018 at 2:35 PM to which she was not assigned with prevention to "help me" and then proceeded to verbally abuse me for labeling an IV line "Levophed" instead of "norepinephrine" and with blue ink instead of black one, both actions she claimed as significant policy violation" can easily be made up by the said Nurse X and nurse manager into "reportable offence" in form of HIPAA breach, because it would be easy to figure what patient was in that room at that time.

    3) being smart and devious as they are, bullies have one thing in common. They are, almost with no exclusions, cowardly, very much concerned about THEIR OWN safety, and easy to scare if they met resistance or uncertainty. Therefore, personal, bold, fearless and unpredictable actions are the best weapons against them. Personal confrontation is rarely successful simply because victims usually are not able to clearly state where things are standing at. But bold, personal and completely unpredictable actions hit the bullies' soft underbelly.

    Refusal of nursing school to send students where their new grad(s) are eaten alive or personal call to facility administration from a local political/religious/economic leader are examples of relatively "soft" actions which usually bring the problem to at least closer point of view.
    Katie, I think you are onto something here, but a little...maybe....reactionary about something? Before you hit back....

    We all took abnormal Psych. I took a bit more, because I was going into another profession, so I did a lot of research on "Personality Disorders".

    The first thing I think needs to be understood is that just because someone passes the NCLEX or the LSAT or the Police Academy---does NOT guarantee that this person does not have a personality disorder.

    In fact, it's hypothesized that certain professions at attractive to certain people with certain personality traits---whether those traits are good, or bad.

    Melissa is talking about NURSING. Anyone here saying "well, this happens everywhere"....is dodging and excusing the behavior. WE ARE TALKING ABOUT NURSING. NOT a comparison of Nursing vs. Soccer Coach.

    Bullies are cowards. The "why" doesn't matter. Their behavior is disruptive, destructive and underhanded. They make a life out of finding pleasure in stirring the pot. THIS is what Melissa is talking about.

    We all know at least one who does it. Sometimes, it's the RN Manager or the Director. I disagree wholeheartedly with Melissa saying that "documentation" will further any type of resolution to the problem.

    Why do I say this? Because Katie is right. RN Managers, if they aren't the perpetrator themselves, know absolutely (or they should, if they actually ever show up to do their job) who the trouble makers are---they are either 1. unwilling to do anything about it (fear or apathy) 2. are willing participants for whatever reason (maybe RN Mgr wants bullied RN to quit. much cheaper than firing them) or 3. so checked out of their own unit and lacking in leadership skills, they aren't much help in any way.

    It's not acceptable and we aren't talking about cleaning up the Police Academy here. Melissa is starting a conversation about bullying in NURSING.

    "Not including RN in activities" means ---going out to breakfast, having parties in the breakroom or outside of work, doing things together---and the defender of that with "well, we needed someone with experience" purposefully misunderstood what Melissa meant.

    "Not helping out"---she meant....when you have a ******** of a patient....and NOT AS AN ORIENTEE/PRECEPTOR arrangement...and you can't find one single RN to help you. Or you are a small unit and certain individuals just neeeeeeeeeever seem available to you, but they sure as hell expect YOU to be their mule....and say so.

    I don't like apologists. I call things for what they are---and for that, I got bullied when I was early in my career. It was subtle---no help from a certain few who were known to be the bullies of the unit. I didn't like talking about my personal life, and when I said that after the umpteenth time of them trying to pry into my life outside of work (getting to know someone is one thing. If that person states that they'd really rather leave their personal life outside...people need to respect that. Some...just want the info. We used to call it "Toting News". They NEED to be "The One" who has all the information. ALL. THE. TIME.)----they started making stuff up. Then, when I would hit back on that---by going to the person directly and saying...

    "Let me clear this up now. If you continue to say X about me, I can not only prove you are wrong, but that you are harming me professionally. We will be visiting HR the next time I hear it, and after that, I will be suing you in civil court for defamation and slander."

    I've done it twice. And it is effective. Because bullies know one thing for sure. They will protect their backsides when the light of truth is shone upon them. Just like the cockroaches that they are....they scurry to the darkest corners and await an easier target.

    Also know---my RN Mgr at the time---was best buds with the bully I had to say this to. He ignored two detailed emails, cc'd to HR and the director---about not some "perception" of bullying---but that this RN was negligent in her duties. IGNORED. Never a response.

    People don't wear tags on their foreheads that state their personality or problems. It takes leadership in management to be willing to hold these people accountable---and be willing to deal with the possible repercussions by someone with a serious personality disorder (which bullies all have).

    Management simply will not do it. There is too much of a downside to it. Bullies like lawsuits. When they are forced out, they like keeping the trouble going. So it's the path of least resistance with managers---unless patient care is directly effected, i.e. someone DIES because bully RN refuses to get off their fat behinds and do their job as a team---they won't interfere.

    Dealing with bullies is not easy, but it's simple to do---as long as you are willing to deal with the consequences, because you don't know what network that this person has developed. Confrontation is a good tool....but you have to back that up with SWIFT and DECISIVE consequences.

    Incivility is one thing. I can get testy but I always recognize when I do it, and I usually apologize to anybody, including CNAs or the janitor or whomever---after I am guilty of it.

    Bullies think their behavior is acceptable. It's normal and enjoyable/pleasurable to them. They don't seek help, just as an alcoholic or a Malignant Narcissist won't. You won't ever see a bully go to HR or to a counselor and say,

    "I am a bully and I just don't like myself. Please help me." If they are allowed to flourish, for whatever reason, they are rewarded for this negative behavior.

    When my kids go to school...if they are bullied, I don't wade in there immediately, but I sure as hell make sure my kids know how to stand up for themselves and find help if the circumstances demand it. I am "That Parent" who will go to the County Solicitor and above if I find that someone's kid is just one of those who is taught that it's all okay to be a jerk.

    It's not okay. I was bullied as a young nurse, but now in my late 40's...I don't care much about what other people think of me, so it's easy to confront people like this. I don't care if they're "my friend". I care about the job and the patients. That's it.

    This makes bullies uncomfortable. They like to hit you where you are vulnerable. I know I am a good RN. Do I make mistakes? Yes. Do I think I am accountable to these people? Nope. I am accountable to the Nursing Boards, my employer, and to my patients. It takes some self confidence to be able to look a bully in the eye and just tell them....do it again and I will make sure that you answer for what you do.

    Lack of leadership is what I see as the main problem, though. Managers are overwhelmed, apathetic and some are the perpetrators of bullying themselves.

    There is no easy solution. I read a study

    The Disturbing Link Between Psychopathy And Leadership

    And this is NOT to imply that "all leaders are psychopathic" or that all bullies are psychopaths.

    What I am pointing out is that certain positions attract certain personalities, and once these personalities are in positions of authority, they seek out and promote others with their same traits. Banks do it, and it was widely knows that certain banks performed personality screening tests that SELECTED for "personalities that are pliable, willing to bend the rules" and downright sociopathic tendencies.

    It doesn't take a written personality test to see who has a personality disorder and who doesn't. The pot stirrers, the ones sitting in the manager's office every day for hours or runs to management every five minutes tattling, the gossipers, the backstabbers, the ones who will pile on instead of helping someone who is being bullied---we all see them, and a good number of people prefer to turn a blind eye.

    Doesn't matter why. I am no a pot stirrer. But I sure as hell will make it my mission to have that person sitting in HR as many times as it takes for them to either move on, suppress their crappy behavior, or get fired.

    Just be sure, though, if you choose to do this, that you cross your T's and dot your I's, because someone will gun for you---nobody likes being held accountable anymore. Yet another reason I am leaving Nursing and doing Direct Care as an NP.
    Last edit by Silverdragon102 on Nov 13 : Reason: changed to all **
  12. by   BeenThere2012
    HomeBound...Your post was spot on and I admire your ability to handle the bullies you referred to. Many of your points I fully agree with from experience.

    I am having more of a "rudeness" issue with some of my coworkers currently, and feel lost as to how to deal with it. I wouldn't call it "bullying" outright, but it is very aggravating and makes my work life more difficult than it already is. The behavior is subtle. There is a clique of nurses who reinforce each others' styles if you will and they gossip constantly. One is the leader and strives to be perfect and better than "everyone". Examples: She will agree to work ANY OT, extra shifts, double shifts etc when asked which sometimes adds up to ridiculous double doubles, 18 days in a row without a day off and so on. She is a "yes" person to anyone in authority. She jumps in the middle of care with my patients for example before I've had the chance to do what my plan was that she overheard me say.
    She will ask me a question. I give the answer, and then she will go to someone else to ask the same question...right in front of me. (She gets the same answer by the way). She interrupts me in report continuously, sometimes shifting her attention to something as I'm in mid-sentence.

    I can't tell if this is a power struggle or somehow I threaten her from being the only darling of the unit.
    It's these subtle behaviors that gnaw at me.

    I'm just trying to ignore her and do my thing at this point. The crap is not worth bothering management over, and frankly is not a threat to our patients in any way. It all just makes my work life so difficult. We have to work together every shift.

    Thanks for "listening". I could go on...
  13. by   TriciaJ
    Quote from BeenThere2012
    HomeBound...Your post was spot on and I admire your ability to handle the bullies you referred to. Many of your points I fully agree with from experience.

    I am having more of a "rudeness" issue with some of my coworkers currently, and feel lost as to how to deal with it. I wouldn't call it "bullying" outright, but it is very aggravating and makes my work life more difficult than it already is. The behavior is subtle. There is a clique of nurses who reinforce each others' styles if you will and they gossip constantly. One is the leader and strives to be perfect and better than "everyone". Examples: She will agree to work ANY OT, extra shifts, double shifts etc when asked which sometimes adds up to ridiculous double doubles, 18 days in a row without a day off and so on. She is a "yes" person to anyone in authority. She jumps in the middle of care with my patients for example before I've had the chance to do what my plan was that she overheard me say.
    She will ask me a question. I give the answer, and then she will go to someone else to ask the same question...right in front of me. (She gets the same answer by the way). She interrupts me in report continuously, sometimes shifting her attention to something as I'm in mid-sentence.

    I can't tell if this is a power struggle or somehow I threaten her from being the only darling of the unit.
    It's these subtle behaviors that gnaw at me.

    I'm just trying to ignore her and do my thing at this point. The crap is not worth bothering management over, and frankly is not a threat to our patients in any way. It all just makes my work life so difficult. We have to work together every shift.

    Thanks for "listening". I could go on...
    It really doesn't matter why your coworker behaves the way she does. She's testing you, like toddlers test their parents. You need to stand up to her. Do not defend yourself or your actions to her; that is giving her your power.

    Constantly interrupting you in report? "I need to get through this. Can you save your questions and comments for later?" "Let's try to stay on track. Do you think you can focus for a few minutes?" Jumping into the middle of your care: "I'm good, thanks. You can get back to your own work. I'll let you know if I need anything."

    When she asks you a question: "I can answer that, or you can ask someone whose answer you might like better." This is all said calmly, authoritatively and with steady eye contact. Just keep calmly putting her in her place, and she'll eventually figure out where that is.
    Last edit by TriciaJ on Oct 17 : Reason: Missed a word.
  14. by   kbrn2002
    The vast majority of bullying behavior I've seen is from resident to staff which is almost always condoned since "they are here because they need help." In my opinion needing help doesn't excuse horrible behavior towards staff by a person that is alert, oriented and well aware of what they are saying and doing.

    The second most prevalent bullying I've seen is from management. Some staff get noticeably preferential treatment while others may be written up for the smallest of infractions. Some get pretty much any day off requested while some others seem to never have their requests approved. Some may always get the gravy assignments while another nurse always seems to get the most difficult patients. When the pattern of bullying is perpetuated by management who exactly are you superposed to complain to? An employee hotline? Not likely to help in the least little bit. Remember they work for the employer not for you so they are not about to take any action that confirms your complaints for fear of opening the company to a lawsuit. Sadly about the only recourse is to tough it out and hope it gets better or leave.
    Last edit by kbrn2002 on Oct 18

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