Bullying & Burnout: The Leadership Challenges of the 21st Century

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Bullying and burnout are huge problems for healthcare leaders in the 21st century and it’s time we started talking about them!

Gretchen was excited when she accepted a leadership position at a prominent hospital in her hometown. She had worked at a local community hospital for the last 6 years and advanced as far as she could go. Now she had an opportunity to work at a large teaching hospital as the manager on a busy telemetry unit.

Within 2 months, Gretchen was questioning whether or not she made the right decision. Although she was looking forward to spending her days helping to improve clinical outcomes, get involved with quality improvement, and adopting evidence based practice, she found herself spending the majority of her time dealing with the disruptive behaviors of her employees and rapid turnover due to burnout.

Why didn’t anyone warn or prepare her?


  • 60% of all healthcare employees report feelings of burnout. There are 3.1 million nurses in the United States. If you do the math, that means more than 2 million of us feel burned out.
  • According to Linda Aiken, more than 40% of hospital nurses report burnout levels that exceed the norms for healthcare employees.
  • Numerous studies show that 73% – 90% of nurses experience or witness bullying in their workplace. Although physician to nurse bullying exists, most incidents involved nurse to nurse.
  • Workplace bullying has been linked to intent to leave, poor patient outcomes and poor productivity.
  • Estimated costs are $30,000 – $100,000 per year per individual and if it’s a specialty nurse, the costs increase to $145,000.

We are hemorrhaging really great nurses to these problems.

Bullying and burnout are quickly becoming the leadership challenges of the 21st century.


Leaders need to build a culture that rejects bullying and addresses burnout.

  • Start talking about it – The problem is that we KNOW nurses are burned out. We KNOW nurses eat their young, but nobody is talking about it. We all need to start engaging in conversations about bullying and burnout.
    • Include these topics as a standing agenda item at your leadership meetings.
    • Talk about it during your staff meetings with your employees.
    • Ask employees for their input on what your unit/department can do to reduce stress and burnout.
  • Acquire a new set of skills – Addressing bullying and burnout are skills that can be learned.
    • Provide training and education to leaders AND staff.
    • Post articles, resources, tips, and tools regarding how to communicate professionally; how to reduce stress, etc.
    • Offer coaching and support.
  • Stop ignoring bad behavior – Leaders have been using silence as a strategy for far too long and START taking action.
    • START setting behavioral expectations with employees.
    • Partner with human resources to address employee’s who are in violation of your code of conduct/policy.
    • Don’t ignore reports of disruptive behavior. Take action right away!
  • Start supporting staff AND each other – The healthcare environment is stressful because of the nature of what we do. However, we are not super human and need support too.
    • Conduct debriefings after really stressful days/codes/patient care situations. This is the time when you encourage staff to talk about what happened and allow them to vent so that they don’t internalize their stress or take their frustrations home.
    • Offer additional resources to your nurses, especially if they are short staffed. Most nurses can tackle any patient load if they have the right support staff.
    • Encourage fun. Laughing is a powerful coping mechanism to stress and burnout. Find ways to infuse fun into the work environment.

The key here is to take action against bullying and burnout because they are not going to go away any time soon without your help.

Gretchen really struggled for a while until she finally stopped taking a passive approach and started taking action. She partnered with her human resource representative and her director regarding her toxic employees. They created a clear plan, set behavioral expectations, and then held employees accountable (she did terminate 2 really toxic employees [one nurse and one unit secretary] because they were not willing to change their behavior). She learned from the staff that a lot of their burnout was caused from not having enough support staff. Gretchen spent one shift working with her nurses hip to hip and realized WHY they were so stressed! She immediately petitioned to add 3 more nursing assistant positions and got them. She also restructured some of the scheduling to account for high volume times.

It was rough for 6 months but once the toxic employees were gone and the staff had more support, things turned around. A year later, Gretchen’s unit is fully staffed and now they are starting their first quality improvement project!!

Patient satisfaction, safety and quality are major concerns for nurse leaders, but if you ignore your bullying and burnout problem, you will never achieve your strategic outcomes.

Be kind. Take care. Stay connected!

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Dr. Renee Thompson works with healthcare organizations that want to overcome the leadership and clinical challenges their people face every day.

If you’d like to find out more about her programs, please visit her website

Contact Renee today at to bring her to your organization to talk about ending the cycle of nurse bullying.

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5 thoughts on “Bullying & Burnout: The Leadership Challenges of the 21st Century”

  1. You seem to not address the bullying that takes place when the people in power are doing the bullying and there are no checks and balances for them. This creates a culture of acceptance of bullying! What do we do?

    1. Renee Thompson

      Hi Jan. Yes!! I do address the bullying that occurs from management/leaders. I’ve actually written several blog posts and have a video about..what if the boss is the bully”…I also have a video about..”what if you clinical instructor is the bully”. We know bullying can come from people in a leader role too!!

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