Bullying in nursing

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The nursing organization workplace has been identified as one in which workplace bullying occurs quite frequently.[1][2] It is thought that relational aggression (psychological aspects of bullying such as gossiping and intimidation) are relevant. Relational aggression has been studied amongst girls but not so much amongst adult women.[3][4] According to a finding, 74% of the nurses, 100% of the anesthetists, and 80% of surgical technologists have experienced or witnessed uncivil behaviors like bullying by nursing faculty.[5] The nursing organisation workplace has been identified as one in which workplace bullying occurs quite frequently. There have been many incidents that have occurred throughout the past couple of years. OSHA, which stands for “Occupational Safety and Health Administration” stated that from 2011 to 2013, the United States healthcare workers experienced  15,000 to 20,000 significant injuries while in the workplace (ECRI, 2017, para. 4).[6]

Various bullying permutations are possible, such as:

  • doctor or management bullying a nurse
  • nurse bullying another nurse
  • nurse bullying a patient
  • patient bullying a nurse
  • nurse bullying other healthcare providers

There was a study that was done that showed 25% of registered nurses reporting physical abuse by a patient or their family members while more than 50% of nurses have reported exposure to verbal abuse.[7]  In 2019, there was also a study conducted on the presence of verbal abuse in nursing and this study concluded that 42.9% of nurses were exposed to this.[8] This proves that this is an ongoing concern in the nursing field. As stated before, the statement goes into a more depth explanation of what nurses are dealing with in their everyday work lives. The main problem in the nursing world that is currently trying to be solved is the issue of nurse abuse. Taking care of patients during vulnerable times of their lives can lead to an increase in the risk of workplace violence.[9] This gives us a reason as to why nurses are dealing with violence at work. Years ago this is not an issue that would have been brought up due to people not talking about it.

There was a lot of research done on healthcare workers and the abuse that they are dealing with at work. Across all of the studies in the different articles, studies were taken on how many nurses are dealing with abuse in their everyday lives. Some of the studies lead to the side effects that the nurses deal with due to workplace violence. All studies were done by professional researchers and the data found was based on nurses. Between the articles the researchers all agree that nurse abuse is an issue that needs to be dealt with, so there is no disagreement.[10]

Bullying acts[edit]

The following are identified as bullying acts in nursing:[11][12][13][14][15]

Such acts are frequently insidious, continuing over periods of time that may be years. Bullies are often serial bullies. The bullies are invariably aware of the damage they are doing. They undertake such actions basically to gain control and power.

Pariona (2020) talks about how somewhere between sixty and ninety percent of nurses have to deal with physical or verbal abuse at some point in their work-life (p. 1). This just shows people how much nurses deal with abuse daily at work. Whereas, Havaei (2020) mentions that since patients do not know how to express their emotions it might lead to violent and aggressive attacks on their nurses”(p. 2). Not that this is an excuse for patients to get violent towards their nurses, it does explain why it happens in some situations. The patient’s emotions are not an excuse for how they treat their nurses. No nurse should have to go to work worried about being verbally or physically abused.


According to various studies, possible causes of bullying may include the following:[16][17][18]

  • insufficient staff
  • stressful situations
  • unfavorable condition in a patient
  • use of alcohol
  • poor enforcement of policies


Workplace incivility can have a tremendous impact on the quality of nursing care. This can cause stress on nurses, and can cause them to have job dissatisfaction.[19] Laschinger, Leiter, Day, and Gilin found that among 612 staff nurses, 67.5% had experienced incivility from their supervisors and 77.6% had experienced incivility from their coworkers.[20] Rude remarks from a patient or family member can distract healthcare professionals and cause them to make mistakes and to provide suboptimal healthcare.[21][22] A study done by Kanitha and Naik found that 91% of nurses who experience workplace incivility are females, and that 77% of nurses have experiences incivility in their workplace.[19]

Bullying of nurses by managers[edit]

The bullying of nurses by their managers is called hierarchal violence, wherein a person of power bullies a less powerful person.[13] An example of this would be a manager to a staff nurse. Often, this occurs with the main purpose of disempowering the person in lesser power. Hierarchal violence involves frequent, intentional humiliating and destructive actions toward a person.[13] According to a study done by Ebrahimi, this can include:

  • verbal abuse
  • humiliation
  • excessive criticism
  • sarcasm
  • intimidation
  • denial of access to opportunities
  • discouragement

In 2003 the Community Practitioners' and Health Visitors' Association in the UK carried out a survey showing that half of the health visitors, school nurses and community nurses working in the National Health Service (NHS) have been bullied by their managers. One in three of the 563 people questioned said the bullying was so bad they had to take time off work. Constant criticism and humiliation were the most common complaints. Others said they were shouted at or marginalised.[23] During Ebrahimi's study done in 2017, it was found that a majority of nurses, typically new graduate nurses, experience some type of bullying by someone in a greater power of position to them.[13]

Nurses deal with abuse from their leaders in the workplace as well as their patients. When bullying is allowed in the workplace it can lead to workplace burnout and complications between coworkers.

Dealing with abuse[edit]

Dealing with abuse can lead to professionals not wanting to come to work. Researchers have found out that 13% of missed workdays are because of workplace violence and how it could affect the quality of care that the patients are getting.[24] Another major effect of the abuse is that the nurses are getting very burnt out. Burnout occurs by being mentally exhausted and detached with negative attitudes towards work.[25] It has also been found that 1/3 of the nurses that endure some type of mistreatment end up suffering a physical health consequence.[26]


Not only does incivility in nursing has a negative influence in the well-being of staff, the delivery of quality care, and the culture of safety, but also contributes to the nursing faculty shortage.[27] There is an increase in nurses' dissatisfaction in their jobs, which is contributing to the ongoing struggle with nurses leaving faculty positions and taking early retirement. Therefore, it is necessary for all healthcare faculty members to have a clear understanding of the cause and effect of incivility and possible strategies to reduce incivility rate. The possible consequences of workplace violence for nurses includes:[11][13][14][28][15]

  • health: mental, psychological, emotional, physical, social
  • anxiety and depression
  • loss of appetite
  • weight loss/gain
  • nausea or vomiting
  • nightmares
  • sleep difficulty
  • menstrual disturbances
  • feelings of shame/embarrassment
  • loss of self confidence
  • feeling of helplessness
  • feelings of isolation
  • destroyed self esteem
  • afraid of physical threats
  • feelings of inadequate support
  • high anxiety levels
  • shorter employment duration
  • lack of self confidence
  • reduced work performance
  • feeling unsafe
  • anger
  • anxiety
  • distress
  • injuries

Nurse bullying inventory[edit]

In order to further investigate and understand the impact of workplace bullying on the nursing work environment, an inventory was developed to address specific workplace bullying constructs within the nursing context.[1]

Associated terms[edit]

Horizontal violence[29] is often the same term used when referring to bullying in nursing. This term describes the appalling behavior shown by colleagues in the nursing field. Such demeaning behavior makes the work place stressful and unpleasant. Another term associated to bullying in nursing is hierarchal violence. This occurs when a person in a position of power, such as a nurse manager or head nurse, bullies a person in lesser power, such as a staff nurse.[13] Lateral violence occurs when one staff nurse were to harass another staff nurse, with neither of them being in a higher position of power than the other.[13]

Remedial action[edit]

Some health organizations are seeking to educate staff and health care team members on how to improve social interactions, proper business etiquette, and foster positive people skills in the work environment. Nurses are entitled to monetary compensation for bullying.[30][31][32][33]

See also[edit]


  1. ^ a b Hutchinson, M; Wilkes, L; Vickers, M; Jackson, D (2008). "The development and validation of a bullying inventory for the nursing workplace". Nurse Researcher. 15 (2): 19–29. doi:10.7748/nr2008. PMID 18283759.
  2. ^ Porter-O'grady, T (2008). "Transforming work environments. Interview by Diane E Scott and Amanda Rosenkranz". The American Nurse. 40 (2): 7. PMID 18494401.
  3. ^ Richards A, Edwards SL A Nurse's Survival Guide to the Ward (2008)[page needed]
  4. ^ Dellasega, Cheryl A. (2009). "Bullying among nurses". The American Journal of Nursing. 109 (1): 52–8. doi:10.1097/01.NAJ.0000344039.11651.08. PMID 19112267.
  5. ^ McNamara, S (2012). "Incivility in nursing: Unsafe nurse, unsafe patients". AORN Journal. 95 (4): 535–540. doi:10.1016/j.aorn.2012.01.020. PMID 22464626.
  6. ^ Groves, Sharon L. (March 2007). "Tools for ICU patient safety and quality improvement plans. Critical care safety: Essentials for ICU patient care and technology. ECRI Institute Staff. Publisher: ECRI Institute; 146 pages, plus CD". Journal of Healthcare Risk Management. 27 (3): 11. doi:10.1002/jhrm.5600270303. ISSN 1074-4797.
  7. ^ Al‐Qadi, Mahmoud Mustafa (7 May 2021). "Workplace violence in nursing: A concept analysis". Journal of Occupational Health. 63 (1): e12226. doi:10.1002/1348-9585.12226. ISSN 1341-9145. PMC 8103077. PMID 33960074.
  8. ^ Trindade, Letícia de Lima; Ribeiro, Suellen Tainá; Zanatta, Elisangela Argenta; Vendruscolo, Carine; Dal Pai, Daiane (31 December 2019). "Agressão verbal no trabalho da Enfermagem na área hospitalar". Revista Eletrônica de Enfermagem. 21. doi:10.5216/ree.v21.54333. ISSN 1518-1944.
  9. ^ Havaei, Astivia (4 June 2020). "The impact of workplace violence on medical-surgical nurses' health outcome: A moderated mediation model of work environment conditions and burnout using secondary data". International Journal of Nursing Studies. 109: 103666. doi:10.1016/j.ijnurstu.2020.103666. PMID 32592889. S2CID 219911782.{{cite journal}}: CS1 maint: url-status (link)
  10. ^ Groenewold, Matthew R.; Sarmiento, Raymond F.R.; Vanoli, Kelly; Raudabaugh, William; Nowlin, Susan; Gomaa, Ahmed (February 2018). "Workplace violence injury in 106 US hospitals participating in the Occupational Health Safety Network (OHSN), 2012-2015". American Journal of Industrial Medicine. 61 (2): 157–166. doi:10.1002/ajim.22798. PMID 29152784. S2CID 43289590.
  11. ^ a b Kahsay, Woldegebriel Gebregziabher; Negarandeh, Reza; Dehghan Nayeri, Nahid; Hasanpour, Marzieh (13 July 2020). "Sexual harassment against female nurses: a systematic review". BMC Nursing. 19 (1): 58. doi:10.1186/s12912-020-00450-w. ISSN 1472-6955. PMC 7324991. PMID 32612455.
  12. ^ Maeve Duggan. PEW Research Center. 2014. "Online Harassment". "http://www.pewinternet.org/2014/10/22/online-harassment/".
  13. ^ a b c d e f g Ebrahimi, Hossein; Hassankhani, Hadi; Negarandeh, Reza; Jeffrey, Carol; Azizi, Azim (24 January 2016). "Violence against new graduated nurses in clinical settings". Nursing Ethics. 24 (6): 704–715. doi:10.1177/0969733015624486. ISSN 0969-7330. PMID 26811399. S2CID 37865494.
  14. ^ a b Chen, Wen-Ching; Huang, Chuan-Ju; Hwang, Jing-Shiang; Chen, Chiao-Chicy (4 June 2010). "The relationship of health-related quality of life to workplace physical violence against nurses by psychiatric patients". Quality of Life Research. 19 (8): 1155–1161. doi:10.1007/s11136-010-9679-4. ISSN 0962-9343. PMID 20521131. S2CID 29206837.
  15. ^ a b Harthi, Moussa; Olayan, Mohammed; Abugad, Hassan; Abdel Wahab, Moataza (1 December 2020). "Workplace violence among health-care workers in emergency departments of public hospitals in Dammam, Saudi Arabia". Eastern Mediterranean Health Journal. 26 (12): 1473–1481. doi:10.26719/emhj.20.069. ISSN 1020-3397. PMID 33355386. S2CID 226429852.
  16. ^ Faghihi, Mitra; Farshad, Aliasghar; Abhari, Maryam Biglari; Azadi, Nammamali; Mansourian, Morteza (19 May 2021). "The components of workplace violence against nurses from the perspective of women working in a hospital in Tehran: a qualitative study". BMC Women's Health. 21 (1): 209. doi:10.1186/s12905-021-01342-0. ISSN 1472-6874. PMC 8136170. PMID 34011330.
  17. ^ Sujittra Chaiwuth (2020). "Prevalence and Risk Factors of Workplace Violence Among Registered Nurses in Tertiary Hospitals". Pacific Rim International Journal of Nursing Research.
  18. ^ Richardson (2017). "Violence and Aggression in NZ Emergency Departments". Emergency Nurse New Zealand.
  19. ^ a b D., Kanitha. "Knowledge and Frequency of Experience of Workplace Incivility among the Staff Nurses". International Journal of Nursing Education: 48–53.
  20. ^ Spence Laschinger, Heather K.; Leiter, Michael; Day, Arla; Gilin, Debra (2009). "Workplace empowerment, incivility, and burnout: impact on staff nurse recruitment and retention outcomes". Journal of Nursing Management. 17 (3): 302–11. doi:10.1111/j.1365-2834.2009.00999.x. PMID 19426367.
  21. ^ Klass, Perri (27 February 2017). "What Happens When Parents Are Rude in the Hospital". The New York Times. ISSN 0362-4331. Retrieved 2 March 2017.
  22. ^ Riskin, Arieh; Erez, Amir; Foulk, Trevor A.; Riskin-Geuz, Kinneret S.; Ziv, Amitai; Sela, Rina; Pessach-Gelblum, Liat; Bamberger, Peter A. (1 February 2017). "Rudeness and Medical Team Performance". Pediatrics. 139 (2): e20162305. doi:10.1542/peds.2016-2305. ISSN 1098-4275. PMID 28073958.
  23. ^ NHS nurses 'bullied by managers' BBC News 11 October 2003
  24. ^ "End Nurse Abuse". ANA. Retrieved 21 September 2021.
  25. ^ Aguglia, Andrea; Belvederi Murri, Martino; Conigliaro, Claudia; Cipriani, Nicolò; Vaggi, Marco; Di Salvo, Gabriele; Maina, Giuseppe; Cavone, Vito; Aguglia, Eugenio; Serafini, Gianluca; Amore, Mario (1 March 2020). "Workplace Violence and Burnout Among Mental Health Workers". Psychiatric Services. 71 (3): 284–288. doi:10.1176/appi.ps.201900161. ISSN 1075-2730. PMID 31640524. S2CID 204850226.
  26. ^ Kahsay, Woldegebriel Gebregziabher; Negarandeh, Reza; Dehghan Nayeri, Nahid; Hasanpour, Marzieh (2020). "Sexual harassment against female nurses: a systematic review". BMC Nursing. 19 (1): 58. doi:10.1186/s12912-020-00450-w. ISSN 1472-6955. PMC 7324991. PMID 32612455.
  27. ^ Peters, Anya Bostian (2014). "Faculty to faculty incivility: Experiences of novice nurse faculty in academia". Journal of Professional Nursing. 30 (3): 213–27. doi:10.1016/j.profnurs.2013.09.007. PMID 24939331.
  28. ^ Yuniati, Putra. "Factors Affecting the Success of Psychiatric Nurses in Conducting Risk Assessment of Violence Behavior". International Journal of Nursing Education: 252–257.
  29. ^ Roy, Josie. "Horizontal Violence". ADVANCE for Nurses. Retrieved 5 October 2011.
  30. ^ Trossman, S (2008). "Behaving badly? Joint Commission issues alert aimed at improving workplace culture, patient care". The American Nurse. 40 (5): 1, 6, 12. PMID 19024048.
  31. ^ Martin, William (2008). "Is Your Hospital Safe? Disruptive Behavior and Workplace Bullying" (PDF). Hospital Topics. 86 (3): 21–8. doi:10.3200/HTPS.86.3.21-28. PMID 18694856. S2CID 207621553. Archived from the original (PDF) on 8 March 2012.
  32. ^ Nurse Work Injury Compensation Eoin Campbell Injury Compensation Zone
  33. ^ Kerfoot, KM (2008). "Leadership, civility, and the 'no jerks' rule". Medsurg Nursing. 17 (6): 441–2. PMID 19248414.

Further reading[edit]


  • Fast Facts on Combating Nurse Bullying, Incivility, and Workplace Violence (2018). ISBN 978-0-8261-3817-0
  • Button SM Bullying of a nursing student: a mixed interpretive study (2007)
  • Dellasega C When Nurses Hurt Nurses: Recognizing and Overcoming The Cycles of Bullying (2011)
  • Nurses and the experience of bullying at work: a report for the Claire Thomson, Working Women's Centre (Adelaide, S. Aust.), Australian Nursing Federation. S.A. Branch – 1998
  • Thompson R "Do No Harm" Applies To Nurses Too! (2012)
  • Webb C, Randle J Workplace Bullying in the NHS (2006)

Academic papers[edit]