How to Prevent Workplace Bullying in Nursing
The uncomfortable truth is that workplace bullying in nursing has existed for years. You’ve likely heard the common phrase “nurses eat their young” in reference to the bullying of novice nurses, but the hostility affects far more than new graduate nurses alone. Systemic aggression in the healthcare industry often starts when a clinician is in nursing school and persists throughout their career.
As a healthcare leader invested in workplace safety, you’re in a unique and empowering position to stop nurse bullying at your organization. This may seem challenging, given how long this harmful behavior has been pervasive in the industry. We’ll review what you need to know about bullying and provide some prevention strategies to keep your team working effectively.
What Is Nurse Bullying?
Bullying, incivility, and violence are distinct terms used to describe workplace aggression. If you’re unsure of how to distinguish the different behaviors, you’re not alone. The American Nurses Association (ANA) provides the following explanations to help differentiate between the varying forms of aggression:
| Forms of Aggression | Explanations and Examples |
|---|---|
| Incivility | One or more rude, discourteous, or disrespectful actions towards a nurse that may or may not have a negative intent behind them.
Example: An outgoing nurse rolling her eyes when the oncoming nurse asks them clarifying questions during a shift change report. |
| Bullying | Repeated, unwanted, harmful actions intended to humiliate, offend, and cause distress in a targeted nurse.
Example: A nurse or group of nurses refusing to help, or finding ways to belittle, “outside” agency nurses filling shifts on a temporary or per diem basis. |
| Violence | Physical, emotional, or verbal acts of aggression toward a nurse that impact their well-being and ability to care for patients.
Example: A distraught family member cursing at and physically attacking a nurse upon hearing bad news about their loved one’s condition. |
Why Does Workplace Bullying in Nursing Exist?
Many may falsely assume that rampant workplace bullying is a sign of mean or rude clinicians. This simply isn’t the case. Why, then, does the most trusted group of professionals demonstrate some of the highest levels of workplace incivility? Here are a few factors to consider:
- Understaffing: Constantly rushing and feeling behind often leaves staff members feeling incapable, exhausted, and alone.
- Job Stress: Healthcare is high stakes; people’s lives are affected by every choice a staff member has to make. Working a stressful 12-hour shift, sometimes without a break, can leave employees feeling short-tempered, anxious, and irritable.
- Lack of Support: In our most recent nursing trends survey, 39% of respondents felt unsupported by hospital leadership, and 42% weren’t happy with the quality of care they were able to provide. This can frustrate staff and cause them to inappropriately lash out.
In a fast paced environment where there’s little time for communication and collaboration among staff, even the slightest miscommunications can have negative rippling effects. Countering workplace bullying in nursing means giving staff the room they need to build trusting and supportive work relationships.
“From my past experience as a float pool CNA, it seems like there’s more risk of horizontal bullying on understaffed units. I was always very well-received by nurses on slower-paced units. But when I floated to understaffed and stressful units, I often faced immediate hostility from people I didn’t even know. It was clear they were stretched thin and likely didn’t have the bandwidth to be welcoming to new faces.”
— Katherine Zheng, PhD, BSN
Inadequate staffing support can also lead to other forms of workplace bullying for nurses — like verbal, or even physical, hostility from patients. Without adequate clinical and security staff in place, nursing professionals can feel as though they have to fend for themselves and can’t rely on their team to support them.
“Sometimes not providing nurses with enough support during shifts can be a form of bullying, especially in acute psychiatric facilities. I was attacked by a patient while working in a severely understaffed psychiatric facility where only two women were assigned to the acute care unit with about 20 Baker-acted patients. In the state of Florida, being Baker-acted means being arrested and transferred to a medical facility instead of jail due to mental health concerns.”
— Ann Real, BSN, RN
How Does Workplace Bullying in Nursing Impact Organizations?
Aggression toward nurses significantly impacts the nursing shortage, according to one survey of over 12,500 nurses conducted by the American Nurses Foundation. Since workplace incivility in nursing and bullying are on the same continuum of aggressive behaviors, they were assessed together and cited as the primary reasons for:
- 18% of nurses having left their position in the six months prior to the survey.
- 14% of nurses intending to leave their position within the next six months.
IntelyCare’s Nursing Trends Report revealed similar findings. Over 75% of nurse respondents reported feeling burned out and nearly one-third of respondents said they felt unsafe going to work. These clinicians expressed concern about the future of the profession and said they weren’t able to cope with the stress and hostility. Nearly 77% said they planned to look for a new job and 45% planned to leave the profession within a year.
In addition to worsening the nursing staffing shortage, nurse bullying also has other extensive repercussions, including:
- Decreased nurse productivity, job satisfaction, organizational commitment, and retention.
- Impaired nursing judgment, and increased medication and patient care errors.
- Diminished nurse physical and mental health, self-worth, and self-confidence.
- Unhealthy work environments.
- Higher rates of turnover and of nurses leaving the profession.
- Increased costs of recruiting, hiring, and training new employees.
- Increased expenses of managing uncivil employees, incidents, and consulting with attorneys.
Preventing Nurse Bullying: 3 Strategies for Facilities
It may seem challenging to address the issue of workplace incivility with so many elements contributing to the problem. However, with small efforts, facilities are able to effectively cut down on employee tension and stress and build a team that employees are proud to be a part of.
It’s important to remember that workplace bullying in nursing can affect all healthcare employees, regardless of age, title, or experience level. Therefore, minimizing its effects requires a system-wide approach. Here are three strategies to help your team begin to cultivate a healthier and more productive work environment.
1. Cultivate a Strong Culture of Respect and Safety
Start by reviewing the tenets of your organization to assess whether they adequately address the prevention of workplace bullying in nursing. Your policies should make it clear that your organization doesn’t tolerate employee incivility, but instead protects those who report it and is committed to holding individuals accountable for their behaviors while on the job.
The ANA advocates for nurses and organizations to work together to instill a culture of respect that promotes nurses’ health, safety, and wellness, thus ensuring optimal outcomes across the healthcare spectrum. The behaviors of those in leadership positions should exemplify these cultural beliefs and showcase your organization’s just workplace culture.
2. Establish a Task Force to Develop Policies and Procedures
Create a task force that includes your organization’s leaders, clinical staff, human resources (HR) representatives, and other stakeholders who are dedicated to mitigating and preventing workplace aggression. The Joint Commission deemed that organizations that fail to address unprofessional behavior, such as workplace incivility in nursing or horizontal bullying, are indirectly promoting these behaviors. They recommend that your task force develop policies and procedures that focus on:
- Minimizing bullying behaviors.
- Reducing fear of retaliation when reporting incivility.
- Responding to witnesses of bullying.
- Initiating disciplinary actions for those that violate codes of conduct.
In addition, your organization’s task force must strategize ways to prevent nurse bullying by patients, family members, and visitors. Since you’ll be creating processes that involve patients and people outside your organization, obtaining guidance from your legal department can ensure policies are enacted appropriately.
Once these procedures are implemented and enforced consistently by your leadership team, it will be easier to demonstrate that your organization values and respects its staff and doesn’t tolerate workplace bullying in nursing. This can help you prevent incivility and create a more positive work experience for staff members.
3. Provide Training and Education
Raising awareness of the issue is essential to preventing nurse bullying. To optimize this strategy, you can provide staff training and education on bullying policies and procedures during orientation and at regular intervals during annual compliance training. This training should include topics that can assist staff in implementing:
- Stress reduction and management techniques
- Crisis intervention strategies
- Conflict resolution skills
- Resilience and wellness resources
- Recognition and elimination of implicit, or unconscious bias
Creating a staff training module provides a cohesive way to tie your organization’s culture and policies together. Providing your staff with clear and consistent messaging increases their knowledge and awareness of your organization’s goal to promote safety and respect.
Find More Ways to Develop a Healthy Work Culture
Now that you’ve gained more insight into preventing workplace bullying in nursing, you’re likely interested in finding other ways to support a healthy work culture. IntelyCare’s free newsletter provides helpful strategies for promoting a positive workplace where your nurses and your organization thrive.
IntelyCare education development nurse and writer Diana Campion, MSN, APRN, ANP-C, contributed to the writing and research for this article.