According Johnson and Rea (2009) differentiated bullying

to the American Nurses Association (ANA) (2015) incivility, bullying, and
workplace violence of “any kind is not tolerated from any source” (p. 1).
According to the ANA (2015), incivility is defined as “rude and discourteous
actions, gossiping, rumors, and of refusing to assist a coworker” (p. 2).
Bullying is the “repeated, unwanted harmful actions intended to humiliate,
offend, and cause distress in the recipient” (ANA, 2015, p. 3). Workplace
violence is “physical or psychological damaging actions that occur in the
workplace or while on duty” (ANA, 2015, p. 4).

Several research studies have been
conducted to describe or define workplace conflicts. Wright and Khatari (2015)
grouped acts into three categories: work-related, person-related, physical
bullying. Olmstead (2013) discussed bullying in terms of verbal behaviors such
as arguing, gossip, bad mouthing, and negative sarcasm to name a few and of
nonverbal behaviors such as not helping others, refusing to communicate,
malicious behavior towards others, and slamming items down among others. Johnson
and Rea (2009) differentiated bullying from lateral violence in that lateral
violence was a one-time incident and bullying was a weekly event that occurred
for six months on longer. Johnson and Rea (2009) also suggested a power
difference existed between the perpetrator and the victim. Lee, Berstein, Lee,
and Nokes (2014) also concluded that the imbalance is not limited to
“superior/subordinate relationship”, but can also include those at the same
hierarchical level withhold information or refuse to help coworkers.

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Ramsey (2015) discusses the
occurrence of mobbing, where at least one other person joins in on bullying the
coworker and cautions healthcare settings to be aware of groupthink, where a
person may experience their input being unfairly undervalued based on consensus
of the majority. Single perpetrator events accounted for half of the bullying
incidents and mobbing accounted for the other half of incidents (Johnson &
Rea, 2009).

It is difficult to believe that
members of the caring profession – nursing – would engage in such deleterious
behavior, but bullying and incivility is a reality in the health care setting. Several
studies have examined the magnitude of negative behavior towards coworkers. Etienne
(2014) found that 48% of respondents stated they had been bullied at work with
over a third experiencing bullying weekly and over a quarter had been bullied
daily. An alarming 16% reported that they had received threats of physical
violence (Etienne, 2014). Typical incidents included being ignored or excluded,
facing hostile reactions upon approaching coworkers, withholding information
that affects performance, assigned unmanageable workload, gossip, criticism,
and personal insults (Etienne, 2014).

Cohen (2014) discussed research that
showed that other nurses bully more often than physicians and that in up to
half of the time, nurse managers and charge nurses were the source of bullying
(as cited in ANA, 2012). Unfortunately, workplace hostility is not a strange occurrence
among nurses either. In fact, the phrase “nurses eat their young” is known
among many healthcare workers (Gillespie, Grubb, Brown, Boesch, & Ulrich,
2017). Almost three quarters of bullied nurses surveyed indicated that they
knew others who were also bullied (Johnson & Rea, 2009).

A variety of factors have been
identified to contribute to workplace bullying. Among nurses surveyed, the
majority felt that it was a part of the perpetrator’s personality or a mental
illness and a third felt it was due to stressful or busy work environments
(Farrell & Shafiei, 2012). The bully often has a strong desire to be in
control (Murray, 2009). Power imbalances, poor management and leadership
skills, high workloads contribute to bullying and in some cases, the workplace
culture facilitates hostility among workers (Cleary, Hunt, Walter, &
Robertson, 2009).

Bullying impacts the victim nurse
directly and as a consequence, the patient indirectly. Victims experience
anxiety, sleep disturbances, chronic illnesses, headaches, post traumatic
stress disorder, self-esteem issues, recurrent nightmares, hopelessness,
helplessness, and depression and suicidal ideation (Murry, 2009; Lee et al.,
2014). Victims described poor job satisfaction and had higher rates of calling
out from work as well as poor relationships with managers and colleagues and
low productivity (Lee et al., 2014). High turnover, decreased communication,
poor reputation, and escalating legal and investigative costs are a few of the
direct organizational impacts of bullying (Lee et al., 2014). The patient is
impacted by the increased risk of patient care errors and the potential for
abuse by the victim or the perpetrator (Lee et al. 2014; Spence Laschinger,