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Two Healthcare Workforce Problems: Incivility and Bullying

April 1, 2021
April 1, 2021

In a recent HealthStream webinar, How to Banish the Bully Who Wreaks Havoc in Healthcare, Linda Leekley, CEO and founder of In the Know, addresses the common question “What exactly is incivility and how is it different from bullying?”

Leekley explains the difference with a metaphor inspired by the recent Olympics. She asks us to “Imagine that bullying is the gold medal of bad behaviors. How do you win a gold medal? You train really hard every day. For the purposes of this example, imagine that incivility is that training. Incivility includes all those little things that when repeated over time, lead to the gold medal of bad behavior—bullying.”

Defining Incivility

Leekley offers a few examples of incivility: “eye rolling, ignoring people, making sarcastic remarks, excluding people on purpose from meetings or outings, temper tantrums (yelling, stomping, slamming doors), being habitually late for work or appointments, gossiping or talking negatively about others, interrupting others, arguing, and feeling the need to always be right.” She cautions us that “isolated acts of incivility should not be considered bullying, but neither should they be ignored.” It’s important to remember, however, that “When the culture of incivility is ignored or left unaddressed, those who are allowed to practice and train in it will almost always advance to the podium and earn that gold medal in bullying.”

Defining Bullying

Leekley reminds us that “bullying is the advanced form of incivility.” The difference being “It causes more damage and has more serious consequences.” The difference is a matter of frequency; “behaviors are considered bullying when they occur repeatedly twice a week or more for a long time, six months or longer, and in situations where the victim finds it difficult to defend against or stop the abuse.” Intent is also a differentiator—“Another fact that separates incivility from bullying is the intent to harm. Bullying can cause victims physical harm, emotional harm, or even financial harm.”

Leekley lists multiple examples of what bullying might look like:

Gossip: While on the list of behaviors for incivility, gossip can go too far. Leekley offers that “Making false statements with the intent to harm the reputation of someone else can be considered bullying.”

Intimidation: The occasional temper tantrum remains a form of incivility. Bullying involves “repeated episodes of emotional tirades, angry outbursts, and verbal attacks.”

Sabotage: Leekley tells us that “Withholding information is a form of bullying when it’s done with the intent to set someone else up to fail, to look foolish, or to appear incompetent on the job.”

Hate or prejudice: There’s no denying that “Intentionally targeting someone based on age, gender, race, or sexual orientation are all examples of bullying.” Just as important, “in most instances, this behavior is also against the law.”

Hazing: Leekley points out bullying practices that may be common when new hires join an organization, such as “assigning unmanageable workloads, telling the person to sink or swim, or ordering the new person to do work that is below his or her competence.”

Bullying and Incivility Are Common in Healthcare

Leekley cites an informal poll taken to assess the pulse of healthcare workers today. She explains that “About half of our respondents were nurses or nurse educators, 20% were direct care workers such as CNAs or non-medical caregivers, and the rest were in administration, HR or front office positions.” Three central questions were the focus:

  1. Have you witnessed incivility or bullying?
  2. Have you been a victim of incivility or bullying?
  3. Have you yourself been uncivil or bullied others?”

Leekley’s results were as follows: “Nearly 85% of the respondents said they have witnessed incivility in their workplace, 80% reported having been the victim of incivility, and… 15% admitted that they have treated others with incivility.” The answer of 15% tells Leekley “that those individuals are self-aware enough to know that they behaved in a way that may have harmed someone else.”

In response she reminds us that “We’ve all been uncivil at one point or another, but turning the behavior around starts with being aware of it, taking ownership of our part in it, and taking steps toward behaving more productively in the future.”

Access the complete Webinar recording. 

About Linda Leekley

Linda Leekley, CEO and founder of In the Know, began her nursing career in the research oncology department at Duke University Medical Center. She then followed her acute care experience with a year in home healthcare.

In 1998, Linda recognized that a void existed when it came to training options for nurse aides and caregivers. So she blended her nursing experience in both acute care and long-term care with her years as a clinical educator and the result was In the Know.

Linda is also the co-author of the book, “The Real Healthcare Reform: How Embracing Stability Can Beat Burnout and Revive Your Healthcare Career.” Published in 2012, the book continues to be used as a primer for stability training programs at healthcare organizations across the country.