Bullies in Nursing: Understanding and Addressing Incivility
After relocating for family reasons, I accepted a position on a step-down unit. My eight years in Med-Surg and Critical Care had prepared me well to care for cardiac and post–open-heart patients requiring drips, arterial lines, and close monitoring.
On my first day, I was assigned to orient with Donna (not her real name).
Donna had entered nursing as a second career, and it seemed her main goal was to be leader of the pack, formal title or not. She was brash, assertive, and made sure the cardiothoracic surgeon’s coffee was ready “just the way he liked it” (in her words) when he arrived for rounds. Her subtle demonstrations of power were everywhere.
When she insisted on accompanying me for my first assessment, I assured her that this wouldn’t be necessary since she had her own patients. She persisted, explaining, “I want to make sure you do your assessment our way.”
Confident in my skills but not eager for conflict, I agreed. But when she corrected me in front of the patient for what she perceived as an error, I knew exactly what I was dealing with.
Donna was a bully.
And unfortunately, she wasn’t the only one. Two charge nurses also made sure everyone knew their place. One had staked her claim on a particular chair at the nurses' station and corrected anyone who dared to sit there with a syrupy-sweet voice that somehow managed to sound both polite and threatening at the same time. Once, when I created the day shift staffing assignment and the charge nurse following me objected in front of the team, I calmly explained my rationale. A few nights later, the other charge nurse pulled me aside.
“You have a lot of potential,” she said, “but you need to learn to be quiet".
A Reflection of Culture
If you’ve been in nursing long enough, you’ve probably met your own "Donna" or chair-hogging charge nurse. Maybe you were unfortunate enough to meet this person when you were only a nursing student. Maybe, as a nurse manager, you’ve lost a promising nurse because of her. Understanding why these dynamics persist, and how to shift them, is one of the hardest and most essential parts of nursing leadership today.
The unit I had joined had a culture that tolerated bullying and incivility. While one nurse held no title, the other two were in bedside leadership positions. It demonstrated that bullying can be found at every level of the organization, from those with formal leadership titles to those “informal leaders” without titles, but with a high level of influence. Even the clinical educator thrived on intimidation.
Studies have shown that a bully's targets are usually well-liked, kind, and non-confrontational, but they also aren’t afraid to ask questions or challenge traditional ways of thinking. This type of behavior challenges a bully, who sees it as a threat to their power. Anything that is outside the toxic cultural norm where they're calling the shots can be met with passive-aggressive behavior, gossip, sabotage, isolation, or worse.
This is where Dr. Marion Conti-O'Hare's concept of the Walking Wounded becomes important. Many nurses who engage in bullying are carrying unhealed experiences of humiliation or disrespect. Sometimes they've been targeted by bullies themselves. When those wounds go unacknowledged, they can manifest as control, criticism, or cruelty.
Unfortunately, sometimes leaders feel like their only choice is to look the other way, especially if the bully has clinical expertise. “That’s just how they are,” we hear, as if tolerating toxicity is the price to pay for clinical competence and a decent schedule.
But the American Nurses Association’s Code of Ethics and Position Statement on Bullying is clear: nurses and employers share responsibility for addressing incivility and creating respectful and healthy work environments. A culture that excuses bullying, even subtly, erodes trust, safety, and ultimately, patient outcomes.
Leading Through Healing
Knowing that a healthy work environment is one of your top priorities, here are four evidence-informed strategies for addressing bullying and the “Walking Wounded” on your team.
1. Ask the Right Questions
Performance improvement plans and “write-ups” may correct behavior temporarily but rarely address the roots of incivility. Take a moment to self- reflect on the system your team is working in:
What’s happening within our culture that allows this person to act this way?
How has my leadership, intentionally or not, enabled it?
Knowing that what I see is only the tip of the iceberg, where else might this be occurring?
What truths about culture have I avoided acknowledging for the sake of staffing stability, provider "favorites" or my own sense of safety?
When leaders approach bullying with curiosity instead of punishment alone, they are better informed to address the individual's behavior while also ensuring that the environment doesn't support the behavior.
2. Identify Risk Factors that Allow Incivility to Grow
Every nursing team brings a unique blend of backgrounds, generations, and communication styles. These differences can be a powerful source of innovation or a foundation for misunderstanding and silos.
Intentional connection-building is essential. Encourage team members to learn about each other’s strengths, stories, and stressors. Build time for shared learning and positive feedback. For ideas on how to do this, click here.
Also, be aware that many of the dynamics that naturally exist in nursing and healthcare are risk factors – organization restructures, departmental process changes, feelings of injustice or low autonomy and high workload.
3. Set Boundaries
Clear behavioral expectations protect your team from developing a toxic culture. Your organization should have policies defining inappropriate conduct, how it will be addressed, and options for safe reporting. Work with your Human Resources department to ensure that progressive corrective action is enacted appropriately and timely.
At the unit level, consider developing a Code of Conduct that every team member signs. This fosters shared ownership of behavior and reaffirms that respect is a collective standard, not a personal preference. If you need to address behavior, you can use this signed document as a focus of your discussion.
When addressing violations, be very specific. Document the incident with date, time, and situation, use quotes from witnesses, and refer to the policy. Consistency is key. Fair, predictable boundaries build trust faster than any team-building exercise.
4. Apply Appreciative Inquiry
Traditionally, we’ve met toxic culture with punitive reactions, responding to negativity with more negativity. But lasting change requires a shift in how we see the problem. Appreciative Inquiry reframes the conversation from “What’s broken?” to “Where are we strong, and how can we build on that?”
Questions for Reflection
Where do you see signs of the “Walking Wounded” on your team?
What’s one small action you can take this week to strengthen your culture of respect?
Write an “I will…” statement and post it where you’ll see it daily.
“I will pause before reacting to incivility, choosing curiosity over judgment.” “I will affirm one colleague each shift for something they do well.” “I will hold every person, including myself, accountable to our shared Code of Conduct.”
The Leadership Imperative
The truth is, most nurses who bully are not bad people. They are often hurting people trying, in clumsy and harmful ways, to regain a sense of control in an environment that they perceive as full of injustices, threats, and "take-aways". That doesn't mean we should tolerate the behavior but understanding why it's happening can help us interrupt the cycle more effectively.
When we respond with consistency, structure, and strengths-based leadership instead of shame, punishment, or avoidance, we not only help transform the work environment for the whole team, but we may just make a difference to the one, as well.
And that, friends, is what leadership is all about.