Identifying bullying between nurses and others in a healthcare setting is not as simple as recognizing bullying on high school dramedies. Such behavior in healthcare can be less visible and ambiguous to observers and even to those experiencing it — at least at first.

For instance, bullying behavior includes frequent eye rolling and sighing, says Brenda Burk, MSN, RN, NEA-BC, a frequent speaker about nurse bullying at national conferences. “It causes a negative environment, which can result in employees leaving because why would they want to work in a place where people are nasty to them and roll their eyes and are sarcastic?”

Bullying also could be continual criticism that is focused on the individual and not offered as constructive feedback on what the employee needs to correct. A coworker or supervisor who points out everything the person does wrong without ever offering positive feedback is engaging in bullying behavior, Burk says. The nurse experiencing the drip-drip-drip of criticism will become fearful at the job, wanting to avoid any contact with other staff. This is a patient safety issue for cases where the fearful nurse is new and supposed to be learning from more experienced staff.

“If the nurse thinks, ‘I don’t want to watch them work because they’ll criticize me, and if I make a little mistake, they’ll jump on me,’ then that’s unfortunate. That’s when a nurse can make mistakes,” Burk explains.

Another subtle form of bullying involves exclusion. If an employee walks into the break room and everyone there stops talking, the employee will feel excluded from the group.

Negative behaviors such as these can lead to sabotage, which is particularly insidious. “It’s very easy if I’m teaching you something to leave out a step,” Burk says. “You don’t [learn] that step, and then I can come in as the hero when you can’t do it.”

For example, Burk heard of a new scrub tech who was learning from an experienced scrub tech. The experienced employee told the newbie how to prepare for a surgery. When the new scrub tech was in the operating room, the surgeon held out a hand, but the new scrub tech did not have the instrument ready. The mentor, who was observing the new scrub tech at work, ran out of the room to grab what the surgeon needed. This led to a delay in surgery, which frustrated the surgeon. The woman who experienced this humiliation explained how it made her feel.

“She kind of realized she was being set up for failure,” Burk says. “If you ask the person doing the training, she’d say, ‘Oh, I forgot to tell you.’ There are many excuses.” Because of the potential for sabotage, as well as simply poor instruction, surgery centers should identify employees who want to provide staff training and will do a good job of it, Burk offers.

Spreading rumors also is a type of bullying. This is one behavior other nurses and leaders should shut down quickly.

Burk suggests confronting those spreading rumors, saying, “You know it is nonsense. Let’s not talk about her. It’s really not nice. We wouldn’t want someone talking about us.”

Manipulation is another form of bullying. For example, a nurse might not like orthopedic assignments and manipulates someone else to take those cases. “Or, they’ll irritate the charge nurse to get out of work,” Burk adds. Manipulators are clever and might push the charge nurse’s buttons to the point where the charge nurse quickly dismisses the manipulator and pulls somebody else in the room. ASC directors can monitor for bullying behaviors and create a culture where all employees (especially recent hires) feel comfortable reporting bullying episodes. “I tell all new hires, ‘This is an OR. Sometimes, people are not nice to one another, but I want to know when it happens. So come back and tell me,’” Burk says.