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Mean Girls (and Guys) in Healthcare

News  |  By Jennifer Thew RN  
   July 18, 2017

While it’s known workplace bullying can compromise patient safety, interfere with communication, and hamper employee morale, a new analysis finds bullying behaviors continue in healthcare.

In 2008, the Joint Commission recommended healthcare organizations adopt a zero-tolerance policy toward bulling behaviors (now called behaviors that undermine a culture of safety). But almost a decade later, a query of the Pennsylvania Patient Safety Reporting System database, finds bullying or aggressive behaviors among healthcare providers persist.

An analysis of the database revealed 44 events associated with bullying behaviors occurred between July 2014 through June 2016. The events occurred among healthcare providers including physicians, nurses, and technicians.

Types of Bullying Behaviors

Analysts searched the database for reports of events that included keywords like bully, cried, disrupt, rude, threat, throw, upset, and yell. They then reviewed the resulting 5,807 event report narratives to identify reports describing behaviors synonymous with the Workplace Bullying Institute definition of bullying.

The institute defines bullying as repeated mistreatment of an intended target in one or more combinations of the following forms—verbal abuse; threatening, humiliating, or intimidating behaviors; or work interference.

Event reports were grouped into related categories by harm score, event type categories, event reporting taxonomy, and care area. Event reports regarding bullying by or toward patients were excluded.  

The bullying incidents were reported in five event categories:

1. Error related to procedure/treatment/test

2. Complication of procedure/treatment/test

3. Medication error

4. Transfusion

5. Other/miscellaneous


Most of the 44 bullying incidents occurred in events classified as other/miscellaneous (56.8%), followed by error related to procedure/treatment/test (27.3%). Analysts found 77.3% of events involved a physician engaging in verbally abusive behavior. The remaining events involved a nurse or technician.

Bullying Hotspots

After examining the event descriptions, analysts sorted the events into five categories of bullying behaviors based on the Workplace Bullying Institute definition. These were:

1. Verbal abuse

2. Intimidating behavior

3. Work Interference

4. Humiliating behaviors

5. Threatening behaviors


The top two events based on frequency were verbal abuse and intimidating behavior. The top three care areas where the events took place were perioperative care areas (29.5%), medical/surgical units (25%), and the emergency department (15.9%). 

Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.

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