What Is Nurse Bullying?

Nursing consistently ranks as the most trusted profession in the United States. Gallup has measured this for more than two decades, and nurses have held the top spot every year but one. That makes nurse bullying a particularly uncomfortable subject. The profession built on care and patient advocacy also has a documented, persistent problem with how its members treat each other.

Nurse bullying is not the same as a difficult shift or a tense interaction between colleagues. It is repeated, targeted behavior that creates a pattern of harm over time. A single hard conversation is not bullying. A sustained pattern of exclusion, undermining, or verbal aggression directed at a specific person is. That distinction matters because bullying is easy to dismiss when each individual incident seems minor. The pattern is what defines it.

 

Researchers who study this problem use two terms that appear throughout the literature. “Workplace incivility” refers to low-intensity disrespectful behavior that violates professional norms, whether or not the intent to harm is clear. “Lateral violence” refers specifically to nurse-to-nurse bullying, the horizontal aggression that occurs between colleagues at the same level of the hierarchy. Both terms describe the same underlying problem from slightly different angles, and both appear in clinical research and organizational policy. This article uses all three terms, nurse bullying, workplace incivility, and lateral violence, because all three are used in practice and all three describe what nurses are actually experiencing.

 

How Common Is Nurse Bullying? What the Research Shows

The scale of nurse bullying is not a fringe concern. Survey after survey finds that the majority of nurses have experienced or witnessed workplace incivility. Estimates consistently place the percentage of nurses who report experiencing bullying at more than 60 percent. In some specialty settings and high-acuity environments, rates are higher. This is not an isolated or uncommon experience. For many nurses, it is a routine feature of the work environment.

The Joint Commission has formally addressed disruptive behavior in healthcare settings, noting that intimidating and disruptive behaviors are linked to medical errors, preventable adverse outcomes, increased cost of care, and nurse turnover. This is not just a human resources problem. It is a patient safety problem with organizational consequences.

Why Nurse Bullying Goes Unreported

The reported incidence of nurse bullying significantly understates the actual incidence. Most nurses who experience bullying do not formally report it. The reasons are consistent across research: fear of retaliation, belief that nothing will change, concern about being labeled a problem employee, and in some cases, uncertainty about whether what they experienced meets the threshold for a formal complaint.

There is also a normalization dynamic. In units where incivility has been present for a long time, nurses may not recognize it as something worth reporting because it has become the baseline expectation. That normalization is one of the most significant barriers to addressing the problem, because it makes the bullying invisible to the organization even when it is highly visible to the staff experiencing it.

Who Is Most Vulnerable

New nurses are disproportionately targeted. Research on first and second-year nurses consistently finds higher rates of bullying exposure, and that exposure is one of the most reliable predictors of early departure from the profession. A nurse who enters their first unit and encounters lateral violence, exclusion, or sustained undermining from more experienced colleagues is a nurse who is significantly more likely to leave within the first two years.

Vulnerability also increases in environments with chronic short staffing, high census pressure, and limited peer support. These conditions do not create bullying, but they create the conditions under which existing incivility accelerates. Nurses who are already stretched thin have fewer internal resources to manage hostile interpersonal dynamics on top of everything else.

What Nurse Bullying Actually Looks Like: Common Forms of Incivility

One reason nurse bullying persists is that its most common forms are easy to explain away. Physical threats and overt aggression are easy to name and document. The behaviors that make up the majority of actual bullying incidents are subtler, deniable, and often invisible to anyone not directly targeted. Research from the Journal of Nursing Administration found that the most common forms of nurse bullying rank from subtle to overt, with the subtle forms far more prevalent.

Exclusion and Marginalization

Being ignored or excluded is the most commonly reported form of nurse bullying. This includes being left out of team communication, having questions or opinions consistently dismissed, being physically excluded from conversations, and being treated as though professional input does not merit acknowledgment. These behaviors are easy to explain individually and extremely damaging cumulatively. A nurse who consistently has their clinical observations dismissed or is left out of shift communication is not just experiencing social friction. They are being undermined in their ability to do their job.

Undermining and Sabotage

Undermining takes several forms: responsibilities removed without explanation, unreasonable workloads assigned selectively, accomplishments downplayed or attributed to others, and critical information withheld that would allow a nurse to perform their job effectively. This category is particularly damaging for new nurses, who depend on more experienced colleagues for clinical information and peer support during onboarding. When that support is deliberately withheld, it creates both professional risk and psychological harm.

Persistent criticism of work, constant references to past errors, and deliberate downplaying of competence also fall into this category. The cumulative effect on a nurse’s confidence and clinical judgment can be significant, particularly when the criticism comes from a more senior colleague whose opinion carries weight.

Social and Verbal Aggression

Gossip, public ridicule, sarcasm, being shouted at, and being told directly or indirectly to quit are all forms of verbal and social aggression that appear in the nurse bullying literature. These behaviors are more visible than exclusion or undermining but are still frequently minimized: ‘That’s just her personality,’ ‘He talks to everyone like that,’ ‘You need a thicker skin in this unit.’ That minimization, especially when it comes from leadership, is itself a form of enabling.

Covert Bullying vs. Overt Bullying

The distinction between covert and overt bullying matters for how leaders identify and respond to it. Overt bullying, shouting, direct insults, explicit threats, is easier to see, document, and address. Covert bullying, exclusion, withholding information, strategic undermining, deliberate exclusion from communication, is far more common and far harder to address precisely because it is harder to prove.

Physical threats and violence rank at the bottom of actual measured nurse bullying behavior. That does not make them less serious when they occur. But it does mean that organizations focused primarily on the most visible, extreme forms of bullying are missing the behaviors that affect the most nurses most often. The quiet isolation of a new nurse by a senior colleague is not dramatic. It is destructive, and it happens every shift in units where this problem goes unaddressed.

Why Does Nurse Bullying Happen? Understanding the Root Causes

Leaders who understand only the surface behaviors of bullying are equipped only to respond to incidents after they occur. Understanding the root causes of nurse bullying is what makes prevention possible.

The “Nurses Eat Their Young” Culture

The phrase “nurses eat their young” has been used in the profession for decades to describe the hazing dynamic in which experienced nurses treat new nurses as having to earn their place through hardship. The idea is that clinical competence is established through trial by fire, and that difficult treatment at the hands of senior nurses is simply part of becoming a real nurse.

This framing is both harmful and persistent. It normalizes predatory behavior toward vulnerable nurses under the guise of professional socialization. It teaches new nurses that staying silent under mistreatment is part of the job. And it creates a cycle: nurses who were bullied as new graduates and were not given tools to process or interrupt that experience may replicate the same dynamic when they become the senior nurses on the unit.

Naming this dynamic directly, rather than treating it as cultural background noise, is a prerequisite for changing it.

Chronic Stress and Staffing Pressure as Amplifiers

High-stress environments do not create bullying, but they accelerate and intensify incivility that already exists. When nurses are chronically short-staffed, working mandatory overtime, and operating at or beyond the limits of safe patient ratios, interpersonal tension increases. Empathy decreases under sustained stress. Emotional regulation becomes harder. The margins that normally buffer difficult interactions get thinner.

This is an important nuance for leaders: addressing staffing and working conditions will not eliminate bullying, but it will reduce the environmental pressure that allows existing incivility to escalate. Organizations that treat bullying as purely a behavioral problem, without addressing the structural conditions that amplify it, tend to see limited and temporary improvement.

Leadership Gaps and Passive Tolerance

Bullying persists most reliably in environments where leadership does not notice it or does not act on it. A nurse manager who is rarely on the floor during shifts when bullying occurs is a nurse manager who cannot intervene. A charge nurse who witnesses incivility and says nothing communicates to the entire team that the behavior is acceptable. Passive tolerance by leadership is itself an enabling behavior, and staff on the unit know it.

Leaders who do observe bullying and choose not to address it, because the offending nurse is high-performing, because the conflict feels interpersonal rather than systemic, or because intervention is uncomfortable, are making a choice with real consequences for the nurses being targeted and for the culture of the unit.

Power Dynamics and Hierarchy

Bullying in nursing flows both downward and laterally, and the dynamics differ in each case. Downward bullying, from supervisors or charge nurses toward staff nurses, is driven by authority and is particularly hard for targets to address because the person causing harm is also the person they would normally go to for support. Lateral bullying, between peer colleagues, is driven more by competition, hierarchy within the peer group, and the informal social structures of a unit.

Both forms are serious. Both require different organizational responses. And both are more likely to persist in environments where power is exercised without accountability.

What Nurse Bullying Costs: The Impact on Nurses, Patients, and Organizations

Nurse bullying is not a interpersonal problem that exists separately from clinical and organizational performance. Its consequences are measurable, and they are significant.

The Cost to Individual Nurses

Nurses who are bullied report higher rates of anxiety, depression, and post-traumatic stress symptoms. Compassion fatigue accelerates. Confidence in clinical judgment erodes when that judgment is persistently dismissed or undermined. Many nurses who are targets of sustained bullying report that the psychological impact follows them outside of work: disrupted sleep, social withdrawal, and persistent self-doubt that affects their ability to advocate for patients.

Intent to leave the profession is consistently elevated among nurses experiencing bullying. For first-year nurses especially, the combination of high clinical demands and hostile interpersonal dynamics often tips the decision toward departure. The profession loses nurses it invested in training and onboarding before it has had a chance to realize that investment.

The Patient Safety Connection

The Joint Commission has documented the link between disruptive behavior in healthcare settings and adverse patient events. The mechanism is straightforward: when nurses are afraid to speak up, ask questions, or raise concerns because doing so has previously resulted in ridicule or dismissal, they stay silent. A new nurse who does not feel safe asking a more experienced colleague to clarify a medication order is a safety risk. A nurse whose clinical judgment has been systematically undermined may second-guess a concern that turns out to be correct.

Nurse bullying suppresses the communication that patient safety depends on. It creates the exact conditions in which preventable errors occur.

The Organizational Cost

The financial cost of nurse turnover is substantial. Replacing one nurse costs an organization an estimated $61,000 when recruitment, onboarding, orientation, and productivity loss are factored in. Nurse bullying is a significant driver of voluntary turnover, particularly among first-year nurses, who are both the most commonly targeted and the most likely to leave when the environment becomes untenable.

HCAHPS scores are also affected. Patient perception of nurse communication and responsiveness is directly tied to nurse morale and unit culture. Units with high incivility tend to produce lower patient satisfaction scores. The organizational case for addressing nurse bullying is not purely ethical. It is financial, clinical, and reputational.

What Nurses Can Do: Responding to Bullying at the Individual Level

This section is for nurses who are experiencing bullying, witnessing it, or trying to determine whether what they are experiencing qualifies. One important framing note: the burden for stopping nurse bullying does not belong primarily to the nurses being targeted. The organizational and leadership sections of this article address where that responsibility actually lies. But there are practical things individual nurses can do now, regardless of where the organization is in addressing this problem.

Recognizing It for What It Is

Many nurses who are being bullied spend significant energy questioning whether their experience is valid. They have been told they are too sensitive, that the offending colleague is just difficult with everyone, or that what they are experiencing is just the culture of the unit. This self-doubt is a predictable response to sustained minimization, and it is worth naming.

If you are experiencing repeated, targeted behavior that makes you feel excluded, undermined, or unsafe, and if that experience is creating a pattern rather than reflecting isolated incidents, that is nurse bullying. It does not have to meet some threshold of severity to be real or worth addressing.

Responding in the Moment

Not every incident of bullying can or should be addressed in real time. But when a direct response is possible and safe, a brief, calm, factual statement can interrupt the dynamic without escalating it. Naming what just happened, without accusation or anger, shifts the interaction and signals that the behavior was noticed. ‘I’d like my input to be heard the same way others’ input is’ is a very different response than absorbing the dismissal silently.

De-escalation does not mean acceptance. The goal of an in-the-moment response is not to resolve the underlying pattern but to decline to participate in it.

Documenting and Reporting

Documentation is the foundation of a reportable case. When bullying occurs, write it down as close to the event as possible: date, time, location, what was said or done, who was present, and any witnesses. Keep this record outside of work systems in a personal document. This is not about building a legal case. It is about creating an accurate record that demonstrates a pattern rather than an isolated incident, which is what formal reporting processes require.

When reporting, go to your nurse manager, HR, or employee assistance program depending on who is involved and what your organization’s reporting structure looks like. If the bullying is coming from your direct supervisor, go above them. Understand what the follow-up process looks like and what protections against retaliation exist before you file.

Supporting a Colleague Who Is Being Bullied

Bystander intervention is one of the most underused tools available to frontline nursing staff. Witnessing bullying and saying nothing communicates that the behavior is acceptable. A simple, direct statement in the moment, ‘That’s not how we treat each other on this unit,’ shifts the dynamic and communicates to the target that they are not invisible.

After the incident, checking in with the targeted nurse matters. Isolation is one of the core mechanisms of bullying. Breaking that isolation, even briefly, reduces the psychological harm and makes it more likely that the nurse will seek help rather than simply absorbing the experience in silence.

The Role of Charge Nurses and Nurse Managers in Stopping Nurse Bullying

The 2018 version of this article gave nurse managers a single vague paragraph. That was not enough. Leadership is the single most important variable in whether nurse bullying persists or is interrupted, and the specific roles of charge nurses and nurse managers are different enough to address separately.

What Charge Nurses Can Do on the Shift Level

Charge nurses are often present when bullying incidents occur. They are the leaders with the earliest visibility and the most immediate ability to intervene. A charge nurse who observes one nurse dismissing a colleague’s clinical concern, excluding a new nurse from a conversation, or speaking to a team member in a degrading way has the authority and the responsibility to address it in the moment.

That intervention does not have to be a formal confrontation. Redirecting the interaction, naming the expectation, and following up privately with both parties after the shift are all within the charge nurse’s role. What is not acceptable is witnessing the behavior and saying nothing. Bystander leadership enables the same dynamic as bystander silence from staff.

Charge nurses also set behavioral norms by how they model communication during their shift. A charge nurse who treats all staff with consistent respect, who addresses conflict directly rather than through avoidance or favoritism, and who makes the unit safe for new nurses to ask questions is actively shaping the unit’s culture in every shift they lead. Developing these skills starts with strong emotional intelligence in nursing and a commitment to using it.

What Nurse Managers Can Do at the Unit Level

Nurse managers hold the accountability that charge nurses do not have: the authority to have formal performance conversations, to document patterns of behavior, and to initiate progressive discipline. When bullying is documented and reported, the nurse manager is responsible for taking it seriously, following through on the reporting process, and communicating back to the reporting nurse that the concern was heard.

Nurse managers also shape culture through structural decisions: how staffing is managed, whether breaks are protected, how new nurses are oriented and supported, and whether the unit has forums for staff to raise concerns safely. A nurse manager who is rarely on the floor during shifts when bullying occurs is a nurse manager who cannot see or interrupt it. Staying connected to unit dynamics, not just through formal reporting but through direct observation, is part of the role.

The Warning Signs Leaders Need to Watch For

Many bullying situations are visible before they generate a formal report. Warning signs include: a new nurse who goes from engaged to visibly withdrawn within the first few months; staff clustering that systematically excludes one or two individuals; a specific nurse whose name appears repeatedly in other nurses’ frustrations or complaints; sudden increases in call-outs or schedule change requests from a particular person.

Leaders who know their staff well enough to notice these shifts early have the opportunity to intervene before a nurse reaches the point of resignation or complaint. That requires being present, asking direct questions, and creating the relational trust that makes it safe for staff to tell you what is actually happening on the unit.

When a Leader Is the Bully

The hardest case is when the bullying behavior is coming from within leadership itself. A charge nurse or nurse manager who uses their authority to intimidate, exclude, or undermine staff creates a particularly damaging dynamic because the people being harmed have no obvious channel for addressing it.

Organizations must have clear escalation paths for this scenario: HR channels, employee relations resources, and senior nursing leadership access that do not route through the person causing the harm. When a leader is the bully and the organization fails to act, it communicates to the entire unit that the behavior is sanctioned. The resulting damage to trust, retention, and culture can take years to repair.

What Healthcare Organizations Must Do to Address Nurse Bullying Systemically

Individual behavior change and strong leadership matter. But nurse bullying that is embedded in unit culture requires an organizational response. The structural conditions that allow bullying to persist, including policy gaps, inadequate reporting systems, and underdeveloped leadership, have to be addressed at the organizational level.

Zero-Tolerance Policy vs. Zero-Tolerance Culture

Most healthcare organizations have a policy against workplace bullying and harassment. Fewer have a culture where that policy is actually enforced. The difference between having a zero-tolerance policy and having a zero-tolerance culture is accountability. A policy that is not enforced communicates to staff that the organization’s stated values do not reflect its actual values. That gap is visible, and it erodes trust in leadership and in reporting systems.

Building a zero-tolerance culture means enforcing consequences consistently, regardless of the clinical performance or seniority of the offending nurse. It means taking reports seriously when they are filed. And it means measuring incivility as an organizational outcome, not just a HR matter.

Building Safe Reporting Systems

Reporting systems only work if nurses believe using them is safe. That means anonymous reporting channels for situations where identification creates retaliation risk, explicit anti-retaliation protections with enforcement, and clear follow-up timelines so that nurses who report know what will happen next and when. A reporting system that accepts complaints and then goes silent is not a safe reporting system. It is a system that teaches nurses reporting is futile.

Investing in Leadership Development as Prevention

Charge nurses and nurse managers who have strong emotional intelligence and conflict resolution skills are upstream of bullying incidents. They notice early warning signs. They intervene before patterns escalate. They create the psychological safety that makes bullying harder to sustain. Organizations that invest in developing these competencies in their nursing leadership are investing in prevention, not just response.

A structured charge nurse leadership training program builds the specific skills that reduce incivility at the shift level: how to address conflict directly, how to set behavioral expectations, and how to hold staff accountable without creating a punitive environment. Teamwork training for frontline healthcare staff builds the peer-level communication skills that make lateral violence less likely to take root in the first place.

Recognition as a Protective Factor

Units with strong recognition cultures consistently show lower rates of incivility. When staff feel seen and valued, the interpersonal dynamics that feed bullying, competition, resentment, and social exclusion, have less room to grow. Recognition is not a substitute for accountability. But it is a meaningful upstream factor in unit culture.

The NCharge Recognition Program provides a structured way to acknowledge the work of charge nurses who are actively developing their leadership skills and building healthier unit environments. That acknowledgment reinforces the behaviors that prevent bullying rather than simply punishing the behaviors that enable it.

Frequently Asked Questions About Nurse Bullying

What is the difference between nurse bullying and lateral violence?

Lateral violence is a specific form of nurse bullying: peer-to-peer aggression between nurses at the same level of the hierarchy. Nurse bullying is the broader category and includes both lateral violence (colleague to colleague) and vertical bullying (supervisor to staff nurse). Both are forms of workplace incivility. The terms are sometimes used interchangeably, but lateral violence specifically describes horizontal aggression between peers.

Is nurse bullying illegal?

It depends on the specific behavior and jurisdiction. Workplace bullying that rises to the level of harassment based on a protected characteristic (race, sex, religion, age, disability) is illegal under federal and state anti-discrimination law. Bullying that does not involve a protected characteristic is generally not illegal at the federal level, though some states have enacted broader workplace anti-bullying legislation. Even when not illegal, bullying violates most healthcare organizations’ professional conduct policies and may trigger disciplinary action.

What should I do if my charge nurse is bullying me?

Document specific incidents as they occur: date, time, what was said or done, and any witnesses. Then go above the charge nurse, to your nurse manager, to HR, or to an employee assistance program, depending on your organization’s structure. You do not have to wait for a pattern to be extensive before reporting. If you are not sure your organization has a clear escalation path for this situation, contact HR directly to ask what the process is.

How do I know if I’m being bullied or if my unit is just demanding?

A demanding unit is hard on everyone. Bullying is targeted. If you are experiencing behavior that is directed specifically at you, that follows a repeated pattern, and that creates a sense of being singled out for exclusion, criticism, or undermining, that is a different experience from a high-acuity environment that is hard on the whole team. Both can be exhausting. Only one is bullying.

Does nurse bullying affect patient safety?

Yes, and the connection is well documented. The Joint Commission has linked disruptive behavior in healthcare settings to medical errors and adverse patient events. The mechanism is straightforward: nurses who are afraid to speak up, ask questions, or raise concerns because doing so has been met with ridicule or dismissal stay silent. That silence creates conditions for preventable errors. Patient safety depends on communication, and nurse bullying systematically suppresses it.