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Workplace Bullying in the Health Care Setting

September 11, 2014

The College of Nursing and Health Professions is pleased to introduce a series of articles authored by Paul Thomas Clements, who will share his expertise on topics such as workplace bullying, stalking, child assessment of abuse, victim assessment, and workplace violence in healthcare.

Paul ClementsBy Paul Thomas Clements, PhD, APRN-BC, CGS, DF-IAFN, Associate Clinical Professor and Coordinator of Drexel’s Forensic Trends and Issues in Forensic Healthcare Certificate Online. 

Bullying in the workplace has become a significant focus in the contemporary era of healthcare. The implications of bullying are far-reaching for employees and employers and need to be actively addressed. Workplace bullying has been defined as any type of repetitive abuse in which the victim of the bullying behavior suffers verbal abuse, threats, humiliating or intimidating behaviors, or behaviors by the perpetrator that interfere with his or her job performance and are meant to place at risk the health and safety of the victim (Murray, 2009).

It is estimated that 1 in 7 employees are bullied at work (Murray, 2009).

There are four generally accepted categories of bullying:

  1. Direct verbal bullying is characterized by threats, insults, and name-calling.
  2. Indirect relational bullying is characterized by exclusionary behavior and rumor spreading.
  3. Cyber-bullying, which is the newest form of bullying, uses electronic methods for inflicting emotional distress on the target. This can include texting, e-mail, and various forms of social media (Facebook, Twitter, etc.).
  4. Retaliation is a type of bullying that uses psychological and social behaviors to cause harm. One example is conceptualized by the adage “Once they stop talking to you, they begin talking about you.”  This can result from the target being perceived as “ratting out” another employee, causing someone to “get in trouble,” being blamed for being “passed over” for a promotion, etc. 

Why does an individual bully?

The bully has an extreme need to have complete control over an individual or an environment. Additionally, the bully may have personality flaws such as an exaggerated sense of self (Murray, 2009).

How does the individual bully?

This usually occurs via a systematic mistreatment of the target. The bully:

  • Sabotages the victim(s) work
  • Uses verbal abuse
  • Employs public humiliation (often in front of co-workers)
  • Excludes or ignores the target

The following examples may help healthcare employees recognize if they are being bullied:

  • Despite attempts to learn a new procedure or complete a task, the supervisor is never pleased.
  • Being called to unplanned meetings with the supervisor (and perhaps others who are witness or participants) where only further degradation occurs.
  • The workplace bully continually undermines and torments an employee who is trying simply to do his or her job.
  • Frequent spreading of rumors or negative comments about an employee’s personal appearance, beliefs, or performance with patients.
  • Making it clear that the employee is not considered “part of the team.”
  • When an employee asks an organizational leader for help, he or she is told to “get a tougher skin” or “work out your differences.”
  • Co-workers and senior leaders share the employee’s concern that the bully is a problem but they take no action to address the concern in the workplace (Murray, 2009).

Impact of bullying in healthcare settings

Bullying encompasses many levels of impact for healthcare employees and agencies. Research has shown that bullying decreases job satisfaction among employees, decreases employee productivity and increases employee absence from work. Additionally, bullying increases job turnover; one report notes that 64% of bullying victims leave their jobs (Tarkan, 2013). The financial impact of replacing large numbers of vacancies with the associated costs of orienting new personnel can be staggering to employers. One study reports that the cost incurred from bullying in the work place can be as much as $4 billion dollars a year (Murray, 2009).

Professional implications

Bullying should be identified as an “abusive work environment.” From a risk management standpoint, such a policy and practice stance can limit employers from secondary liability risk when such behaviors are documented, impact is assessed, and actions are taken. Such an approach can include termination of the bullying employee. Zero tolerance for violence policies that include bullying as a facet holds both the employees and employer accountable for bullying in the workplace. Employers should clearly indicate that bullying will not be tolerated and that cases of reported bullying will be investigated.

When an employee believes they are being bullied

It is important to examine the healthcare agency’s policy on workplace violence and bullying. This will increase the ability to recognize when bullying is occurring. If the policy is unclear, an employee should seek information from the Office of Human Resources for guidance. Anti-bullying actions are a “culture” change on the part of all employees, management, Human Resources and Administration.

Employees should document all incidences of workplace bullying –specifically including date, time, occurrence, and witnesses. It is also important that employees report if they witness another employee being bullied. In either situation, this includes bringing the incident to the attention of the manager immediately (and repeatedly if there are subsequent events) and “document, document, document” (Murray, 2009). Additionally, employees can familiarize themselves regarding state and federal rights on workplace bullying and harassment.


Bullying in the workplace is a significant issue in the contemporary era of healthcare. It has both measurable and immeasurable costs for employees and employers. The prevention of workplace bullying will occur when there is an increase in recognition, reporting, and response from the continuum of those working at the bedside, to management, Human Resources, and Administration in each healthcare facility nationwide. This requires a clear stance that workplace bullying is not acceptable and is not tolerated.


Murray, J.S. (2009). Workplace Bullying in Nursing: A Problem That Can’t Be Ignored. MEDSURG Nursing, 18 (5), pp. 273-276.

Tarkan, L. (2013).  How to cope with bullying in the workplace. Retrieved from: