Confronting Bullying: The Who, What, and When

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Confronting BullyingBullying, incivility, disrespectful communication, rudeness, and cruelty are on the rise in healthcare.  It’s sad but true. To make matters worse, because we’re currently in a major staffing crisis, leaders are even more reluctant to confront bad behavior because the mindset is, well, a bad nurse is better than no nurse. That’s faulty thinking on so many levels. And, often, leaders aren’t sure who they should confront, how to confront them, and when is the best time. So, they do what’s more comfortable – they do nothing. It’s time we get crystal clear on confronting bullying, incivility, and all other forms of bad behavior by understanding who to confront, what to actually say, and when to say it.

Why is confronting bullying and incivility important now?

Because numerous studies show the primary cause of turnover, burnout, and disengagement is a bad culture.

  • According the 2022 McKinsey Report, the number one cause of burnout and intention to leave is a toxic work culture.
  • Research conducted by MITSloan Management Review revealed a toxic culture is more than 10 times more likely to contribute to turnover than compensation.
  • A study reported in Safety and Health Practitioner showed that when dealing with bullying and incivility at work, 66% said their performance declined.

It’s clear. If healthcare organizations want to retain their best people and grow high-performing teams, they must equip their leaders with the skills and tools to confront bullying and incivility. And, leaders need to shift their mindset and learn the mechanics of confronting bullying. They need to learn the who, what, and when method of confronting bullying and incivility.

  1. Who should you confront?

Many times, leaders get confused over who they should confront. What if a nurse or tech gets pulled to your department and they yell, argue, or criticize your employees? They don’t report to you. Should you confront them? What about physicians or radiology techs doing a portable CXR? Or, a physician who is incredibly condescending or belittles your staff?

Who do you confront?

    • Your direct reports
      If you are in a leadership role and have direct reports, you are responsible for confronting their behavior. Even if they are your most competent team member, been there the longest, are having a tough time – whether you witness their bad behavior or not, you’re responsible for confronting them.
    • Employees who don’t report to you
      It’s easy to ignore someone’s bad behavior because they don’t report to you. You don’t feel that it’s your responsibility. Let’s say, there’s a hand off, and your nurse is receiving a patient from the ICU. Your nurse asks questions, and the ICU nurse gets very condescending, does the whole “eye-rolling – sighing thing” to your nurse.

Should you intervene immediately even though this ICU nurse doesn’t report to you, or should you complain to the ICU manager? It doesn’t matter if the person reports to you, if someone’s acting in a way that’s disrespectful, you need to confront them. Confront and then tell their manager about the incident.

    • Physicians and Providers
      The primary reason why leaders don’t confront disruptive physicians is because they don’t think anything will be done about it. When a physician or a provider is being rude, openly criticizes, or is overtly condescending to somebody on your team – it doesn’t matter if they are being held accountable by someone else, you have to speak up in the moment. Because your employees need to see you advocating on their behalf.

If a physician or a provider is acting out in a way that’s incredibly disrespectful. Confront them just like you would an employee who reports to you.

So, basically, the “who” is everybody. When you see disruptive behaviors, you need to confront them.

  1. What do you say when confronting bullying? 

Now that you understand who you should confront, how do you actually do that? What do you say and how do you say it?

Let’s say that during a staff meeting or huddle, one of your nurses starts criticizing a co-worker. Do you confront it immediately or wait and discuss it later, privately?

The answer is – confront immediately!

Even if you have good intentions of talking with the person later, the rest of your team are not mind readers – they don’t know that. If you don’t say anything in the moment, you’re sending a message that it’s okay to treat people that way.

But how you confront matters.

Apply the visual and verbal cue method of confronting bullying and incivility.

Visual Cue– It’s important to “catch” the disruptor’s eye using a visual cue. My favorite is doing the “time-out” symbol with your hands. Using a visual cue catches their attention and alone, can sometimes stop the behavior. When you do the symbol, say – “time out”.

Verbal Cue – Name the behavior – yelling, pointing fingers, criticizing, arguing, etc. Get crystal clear on what that person’s behavior is, name it and tell them to stop.

You’re yelling, and you need to stop. You’re yelling in a patient care area and need to stop.

You are arguing. You are cursing in front of the team, and you need to stop.

                Putting it all together – During your meeting, your nurse criticizes a co-worker.

“Time-out (use the timeout symbol to catch their attention). You are criticizing Ayana in front of everyone and you need to stop.”

And then have a meeting with that person later to discuss.

  1. When?

Do you confront immediately or wait until later? Here is a simple way to decide:

If the behavior is overt – yelling, cursing, criticizing, etc. – confront immediately.

If the behavior is covert – exclusion, gossip, mocking, clique behaviors, etc. the general rule of thumb is to confront within 72 hours, that’s when people remember the incident. If you wait any longer, details get cloudy.

If you are not doing this well right now, it’s okay! Just start with overt behaviors first. It is easier. These things take time and practice.

“There is nothing that will kill a good employee faster than watching you tolerate a bad one.” Perry Belcher.

Bullying and incivility happen because they can. It takes dedicated and equipped leaders to put a stop to it. We have important work to do in healthcare and zero time to lose dealing with bad behavior.

Got bullying?

To get the skills and tools you need to address bullying and incivility in your department, enroll in our powerful and popular eLearning program, Eradicate Bullying and Incivility in Healthcare: Essential Skills for Leader.


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