Bullying in nursing is a measured, documented phenomenon rather than an edge case. A 2022 overview of reviews in the International Journal of Environmental Research and Public Health synthesized 12 systematic reviews and found reported prevalence spanning an enormous range – 1% to 90.4% across studies – with the most recent pooled estimate placing it at 26.3% of nurses. Roughly one in four is the defensible number to carry. What the research cannot do is tell you whether your specific hospital’s HR process will protect you, whether documenting in your situation carries retaliation risk, or whether your experience meets the threshold for a reportable complaint. That requires your judgment about your specific circumstances.
This guide gives you the framework to make that judgment well.
How to classify what you’re experiencing
The most important first step is accurate classification. Different levels of workplace aggression require different responses, and escalating a minor incivility to HR with the same urgency as a sustained harassment campaign creates risk without benefit.
| Category | Definition | Examples | Appropriate response |
|---|---|---|---|
| Incivility | Rude, disrespectful behavior that does not meet the threshold of targeted, persistent aggression | Eye-rolling at your questions, dismissive comments, being interrupted in report | Direct peer conversation; set expectations; document only if it persists |
| Lateral violence | Horizontal aggression between nurses of similar rank – destructive behaviors intended to harm a colleague's professional standing or emotional wellbeing | Sabotaging your patient assignments, spreading rumors, withholding clinical information, excluding you from communication | Document each incident; consider peer or charge nurse conversation; prepare for escalation |
| Workplace bullying | Persistent, targeted, repeated mistreatment that a reasonable person would find humiliating or threatening. Power imbalance is common but not required. | Consistent public humiliation, targeting for criticism that others are not subject to, undermining your competence to patients or other staff | Document systematically; escalate through the formal process; consult HR or union rep |
| Hostile work environment (legal threshold) | Harassment severe or pervasive enough to alter working conditions, usually tied to a protected characteristic (race, sex, religion, disability, etc.) | Discriminatory comments about a protected characteristic combined with differential treatment; sexual harassment; targeted racial hostility | Consult HR immediately; contact EEOC if internal processes fail; consider legal counsel |
Escalation decisions turn on whether the behavior is targeted, persistent, and documented. Subjective distress is real and matters, but the formal process works better with objective evidence.
The legal reality worth understanding first
There is no federal law in the United States that prohibits workplace bullying as such. This is the single most important thing to understand before you escalate, and most workplace guidance obscures it.
Federal anti-discrimination law, enforced by the EEOC, only reaches harassment that occurs because of a protected characteristic – race, color, religion, national origin, sex (including sexual orientation, gender identity, and pregnancy), disability, age 40 and over, or genetic information. Conduct that is severe, sustained, and destructive is still lawful under federal EEO law if it stems from personal animosity rather than a protected-class motive. A charge nurse who systematically undermines you because they dislike you has not violated Title VII. The same conduct directed at you because of your national origin has.
What that leaves you is real but different in kind: your employer’s own code of conduct, your union contract if you have one, accreditation requirements, and state law in the minority of states that have enacted relevant provisions. The Healthy Workplace Bill has been introduced in many state legislatures over two decades without a general anti-bullying statute passing.
The accreditation layer is the one most nurses do not know about and it is worth using. The Joint Commission issued Sentinel Event Alert 40, “Behaviors that undermine a culture of safety,” on July 9, 2008, and its Leadership standard LD.03.01.01 has since required accredited organizations to have a code of conduct defining acceptable, disruptive, and inappropriate behaviors (EP 4) and a leadership process for managing those behaviors (EP 5). Your hospital is required by its accreditor to have that process. Naming the standard in a written complaint changes the register of the conversation, because a failure to have a functioning process is an accreditation exposure rather than an interpersonal dispute.
How common is workplace bullying in nursing?
The research is extensive and the headline numbers are difficult to reconcile because studies define and measure bullying differently. Goh, Hosier and Zhang’s 2022 overview of reviews applied Cochrane methodology to 12 systematic reviews published between 2013 and 2020 and reported:
- Workplace bullying prevalence among nurses ranging from 1% to 90.4% across the reviews, with the most recent review estimating a pooled prevalence of 26.3%
- Horizontal or lateral violence specifically (peer-to-peer aggression) ranging from 1% to 87.4%
- At least five categories of antecedent: demographics, personality, organizational culture, work characteristics, and leadership and hierarchy
Treat that range as a warning about the literature rather than as a finding. A study asking “have you ever experienced any of these behaviors” will return a number near the top of it; a study requiring persistent, targeted, repeated mistreatment over a defined period will return a number near the bottom. The pooled 26.3% is the figure to use when you want one.
The consequences are where the evidence is more consistent. The same review found that 78.5% of bullied nurses with fewer than five years of service resigned to move to other jobs, that bullied nurses were 1.5 times more likely to report absenteeism, and that 10% of bullied nurses develop post-traumatic stress disorder symptoms.
These numbers put the profession in clear relief: workplace bullying is a structural problem in nursing, not a personal failure on your part. Knowing this matters when you are trying to assess whether staying and fighting is worth it, or whether leaving is the rational response.
How to document workplace bullying
Documentation is the foundation of any formal escalation. Without it, you have a narrative; with it, you have evidence. The goal is an objective, contemporaneous record that can be reviewed by someone who was not present.
What to record for each incident:
- Date and time
- Location (which unit, room, hallway)
- Exact words spoken or written (quote directly when possible; paraphrase otherwise)
- Witnesses present (names, or “two other nurses were present; I do not know their names”)
- Your response at the time
- How the incident affected your work or wellbeing
- Any relevant context (was this an isolated incident or part of a pattern?)
Where to keep records: Keep documentation on a personal device, not a work computer or work email. Work systems are owned by your employer and can be accessed without your knowledge. A dated notes file on your personal phone or a personal email drafts folder creates a contemporaneous record that is yours to control.
Correspondence: If there is email or text evidence – a bullying message sent via work communication channels, a witnessed exchange – screenshot it and save it externally immediately. Digital records can disappear.
Pattern documentation: A single incident rarely meets the threshold for formal action. Document each occurrence and note the pattern: Is this the same person each time? Is it always in front of the same audience? Does it happen after specific triggers (physician complaints, charge assignments)?
If you have a union, your union representative can advise on whether your documentation meets the bar for a grievance.
The escalation ladder
Work through escalation steps in sequence unless the behavior is severe enough to skip levels. Each step carries a different risk-benefit profile, and jumping to HR without attempting lower-level resolution can foreclose resolution options and create adversarial dynamics prematurely.
| Step | Who | What it achieves | Risks |
|---|---|---|---|
| 1. Direct peer conversation | You and the person who bullied you | Resolves incivility and minor lateral violence; makes behavior visible to the person who may not recognize its impact | May not be safe if significant power imbalance; may not be appropriate if behavior is severe |
| 2. Charge nurse | Your unit's charge nurse | Informal escalation within the unit; puts the behavior on someone's radar; can change assignments or unit dynamics | Charge nurses vary widely in willingness to intervene; some are the problem |
| 3. Nurse manager | Your direct unit manager | First formal escalation; manager has authority to counsel the individual; documents the issue in their awareness | Manager may be protective of the bully (especially if senior staff or strong clinical performer); may be minimized |
| 4. HR | Hospital HR department | Formal investigation process; creates employer record; HR is obligated to investigate claims of harassment | HR works for the hospital, not you; investigations favor institutional stability; retaliation risk exists even when prohibited |
| 5. Union representative | Your union rep (if applicable) | Grievance filing; contractual protection during investigation; experienced advocate who has seen the process before | Limited to unionized settings; not all hospitals have unions |
| 6. State nursing board | Your state's Board of Nursing | Appropriate when bullying creates patient safety risk – witness to unsafe practice, coercion to document inaccurately, clinical decisions made under duress | Not the right venue for interpersonal conflict without patient safety implications; board actions affect nursing licenses |
| 7. EEOC | Equal Employment Opportunity Commission | Appropriate when bullying is tied to a protected characteristic and internal processes have failed | Formal federal complaint; required before most employment discrimination lawsuits |
A note on HR: the most common misconception about HR escalation is that HR is an employee advocate. It is not. HR’s primary function is to manage employer legal risk. HR will investigate a bullying complaint because a failure to investigate creates liability, not because your wellbeing is its priority. This does not mean HR escalation is pointless – it is often necessary and sometimes effective – but you should understand who you are dealing with.
When does bullying become reportable to the state nursing board?
State Boards of Nursing license nurses and can investigate behavior that constitutes unsafe practice or professional misconduct. The threshold for board-reportable behavior is higher than “I am being bullied.”
Bullying rises to board-reportable levels when it:
- Creates a direct patient safety risk – a colleague undermines your clinical decisions in front of patients, refuses to hand off critical patient information, or engages in behaviors that result in care errors
- Involves coercion to falsify documentation or participate in fraudulent billing
- Constitutes abuse of a patient or a witness to abuse of a patient
- Involves diversion of controlled substances
Being unkind, sabotaging your social standing, or creating a hostile work environment for colleagues is not directly reportable to the nursing board as a practice violation, though it may be reported through other channels. If you are unsure whether a specific behavior crosses the threshold, your state nursing board’s website typically lists the categories of reportable conduct.
What the research says about what works
The evidence on anti-bullying interventions in nursing is honest in a way that most hospital policy language is not: most interventions have weak evidence.
A 2024 qualitative study in SAGE Open Nursing interviewed 35 nurse leaders at a Swiss public hospital and found they struggled to distinguish and recognize bullying and lateral violence in the first place – one participant remarked that “it would be interesting to know what you are fighting against.” The leaders were particularly unlikely to notice behavior occurring outside their direct presence, including through digital communication channels. It is a single-site qualitative study rather than a prevalence estimate, so read it as a mechanism rather than a measurement: the people responsible for intervention often do not perceive the problem accurately, which explains why escalation frequently stalls at the manager level.
What the literature does support:
- Leadership behavior modeling has stronger evidence than formal policy alone. Units where senior nurses and managers actively demonstrate respectful behavior and call out incivility have lower rates of bullying – but this requires committed leadership, not policy sign-offs.
- Bystander training has moderate evidence in some settings. Teaching nurses to interrupt bullying behavior when they witness it, rather than waiting for victims to escalate, changes the unit’s social equilibrium.
- Zero-tolerance policies without follow-through are the most common and least effective intervention. Policies deter nothing if retaliation for reporting is allowed to go unaddressed.
The professional bodies are unambiguous about the standard even where the law is silent. The American Nurses Association’s 2015 position statement on incivility, bullying, and workplace violence holds that nurses and employers share an ethical and legal responsibility to create a culture of respect free of these behaviors, and defines bullying as “repeated, unwanted harmful actions intended to humiliate, offend and cause distress.” The ANA cited a survey of 3,765 registered nurses in which nearly a quarter reported being physically assaulted at work by a patient or family member, and up to half reported being bullied by a peer or someone in a position of authority. The American Association of Critical-Care Nurses takes a parallel position, stating plainly that bullying, incivility, and verbal abuse are unacceptable, and reporting that 65% of 7,399 registered nurses it surveyed in 2021 had experienced verbal abuse in the preceding year.
What this means for your decision: virtually every hospital has a zero-tolerance policy on paper. What separates units is whether leadership will enforce it when doing so costs them a high-performing or senior staff member.
Red flags before you join a unit
The best time to assess a unit’s bullying culture is before you accept the position. Some questions and signals that provide real information:
Ask in the interview:
- “How does this unit handle interpersonal conflicts between staff?”
- “What is your turnover rate, and what do exit interviews typically show as the reason for leaving?”
- “How long have the more senior nurses on this unit been here?”
A manager who deflects the turnover question, provides a suspiciously low rate, or becomes visibly uncomfortable with the interpersonal conflict question is telling you something.
Glassdoor and Indeed signals: Not perfect data, but patterns are meaningful. If multiple reviews from nurses at a specific hospital or unit mention cliques, bullying, or management favoritism, that pattern is more reliable than a single outlier review.
Shadow shift: If the hospital offers a shadow shift before you accept, take it. Observe how charge nurses talk to staff, how senior nurses respond to newer nurses’ questions, and how team communication flows under pressure. Dysfunction that exists shows up in those interactions.
Turnover concentration: High turnover concentrated among nurses with 1–3 years of experience on a unit is a specific signal. That pattern often indicates that experienced nurses are driving out newer ones – a classic lateral violence dynamic.
Deciding what to do next
If you have been documenting, escalated appropriately, and the behavior continues or worsens, the decision is whether to stay and continue escalating or to leave. There is no objectively correct answer – it depends on your financial situation, your licensure risk, your career goals, and your wellbeing.
Staying and continuing escalation is worth considering when:
- HR has opened a formal investigation and is actively managing it
- The bully is above you in rank and a transfer within the hospital is feasible
- You have union representation that can protect you through the process
- The behavior is tied to a specific individual who is likely to be managed out
Leaving is worth considering when:
- The bullying is unit-wide or management-endorsed rather than attributable to one individual
- Retaliation has already occurred after you reported
- Your physical or mental health is showing signs of serious impairment
- The hospital has a documented pattern of ignoring bullying complaints
If your situation has reached the point where staying is no longer viable, see leaving nursing guide for a framework on non-bedside and alternative career options, and first-year nurse guide if you are early in your career and wondering whether this is normal.
Bullying is also a leading driver of nurse burnout – if you are experiencing both, treat them as related problems. Burnout accelerates the psychological harm of bullying, and bullying accelerates burnout.
For resources on assessing specialty environments before moving to a new unit, see which nursing specialty is right for you and nursing interview questions.
Frequently asked questions
References
- Goh HS, Hosier S, Zhang H. “Prevalence, Antecedents, and Consequences of Workplace Bullying among Nurses – A Summary of Reviews.” International Journal of Environmental Research and Public Health, Vol. 19, No. 14, 2022, article 8256. doi:10.3390/ijerph19148256. PMCID PMC9317144. Overview of 12 systematic reviews published 2013–2020.
- Luca CE, Pezzoli G, Kunz S, Bianchi M. “Nursing Leaders’ Knowledge and Awareness of Bullying and Lateral Violence: A Qualitative Study.” SAGE Open Nursing, Vol. 10, 2024, article 23779608241274210. doi:10.1177/23779608241274210. PMCID PMC11329920.
- American Nurses Association. “Position Statement on Incivility, Bullying, and Workplace Violence.” Adopted July 22, 2015. nursingworld.org.
- American Association of Critical-Care Nurses. “AACN Position Statement: Bullying, Incivility, and Verbal Abuse.” Originally published 2019, updated June 1, 2025. Reports that 65% of 7,399 registered nurses surveyed in 2021 experienced verbal abuse in the preceding year. aacn.org/policy-and-advocacy/position-statements/zero-tolerance.
- The Joint Commission. Sentinel Event Alert Issue 40, “Behaviors that undermine a culture of safety,” July 9, 2008. Leadership standard LD.03.01.01, EP 4 (code of conduct) and EP 5 (process for managing disruptive and inappropriate behaviors), effective January 1, 2009.
- The Joint Commission. Workplace violence prevention requirements at Environment of Care standard EC.02.01.01 EP 17, Human Resources standard HR.01.05.03 EP 29, and Leadership standard LD.03.01.01 EP 9, effective January 1, 2022.
- US Equal Employment Opportunity Commission. “Enforcement Guidance on Harassment in the Workplace,” April 29, 2024. eeoc.gov – harassment is unlawful under federal EEO law only where based on a protected characteristic.
- US Equal Employment Opportunity Commission. “Harassment” and “Small Business Fact Sheet: Harassment in the Workplace.” eeoc.gov – protected characteristics and the hostile work environment standard under Title VII of the Civil Rights Act of 1964.
- Job Accommodation Network, US Department of Labor Office of Disability Employment Policy. “Prevent Harassment and Bullying in the Workplace.” askjan.org – notes that bullying itself is not unlawful under federal law absent a protected-class connection.
- Cole DA, Bersick E, Skarbek A, Cummins K, Dugan K, Grantoza R. “The courage to speak out: A study describing nurses’ attitudes to report unsafe practices in patient care.” Journal of Nursing Management, Vol. 27, No. 6, 2019, pp. 1176–1181. doi:10.1111/jonm.12789.
- National Council of State Boards of Nursing. State-by-state Nurse Practice Act summaries and grounds for discipline. ncsbn.org.