Feature
Nurses and Bullying
Workplace culture expert Renee Thompson discusses what’s changed, what hasn’t, and where we go from here
Bullying among nurses can take many forms: malicious gossip in the breakroom, mocking eye-rolls in patient areas, harsh words in the group chat, and cruel hazing of newcomers.
Have things gotten worse in recent years, or are they finally changing for the better? Working Nurse asked an expert.
Renee Thompson, RN, DNP, FAAN, is the founder and CEO of the Healthy Workforce Institute, which works with healthcare organizations to address bullying and incivility in order to create a more positive workplace culture.
She has published several books on these subjects, and contributed the popular Healthy Workforce column to this magazine. (You can find past articles here.)
We talked to her about where we stand now in the battle against toxic behavior in nursing.
How did you come to be a nursing workplace expert?
I’ve done almost everything you can do as a nurse. I started in cardiac step-down, worked for a home care company, and was the quality manager for a managed care company. It was when I went back into acute care as a unit manager that I had my first real experience with a toxic work culture. I resigned, finished my master’s degree, and became an educator.
From there, I took a role at the corporate level, where I was responsible for the professional development of about 10,000 nurses. That role gave me a new understanding of bullying that went beyond myself or my unit. Numerous nursing students, new grads, and experienced nurses shared with me their stories of being mistreated at work.
Realizing the scope of the problem was eye-opening. I said to myself, “Enough is enough.” I quit my corporate job and decided I was going to devote myself to finally putting an end to bullying and workplace incivility in healthcare. That eventually led me to found the Healthy Workforce Institute.
What is your process when working with hospitals and nursing teams?
We start by assessing the current culture to really understand what’s happening on the ground, using a range of assessment tools.
From there, we work with leaders and teams to heighten awareness of disruptive behaviors, set clear expectations, provide skill development for appropriate professional conduct, and put accountability systems into place.
How has your work changed from when you started?
Back then, my work focused a lot on raising awareness — convincing people that bullying and incivility were real problems that needed to be addressed. There were some organizations that even told me not to say the word “bullying” during my presentation!
Thankfully, today most organizations acknowledge the problem, and there’s been a shift towards solutions. Leaders want practical strategies they can use, and team members want to be confident that reporting bad behavior won’t make things worse.
What kinds of incivility do you see most often among nurses?
The most common behaviors I see are condescending remarks, gossiping, eye-rolling, passive-aggressive behavior, exclusion, mocking, and undermining colleagues. Sometimes it’s subtle, but the impact is profound. These covert behaviors erode trust, morale, engagement, and retention.
Can you give an example of these kinds of covert behaviors?
In one unit, there was a nurse — let’s call her “Edna” — who had a habit of tuning out if a nurse she didn’t like was giving report. Edna would just stop listening and start doing something on the computer, not taking notes or paying attention, until the nurse giving report trailed off, feeling stupid.
The rest of the staff all tolerated this, and would tell Edna’s victims, “Oh, that’s just the way she is.” One nurse Edna did this to started calling out whenever she saw that she and Edna were scheduled for the same shift.
Another common behavior that can be really damaging is setting up a colleague for failure, especially when it’s in front of others.
For example, a new OR nurse I talked to had made a mistake setting up a patient tray. Their more experienced coworker noticed that it wasn’t right, but deliberately waited to mention it until they were in the OR in front of the surgeon, who was notorious for getting angry when things weren’t to his liking.
Do you also see a lot of demeaning behavior in front of patients?
Sometimes, yes, and not only from other nurses. There was a rapid response nurse in one organization who had been late bringing the patient down to the cath lab. The physician exclaimed, “Why are you so late? If this patient dies on the table, it’s your fault!” This was right in front of the patient.
The M.D. then saw that the rapid response nurse was a traveling nurse and added, “Oh … you’re not a real nurse.” The patient had to comfort the nurse!
The physician later denied ever saying that, so nothing came of it.
Why does this kind of incivility happen?
Contributing factors include chronic stress, heavy workloads, and staffing shortages. However, in some cases, incivility is exacerbated by a workplace culture that’s tolerated bad behavior for decades.
The good news is that more organizations are starting to address the problem. They’re writing clear policies, educating leaders on how to have difficult conversations, and recognizing that a healthy culture isn’t just “nice to have” — it directly affects patient safety and outcomes.
Have you seen any particularly egregious behavior that has shocked you?
Unfortunately, yes. A nurse once shared with me that she had confronted a coworker who wasn’t following protocol regarding an IV infusion. The coworker made a negative comment and ignored her.
When the coworker violated the protocol again, this nurse filed a report. The following day, she walked into the locker room to find plastic rats taped to her locker! After that incident, she quit.
I can’t imagine how that felt. Bullying and incivility need to stop.
Have there been any improvements you’d like to highlight?
Yes, absolutely. I’m seeing more leaders hold people accountable for their behavior in ways that didn’t often happen 10 or 15 years ago. Back then, it was very common for managers to dismiss the chronic bad behavior of nurses like Edna by saying, “Oh, that’s just how she is.” That excuse is much less acceptable today.
We’re also seeing stronger partnerships among the interprofessional team. Bullying and incivility are not just nursing issues — physicians, front-line team members, administrators, and human resources all have a part to play in establishing and sustaining a healthy work culture.
Can every toxic workplace be helped?
Not every workplace can be “fixed,” but most can be improved. The key is leadership commitment. If leaders tolerate toxic behavior — or worse, engage in it themselves — the culture won’t change.
But, when leaders set the tone, enforce expectations, and model respect, even deeply entrenched cultures can turn around. I’m happy to say I’ve played a role in that shift.
What impact did COVID have?
I had hoped that going through a global pandemic together would strengthen our relationships and remind people that the way we treat each other is most important. Unfortunately, that really didn’t happen.
Overall, I would say that COVID magnified what was already there. Teams that already had a strong culture often became stronger and rallied together.
For instance, in one organization I saw, the oncology department recognized that a lot of new grads were on the night shift, and asked the department’s experienced nurses to take turns spending a few hours on nights — not taking patient assignments, just helping — to support the new grads.
However, teams that were already struggling with toxicity before COVID saw those struggles intensify due to the added workload and stress.
I’m frequently asked if bullying and incivility are worse since COVID or if we have just gotten better at recognizing and reporting them. I would say both.
There’s a longstanding truism that nurses haze and bully new grads. Have things improved in that area?
We’ve made progress, but nurses “eating their young” is still all too common.
A positive trend I’m seeing is more focus on onboarding new nurses with supportive preceptors rather than throwing them into “sink or swim” environments. That shift has helped decrease hazing behaviors in some settings, though there’s still work to do.
Even so, new grads can still feel targeted, especially when seasoned staff are overwhelmed. However, today’s new grads are more likely to speak up if faced with bullying or incivility. They won’t put up with it, and they will leave if it persists.
I think that’s encouraging: It’s an important step towards breaking the cycle. As I often remind leaders, protecting and supporting new nurses isn’t just about retention (although that’s important) — it’s about building the next generation of our workforce.
What technological and social changes concern you most?
Technology has created new ways for nurses to communicate, which sometimes creates new ways to be unkind. “Digital incivility” is one of my biggest concerns, because it’s often hidden, and harder for leaders to detect.
Group texts, messaging apps, and social media can be used to gossip, exclude, or criticize colleagues. We refer to these tech attacks as someone having “keyboard courage.” It’s easier to zing someone if you don’t have to look at them.
For example, on one unit, a new nurse’s coworkers tried to get rid of her by sending her Facebook messages with job listings at other hospitals, telling her she should apply!
Another cultural problem we’re seeing is blurred boundaries between personal and professional spaces. That can create friction if colleagues expect constant access or have a habit of venting excessively outside of work hours. Leaders have to help teams establish healthy boundaries in these new environments.
If you could make one sweeping systemic change, what would that be?
For people to stop using silence as a strategy — it doesn’t work. The problem will persist unless we’re willing to name it.
This has to happen at every level. It can’t be just leaders or just nurses. I like to say that really stopping bullying and incivility requires a “top-down, bottom-up, and everything in between” approach. Building and maintaining a healthy work culture requires us all.
In this Article: Bullying and Incivility, Nursing Workforce
