Disruptive Behavior, Bullying, & Incivility: A Glossary of Violence in Healthcare Workplaces

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One of the most important steps that nurses can take to address  the pervasive and troubling implications of workplace violence is to talk about it.  Conversations with peers, leaders, family, and friends will help to build awareness and decrease tolerance of inappropriate behavior in healthcare settings.

The timing is perfect for these discussions, as this issue is appearing more frequently in mainstream news and professional literature.  More and more we are seeing that abusive behaviors are taking their toll on quality, safety, and job satisfaction.

Recently I attended a local meeting of Holistic Health Nurses held at a Bed and Breakfast in York Beach, ME.  It was my first meeting with this group, and we followed a brief welcome meditation with introductions around the room.  When my turn came, I shared some of my work, which included research on workplace violence for a book I am writing about communication and workplace dynamics for nurses.    An immediate and intense discussion followed.   Many terms were flying through the air, and the energy was palpable.

Isn’t workplace violence about patients assaulting staff?

Part of the reason I left my last job was because of nurse-to-nurse bullying.  I thought that was workplace violence?

That sounds like horizontal violence.

I read an article that talked about covert abuse. That is what nurse-to-nurse bullying is.

What about belligerent docs?  There is one physician in our clinic that yells at nurses all the time.  We all hate to work with him.


I think that is vertical abuse.

I just read about physicians and something called ‘disruptive behavior’.  Isn’t that the right term?

This group, I realized was eager to share stories, ask questions, and explore this issue! But, they were getting lost in the terminology!  This is easy to understand.  There is much overlap in terms we are using and a variety of targets, types, and perpetrators of abuse.

A Glossary of Violence

Abuse: The International Council of Nurses (ICN 2004) defines abuse as “behavior that humiliates, degrades or otherwise indicates a lack of respect for the dignity and worth of an individual.”

Bad Behavior:  This news release from the Joint Commission addresses bad behavior and sets the stage for a related accreditation requirement  going into effect January 2009.   For more information about TJC’s:  Sentinel Event Alert.

Bullying:  Abusive behavior towards another which often takes place repeatedly over time.

Covert Abuse:  Abusive behavior which is difficult to identify or prove and often more passive or passive-aggressive.

Disruptive Behavior:  The American Medical Association (AMA) has written, “Personal conduct, whether verbal or physical, that affects or that potentially may affect patient care negatively constitutes disruptive behavior. ”

Horizontal Abuse:  When a colleague is abusive to a peer or other at a similar level in the organizational or professional hierarchy.

Incivility:  Any kind of rude or discourteous behavior.

Interactive Workplace Violence or Trauma (IWPV or IWPT):  Often used to describe abusive behavior taking place between peers or others at similar level.

Lateral Violence:  When a colleague is abusive to a peer or other at a similar level in the organizational or professional hierarchy.

Non-verbal Abuse:  A wide range of belittling gestures or body language become abusive when used to disrespect another such as rolling eyes, smirking, whispering, ignoring, violating personal space, or hands on hips.  These are often insidious and passive or passive-aggressive power displays which may be hard to identify.

Overt Abuse:  Abusive behavior that is obvious to all and typically more aggressive.

Psychological violence:  Intentional use of power, including threat of physical force, against another person or group, that can result in harm to physical, mental, spiritual, moral, or social development. It includes verbal abuse, bullying/mobbing, harassment,  and threats. (Adapted from WHO definition of violence)

Toxic behavior:   Can range from the very serious  aggression,  bullying, and sabotage of abusive colleagues to the annoying and hard-to-cope with behavior of negative co-workers.

Verbal Abuse:  Any kind of tone or language used to intimidate another.  Although not healthcare specific, Patricia Evans is a pioneer in studying and writing about verbal abuse, and this link will take you to her website page with FAQs about this topic.

Vertical Violence:  Used to describe abusive behavior towards those in less powerful positions such as physician-to-nurse or nurse-to-home health aide.

The above conversation made it clear to me that much needed discussions among nurses and others could easily become diluted with uncertainty about the language. This topic is so important, and there is so much overlapping terminology,  it seemed like a glossary would be a helpful resource.  I have adapted the ones I have come across most frequently with cited references in specific cases.

Talking and listening to concerns about abusive behavior is an important part of any process for creating and following a new standard of behavior.  Identifying problems,validating each other’s experiences,   and setting healthy limits requires confidence and organizational support.

There is no room for a double standard. As nurses, we cannot make anyone respect us, but with organizational support and effective communication skills, we can insist on and expect enforcement of respectful treatment in the workplace!

Let me know if this article has been helpful or how you might add to this advice.

Special book offer:  SAVE  20% NOW!  “Confident Voices:  The Nurses’ Guide to Improving Communication & Creating Positive Workplaces”  Exclusively at Beth’s EStore  (Use coupon code:  D359FSBP . )

Beth  can be reached at beth@bethboynton.com or 603-319-8293

P.S. Want help promoting respectful dialogue about bullying behavior among nurses and other healthcare professionals? 

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3 Responses to Disruptive Behavior, Bullying, & Incivility: A Glossary of Violence in Healthcare Workplaces

  1. All of these definitions come under human aggression. Incivility, disruptive behavior, bullying, are on the lower scale with physical violence towards another at the top of the scale. As we learn to tell the stories of aggression nurses experience from our peers, physicians, patients, and families, we need to make it clear that these behaviors are unacceptable, should not be rationalized, and should be reported up the chain of command consistently.

    • Beth Boynton says:

      I so agree, Peggy. It is like a continuum. It seems to me that the more oppressed humans are , the more passive-aggressive our behaviors…maybe we have to be in order to have some voice.

      I think this is how vertical and horizontal violence in healthcare/nursing are connected. Sometimes, I think that human beings are emerging from an age of aggression into an age of assertiveness…. We could lead the way in healthcare!!

      Thank you for reading and commenting. I look forward to hearing more of your insights.


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