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Expert Shares Strategies to Address Bullying and Incivility in Healthcare

Analysis  |  By Christopher Cheney  
   October 12, 2020

In healthcare, disruptive behaviors weigh heavily on physicians, nurses, and other staff members.

A former senior nurse is leading a for-profit institute dedicated to addressing bullying and incivility in healthcare settings.

Bullying and incivility are rampant in healthcare organizations. A 2018 study found that 43% of nurses had experienced at least two negative behaviors on a weekly or daily basis, and 12% of nurses self-identified as victims of negative behaviors. A 2020 study found that one or more of six disruptive behaviors were reported at 97.8% of healthcare workplaces, with disruptive behaviors associated with poorer teamwork climate, safety climate, job satisfaction, and perceptions of management.

Renee Thompson, DNP, RN, left nursing a decade ago to become a national speaker on bullying and incivility in healthcare. In 2017, she founded the Oldsmar, Florida-based Healthy Workforce Institute, which provides resources to curb bullying and incivility, consultancy services, and training for healthcare leaders.

Thompson recently talked with HealthLeaders about the scope of healthcare workplace bullying and incivility as well as the Healthy Workforce Institute's efforts to address the problem. The following is a lightly edited transcript of that conversation.

HealthLeaders: Why are bullying and incivility widespread in healthcare?

Renee Thompson, DNP, RN: There is more bullying and incivility in healthcare than any other industry. For many people, it is unexpected because healthcare is a caring and compassionate industry.

There are a couple of reasons. First, think about the high level of stress, particularly this year. Our healthcare teams are dealing with more stress than they ever have had to deal with before. When people are burned out and they are stressed, they do not behave well. There also is the unpredictability of care and the life-and-death situations that healthcare professionals find themselves in.

Another reason is we accept bad behavior as the norm in healthcare. One of the things we hear about physicians is that we tolerate bad behavior because of how excellent they are clinically. So, we have normalized deviant behaviors—we do workarounds, and we justify, and we rationalize for why someone behaves badly.

HL: What role can healthcare organization leaders play in addressing bullying and incivility?

Thompson: What we have found is that executives are not doing a good job equipping their frontline leaders with the skills and tools they need to address disruptive behaviors. Leaders need to be equipped with skills to address disruptive behaviors in the same way that they are equipped with skills for managing budgets and meeting regulatory requirements.

HL: What are the kinds of skills you teach healthcare leaders?

Thompson: First, we always start with heightening awareness. People in healthcare have been behaving badly for decades. You can't just come in and say, "We are going to start being nice to each other." You must heighten awareness because some people do not realize that their behavior needs to change.

We do things like build in content related to disruptive behaviors into new employee orientation, nurse residency programs, preceptor programs, and physician residency programs. It must be ongoing. You must infuse content related to behavior in everything you do.

With the leaders, we do the same thing. We equip them with the tools they need to heighten awareness among their staff. We teach them how to set behavioral expectations as a team.

We spend a lot of time teaching leaders how to confront disruptive behaviors. You may have a seasoned, experienced, and clinically excellent nurse who is toxic. We teach leaders how to have a conversation with that kind of an employee. We are big on scripting—giving leaders scripts to know what to say to someone, when to say it, and how to say it.

Leaders also have to hard wire addressing bullying and incivility. Once you create a caring culture, it can quickly regress if you do not hard wire healthy workforce best practices into the fabric of your hospital departments. For example, if a leader is interviewing a job candidate, the department norms should be pulled out. A leader should say, "This is what you can expect from us, and this is the behavior we expect of you. Things like kindness, respect, and giving and receiving feedback are not optional here—they are part of the job requirements."

HL: Is there a connection between bullying and incivility on one hand and burnout on the other?

Thompson: During the pandemic, we are seeing an uptick in bad behavior. There are some healthcare teams that are pulling together, but there are a lot of teams that are falling apart. You must acknowledge that when people are stressed and burned out, they do not behave well.

So, you must address burnout to address bullying and incivility. There is a strong connection between somebody's well-being, their stress level, and how they perform in the workplace. When you are under stress, you are not always behaving in a professional manner.

Related: Researchers Find 13.6% of Medical Residents Experience Bullying

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.


A recent study found that one or more of six disruptive behaviors were reported at 97.8% of healthcare workplaces.

Stress and a longstanding tendency to tolerate disruptive behavior fuels bullying and incivility in healthcare, Healthy Workforce Institute founder Renee Thompson says.

The top executives of healthcare organizations need to equip frontline leaders with skills to address bullying and incivility, Thompson says.

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