Most people imagine a hospital or clinic as a place built on compassion and teamwork. For a great many providers, that is genuinely true. But there is another side to working in clinical environments that rarely surfaces in public conversation: the bullying that plays out in staff rooms, shift handovers, hierarchical structures, and daily team interactions, week after week, year after year.
Healthcare workers enter their careers wanting to help others. What many of them do not anticipate is how much of their psychological energy will eventually go toward managing the behavior of colleagues, supervisors, or institutional cultures that undermine rather than support them. The impact on mental health is real, it is measurable, and it is serious enough to warrant an honest conversation.
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What Workplace Bullying in Healthcare Actually Looks Like
Workplace bullying is not always the obvious, loud confrontation that people tend to picture. In healthcare settings, especially, it often shows up in quieter and more corrosive ways.
Most widely accepted definitions describe it as repeated, health-harming mistreatment by one or more individuals, taking the form of verbal abuse, threatening behavior, humiliation, intimidation, or deliberate interference with someone’s work. The word “repeated” matters here. A single difficult exchange does not constitute bullying, but a sustained pattern of behavior that chips away at someone’s sense of safety and self-worth absolutely does.
In hospitals, clinics, and care facilities, the behavior tends to fall into a few recognizable patterns:
Horizontal violence describes peer-to-peer bullying between colleagues at the same level. Nurse-on-nurse mistreatment is one of the most studied examples in the literature, and it appears consistently across settings and countries.
Vertical bullying travels downward through the hierarchy. From physicians to nurses, from charge nurses to newer staff, from administrators to frontline workers — the power imbalance in these relationships makes it significantly harder for targets to respond or report.
Covert bullying is the kind that is hardest to name but no less damaging. Being deliberately excluded from information, having work undermined or sabotaged, receiving persistent silent treatment, or having contributions dismissed in front of others all qualify. Because this behavior is harder to pinpoint, it is also easier for the target to doubt their own perception of it.
How Common Is It?
The numbers are hard to ignore. Research published in peer-reviewed journals estimates that up to 40% of nurses have experienced bullying behaviors at work, with some studies reporting considerably higher rates in high-pressure units like intensive care and emergency departments. A large systematic review of nursing literature estimated a pooled prevalence of approximately 26.3%, meaning that roughly one in four nurses, by a conservative measure, has been subjected to this kind of mistreatment.
More than half of nurses report exposure to verbal abuse at work. Studies on medical residents and junior physicians tell a similar story, with bullying and intimidation by senior colleagues well documented in teaching hospital settings. The culture of medical training has historically normalized a kind of hardship-as-preparation mentality, which has allowed harmful behavior to pass down from one generation of clinicians to the next without being named for what it is.
The American Nurses Association has formally recognized incivility, bullying, and workplace violence as serious professional concerns affecting the nursing workforce. The Joint Commission has also addressed the issue directly, identifying intimidating and disruptive behaviors in healthcare institutions as threats to patient safety and staff wellbeing alike.
Why Healthcare Settings Are Particularly Vulnerable
Healthcare work creates conditions that, when left unaddressed, allow bullying to take root and persist. Chronic understaffing, sustained time pressure, emotionally demanding patient caseloads, and rigid hierarchies with pronounced power imbalances all combine to produce environments where unhealthy interpersonal dynamics can become entrenched.
The phrase “eating their young” — long used within nursing to describe how experienced staff sometimes treat newer colleagues — is not simply a metaphor. It reflects a professional culture in which being subjected to hardship has, in some settings, been framed as a normal rite of passage. This framing causes serious damage. It discourages staff from reporting mistreatment, normalizes behavior that should never be acceptable, and signals to people going through it that the institution will not protect them if they speak up.
High-stress environments also reduce people’s capacity for self-regulation. Compassion fatigue, the emotional exhaustion that results from sustained exposure to the suffering of others, can erode the emotional reserves that help clinicians maintain healthy relationships with colleagues. When people are running on empty professionally and emotionally, the risk of unhealthy dynamics escalates. Our guide to compassion fatigue in helping professions explores that connection in more depth, including the organizational factors that make it worse.
The Mental Health Impact
This is where the consequences become most serious, and for many people, most personal.
Research consistently confirms that being subjected to workplace bullying carries a significant mental health burden. A large meta-analysis examining both cross-sectional and longitudinal data found consistent positive associations between bullying exposure and symptoms of depression, anxiety, and stress-related psychological complaints. These associations held across time, meaning the mental health effects do not simply resolve when someone walks out of the building at the end of a shift. They accumulate.
Anxiety is among the most commonly reported outcomes. Healthcare workers who experience repeated mistreatment describe a state of hypervigilance at work — a constant monitoring of the interpersonal environment, watching for threats. That sustained alertness is exhausting, and it tends to follow people home. Persistent worry, disrupted sleep, difficulty quieting the mind, and a general inability to switch off are all common.
Depression develops in a significant portion of people who experience chronic bullying. Feelings of helplessness and worthlessness, a fading sense of meaning in work that once felt purposeful, and a loss of connection to one’s professional identity are particularly common. These symptoms can worsen steadily over time if the situation is not addressed.
Post-traumatic stress responses are more prevalent in bullying victims than most people recognize. Research indicates that approximately 10% of nurses who experience workplace bullying go on to develop post-traumatic stress disorder. The intrusive thoughts, emotional numbing, hyperarousal, and avoidance behaviors associated with PTSD are not limited to combat veterans or disaster survivors. They can and do develop in response to sustained interpersonal threat, and for clinicians who already carry a trauma load from their clinical work, bullying by colleagues adds another layer that the nervous system must absorb on top of everything else.
Burnout is closely intertwined with bullying exposure. Staff who feel unsafe, unsupported, or targeted at work lose their connection to meaning and purpose at a significantly faster rate than those in psychologically safe environments. If you have been wondering whether what you are experiencing at work is crossing into something more serious, our piece on what burnout actually is and what its warning signs look like may help you recognize where you are.
Suicidal ideation has been documented in healthcare workers experiencing severe or prolonged bullying. It is not the typical outcome, but its documented presence in the literature underscores why this issue must be taken seriously as a mental health emergency in some cases, not merely a workplace conduct matter.
What makes all of this particularly difficult is the cumulative nature of the harm. Someone experiencing ongoing bullying is not dealing with a single stressful event that they can recover from with a good night’s sleep. They are managing a threat that renews itself each working day, inside an institution they depend on professionally and financially, often within a culture that actively discourages them from naming the problem out loud.
Physical Health Consequences
The body keeps its own record of sustained psychological stress. Healthcare workers subjected to bullying frequently report sleep disturbances, headaches, gastrointestinal problems, elevated blood pressure, chest discomfort, immune dysfunction, and increased vulnerability to illness. The Workplace Bullying Institute documents physical indicators, including uncontrollable crying, tremors, nausea, and weight changes, alongside psychological symptoms.
The relationship between mental distress and physical health is not a loose metaphor. It is biology. Chronic activation of the body’s stress response system takes a measurable and cumulative toll on physical health, and that toll does not wait for permission.
How Bullying Affects Patient Care
There is a patient safety dimension to this problem that often gets lost in conversations focused only on the worker being harmed.
The Agency for Healthcare Research and Quality has noted that the psychological effects of workplace violence and bullying, including anxiety, depression, and burnout, lead to higher rates of absenteeism and negatively affect the quality of care delivered. A clinician who is hypervigilant, emotionally depleted, or struggling with depression has fewer cognitive and emotional resources available for the patient in front of them. This is not a personal failing. It is the predictable consequence of insufficient support.
Team communication — which is foundational to safe clinical care — breaks down in environments where trust has been eroded by mistreatment. People who do not feel safe with their colleagues are less likely to raise concerns about medication orders, patient deterioration, or procedural risks. In that context, the consequences of unchecked bullying extend far beyond the individuals being targeted.
Barriers to Reporting
One of the most consistent findings in research on healthcare bullying is how rarely it gets formally reported, and how understandable the reasons for that are.
Fear of retaliation is the most commonly cited barrier. Healthcare workers worry that coming forward will damage their professional reputation, worsen the situation with the perpetrator, or lead to institutional consequences for them rather than the person responsible. In hierarchical settings, that concern is often not unfounded.
There is also a professional culture layer. In fields where endurance has historically been valued and where admitting difficulty can be read as weakness, naming the experience of being bullied requires a kind of courage that many people simply do not feel they can afford. Many clinicians describe feelings of shame about what is happening to them, even when they understand at an intellectual level that the behavior is not their fault.
Some workers report not knowing where to go, whether anyone would act on what they said, or whether the outcome would be worth the risk of speaking up. These are not irrational concerns. They are rational responses to real institutional dynamics, and they are part of why the problem persists at the rates it does.
Recognizing When You Need Support
If something in this article resonates with what you have been carrying, it is worth pausing to look at your own mental health honestly, without minimizing what you are describing to yourself.
Some questions worth sitting with:
- Are you dreading shifts or work days in a way that feels qualitatively different from ordinary tiredness?
- Have you noticed persistent anxiety, irritability, or difficulty concentrating that you cannot fully account for?
- Is it harder to connect with colleagues, patients, or people you care about outside of work?
- Has sleep become a problem, particularly around workdays or when you know a difficult colleague will be present?
- Do you find yourself replaying interactions from work even when you are away from the environment?
- Have people who know you well mentioned that you seem different, withdrawn, or unlike yourself?
These are not signs of weakness or inadequacy. They are signs that your system is responding to something real. Recognizing the pattern is where things begin to change.
It is also worth understanding how the root causes of chronic stress and burnout interact with experiences like workplace bullying. The two feed one another, and addressing one often means looking carefully at the other.
What Can Help
At an individual level, a few practical steps can make a genuine difference even before the institutional picture changes.
Document what happens. Keeping a private, dated record of incidents — including what was said or done, who was present, and how it affected you — creates clarity and a factual basis for any process you might later need to pursue.
Find your support structure. This might include trusted colleagues, a union representative, an employee assistance program, or an occupational health service. Isolation amplifies everything that bullying is already doing to you. Connection is one of the most protective things available.
Speak with someone outside the situation. A mental health professional — particularly one who understands the specific demands of healthcare work — can provide a space to process what you are experiencing without the professional stakes that exist inside your workplace. Evidence-based approaches, including Cognitive Behavioral Therapy, are effective for the anxiety and depression that result from bullying exposure, and working with someone who understands both psychiatric care and the pressures specific to clinical careers can make a real difference.
The services at Inner Balance and Wellness are designed specifically for professionals in high-pressure environments, including support for anxiety, stress, burnout, and emotional exhaustion. Telehealth appointments are available across California, which means accessing care does not require finding time in an already demanding schedule.
Seeking Care Is Not the Last Resort
No version of this ends with “you should just keep pushing through.” Healthcare workers are people first, and the mental health consequences of sustained mistreatment are both real and treatable.
If you have been managing this for a while and the weight of it has begun to affect your sleep, your relationships outside of work, your sense of who you are, or your ability to find meaning in work you trained hard for and genuinely care about, that is the moment to reach out. Waiting tends to make recovery longer, not shorter.
Monique Strickland, PMHNP-BC, brings more than 25 years of healthcare experience to her practice, alongside a Certified Compassion Fatigue Professional (CCFP) designation. That background means she understands what clinical environments actually look and feel like from the inside, which matters when you need someone who does not require a lengthy explanation of what the job involves.
Workplace bullying in healthcare is not a fringe issue or an exaggeration. It is embedded in the culture of some of the institutions responsible for delivering care, and it has documented, measurable consequences for the mental health of the people working inside them.