Bullying in Nursing

If you’re trying to find work as a nurse, you’ve probably noticed there are tons of available nursing jobs, online and in your local area. RN work, LPN work, CNA work— you name it, there’s plenty of it to go around. One of the questions in the back of your mind, though, is probably this: Why can’t they find anyone to fill these positions?

While the nursing shortage and ongoing pandemic are two major reasons there are so many available nursing jobs, there’s another reason why some nursing positions become vacant and difficult to fill. It’s one of those things no one wants to talk about that has been around for a long time—bullying in nursing.

In fact, the scope of the problem becomes glaringly obvious as the Workplace Bullying Institute reports that 36% of the calls they receive are from nurses, which exceeds any other profession. On top of this, “60 percent of new nurses leave their first job within six months because of some form of verbal abuse or harsh treatment from a colleague.”

What Is Bullying?

Bethany Carter, AS, RN, began her nursing career working in cardiac intermediate care, oncology, and cardiovascular intensive care. After recently completing nursing school, she started experiencing bullying in one of her first nursing jobs:

“I was ‘volentold’ to work four 12-hr shifts without my consent multiple times, without days off in between, or with only one day off between 2 back-to-back sets of three 12-hr shifts. This was because I was new and it was thought that I would not stand up for myself.”

The American Nurses Association (ANA) explains “Incivility, bullying, and violence in the workplace are serious issues in nursing, with incivility and bullying widespread in all settings. Incivility is ‘one or more rude, discourteous, or disrespectful actions that may or may not have a negative intent behind them.”

The ANA further defines bullying as “repeated, unwanted, harmful actions intended to humiliate, offend, and cause distress in the recipient.”

Bullying in nursing is also referred to as lateral or horizontal violence meaning intentionally harmful behavior that is directed at a fellow employee.

Who Is Bullied in Nursing?

One of the most commonly held beliefs, and often repeated statements, is that “nurses eat their young,” referring to older, more experienced nurses picking on and bullying new, younger, and/or less experienced nurses. 

While this does happen, the problem is much more widespread than this. Bullying occurs in virtually every type of nursing workplace from nursing schools to medical clinics to hospitals right up to the board room.

Bullying happens between RNs, nurse managers and their nursing staff, LPNs and RNs, CNA‘s and LPNs or RNs, male and female nurses, experienced and less experienced nurses, older and younger nurses, nursing staff who are familiar with a unit and staff who aren’t—the combinations of victims and perpetrators is almost endless.

Sometimes older more experienced nurses are targeted for bullying as well. 

Elizabeth Hanes, BSN, RN, returned to school to become a nurse after a career in the corporate business world. 

Despite being an experienced adult nurse, she says “Later in my career, I was bullied relentlessly by unlicensed assistive personnel (a scrub tech and a receptionist) who constantly questioned my nursing interventions with post-surgical patients, complained to the surgeon about me, and even complained to my nurse manager. It truly made me feel incompetent as a nurse and greatly undermined by general self-esteem. That was my last bedside nursing assignment. I left it to become a full-time freelance nurse writer.”

When Does Bullying in Nursing Start?

Unfortunately, bullying in nursing begins long before a nurse becomes a nurse. Sherry Dillon, RN, CPHRM, an emergency room nurse, recounts how proud she was that her daughter wanted to “follow in her footsteps” and become a nurse. Joining her daughter at a freshman orientation for students interested in applying to the nursing program, her pride turned to concern when she witnessed how nursing students leading the orientation bullied and discouraged potential nursing students.

She explains “They discouraged academic rigor in favor of taking the easiest classes to increase the chances of admission and called my daughter ‘stupid’ for considering an honors English course. They used their position of ‘authority’ to scare the students about the program and made them to feel incompetent.”

Unfortunately, this bullying continues in nursing programs not only by nursing students, but by nursing instructors and nurses in clinical settings as well. One study of undergraduate nursing students found that, over a six-month time period, 78% of 674 nursing students experienced bullying by nursing instructors or nursing staff they were working with during their clinical rotation.

As Dillon explains above “Many nurses are indoctrinated into lateral violence before they can even put the credentials, RN, behind their name. This leads to a perception that bullying is a normal part of the profession from early in their careers.”

What Does Bullying in Nursing Look Like?

Bullying can take many different shapes and runs along a broad continuum from more subtle passive aggressive behavior such as making fun of an employee to outright threats of physical violence.

In another study of undergraduate nursing students, researchers identified 6 different types of “bullying behavior” from interviews with students about their clinical rotations. Bullying behaviors reported by the students included:

• Being ignored, avoided or isolated

• Witnessing non-verbal behaviors

• Experiencing negative interactions

• Being denied an opportunity to learn

• Being hazed

• Being intimidated

Other studies have found these types of bullying behaviors amongst nurses who work together as well. 

In the article Our Own Worst Enemies: The Nurse Bullying Epidemic, the authors explain “Bullying can run the gamut from incivility and exclusion to physical violence and [even] death threats.” Similarly, they point out that bullying “occurs along a continuum that can escalate when not addressed.”

The authors also roughly categorize bullying as either covert or overt behaviors.

They explain “Covert bullying is indirect and passive-aggressive, and can include rumors and gossip, withholding information, unfair assignments, low grades or undesirable tasks as punishment, and sabotage. Microaggressions—brief and commonplace indignities denigrating a person's race, religion, or membership in another marginalized group—are also considered a form of covert bullying.”

Overt bullying, on the other hand, is an escalation of this behavior and is usually much easier to recognize. It can include things like:

• Verbal criticism

• Insults

• Name-calling

• Extreme micromanaging

• Direct threats

Hanes recalls a time when one of her nursing colleagues was on the receiving end of overt bullying. 

“My colleague had made an offhand comment (‘thinking aloud’ is how I would describe it) to a senior nurse whose patient was experiencing abnormal vital signs (VS) while waking up from anesthesia. Several minutes later, my colleague and I entered the break room together for lunch, and the senior nurse ran in, slammed the break room door, physically barred it with her arms, and shouted at my colleague, “Who do you think you are, telling me how to nurse a patient? I am going to kick your [expletive] .”

Overt bullying can also be done through social media. A nurse might receive threats or demeaning texts, messages, or emails directly from another nurse or co-worker they work with. 

Nurses can also be bullied indirectly in some of the same ways identified by nursing students above, or by someone who posts derogatory and demeaning comments about them on social media or their online work platform as well.

Why Does Bullying in Nursing Happen?

There are a handful of theories about why bullying happens in nursing. One theory is that the high stress and unpredictable patient outcomes that nurses work with may result in nurses trying to regain some control of their work situation which leads to bullying. 

This idea is supported by research that links “bullying to work-related factors and stressors such as job insecurity, workload, role conflict/ambiguity, and cognitive demands of the job.” Interestingly though, other studies haven’t found a consistent relationship between bullying and these work-related stressors.

Another theory about why bullying occurs identifies certain personality traits of bullied targets as risk factors for encountering this behavior.

A 2021 study examined this idea using the Victim Precipitation Theory which “states that people may exhibit certain characteristics or behaviors that may act as vulnerability factors for either being picked as a target or for provoking others, hence contributing to escalate an underlying conflict and then increase the risk of victimization from others.” 

The problem with this theory, though, is it can make bullied targets feel like it’s their fault that they’re being bullied. Instead, some would argue that the personality traits of bullies should be studied to help identify what drives certain people to inflict this cruel behavior on others.

The Workplace Bullying Institute (WBI) suggests there’s still another reason why bullying occurs. They refer to it as “ingratiation “—more commonly known as “kissing up, boot licking and butt kissing.” They suggest that bullies engage in their behavior to win the favor of someone in power or authority above them, such as a boss or manager. 

Such was the case with Carter when she reported what was happening to her at work:

“My bully was my nurse manager and she had her superior in her back pocket so when I did attempt [to report the bullying], I was met with serious consequences and false accusations to silence me.”

With ingratiation, the person in authority rewards the bully’s behavior in one or more ways. They might decide that a “personality clash” exists between the bully and the victim. In this case, the victim is often told they need to “deal with” or “work on” fixing this issue with the bully and the bully is left free to continue their behavior.

This is precisely what happened when Hanes revealed to her nurse manager that she was being bullied:

“…basically, I was told that I was the source of the problem, that I needed to modify the way I interacted with the people who were bullying me so they would stop doing it.”

The second way a boss or manager rewards bully behavior is by deciding that they’re dealing with a “he said, she said “ situation in which they can’t determine the truth. So the bully gets off without any consequences while the victim continues to suffer and is possibly labeled as a “complainer” or “problem employee.”

Thirdly, the bully might be seen as the “golden child” by management. In these situations, the bully’s behavior is not addressed or not believed to be true and the bullied target continues to be abused.

What Can You Do if You’re Being Bullied at Work?

Those who are targets of bullying in nursing often blame themselves for how they’re being treated. If this describes you, you need to know—it’s not your fault. And there are things you can do to stop this behavior and protect yourself going forward.

If you’re being bullied at work, the Workplace Bullying Institute (WBI) has two important messages for you:

1.  You are not alone, and 

2.  Nothing you did is responsible for the misery to which you are subjected.

Hanes agrees: “…It’s not your fault. You are not doing anything to ‘invite’ this behavior. It is not ‘weak,’ ‘whining,’ or ‘wrong’ to report this behavior to management. If nothing is done, find a better work environment. In my case, I started my own business, RN2writer, in part to escape the bullying while still using my nursing knowledge to help people, and I have never been happier. Nobody can bully me at my own desk! And I’m helping way more people through writing than I ever could have at the bedside.”

Carter echos these sentiments as well:

“You don't deserve it. It is not your fault. And if the situation is too complicated for you as one person to handle, never be afraid to leave. You matter, and your care for others matters. Find a place that supports you while you support others.”

For help dealing with bullying in nursing, see these tutorials offered by WBI that walk bullied targets through what is happening to them, and “allow targets to make choices that minimize damage to their health.” 

The WBI tutorials are educational and information presented is based on research and studies done on bullying in the workplace in the U.S. These tutorials include topics such as:

• Recognizing what happened (or is happening) to you

• What “it” (bullying) is

• What bullying is not

• Why it happens

• Bully types & tactics

• Targets, the best among us. Why them?

• About your perplexing co-workers

• Impact on your health

• Effects on your family

• Selecting a therapist

• Checking legal options

• Action steps for targets to take (including what NOT to do)

• Living after bullying

Although bullying casts a dark cloud over one of the most trusted and highly regarded professions there is, nurses must stand together and stand up for one another because our health and reputations as professionals depend on it. 

At the same time “Nurses and stakeholders also must actively work to change the culture, and understand that bullying has no place in the nursing profession or anywhere else in health care.”