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Is your workplace toxic? ​​​​

A hostile work environment is an environment in which intimidating, offensive, aggressive, shunning, disruptive, or undermining behavior occurs between team members and interferes with your ability to successfully perform your job without distress. Hostile behavior is directly linked to lowered productivity, reduced patient safety, medication errors, and sentinel events. 

The 2010 National Health Interview Survey found that 16.3% of all healthcare workers feel that their work-life balance is suboptimal and 7.8% of all healthcare workers exit the healthcare industry because of a hostile work environment (being bullied or harassed).

To maintain a culture of safety, we must ensure that respectful communication occurs among all members of the healthcare team. Maintaining open, honest communication and being proactive in offering assistance to all healthcare team members can help maintain a healthy workplace and prevent a hostile work environment from occurring.

On the lookout

Identifying a hostile work environment is usually an easy task. You can assess your workplace culture and workgroup dynamics by carefully observing the environment and team members’ actions, inactions, and group interactions. The three social relationships that you should focus on when assessing for a hostile work environment are employee-environment, employee-employee, and employee-manager.


Evaluate your healthcare environment for adequate staffing, properly functioning equipment, and adequate supplies necessary to safely perform your job. Short staffing, malfunctioning equipment, and lack of necessary supplies can contribute to increased workplace dissatisfaction, which may be the underlying cause of hostility. If you note that the physical environment is contributing to the hostile work environment, consult with the management team immediately for a resolution. If you identify a system delay or failure that impacts your ability to perform your job successfully or impacts patient care, consult with the management team and supportive staff immediately to resolve the problem.


Common signs that your fellow employees may be contributing to a hostile work environment include selectively offering assistance to others and encouraging others to do likewise directly or indirectly, routinely conveying others’ personal information in the work area, encouraging others to withhold valuable information from a peer or team member, openly conveying disrespect for peers, and undermining peers’ or administrative team members’ endeavors.


Employees who have managers with realistic expectations and who view their manager as caring and supportive have increased job satisfaction. Entry-level managers often have little formal power—the ability to effect immediate changes such as buying needed equipment, hiring and terminating an employee, or changing system designs or policies within the work area. This can cause great distress to an employee if he or she believes that the manager has the authority to enact immediate changes. Many managers only have informal power—they can suggest changes to positively impact the workgroup or environment, but lack the true authority to enact those changes. A supportive manager should convey his or her job role abilities or limitations as a change agent to prevent the displacement of anger or frustration by the staff.

Although most managers are committed to ensuring that the work environment remains efficient and positive, there are rare instances in which the manager can actually contribute to hostility. Common signs that your manager may be contributing to a hostile work environment include:
  • conveying unfavorable opinions or personal information about direct reports to new employees or other members of the healthcare team
  • utilizing direct reports as scapegoats for an organizational system failure, sentinel event, or inability to perform job duties in an effort to shift the focus off his or her own professional failures
  • refusing to address employees’ concerns regarding inadequate staffing, lack of supplies, or educational needs 
  • avoiding addressing unprofessional behavior of direct reports and using excuses such as the need for a skill or experience mixture when making necessary reassignments to resolve the hostile work environment
  • routinely engaging in condescending, mocking, or disrespectful communication when addressing direct reports in both private and public forums 
  • providing excessive criticism or counseling to direct reports in a public forum or work area
  • making favorable assignments, granting requests for time off, or selectively reassigning schedules based on a personal like or dislike of the employee
  • assigning schedules to employees that are not conducive to patient safety or employee health
  • taking steps to hinder a team member’s career and/or attempting to force the team member from the job site or into early retirement.

Beware the toxic 12

In addition to assessing social relationships, there are 12 common behaviors that occur within a hostile work environment:
  1. Gossip is engaging in conversations about others, typically involving details that aren’t confirmed to be true, which is destructive to fostering professional working relationships.
  2. Sabotage is behavior that includes taking another’s credit, failure to pass on vital patient data, failure to provide all of the necessary steps or information needed to successfully perform a task, or falsely reporting adverse actions that didn’t occur.
  3. Sexual harassment is unwanted verbal, visual, or physical contact of a sexual nature, which makes it difficult for the target of the harassment to perform his or her job without distress, fear, or coercion.
  4. Hazing is defined as an initiation process involving harassment. 
  5. Scapegoating is when a person is made to bear the blame for others’ actions or inactions or is the convenient object of another’s irrational hostility.
  6. Lack of cohesiveness is a lack of unity or poor teamwork between members of a group; it’s impossible to have a cohesive unit that functions effectively when team members feel demeaned, harassed, or intimidated.
  7. Bullying is intimidating, offensive, demeaning behavior or abuse of power committed by an individual or group that makes the target feel devalued, anxious, threatened, fearful, embarrassed, or defenseless.
  8. Slander is untruthful communication that directly results in the defamation of a person’s professional reputation.
  9. Shunning is the intentional social rejection of a person or group with the specific goal of isolating the target(s) from activities and conversation; it can be an organized, formal decision by a group or a less formal group action that spreads to all members of the group as a form of solidarity, with group members complying out of fear that they, too, will be shunned.
  10. Physical assault is the threat of violence or actual episodes of physical violence; this should never be tolerated.
  11. Staff splitting is the intentional attempt to pit staff members against each other in an adversarial role.
  12. Instigation is the intentional act of inciting feelings of anger, frustration, fear, or shame in another team member; the instigator often feigns genuine concern, innocence, or outrage over an untruthful act or alleged witnessed event of another and conveys this to a peer to illicit cyclical anger, shame, or embarrassment.

Action STAT

If you suspect that your work environment is hostile, first assess your role in the situation. Have you participated in any of the toxic 12 behaviors? Have you conveyed your concern to management and the healthcare team? After the group acknowledges that a hostile work environment is present, you can develop an action plan to resolve the hostility. Common components of an action plan include:
  • agreeing not to gossip
  • exploring team members’ rationales for behavior that’s perceived as disrespectful or hostile
  • supporting peers’ projects and professional endeavors
  • ensuring that both verbal and nonverbal language conveys supportive commitment to team members 
  • formulating a mission statement with peers that dictates acceptable and nonacceptable workplace behaviors
  • modeling fair, professional, and honest behavior when dealing with all team members
  • improving communication skills and civility by incorporating evidence-based practice interventions.

Positive changes ahead

Maintaining healthy work environments improves the operational profits for the healthcare organization, which can allow management teams to hire additional team members. You can be a positive change agent in your work area to achieve a healthy work environment.

Adapted from “Is your work place toxic?“ by Jolinda Chrisman, ASN, RN; Nkechi Azubike, MSN, RN, FNP-BC; Andrea Stone, BSN, RN; and Charlotte Davis, BSN, RN, CCRN. This article originally appeared in the May/June 2014 issue of Nursing Made Incredibly Easy! © 2014 Lippincott Williams & Wilkins.
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