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Confronting Workplace Incivility and Bullying in Healthcare: Supporting Nurses, Protecting Patients

Healthcare professionals dedicate their lives to healing others, but far too often, they find themselves working in environments where incivility and bullying compromise not only their well-being but also the safety of their patients. Among all healthcare workers, nurses are particularly vulnerable to workplace hostility, both from colleagues and patients. Understanding, addressing, and ultimately transforming these toxic dynamics is crucial to building safer, more respectful healthcare systems.

Defining "Bullying" and Differentiating It from "Incivility"

Workplace bullying is a pattern of repeated, health-harming mistreatment of one or more persons by one or more perpetrators. It can include verbal abuse, offensive conduct/behaviors (including nonverbal), and work interference. Unlike one-off conflicts or personality clashes, bullying involves persistent behaviors intended to intimidate, degrade, or undermine another individual.

Workplace incivility, on the other hand, refers to low-intensity, rude or discourteous behaviors with ambiguous intent to harm. While it may seem less damaging on the surface, incivility often escalates into more overt forms of bullying and contributes to a hostile work environment.

The key difference lies in intent and repetition: bullying is intentional and repeated; incivility may be unintentional but still erodes professional culture and morale over time.

Why Bullying Often Goes Unreported

Despite its prevalence, bullying in healthcare—especially among nurses—often goes unreported due to:

  • Fear of retaliation or making the situation worse.
  • Power imbalances, particularly when the bully is in a supervisory or influential role.
  • Normalization of toxic behaviors, where aggression is seen as “part of the job.”
  • Lack of institutional support, policies, or trust in the reporting process.

This silence allows bullying to persist, further entrenching a culture of fear and disrespect.

The Consequences: Patient Care, Burnout, and Turnover

The effects of bullying and lateral violence in nursing are profound:

  • Patient care suffers, as communication breaks down, collaboration weakens, and mistakes become more likely.
  • Nurse burnout increases, driven by stress, emotional fatigue, and feelings of helplessness.
  • Turnover rates climb, contributing to staffing shortages and creating a vicious cycle of overwork and dissatisfaction.

In short, toxic workplace behaviors don't just harm staff—they directly endanger patients.

Dealing with Aggressive and Uncivil Patients

Nurses also face aggression from patients and families. Handling these situations requires:

  • Staying calm and not escalating the behavior.
  • Setting clear boundaries, using firm but respectful language.
  • Engaging security or other support staff when personal safety is at risk.
  • Documenting the incident thoroughly, including time, behavior, response, and witnesses.

When a patient’s behavior crosses the line into assault, it is critical to treat the incident with the seriousness it deserves.

Reporting Patient-on-Nurse Assault

If a nurse is assaulted by a patient, reporting to the police is both appropriate and necessary. The process includes:

  1. Ensuring safety first and seeking medical attention if needed.
  2. Reporting internally through the organization’s incident reporting system.
  3. Filing a police report, providing documentation, witness accounts, and any available evidence.
  4. Following up with administration, HR, and union representatives (if applicable) to ensure the incident is addressed legally and procedurally.

Legal protections vary by state, but nurses have the right to work free of violence and threats.

State-Specific Laws Addressing Workplace Violence in Nursing

Several states have enacted laws to protect nurses from workplace violence:

  • Texas: Senate Bill 240, effective September 1, 2024, mandates healthcare facilities to adopt workplace violence prevention plans. These plans must include definitions of workplace violence, annual training, incident response protocols, and mechanisms for reporting and investigating incidents. Facilities are also required to adjust patient assignments to prevent exposure to known threats. Non-compliant facilities may face disciplinary actions from licensing agencies .
  • Ohio: House Bill 452, signed into law in January 2025, requires hospitals to develop workplace violence prevention plans, establish incident reporting systems, and provide security personnel with training. The bill also mandates surveys of healthcare programs to assess training on workplace violence prevention .
  • Louisiana: The "Lynne Truxillo Act" (La. R.S. 40:2199.11–2199.19), effective August 1, 2022, mandates healthcare facilities to develop violence prevention plans, display signage against violence, and prohibits retaliation against employees reporting incidents. The law also classifies battery of healthcare professionals as a crime, with penalties for repeat offenders .
  • Rhode Island: The Workplace Violence Prevention Act (Senate Bill 55 and House Bill 6018), enacted in July 2021, requires healthcare facilities to create workplace safety committees, provide training on assault prevention, and establish complaint mechanisms. The law also offers protections against retaliation for reporting incidents .
  • Illinois: The Health Care Violence Prevention Act, effective January 1, 2019, mandates healthcare employers to develop workplace violence prevention programs, provide training, and post notices about the consequences of violence. The law also requires employers to offer post-incident services and prohibits discouraging employees from contacting law enforcement .

These laws represent significant steps toward safeguarding nurses and other healthcare workers from violence. However, enforcement and compliance remain critical to their success.

Creating a Culture of Change with Pedagogy Education

The journey toward a safer, more respectful healthcare environment starts with awareness, education, and accountability. Pedagogy Education offers two powerful online continuing education courses designed to confront bullying head-on and empower nurses and administrators to lead cultural change:

These CEU/CNE courses equip healthcare professionals with practical strategies to recognize, report, and respond to bullying, while fostering environments built on respect, communication, and collaboration.

It’s time to break the silence and commit to change. Empower yourself and your team through education—and help create a culture where every nurse feels safe, respected, and supported.