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Unfortunately, nurse bullying, also referred to as nurse incivility or lateral violence, is common.

The American Nurses Association’s definition of bullying, “repeated, unwanted harmful actions intended to humiliate, offend, and cause distress in the recipient,” is similar to the dictionary definition of mistreatment or abuse of someone vulnerable by someone more powerful.

Nurse bullying can occur in any care setting and at all levels, including among executives. Researchers reported in a 2018 Journal of Nursing Management study that 60% of nurse managers, directors, and executives experienced bullying in the workplace. Of these, 26% considered the bullying “severe.”

To understand why it happens, first consider the many forms nurse bullying can take. 

Nurse Bullying Forms

Similar to school bullying, workplace bullying involves destructive behavior by one person toward another. The behavior may be overt, such as threatening a colleague, or it can be more passive and insidious, such as refusing to cooperate.

Overt forms of nurse bullying include:

• Belittling: Harshly or unfairly chastising a colleague for doing a subpar job, especially in front of patients or other clinicians 
• Minimizing: Telling a colleague who is struggling to “suck it up”
• Name calling: Referring to a colleague as a “bad nurse”
• Yelling: Raising one’s voice to intimidate or scare another person 
• Pushing or shoving: Committing acts of physical aggression toward a colleague 
• Blocking someone’s way: Preventing a person from leaving or going where they want to go 

More covert forms of nurse incivility include:

• Ostracizing: Purposely not including a colleague in conversations or group activities that contribute to morale 
• Gossiping: Spreading rumors about a colleague 
• Ignoring calls for support. Ignoring another nurse’s calls for backup, forcing the nurse to complete hazardous tasks alone or to delay care until another nurse becomes available  

Common Nurse Bully Types

As a part of their effort to curb nurse incivility, the American Nurses Association highlighted common types of bullies in the nursing profession. 

• Supernurses. More experienced or specialized “supernurses” condescend to co-workers. Their elitist attitude and “corrective comments” belittle and deride. 
• Cliquish nurses. This type of bully uses exclusion as a means of aggression. By showing favoritism to some while ignoring others, this bully creates an us-versus-them dynamic within a healthcare organization.
• Two-faced nurses. These nurses cultivate fake alliances that they then betray, wielding information as a weapon to increase their own standing.

Resentful nurses. These bullies tend to create a hostile work environment by holding grudges against other nurses, staff, patients, or the healthcare system itself.

In the journal article “Our Own Worst Enemies: The Nurse Bullying Epidemic,” nursing researchers describe the causes of nurse bullying. They explain how bullies often lack self-confidence, and thus see some colleagues as threats.

Just as important to understand, certain workplace cultures give rise to bullying more easily than others, suggesting that systemic changes can decrease the impact of bullying among nurses. Researchers suggested the following environmental contributors to nurse bullying.

Low Leadership Quality

When supervisors and managers lead by intimidation and fear, they foster similar behaviors in their staff. 

Nurses in management roles may adopt a leadership style modeled on bad bosses, which may intensify under pressure.

Then, as bullying becomes part of an organizational culture, bullying behaviors tend to persist, even as individual nurses come and go.

Modeling compassionate communication can therefore act as a buffer against workplace bullies. 

Disempowered Employees

Nurses in management have some of the highest-stress positions in healthcare. Not only are nurses responsible for the care of patients day in and day out, they also work closely with other nurses who run a high risk of burnout.

When studying bullying among nurses, researchers hypothesized that bullies emerge in environments where managers feel powerless, such as situations when nurse managers experience a lack of authority coupled with a high level of accountability.

The solution? Healthcare organizations that give nurse managers more autonomy, flexibility, and resources (such as a larger budget, adequate staff, or crucial resources such as personal protective equipment) discourage bullying before it occurs.

Healthcare organizations should think strategically about reducing and preventing nurse bullying. The following tactics may help:

• Recognize the problem. Nurse bullying can occur in any organization and thrives when it goes unnamed. Recognizing that bullying is a systemic problem in their organization can help leaders address the phenomenon proactively. 
• Adopt a zero-tolerance policy for nurses who bully and enable bullying. Creating policies in advance that detail how bullying should be reported and addressed sets clear expectations for the entire nursing staff. It also communicates that nurses deserve safety and respect at work. 
• Oversee online environments. Bullying can take the form of attacks, harassment, or exclusion in online settings, too. Include consequences for incivility in online media policies and social media policies. This demonstrates that no personal attacks are allowed, whether in person or online.
• Take reports seriously. For nurses to report acts of bullying to their leaders, they need to feel supported. Have a clear system for reporting bullying, and respond to reports immediately. 
• Train leaders to model collaboration. An organization’s culture affects whether nurses feel safe speaking out against nurse incivility. Leaders should model the positive, collaborative behavior they expect from nurses. 
• Foster communication between nursing staff and human resources. Nurses in some organizations may feel nervous about reporting bullying to human resources. To address bullying as it occurs, take a systems approach. Open communication channels among nurses, administrators, and human resource staff to contribute to a more supportive workplace environment. 
• Reduce avoidable stressors in the workplace, such as work overload. Stress, fatigue, and burnout lead to short tempers and a minimized ability to empathize. 
• Support mental health counseling. Bullying affects physical and mental well-being, leading to low self-esteem and reduced motivation. Encourage bullying victims to seek counseling as needed.
• Talk about bystander accountability. Bullying rarely occurs between just two people. Bystanders to bullying should also feel responsible for saying something when they see inappropriate behavior among co-workers. Empower nurses to hold one another accountable and call out bullying behaviors when they witness them.

Nurses everywhere deserve respect in the workplace. To provide the best quality of care for their patients, and to prevent burnout, nurses need to do what they can to stop nurse bullying within their teams. A more inclusive healthcare organization will encourage nurses to work collaboratively, rather than competitively, and to treat one another as sources of resilience and strength when inevitable work stressors pop up.

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