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Creating a culture of safety: how to identify bullying and work to prevent it among nursing staff

By Adele Webb, PhD, RN, FNAP, FAAN


The definition of bullying is straightforward: it’s the repeated, health-harming mistreatment of one or more persons by one or more perpetrators.

It’s when individuals engage in behaviors that negatively impact others and their daily responsibilities. And there is often a power dynamic at play between those bullying and the targets of their actions. For nurses, this behavior can be particularly detrimental. It can affect their emotional health, contribute to a toxic work environment, and lead to negative patient outcomes. It’s a problem that is more commonplace than many of us are willing to admit. Through careful examination, nurse leaders can get a better understanding of bullying—the ways it can lead to toxic environments, how to prevent it, and how to create a culture of safety and support for nurses as they carry out their vital work.

How does bullying manifest among nurses?

In nursing, there is a notorious phrase: “nurses eat their young.” In other words, seasoned nurses may show aggression toward newer nurses. This can be due to experienced nurses believing that their way of doing things is the only correct way to do them, and that newer nurses’ ideas are less valid. Nurses who have worked hard for many years to establish themselves can sometimes seek ways to maintain their authority over others. This can be expressed in a variety of ways. Some are subtle, such as incivility or being discourteous toward the other nurses on staff. It can also include gossiping, spreading rumors, or refusing to assist each other. If left unchecked, these behaviors can escalate to include verbal abuse, intimidation, or actively trying to humiliate nurses in front of others—creating an atmosphere of tension and fear. This is known as lateral violence and is separate from the daily stressors that nurses already face: pressure from families and patients, constantly changing work dynamics, etc.

How does bullying affect nurses and their institutions?

We all want to feel validated, work in a safe, supportive environment, and we want our work to have meaning. This is particularly true for nurses, as they intentionally entered careers where they would be tasked with the health and well-being of others and want to have a positive impact on other people’s lives. When a nurse is bullied, it decreases their sense of well-being. It can lead to feelings of defenselessness or injustice. And as with any emotional stress, it can also start to affect their physical health.

This also has a disruptive effect on their departments. When a nurse or group of nurses is bullied, productivity decreases. Patients experience less successful outcomes or even loss of safety. Bullied nurses are more likely to leave their positions, resulting in a higher turnover rate and contributing to nurse shortages. And, because so many institutions’ reputations rely on patient feedback and ratings, leaders need to be aware of how bullying can trickle down and translate into lower overall patient satisfaction.

What can be done to prevent bullying?

Although bullying is a widespread problem, there are steps leaders can take to address and prevent it. The first step is to acknowledge the issue: there needs to be dialogue about how these behaviors can affect all nurses and departments. Staff should be educated on how to model professional behaviors and how to recognize when bullying has taken place. Nurses and nurse leaders alike need to understand that everyone is responsible for creating a positive work environment.

Second, organizations need to create safe spaces. This includes building mechanisms for reporting when it has occurred and making sure everyone understands that there is a zero tolerance policy for it. As a result, nurses will understand that they are supported, and they’ll feel more comfortable openly discussing incidents of bullying. Nurses, particularly those in leadership roles, also need to be assess their own behavior. It’s possible that many bullies don’t recognize how harmful their actions have been. By asking nursing staff to self-assess and ask how their own behaviors influence the work environment, these habits can be brought into the light and start to improve the situation. Open dialogue is the key—it’s the beginning of the process of conflict resolution.

Through the efforts mentioned above, organizations can identify bullying within their teams. If left unchecked, these behaviors can become harmful to nurses and it can limit their ability to care for others. Once identified, bullying can be addressed and minimized, which will help create a more ethical workplace of civility, kindness, and respect. Nurses deserve nothing less.


Adele Webb, PhD, RN, FNAP, FAAN

Executive Dean of Healthcare Initiatives, Strategic Education, Inc