Behavioral Health Enterprise Risk Management Patient Safety/Clinical Care

Bullying Has No Place

It is often said that bullying behavior has no place in schools or in the work setting. Actually, bullying doesn’t fit in anywhere. There should be no tolerance for such behavior in any environment.

Not to be confused with sexual harassment in the workplace, bullying is in a class of its own. The Joint Commission (2016) in their Quick Safety Issue No 24, defines bullying in the following way:

“Workplace bullying (also referred to as lateral or horizontal violence) is repeated, health-harming mistreatment of one or more persons (the targets) by one or more perpetrators.”

Bullies take one or more of the following forms of action against a target (or victim of such abuse):

  • Verbal abuse
  • Threatening, intimidating or humiliating behaviors (including nonverbal)
  • Work interference – sabotage – which prevents work from getting done


In a study completed by The Workplace Bullying Institute (2014) 65.6 million U.S. workers are directly impacted by or have witnessed bullying. A 2014 Workplace Bullying Institute survey found that 69 percent of bullies are men and 57 percent of targets are women. Typically, women bullies target women in 68 percent of reported cases.

In an additional survey completed by the Workplace Bullying and Trauma Institute (2017), the following findings were revealed:

  • More men (70 percent) are bullies and women are the most frequent targets of bullies (60 percent).
  • Female bullies most often target other women (80 percent).
  • Up to 81 percent of employers are perceived as doing nothing and resisting acting when targets of bullying fill out a survey. In the general public, only 44.8 percent perceive the employers as doing nothing.
  • 71 percent of employer reactions are harmful to the workplace targets of bully behavior.
  • 40 percent of people targeted by a bully experience stress-related health problems including debilitating anxiety, panic attacks and clinical depression.

Additional negative impacts of bullying behavior at work include high turnover rates for that position or department, confidence in administration erodes and team spirit dissolves. Fear of bullying attacks and intimidating behavior present a barrier to the open communication needed for safe patient care. At a time when healthcare needs caregivers as the baby boomer population ages, bullying behavior may impact turnover and staff retention.

Who becomes a bully?

According to Koenig, (2017), some bullying personality traits are linked to a history of “aggressive behavior. People who are emotionally unstable, easily angered or irritated, unconscientious about following rules or uncaring about others’ feelings are more likely to become bullies.”

Bullying is not limited to the front-line work force. This behavior is found in all levels of the organization. Bullying may be coming from boss to subordinate; peer-to-peer; or from an informal leader against a fellow co-worker.

Examples of workplace bullying

  • A director and peer of the target intentionally sabotage the work of the target through fabrication, omission, lies and deceit.
  • A seasoned bully misdirects an employee (usually a new staff member) with the intent of embarrassing them in front of the team.
  • An experienced and competent staff member is targeted by the bully who sets out to manipulate and control people’s impressions of the target.
  • Intimidating behavior from someone in a position of power or a perceived position of power over their target. For example: The bully has been with the company for many years and is perceived as an informal leader within a group. The bully mocks and belittles the target causing others to question the target’s credibility.
  • A staff member calls the bully out on the unwanted behavior and when unsuccessful – follows chain of command to report the situation. But a solution may not happen with this step. Senior management may confuse the bully’s aggressive behavior for ambition and support the bully, assume a “personality clash” or may not welcome having the incompetence of the bully (and lack of corrective action) being exposed (Namie, 2017).

Remedies and solutions for the target

  • Legal Remedy: Although laws against workplace bullying are in place in Europe, such laws are not as readily found in the United States (Koenig, 2017). Yet, employers have a duty of care to ensure for the welfare of employee. A target may take a legal route when bullying becomes unbearable, a health hazard or results in being pushed out of the organization.
  • Emotional Support: Reach out to the Employee Assistance Program (EAP) or if one is not available, seek out a doctor or counselor.
  • Human Resources: Contact human resources and discuss concerns. It may be the case that others in the organization have had the same experiences. However, be aware that human resources may chalk bullying up to “personality differences” rather than an abuse of power. If human resource is not able to assist, a more formal grievance may need to be made. (Koenig, 2017)
  • Limit Setting: Learn more about using limit-setting strategies with the bully or call out the behavior.
  • Documentation: Be thorough and diary interactions with the bully, efforts to stop the unprofessional behavior and the response from the employer.
  • New Job: Seek out other employment – wellbeing and sanity are far too important to continue in an unsolvable situation.

Prevention strategies for the employer

Many organizations are taking a stance on bullying behavior as its impact on the company may be financial due to high turnover rates, may affect the company’s reputation in the community and can erode trust in leadership.

Some organizations are creating a change in culture as seen in this position statement from the American Nurses Association:

“This statement articulates the American Nurses Association (ANA) position with regard to individual and shared roles and responsibilities of registered nurses and employers to create and sustain a culture of respect, free of incivility, bullying and workplace violence. Registered nurses and employers across the healthcare continuum, including academia, have an ethical, moral, and legal responsibility to create a healthy and safe work environment for registered nurses and all members of the health care team, health care consumers, families, and communities.”


Plan: Create a plan to prevent workplace aggression, bullying and violence.

Inform: Educate the leadership team as to the definition of workplace bullying, their role in removing such behavior from the organization and their accountability for the financial impact to the organization when bullying behavior is left unchecked.

No Bully Zone: Establish a “no bullying” culture by making behavior expectations for all staff clear. When bullying is found, enforce consequences.

Role Modeling: Model the behavior desired of employees.

Feedback: Get input from staff through surveys or other tools that encourage communication and feedback regarding work conditions.

Enhance Communication: Use communication and team training such as TeamSTEPPS, provided through the Agency for Healthcare Research and Quality.



American Nurses Association (2015).   Incivility, Bullying, and Workplace Violence.

Retrieved from:

Heathfield, S. (2017). How to Deal with a Bully at Work. The Balance. Retrieved form:

Koenig, R. (2017) Battling Bullying in the Workplace.  U.S. News. Retrieved from:

The Joint Commission (2016) Quick Safety 24: Bullying has no place in health care. Retrieved from: TcEobEhA7d2RU=

Namie, G., & Namie, R. (2017).  Workplace Bullying. FAQs: How is this different from harassment? Workplace Bullying Institute. Retrieved from:

Namie, G., & Namie, R. (2017). Workplace Bullying. When I Told My Employer, It Got Worse.  Workplace Bullying Institute. Retrieved from:


Joan M. Porcaro, RN, BSN, MM, CPHRM, is a senior risk management consultant at the Mutual Insurance Company of Arizona.

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