A healthcare nursing culture with all manner of occupational hazards has one of the toxic variety that comes in two distinct personas: the overt bully and the covert bully. Pick your poison.

As outlined by nursing leader and work culture expert, Renee Thompson, DNP, RN, CMSRN, CEO and president of RTConnections, LLC (www.rtconnections.com), bullying is a major reason 60% of new nurses quit their first job within six months.1

The overt bully commonly displays the following unsavory behavior:

  • verbal criticism or name-calling;
  • intimidation;
  • blaming;
  • ethnic jokes or slurs;
  • finding fault;
  • threatening;
  • physical violence.

As one might expect, covert bullying is a little more insidious, as a seemingly nice and helpful worker attacks the victim through gossip and innuendo. The covert bully has their own distinct cruel practices, including the following:

  • sabotage;
  • withholds information;
  • excludes others;
  • unfair assignments;
  • undermines;
  • downplays accomplishments.

A frequent speaker on such workplace challenges, Thompson gave Hospital Employee Health some common sense advice on how to defuse these difficult situations.

HEH: Do you detect any trends — for better or worse — on this issue of nurse bullying? It’s been a recurrent issue of discussion. Are there any favorable signs of healthcare settings that are successfully addressing this problem? On the other hand, healthcare is under a lot of fiscal pressure so it may be hard to break out of such a culture in a stressful environment.

Thompson: When I speak on this topic, a lot of nurses ask me if there is a higher prevalence of bullying on the East Coast, in the North, West or South, and I always say it is the same everywhere. Though there is no difference in trending from any part of the country, I do see an increase in people reaching out and asking for help in dealing with a bullying situation at work. Almost every day of my life a nurse reaches out to me for help — somebody messages me on Facebook, sends me an email, or contacts my website asking for help. I think we are seeing a trend where it is getting worse: We are seeing increased stress in the hospital setting, especially the acute care setting. They are being asked to do more and more with less and less. We work in stressful environments and the unpredictability of healthcare causes stress. As human beings, none of us are always well-behaved when we are in stressful situations; we tend to lash out at each other. But there is a difference between [bullying and] ‘my patient is coding and I’m freaking out.’ I may say something unprofessional, but that is different from repeated patterns of bullying behavior over time. I do think we are seeing an increased prevalence of bullying, especially in the acute care settings.

HEH: Can you elaborate a little on “naming the behavior” as a way to disempower bullying? Does openly stating what you are being subjected to change the dynamic, make it “real” and concrete?

Thompson: It makes it clear what the behavior is that might be considered destructive in terms of the [work] environment and even to the point of bullying. Here’s what typically happens: I used to be a unit manager of a very large medical-surgical unit, and some of my employees would come say, ‘She is bullying me or this one is a bully.’ I can’t help you [unless] you help me understand what this person is doing. What is the behavior that makes you think she is bullying you? So for example, naming the behavior makes it very clear. It takes all of the opinion and the emotion out of it.

Something that typically happens is, say you are a new nurse in the middle of the nurses’ station working with an older experienced nurse. You say something or do something that is wrong. The older nurse might say to you in front of other people, “That’s so stupid I can’t believe you made that mistake.” Or, “You are an idiot.” That new nurse — or it can be an experienced nurse, it can be anyone — says, “You just called me an idiot in front of people. You are screaming at me in the middle of the nurses’ station.” It is a reflection back to that person that the behavior is inappropriate. The problem is that these types of behaviors go unchecked. People think, “Uh-oh, she is at it again,” and no one says anything. When we use silence as a strategy, the behaviors escalate. The behaviors continue. Naming it is a simple way of addressing it. For example, “I just saw you role your eyes at me,” or, “When I left here last night you said everything was fine. When I came back, I found out you were talking behind my back.” It’s very objective. It’s very clear.

HEH: Should this be done in front of witnesses or is it more effective in a one-to-one?

Thompson: It can be one to one, but even if other people are there the person can say and should say something. However, some people may not have the courarge to say something to [the bully] in front of other people. This is where the bystander effect comes into play. The best and strongest intervention is for the witness to speak out. For example, if one nurse is screaming at another nurse, whomever is witnessing this behavior should stand up and say, “Excuse me, you just called her an idiot in front of everybody and you need to stop right now.” The witness speaks up. So the individual can absolutely speak up, but if they don’t have the courage to do that yet, whoever else hears it has an ethical responsibility to speak up.

HEH: If a worker begins to feel their manager is bullying them, that certainly is a more difficult situation. In addition to documenting incidents you mention seeking out someone to talk to and get feedback on the issue. Would the nurse be likely to lose the battle — and possibly her job — if she reported her boss’ behavior to their supervisor?

Thompson: This is a common problem. I have probably received more comments, emails, and responses from nurses related to this topic than any other related to bullying. I‘ve had so many nurses say, “This is my situation right now.” I don’t really like to label people bullies because that doesn’t solve the problem; we need to focus on the behavior and not labels. However, it’s easier to say you are dealing with a bully, but let’s just say you have identified somebody as very abrasive. These people tend to be very competent at what they do. That’s a whole other conversation, but they are very competent and therefore get promoted easier than other people. Again, if those behaviors go unchecked, they now have a perceived and somewhat real power over people.

In this situation, I always recommend that nurses first observe the boss’ behavior. Is she or he singling you out or does this person treat everybody the same way? Gather your facts. You say your boss never gives you the dates you want off — always changes your schedule but everybody else gets the days they want off. I don’t know that I would call this bullying, but if this is the situation and you think you are being targeted, observe until you have facts and then start documenting everything. Document conversations and be extremely objective — dates, times, witnesses to what happened. Anytime you can use a verbatim comment, it makes it easier to identify a clear pattern to this type of behavior. Sometimes I recommend, depending on the situation, that you schedule a meeting with your boss. Go to your boss and say, “I’m really struggling with this. The relationship I have with you is really important to me and I want to talk about some things that I have noticed that I’m not really sure you are aware of.” There are so many people who do not realize they are behaving in an abrasive and aggressive manner. This could be an opportunity to sit down and have a conversation.

HEH: While some may fortunately recognize their behavior as negative, what are some other possible reactions?

Thompson: When you actually bring up to that person the behavior you have observed, you are going to get one of three results. The first result is, “Oh my gosh, I had no idea I was coming across this way. I’m so sorry.” I love that person — you can work with that person. The second response is that this person has deep-seated issues, maybe mental health issues, some things going on at home that are affecting their ability to function professionally in the work place. I’m not sure you can help this person; they may need an employee assistance program or some kind of counseling, but you can’t do it by yourself.

The third category are people who are unwilling to accept any responsibility; they have no sense of self awareness. What you do with these people is you don’t work with them — you fire them. They usually represent only about 3% of people in an organization, but they are toxic and are sometimes referred to as sociopaths. You cannot change their behavior. Especially in healthcare, where we are responsible for human lives, you have to fire these people — you can’t work with them. [If this is your boss] you can file a complaint, you can go and meet their supervisor, but unfortunately there are situations where I just tell the nurse to leave. Seriously. If they are friends with the executive director and [top administration] the chances of you getting the behavior to change are not very good. There is nothing more important than your physical, emotional, and psychological health. I tell nurses, “You have done your due diligence, you tried to address the problem. It’s not worth it. Find another place [to work].”

Editor’s note: For more information on Dr. Thompson, please visit: http://nursesdonoharm.com. She recently published an ebook on bullying that is available at: http://bit.ly/21DQuF1.


  1. Townsend T. Break the bullying cycle. American Nurse Today Jan. 2012: http://bit.ly/24BS3lP.