Bullying & the 3 P’s

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Let’s face it; bullying is awful. Nobody likes to be yelled at, made to feel incompetent, or treated with disrespect in the work place. However, the healthcare environment can be extremely stressful and unpredictable, requiring quick action, which can sometimes lead to folks coming across as either snarky or barky.  High stress can also lead to disruptive behaviors. While some might just say, “suck it up buttercup”, the effects of disruptive behaviors reach far beyond the medical staff.

Disruptive behaviors among healthcare employees ultimately reach the patients we serve.

According to a report noted in FierceHealthcare, a 2013 study in the UK, found that one in four doctors and surgeons and one in three nurses said bullying has caused them to behave in ways that are bad for patient outcomes.

A study conducted by the Institute of Safe Medication Practices (ISMP) showed that among physicians and nurses, reluctance to follow safety practices or work collaboratively occurred 66% of the time with reluctance or refusal to answer questions or return calls occurring 77% of the time.

Recently, I was interviewed for an article by the Pennsylvania Patient Safety Authority about how bullying impacts patient safety.   In their report, they state that disruptive behaviors delay communication between clinicians, which can compromise patient safety.

Just two days after the PA Safety Authority’s article was released, a reporter from the Philly News contacted me to further discuss the study results. In the PA Safety Authority’s article, they reported 44 cases of bullying behavior among healthcare employees over a 2-year time period.  As I told the reporter, I think this is way under reported, especially among nurses.

Whether it’s physician to nurse, nurse to physician, or nurse to nurse – disruptive behaviors are a threat to patients.

Specifically, when healthcare employees are disruptive, they impact three primary things that all have one common denominator – PATIENTS.


A new nurse, Jessica, is working in the ICU. Her charge nurse, Holly, is abrasive, intimidating, and always tries to find fault with the new nurses. It’s the classic, “nurses eat their young” situation. During Holly’s daily patient rounds for “safety”, she writes Jessica up for not having her patient’s call bell within reach.  Holly makes a big deal about it in the middle of the nurses’ station and even uses the words, “compromising patient safety.”  Jessica is mortified and went home in tears. After all, she THOUGHT she put the call bell next to her patient. Maybe she didn’t.

However, when Jessica came to work the next day, she was asked to meet with her boss. She was SURE she was getting fired.  But that wasn’t the case.  Apparently, Jessica’s boss found out that during rounds, Holly actually took away the patient’s call bell deliberately so she could get Jessica in trouble. What Holly didn’t realize was that patient was awake and witnessed her moving his call bell. He then reported it to the manager.

Still don’t think bullying impacts patient safety?

As nurses, WE KNOW THIS!!!

It’s 2 o’clock in the morning and a nurse is concerned about a patient. The doctor on call, however, is notorious for screaming and yelling at nurses – treating them like idiots. The nurse says to her colleagues, “I’m not calling him. No way! He’s a monster.”

A new nurse overhears the exchange. Weeks later, when faced with a similar situation, the new nurse makes the same choice. Think about the impact to the patient.

When you are not comfortable communicating with someone, it stops the flow of information and that’s not okay for the patients we serve.


Did you know that when someone is acting out (acting like a fool!!), yelling, openly criticizing, or berating a colleague at the nurses’ station, it affects the performance of any witnesses for the next 4 hours. Four hours! Our healthcare environments are becoming more and more complex. We don’t have any wiggle room to be distracted or for our performance to be affected.

When you are distracted, it affects the care you provide to patients.

Let’s say you’re a brand new nurse and find out you will be working for the first time with the “gang” of bullies on the night shift. When the schedule gets posted, some of your colleagues actually whisper “good luck” to you as they walk by.

Think about it. For an entire 12-hour shift, are you going to be focusing on your patients (scrubbing the hub for 15 seconds, checking the potassium level before that hefty dose of Lasix, etc.) or will you be focusing on staying out of the gang’s way?

Make no mistake about it. If bullying exists in your department, your patients aren’t getting the care they deserve!

In a study conducted with physicians and nurses, 71% of docs and nurses linked incivility to medical error and 27% linked incivility to a patient’s death.  99% of physicians (out of 800) believed bad behavior negatively impacted patient care.

Elements essential to quality patient care include effective teamwork, communication, and collaboration among the team. Disruptive behavior influences the way we communicate and collaborate with each other. Lack of these elements leads to errors and adverse events.

Still don’t think bullying impacts patient quality? Think again.


A few months ago, my hubby and I took my mother-in-law into the outpatient center of our local hospital for a GI diagnostic procedure. Everyone was SO NICE!! Seriously, from the woman at the registration desk to the young male nurse in the GI reception area – they were terrific.

She had the procedure and then we had to wait in one of the patient rooms within the GI lab (you know, the ones with just a curtain in front) for the physician to tell us the results. We were waiting for a while but then I actually had to step out to make a call. Of course I missed the physician (everything was fine) but my husband told me about his experience after I left the room.

He said 2 employees started arguing about a piece of equipment right in front of their room. It went on for a while until the point where he and his mom felt very uncomfortable. Of course he told me all about it because I always say that patients and their families hear everything!!!

The point is, if you asked my mother-in-law about her experience or gave her a patient satisfaction survey, what would she remember? How nice the registration or reception employee was or would she remember the employees who argued in front of her “room”?

Humans ALWAYS remember negative events over positive ones. Why? Because your Hippocampus (memory center) is studded with cortisol receptors like cloves on a Christmas Ham. Cortisol is released when you’re stressed (over hearing disruptive behavior like arguing, is stressful) because your body sees it as a threat. And trust me, you always want to REMEMBER any time you’ve been “threatened.”

When patients and/or their family members over hear or see employees behaving badly, it affects their satisfaction in a negative manner.


As a leader, your job is to ensure that your employees keep patients safe, provide the highest quality care, and go out of their way to make sure patients and their families have a good experience. If you have ANY bullying or incivility, one or all of these outcomes are compromised.

It’s time for you to take action.

  1. Always link disruptive behaviors to a patients safety, quality, or satisfaction concern

Any time you counsel employees about their behaviors (I’m assuming you are counseling them…), don’t just tell them, “You need to stop behaving this way…” instead, clearly articulate how their behavior directly or indirectly impacts patient safety, quality, or satisfaction. For example, if one of your experienced nurses berated a new nurse during bedside shift report, talk about how this behavior makes patients uncomfortable, thereby, affecting their overall experience, similar to the experience my mother-in-law had.

  1. Infuse safety, quality, and satisfaction into your meetings and activities.

Ask the questions, “What are we doing today to communicate in a way that improves patient safety?” During staff meetings, provide ongoing mini education and training on effective communication or on creating a more professional work environment. If you have shared governance, always, always, always, tackle “professional” improvements in addition to clinical improvements. When listening to employees who complain about their coworkers, ask the question, “Well. How did this impact safety, quality, or satisfaction?” By doing this, you are constantly reminding them that all roads lead to the patient.

  1. Hold employees accountable for any behavior that impacts safety, quality, or satisfaction.

While we know that leaders spend time dealing with some drama, conflicts, and petty arguments, it’s important to draw a line in the sand. If an employee’s behavior impacts the patient, then deal with it immediately. If it doesn’t, ignore it (well, sort of). But seriously, leaders are bombarded with employee and patient issues. There has to be a way to sift through the muck and prioritize your attention. The way to do this is with every issue, pause and ask yourself, “Does this impact safety, quality, or satisfaction?” If the answer is yes, put everything else on hold and address it with your employee immediately.

All healthcare leaders have an obligation – an ethical responsibility to address any behaviors that directly or indirectly impact patient safety, quality, or satisfaction. Still not convinced? Take the mother test.

If your mother was a patient on your unit and you found out your employees were behaving badly, would you step in?

It’s time for us all to step up and speak up!

Thanks so much for reading!

Take care. Be kind. Stay connected.

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6 thoughts on “Bullying & the 3 P’s”

  1. Hello. I am a new nurse. Currently I am experiencing bullying at my hospital by another nurse who thinks that a few more months of experience makes her better at nursing since I am new to this hospital and have only been a nurse for 6 months. In turn, I made a mistake with a new patient who did not have orders for an AccuCheck. My patient has adrenal insufficiency, and I did not check her blood sugar every 6 hours due at 0000 and 0600. When I did an AccuCheck at 0830 because I was busy providing total care for another patient (no CNA), it was 36. It was change of shift, and the day nurse gave dextrose. Although I explained my actions to the nursing manager, she yelled at me about the expectation for a nurse. How are new nurses supposed to know what is critical? Nursing school does not teach us when to call Rapid Response or how to navigate the politics at your facility.

    1. So sorry you are going through this. We should all support each other! I’m not sure based on what you shared if this is a bullying situation or a general lack of support. We KNOW that nurses make mistakes or sometimes don’t make the best decisions. It’s sometimes because of the complexities of our environments and lack of resources. As you mentioned, you were supposed to check the blood sugar but because of other demands and lack of a CNA, got behind. This happens to me too! Instead of being so hard on you, they should have helped you learn from this and support you. Don’t give up! You are still learning – we all are! Find someone on your unit who you respect – an older, wise nurse who doesn’t want to “eat you”. Ask for their help. Learn from them. Nursing is a wonderful profession! Not easy but totally worth it :-).

    2. I agree that Nursing School does not teach you how to navigate politics. I think it is because Schools have turned out so many new Nurses that they somehow believe Old School is gone, and “it is not how it used to be,” and “it is getting better.” Well, It is not. I am grateful, however, that I do not have to concern myself with that. I am fortunate that I have 25 years of Nursing experience to draw upon in my current role.
      I have Student Nurses come to my facility in a clinical capacity in their last semester prior to their graduation and I always talk to them about bullying. I encourage them to speak out about it and I ask them to always be mindful of how subtly it can be brought into a group. Inevitably they have a story or two. I can tell you that I am always ashamed when that bully is a Nurse. I am ashamed because I know the Bully is an insecure Nurse who doesn’t trust herself, who feels she has to scold other Nurses to bring them down to her level. This helps no one. It Scares the Bully that she may lose her job to a ‘competent’ Nurse, It leaves the ‘New’ Nurse wondering if she took the right job and if she will ever fit in, It leaves the Supervisor concerned about teamwork and motivation with her Nurses, and It leaves the Patient veritably alone in his room with the call button just out of reach. It is shameful.

  2. Pingback: Bullying & the 3 P’s - The Nursing NotesThe Nursing Notes

    1. Thanks so much!! So glad you’re enjoying. By the way, I do take requests :-). Make sure you check out my YouTube video series, Coffee and Conversations About Nurse Bullying” too!

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