Nurse bullying is a well-known issue that creates difficult work environments. Staff are less likely to stay in a workplace where they are belittled or unsupported, whether bullying behaviors are obvious or subtle. This article describes examples of bullying behaviors and provides strategies to decrease this conduct.

Workplace toxicity can become a pervasive problem. What leaders tolerate often spreads. Consider the following example.

Sara is a long-time nurse at the nursing home. When a new employee approaches her to ask questions about a process, Sara responds by stating that it isn’t her job to train staff. The new employee walks away still unclear on the process and questioning whether he wants to continue his employment at this nursing home. Later that day, a nurse from another unit asks Sara a question about a medication, and before walking away, Sara replies, “Do I look like the pharmacist?” The director of nursing overhears this conversation and offers to help the nurse with medication questions.

Situations like these happen frequently. Sara’s rude, abrupt, and unhelpful behavior puts the facility at risk for increased turnover and decreased patient safety. The director of nursing is now aware there is a problem but isn’t sure what to do.

The American Nurses Association defines nurse bullying as “repeated, unwanted, harmful actions intended to humiliate, offend, and cause distress in the recipient.” While bullying and incivility may seem similar, they differ slightly. Incivility is “any rude or disrespectful behavior toward another with or without the intent to harm.”¹ Both can make a workplace toxic.

Staffing shortages may cause nurse leaders to downplay bullying among staff, yet hoping the bullying will resolve on its own rarely succeeds. It is more likely that the toxic work environment will drive away nurses who otherwise love their jobs, exacerbating staffing burdens. The longer situations continue unaddressed, the more they become part of the culture of the facility. Instead of tolerating incivility, in the earlier scenario, the director of nursing should have addressed the behavior as it occurred in a firm but non-accusatory manner. Recognizing behavior as bullying or incivility—and naming it—is often the first step in eliminating it.

Newer nurse managers or directors of nursing may struggle to address these types of issues. Nursing education focuses more on clinical aspects of nursing, not on interpersonal issues. Therefore, organizations may benefit from training on navigating difficult conversations. Addressing these issues can be uncomfortable, but giving the leader tools to guide caregivers in the right direction reduces the challenge.

The Many Faces of a Bully

It is important to recognize that bullying can take many forms. These include backstabbing; refusing to help; threatening, intimidating, or excluding; being physically violent; sabotaging or withholding information; gossiping; giving unfair assignments; or nonverbal expressions, such as eye-rolling.

While nurses are known for being kind, compassionate caregivers, that doesn’t prevent them from bullying or being uncivil. With most bullies, there are larger issues at play. They may be insecure, feel threatened by others, or have learned this behavior early in life. Nurse leaders must model professionalism in their own interactions and clearly establish the expectation that bullying isn’t allowed.

When the Inappropriate Behavior Is Not Obvious

In the scenario at the beginning of this article, the unacceptable behaviors were overt.  But what about not-so-obvious situations? Take this example.

Christy, a nurse at the facility for five years, picks up many vacant shifts. She regularly comes in early and stays late to help. Nursing leaders count on her to pick up shifts so they can avoid having to staff shifts themselves when on call. Christy also likes to tell residents that she is the only nurse who really cares about them. She often shares information, sometimes untrue, about other nurses with resident family members.

She often brings treats to the nurse aides when she works weekends and tells staff that if the other nurses liked them as much as she does, they, too, would bring treats. Other nurses have complained to the director of nursing and the administrator, but leadership has not acted; staff believe Christy gets away with her behavior because she picks up so many hours.

In a Nursing Administration Quarterly article, the authors describe Christy as a PGR nurse: one who uses put-downs, gossip, and rumors (PGR) to bully other nurses.² This bullying may not have been obvious to nursing leadership, but once nurses complained about Christy’s behavior, leadership should have addressed it. Be aware that even individuals who leadership views as essential can still create issues with other staff. Investigate all concerns brought forth about incivility and rude behavior.

Ensure human resources is aware of the concerns and investigations. Involve this team to help address the issue as soon as possible.

Workplace Culture

Here’s how to build a workplace environment that reduces bullying or incivility:
1. When bullying or incivility occurs, address it immediately.
2. Have and enforce zero tolerance policies. Include examples of the type of behavior the organization rejects, and clarify how to report incidents. Such policies can include opportunities to improve, but the facility should not permit those who do not change their behavior to continue to harm or demean others.
3. Provide zero tolerance policies during the interview process, and reiterate expectations during orientation.
4. Investigate every reported incident of bullying or incivility.
5. Educate nurse leaders on recognizing and addressing bullying behaviors.
6. Expect respect and model that behavior as a leader.
Applying these strategies helps create a workplace environment that is less likely to include bullying, but it doesn’t mean bullying won’t occur. The emotionally charged, high-demand work that nurses perform may prompt some to lash out with bullying as a result of their own poorly managed stress. Setting expectations early and taking bullying accusations seriously every time decreases the behaviors.

Moreover, equipping nurses to confront challenges productively can avert bullying before it occurs. This does not necessarily require additional resources—though reducing workload often helps. Increasing nurse autonomy or flexibility can prevent feelings of powerlessness that can lead to bullying. Investing in staff’s conflict-resolution skills and emotional well-being can help defuse underlying causes.

All staff deserve a safe and respectful workplace. Nurse leaders can cultivate such an environment by addressing behaviors that undermine it, even when they come from within.

Amy Stewart, MSN, RN, DNS-MT, QCP-MT, RAC-MT, RAC-MTA, is vice president of education and certification strategy for the American Association of Post-Acute Care Nursing (AAPACN).

References
1. Frankenfield, R. (2019). Recognize and respond to incivility in nursing. https://voice.ons.org/
news-and-viewsrecognize-and-respond-to-incivility-in-nursing

2. Edmonson, C. & Zelonka, C. (2019). Our own worst enemies: The nurse bullying epidemic. Nursing
Administration Quarterly, 43(3), 274-279. https://doi.org/10.1097/NAQ.0000000000000353