Enough is Enough: Ending Nurses’ Toleration of Workplace Violence and Bullying

Enough is Enough: Ending Nurses’ Toleration of Workplace Violence and Bullying

Nursing is a profession of service to others. Daily, nurses meet the physiological, psychosocial, and spiritual needs of the patients and patients’ significant others to whom health care is provided. The provision of quality, safe, evidenced-based practice nursing care is delivered by nurses in both inpatient and outpatient health care settings. However, the provision of nursing care can be significantly impacted when nurses are not provided safe environments to work within.

In 2018, I had the opportunity to work with my fellow nursing colleagues on the American Nurses Association (ANA) Professional Issues Panel #endnurseabuse. The panel was an advisory committee consisting of nurses throughout the United States. Our mandate, to critically and honestly discuss workplace violence perpetrated against nurses. I commend the ANA on their stance on violence against nurses in the workplace perpetrated by such entities as visitors, patients, intimate partners, nurses-to-nurses, and others, as well as their 2015 position statement on bullying, incivility and violence within the workplace. In 2019, Ambrose H. Wong, M.D., MSEd, Jessica M. Ray, PhD, and Joanne D. Iennaco, PhD, PMHNP-BC, APRN, noted in an article written within The Joint Commission Journal on Quality and Patient Safety, that “Health care workplace violence is a growing, pervasive, and underreported problem.”  Of concern is that despite the identification of the problem of workplace bullying and violence, it remains an ongoing issue.

Enough is Enough

Workplace violence can consist of both physical and psychological threats against others. While bullying can become physical, perpetrators tend to use negative words (i.e., humiliation, backstabbing, verbal abuse) to gain psychological intimidation over their victims. In February 2019, as I sat within a Sigma Theta Tau International conference on healthy workplaces breakout session, a normally quiet person, I found myself verbalizing the words, “Enough is Enough,” as stories were shared of working with disrespectful nurse colleagues in clinical and academic settings. I have been a nurse for over 29 years and became a nurse to administer care to the physically and mentally ill. It is a privilege to help in the healing process of others. If I would have known that violence and bullying was tolerated within the nursing profession as a normal ritualistic patterned behavior, I may have rethought my entry into health care.


Alas, I am a nurse for life. And although I have contemplated leaving the profession I never will. The truth is, I love being a nurse and I love caring for patients. And, I enjoy the collaboration that occurs with my colleagues that leads to positive health outcomes with patients we jointly care for in clinical settings.

And so, I am challenging my nursing colleagues in clinical and academic settings, nursing leadership, and nursing health care organizations, to take back our profession by deeming violence and bullying in nursing as not being acceptable. By ignoring violence and bullying in the workplace, nurses perpetuate the cycle of anger and violence. The co-existence of anger and violence in health care environments will continue if nurses do not deem these behaviors as harmful to our profession. As a profession of caritas that places the safety and health of others as a priority, we must take this professional ideal and transfer it not only to the care of our patients, but our care for one another.

​Ways Nurses Can End Violence and Bullying

Nurses are wonderful advocates for patients. Let’s become advocates for one another. If you observe bullying or violence within the health care environment, report it (i.e., notify your immediate supervisor, nursing leadership, and human resources). Calmly acknowledge that you have observed the behavior of the perpetrator and affected nurse and ask, “Can I assist the two of you in anyway? There appears to be a disagreement of some kind.” This places the bully or potentially violent person on notice that others have witnessed their behavior.

Nurses can educate themselves on how bullying and violence presents itself in the workplace by becoming familiar with the ANA Code of Ethics with Interpretative Statements, the United States Department of Labor Occupational Safety and Health Administration (OSHA) workplace guidelines, and The Joint Commission’s stance on workplace bullying and violence. Additionally, there are now several nursing articles that can provide further insight on behaviors that can negatively impact health care environments, health care workers, and patients. A list of current websites is provided in the sidebar for your reference and support.

Together, nurses united can create healthy and supportive workplace environments for all!

The Joint Commission Addresses Workplace Violence

The Joint Commission Addresses Workplace Violence

A recent report by The Joint Commission has tackled the issue of workplace violence in healthcare organizations head on.

The Sentinel Event Alert 59: Physical and verbal violence against health care workers gives hospitals and healthcare organizations guidelines to address the increasing workplace violence taking place around the nation.

While healthcare workers like nurses and physicians are targets of both physical and verbal violence, they can also become pulled into a situation when a patient is being threatened. Unfortunately, this environment causes enormous upheaval in a place where people are being helped and where those professionals are expecting a safe workplace.

According to the alert, these seven guidelines will help staff report instances of violence and will help create standards for recognizing potential situations, reporting them, preventing future instances, and reacting in an emergency situation.

  • Recognizing that data come from several sources, capture, track and trend all reports of workplace violence—including verbal abuse and attempted assaults when no harm occurred, but in which the health care worker feels unsafe. 
  • Provide appropriate follow-up and support to victims, witnesses and others affected by workplace violence, including psychological counseling and trauma-informed care if necessary.
  • Review each case of workplace violence to determine contributing factors. Analyze data related to workplace violence, and worksite conditions, to determine priority situations for interventions.
  • Develop quality improvement initiatives to reduce incidents of workplace violence. 
  • Train all staff, including security, in de-escalation, self-defense and response to emergency codes.
  • Evaluate workplace violence reduction initiatives. The Joint Commission

The Commission’s infographic on workplace violence clearly defines what constitutes violence including instances of biting, scratching, intimidating, or yelling. While some nurses encounter these things infrequently, others, like ED nurses where crowding is more common, tensions are high, and some patients might be agitated, will encounter it more often. Either way, reporting such instances will help organizations get a realistic picture of what is happening with patients and staff and make a plan to help fix it.

Nurses who do encounter workplace violence should receive immediate treatment for the physical injuries, but they also will need treatment for the emotional distress. Workplace violence can lead to stress, anxiety, depression, fear, and burnout and impact a person’s quality of life as well as the ability to offer the best patient care possible. The repercussions can’t be underestimated, so nurses shouldn’t brush it off or try to minimize it.

Each healthcare organization needs to address this issue and have plans in place for preventing, reporting, and responding to workplace violence. Failing to do so is failing to protect employees and patients from getting the treatment they need in a safe environment.