Incivility and Bullying in the Workplace

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Build a culture of respect and psychological safety, allowing employees to flourish and innovation to thrive

By Brandy Schwarz, PT, DPT, EdD, MBA, Jane Oeffner, PT, DPT, MBA, Haylie Miller, PhD

Do you have a bully in your organization? Would you know if you did? Is it you? Does something feel off, but you can’t put your finger on it?

Maybe there is nothing overtly wrong, but your organization just doesn’t seem to be thriving. Maybe you’ve noticed whispering, rude remarks, raised voices, sarcastic comments, or withholding of thanks or compliments. Employees may be hesitant or have stopped giving input, even when asked. Or maybe worse, you are the recipient of or have witnessed public rebukes, passive-aggressive behaviors, belittling remarks, or gaslighting.

These behaviors are examples of workplace incivility and, when persistent over time, constitute bullying. While not actionable by law in any state at this point, the consequences can be devasting for individuals, your team, your organization, and your patients. As a leader you must educate yourself and your employees, put prevention measures in place, and create processes to address and eradicate incivility and bullying to “bully-proof” your organization.


Anderson and Pearson define workplace incivility as “low-intensity deviant behavior with ambiguous intent to harm the target, in violation of workplace norms for mutual respect.”1 Without intervention, these behaviors can turn into bullying, harassment, and workplace violence. The Workplace Bullying Institute defines workplace bullying as “repeated, health-harming mistreatment by one or more employees of an employee: abusive conduct that takes the form of verbal abuse; or behaviors perceived as threatening, intimidating, or humiliating; work sabotage; or in some combination of the above.”2

Although it is difficult to believe professional adults would engage in such behavior, it is unfortunately fairly commonplace in organizations across sectors. Among U.S. workers, 49% of people have experienced (30%) or witnessed bullying (19%) in the workplace.3 In healthcare specifically, The Joint Commission has stated that bullying has reached “epidemic levels.”4 While estimates vary, studies have reported that up to 85% of healthcare workers personally experience incivility in the course of a year.5 Bullying occurs much more frequently than illegal harassment and yet does not receive the focus or support within federal or state policy. The Workplace Bullying Institute has been advocating for passage of the Healthy Workforce Bill since 2003 and to date, only 31 states have introduced, and none have passed this legislation,6 despite the fact that 90% of those surveyed support enactments of such a law.3

Raynor and Hoel created five categories of bullying behavior (Figure 1)7:

  1. Threat to professional status
  2. Threat to personal standing
  3. Isolation
  4. Overwork
  5. Destabilization

Additional examples of bullying include:

  1. False accusations of wrongdoing
  2. Public reprimands for mistakes
  3. Hostile glares and other intimidating gestures
  4. Purposeful monopolization of resources and services
  5. Criticism for not meeting unclear or unspoken expectation
  6. Aggressive texts, emails, and notes

Any book on leadership and management will tell you that these behaviors are in direct conflict with sound leadership and a sustainable culture in the workplace, and yet, they happen regularly. These behaviors are also in contrast to our Physical Therapist Code of Ethics, yet occur at all levels within our profession, including our academic programs, and professional organizations.8 Of course, naysayers exist — those who do not believe that people actually endure these negative experiences in the workplace. In fact, 34% of U.S. workers are unaware of or do not believe that bullying or incivility exists.3 Others will say that the individual experiencing bullying should “get thicker skin,” or are engaging in victim-blaming. Here lies an opportunity to set the record straight through education.

Lastly, it is important to understand what bullying is not. Differences of opinion, constructive feedback and counseling regarding work performance, managerial action that is fair and equitable, and high-performance standards do not constitute bullying when conducted correctly.


Adverse consequences exist not just for the individual who is targeted, but for organizations, teams, and patients. Those targeted — or even those who simply witness uncivil behavior — are likely to experience lower job satisfaction, higher anxiety, and depression, intention to leave the workplace, absenteeism, and presenteeism. In addition to emotional and psychological impact, victims may experience physical symptoms such as headaches, sleep disturbances and fatigue, gastrointestinal distress, and the many manifestations of a compromised immune system. In a 2015 study, Porath, Foulk, and Erez found that both those directly experiencing and those witnessing incivility demonstrated a decreased ability to solve complex problems and reduced creativity and effort at work.9 When people feel left out, betrayed, or unrecognized in the workplace, the brain perceives a threat. The response is to minimize the danger, ducking for cover to avoid being targeted, which leads to decreased efficiency and limited interaction and commitment to the organization.10 Organizations are then subject to increased turnover, increased costs, and decreased productivity.

The impact can also trickle down to patients who witness rude or short comments or have practitioners take out frustrations on them, damaging the reputation of your organization and brand. Incivility can disrupt attention, negatively impact working memory, and cause clinicians to overlook critical information, all which can contribute to decreased safety and poor patient outcomes. Additionally, teams become dysfunctional, failing to share workload and important information that can also contribute to decreased safety and outcomes.9


Workplace incivility can be a silent crisis, as, for a variety of reasons, it is often unnoticed and under-reported. Individuals exhibiting such behaviors are often in positions of leadership or are high achievers who bring value to the organization, which can lead others to willingly overlook certain conduct concerns. Bullies are astute — they are often aware of where the line is between uncivil behavior and harassment, so they approach the line repeatedly, but avoid crossing it. They are also opportunists and covert, rarely making their moves in front of others, so as to make it difficult for the target to prove to others. Another tactic is making the victim’s life difficult over a collection of “little things,” such that the victim is constantly uncomfortable and upset but isn’t able to put their finger on what is happening, oftentimes until after they leave the organization.

categories of bullying

Bullies often target the organization’s most talented employees as they are threatened by them. Additionally, bullies prey on the vulnerable, those who are new, weak, and different11 — “the nail that sticks up gets hammered down” (Japanese proverb). Victims often self-blame, thinking that they aren’t doing things right and have to get used to others’ styles.

What drives an employee to resort to bullying? Insecurity, resentment, jealousy, need for control, and their own perceived powerlessness within the organization. High workloads and insufficient staffing create tension among employees, increasing the potential for incivility and bullying. Power imbalances created by superiors who employ a top-down, bottom-line style can push employees to seek power through bullying others. Ineffective leaders may resort to bullying to achieve results. Organizations that reward or normalize bullying by tacit encouragement or failure to intervene, ensure a place for such behavior in their culture.

It is critical for all to learn to recognize and surveil for bullies and the signs of incivility and to be given the tools, resources, and empowerment to speak up, in turn, fostering a culture of respect and psychological safety.


Awareness is only the first step toward preventing bullying. Proactive and real-time action is required. Leaders must establish and model norms of acceptable conduct and ensure adherence to those norms by quickly correcting behaviors that deviate from the desired culture.12 Passive leadership fails to prevent and control negative behaviors; employees working under a passive leader are more likely to encounter workplace incivility and to engage in uncivil behaviors themselves.13

Employees in clinical settings with a higher forgiveness climate — an organizational level phenomenon that reduces punitive intent in response to errors, mistakes, or offenses in the workplace — experienced more job satisfaction even in the presence of workplace incivility.14 On the contrary, organizational cultures that misuse authority to control resource allocation and disregard social inequities foster the existence of incivility and bullying in the workplace.15 In addition to fostering a positive culture that minimizes bullying and incivility, there are seven concrete strategies that leaders can implement to further ensure a healthy workplace:

  1. Create and support and Code of Conduct.
  2. Establish an anti-bullying policy that defines bullying, describes unacceptable behaviors, and delineates the consequences for those who bully, giving targeted employees the backing they need to confront incivility or bullying.11
  3. Conduct confidential climate/satisfaction surveys that employees submit to a third party to uncover bullying and uncivil behavior.11
  4. As 65% of bullying is top-down,3 have the leadership team complete a periodic confidential self-assessment to foster self-reflection and behavior modification.
  5. Ensure your reporting, investigation, and mediation policies and procedures regarding employee complaints about their supervisor and co-workers include an anti-retaliation provision.11
  6. Implement employee and manager training on the behaviors, risk factors, and dangers of bullying as well as strategies to reduce and address bullying. Zero tolerance for bullying and incivility should be emphasized at new-hire orientation and the policy shared.11
  7. Get off to a good start by hiring individuals who prioritize civility and are responsive to feedback about how they engage with the team. When interviewing potential employees, dig past the resume, do a thorough questioning of references, and notice how the candidate treats people throughout the hiring process, from the front desk staff to whomever they consider the “most important” decision-maker.


Bullies need to be confronted early in a calm and objective manner. In the best-case scenario, the perpetrator genuinely may not know how their behavior is being perceived and strive to correct it. If the behaviors persist, the target should document concrete, objective examples of the negative interactions with the individual, including dates and details. Employees need to be empowered to address bullies and know they are backed up by the organization in the event the conflict is not resolved. Leadership must hold employees accountable for their behaviors, investigating and addressing complaints immediately.

Bullying. It exists, it’s real, and it is our responsibility to move it out of the shadows and into the light. 

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1Andersson LM, Pearson CM. Tit for tat? The spiraling effect of incivility in the workplace. The Academy of Management Review. 1999;24(3):452-471.

2Workplace Bullying Institute. Accessed July 19, 2022.

3Namie G. 2021 Workplace Bullying Institute U.S. Workplace Bullying Survey. Workplace Bullying Institute. Accessed July 19, 2022.

4The Joint Commission. Bullying has no place in health care. Quick Safety. Published online 2006.

5Keller S, Yule S, Zagarese V, Parker SH. Predictors and triggers of incivility within healthcare teams: A systematic review of the literature. BMJ Open. 2020;10(6). doi:10.1136/bmjopen-2019-035471

6WBI. “Healthy Workplace Bill to Prevent & Correct Abuse at Work.” Accessed July 19,2022.

7Raynor C, Hoel H. A summary review of literature relating to workplace bullying. J Community Appl Soc Psych. 1997;7:181-191.

8Schwarz B, Miller H. (2022) Workplace Bullying and Incivility in Physical Therapist Education Programs. Physical Therapy Education, 36(2): 154-162.

9Porath C, Foulk T, Erez A. How incivility hijacks performance: It robs cognitive resources, increases dysfunctional behavior, and infects team dynamics and functioning. Organ Dyn. 44(4):258-265.

10Rock D. Managing with the Brain in Mind: Neuroscience research is revealing the social nature of the high-performance workplace. Strategy + Business. 2009;56. Retrieved from:

11Daniel T. “Bullies in the Workplace: A Focus on the ‘Abusive Disrespect’ of Employees (White Paper).” SHRM. Accessed July 19, 2022.

12Porath C, Pearson C. (2013). The Price of Incivility. Harvard Business Review.

13Harold C, Holtz B.The effects of passive leadership on workplace incivility. J Organ Behav. 2015;36(1):16-38.14. Khan M, Elahi N, Abid G. Workplace invicility and job satisfaction: Mediation of subjective well-being and moderation of forgiveness climate in health care sector. Eur J Investig HealthPsycho. 2021;11(4):1107-1119.

14Khan M, Elahi N, Abid G. Workplace invicility and job satisfaction: Mediation of subjective well-being and moderation of forgiveness climate in health care sector. Eur J Investig Health Psychol Educ. 2021;11(4):1107-1119.

15LaGuardia M, Oelke N.The impacts of organizational culture and neoliberal ideology on the continued existence of incivility and bullying in healthcare institutions: A discussion paper. Int J Nurs Sci. 2021;8(3): 361-366.

Brandy Schwarz, PT, DPT, EdD, MBA, Jane Oeffner, PT, DPT, MBA, and Haylie Miller, PhD

Brandy Schwarz, PT, DPT, EdD, MBA, is an associate professor in the Doctor of Physical Therapy Program at Hawaii Pacific University in Honolulu, HI. She can be reached at

Jane Oeffner, PT, DPT, MBA, an APTA Private Practice member and Impact editorial board member, is director, strategic clinical partnerships, at Widener University in Chester, PA. She can be reached at

Haylie Miller, PhD, is assistant professor of movement science and director of the Motor & Visual Development Laboratory at the University of Michigan School of Kinesiology. She can be reached at

Copyright © 2018, Private Practice Section of the American Physical Therapy Association. All Rights Reserved.

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