Dealing with workplace bullying: the occupational health nurse’s role

stop bullying

OH nurses have a role in combating workplace bullying, but they can also be a victim of it. What is the best approach to the problem? Caroline Whittaker, Lyndon Davies and Glyn Morris investigate.

Workforce bullying can be overt, such as shouting or swearing, or it can be subtle. This could include: repeated comments that seek to undermine; deliberate exclusion from meetings; being taken out of important decision making; being added to email lists as an after thought; receiving constant unwarranted criticism; and, for managers, having their staff reporting directly to another, thus undermining their authority.

Workplace bullying has a different meaning for different people, and there are many definitions. The overall theme is always the misuse of power or position (Royal College of Nursing, 2005a,b). It is important to understand the concept of attribution when addressing the issue of bullying.

Kelley (1967), in his “covariation model”, suggests that the question to ask when accurately understanding a situation is: should the action of the individual be attributed to an internal characteristic of the person involved, or an external influence such as the situation or the environment? In asking this question we begin to understand whether certain people are hardwired to be bullied or bullies.

McLeod (2010) refers to how we attach meaning to others’ behaviour or our own as attribution theory. For example, is someone angry because they are bad tempered or because something bad happened? It is easy for onlookers to make the mistake known in psychological and sociological study as fundamental attribution error.

Ross (1977) suggests that evaluations of incidents are the product of intuitive tendencies to exaggerate the role of personal factors, while underestimating environmental influences. In other words, we blame the individual and not the situation.

A classic example is the bullied child, when faced with a bigger, stronger nemesis, being told to stand up for himself or to take on the biggest and the baddest when targeted by a crowd.

The child who “crumbles” under the weight of this situation is then blamed for letting the bullies beat him. Another example is when there is a group of five individuals, one assumes the role of bully and one assumes the role of victim. This leaves three roles for the remaining people. Do they stand up and be counted or do they seek security from future victimisation of themselves by the aggressor?

If they choose the latter option then we would be making a “fundamental attribution error” if we were to criticise their choice. Choosing to support the bully might be the easier option.

In legal terms, bullying is not covered by specific legislation, unlike harassment which is covered by legislation (Mistry and Latoo, 2009), in particular the Equality Act.

However, it is an increasing problem within the workplace. McAvoy and Murtagh (2003) suggest that workplace bullying affects up to 50% of the UK workforce during their working life. This has a resultant cost to society of £4.55 billion for work­-related stress – of which of £682.5 million per annum is directly associated with workplace bullying (Giga et al, 2008).

When the figures for absenteeism, staff turnover and reduced productivity are included, the total cost for organisations in the UK is estimated at upwards of £13.75 billion (Giga et al, 2008).

Blaug et al (2007) propose that workers report more stress in the public sector than the private sector, of which bullying is increasingly cited as a cause.

This correlates with Fevre et al’s (2009) findings, which indicate that bullying is more prevalent in the public sector rather than the private sector; however, this is not to say that bullying is not a problem in the private sector. There may be varying factors between the cultures of these organisations that may influence the reporting and recording of such occurrences. It is possible that staff within the private sector are more reluctant to raise their concerns for fear of losing their job.

Bullying behaviour in some cultures can be seen as normal “office banter” with the perpetrator not realising the affects of their actions on others. “Healthy banter” can help maintain morale, good spirits and team cohesion, but there is a fine line between this and what can cause offence or be perceived as offensive.

On this point, significant work has been achieved over recent years by many organisations on equality and diversity training, and dignity at work policies, to raise awareness that bullying is unacceptable.

Basic core values of professionalism, respect for others and the moral courage to challenge unacceptable behaviour is paramount in any working environment and a combination of these factors will help achieve a reduction in bullying at work. The two anonymised case studies (see box 1 and box 2) demonstrate the effect of bullying.

Role of an OH nurse in allegations of bullying

The OH nurse may have to become involved in resolving bullying issues at work through:

  • sickness absence consultations where the nurse is informed by the employee, or by the manager making the referral, that the reason for the sickness is related to bullying at work;
  • self­-request consultations where an employee approaches the nurse for advice and subsequently discloses a bullying at work issue;
  • identification of a trend in a particular work area after seeing a number of cases, where the nurse may deem it necessary to highlight concerns to management;
  • and involvement in dignity at work policy development.

If an OH nurse is made aware of bullying at work, then there are responsibilities that they should consider in terms of supporting the employee.

The nurse in this context may act as advocate to the employee and may also support the organisation in delivering their duty of care towards that individual while the matter is being addressed.

The OH nurse should be familiar with the organisation’s policy on bullying and aware of how to respond appropriately. Signposting the individual to relevant sources of support and intervention may help facilitate a prompt resolution.

While OH nurses may become involved in allegations of bullying at work, it is fair to say that in the majority of situations, the issue is a management one and not medical. One must be careful not to inappropriately “medicalise” interpersonal relationship issues and allegations of bullying at work.

The reality is that the medicalisation of such matters does occur, particularly when the employee seeks advice from the GP for stress-related symptoms and is then issued a fit note, or is commenced on medication.

The OH nurse’s role is to reassure people that stress symptoms in these circumstances are “normal” reactions and not a sign of significant psychological illness. However, there will be times when the effects of bullying are beyond the range of normal reactions and the individual shows signs of a recognised health condition, such as anxiety or depression, requiring medical intervention.

Some organisations have access to counselling, cognitive behavioural therapy or mediation services that will offer the appropriate intervention to support employees in these circumstances.

It is important to recognise that long-­term sickness absence is counterproductive to an individual’s confidence and psychological wellbeing. Reduced work activity, loss of peer support and contact with colleagues and the removal from the work environment does not help to address their concerns.

A way forward is needed whereby the employee’s attendance at work is maintained without risk of further bullying. Solutions include a temporary change of type of work or location.

Prompt intervention to avoid a protracted situation is in everyone’s interests and the OH nurse may be asked to provide an opinion on an employee’s fitness to be involved in the discussions. This is a difficult area, especially if a stressed employee is reluctant to meet with management.

The employee should be advised that delaying essential discussions to resolve the matter could be counter productive. The discomfort of attending any meeting compared with the alternative of a protracted and unresolved matter is probably the lesser of the two evils. The facilitation of early constructive dialogue with an appropriate representative from management is likely to be beneficial.

The involvement of an HR or trade union representative helps to ensure a safe environment for the employee to meet with management. A problem in facilitating constructive discussion arises where the perceived perpetrator is the direct line manager – in that case the matter is best referred to a higher organisational level.

The OH nurse must maintain a degree of impartiality and be mindful that there may be two sides to the story. It is not the role of the OH nurse to play the part of judge and jury. Care should be taken to ensure that OH’s reports to management avoid being seen as judgmental towards management or a specific individual, or the organisation as a whole.

Phrases such as “the individual perceives that he is being bullied by his line manager” are likely to be better received than “the individual is being bullied by his manager”. The latter will only risk accusations by management against the OH professional of non-impartiality.

The OH nurse must therefore be aware that other factors may influence an individual’s perception of the situation and that the information presented during a consultation could offer only a one-sided account based on the individual’s perception. One must also be mindful of the possibility that some allegations may be unfounded or based on malicious intent.

The Health and Safety Executive Management Standards on stress at work are helpful in these cases. The stress risk assessment approach is a useful method on which to base the necessary discussion.

For allegations of bullying at work, the “relationships” component of the stress risk assessment is relevant but an individual may have been subjected to unreasonable work demands, or have been undermined in their role.

A potentially difficult situation occurs when the individual discloses that they perceive they are being bullied at work, but refuses to give consent for the OH nurse to share this information with management. In such circumstances, the OH nurse should check that the individual is familiar with the organisation’s policy on bullying and is aware of all the options available to them.

The individual should be advised that it is very difficult to address the situation if they refuse to allow their concerns to be shared with management. The OH nurse can help with referral to counselling services or offer to maintain contact.

In the event that the situation is posing a significant risk to the individual, the OH nurse may have to decide whether to revisit the issue of consent to disclose or, ultimately, breach confidentiality in the interests of the individual.

Before taking such action, OH nurses are advised to seek further advice from a senior OH adviser or an OH physician.

OH nurses may be vulnerable to bullying

OH nurses often work in isolation, where managers do not appreciate a nurse’s professional obligations, their impartiality and their role in supporting employees, who technically are their patients. This can lead to conflict between the OH nurse and the organisation.

For OH nurses, this often takes the form of a continual clash with managers and HR relating to access to medical records. The OH nurse can feel under pressure with confidentiality issues and this leads to feeling bullied or intimidated.

The situation is made worse when non-medical individuals within an organisation fail to appreciate or respect the nurse’s duty of confidentiality and their responsibility to maintain the safe custody of health records.

Acting in the role of advocate to the employee can often be viewed by some managers as the wrong stance to take, where attention is drawn to the nurse for seemingly “siding with the employee”, which could leave the nurse in a vulnerable position to receive yet further unwarranted criticism.

Another example would be where a nurse’s OH report is not favourable to either the employer or the employee. This can lead to intense scrutiny of the nurse that in some cases has been known to develop into unfair persecution with attempts to tarnish their credibility and reputation. Hopefully, such circumstances are rare, but where they occur they have to be challenged by the application of moral courage, and the nurse needs to seek advice and support from their professional body.


We all need to be aware how our actions can be perceived by others and mindful that pressures on all of us can, at times, lead us to behave out of character. Some individuals may genuinely be horrified if they learnt that their behaviour was resulting in others feeling bullied in the workplace.

Other individuals may naturally have controlling personalities. Education of managers and support from a clear organisational policy are helpful measures in addressing and eradicating bullying at work.

We all have a personal responsibility to ensure appropriate behaviour at work and to challenge unacceptable behaviour where we witness it. It is important that individuals who perceive that they are being bullied have the confidence to speak out without fear of further harassment or discrimination. Organisations should have robust systems in place to deal with any of these situations promptly and appropriately.

Finally, perpetrators need to be made aware of the damage that their behaviour can have on others and that they must be held to account. They should not be moved sideways into another role or promoted; they should take responsibility for their actions.


Acas (2014). “A guide for managers and employers: Bullying and harassment at work”. Available from Acas.

Blaug R, Kenyon A, Lekhi R (2007). “Stress at work”. London: The Work Foundation.

CIPD (2005). “Bullying at work: beyond policies to a culture of respect”.

Einarsen S, Raknes BI, Matthiesen SB, Hellesoy OH (1994). “Harassment and serious interpersonal conflicts at work”. European Work and Organizational Psychologist; vol.4; Issue 4, 1994.

Einarsen S, Hoel H, Zapf D, Cooper CL (2003). “The concept of bullying at work: The European tradition”. In Einarsen S, Hoel H, Zapf D, Cooper CL (Eds), “Bullying and emotional abuse in the workplace: International perspectives in research and practice”. London; Taylor & Francis; pp.3-30.

Giga S, Hoel H, Lewis D (2008). “The costs of workplace bullying”. Research commissioned by the Dignity at Work Partnership: A partnership project funded jointly by Unite and the Department for Business, Enterprise and Regulatory Reform. University of Manchester.

Kelley HH (1967). “Attribution theory in social psychology”. In D Levine (ed), Nebraska Symposium on Motivation (vol.15, pp.192-238). Lincoln: University of Nebraska Press.

Lee D (2000). “An analysis of workplace bullying in the UK”. University of Derby.

McAvoy B, Murtagh J (2003). “Workplace bullying the silent epidemic”. British Medical Journal; 326: pp.776-777.

McLeod SA (2010). “Attribution theory”. Simply Psychology website.

Mistry M, Latoo J (2009). “Bullying: a growing workplace menace”. British Medical Journal; 2 (1); pp.23-26.

Ross L (1977). “The intuitive psychologist and his shortcomings”. In L Berkowitz (Ed), Advances in Experimental Social Psychology (vol.10, pp.173-220). New York: Academic.

Royal College of Nursing (2005a). “Dealing with bullying and harassment at work: guide for RCN members”. London: RCN.

Royal College of Nursing (2005b). “Bullying and harassment at work: a good practice guide for RCN negotiators and health care managers”. London: RCN.

Case Study 1 – How do you know you are being bullied?

I didn’t know I was being bullied, I just knew that I was unhappy in my job. My boss didn’t like me much and was rude to me at every opportunity, belittling me in front of my colleagues. I worked for a large well-known professional organisation and this all happened 20 years ago, but the memory of that time is as clear to me today as it was then.

The nature of my work meant that I could keep out of his way most of the time, and colleagues would deal with him directly so I wouldn’t have to. At meetings I mostly kept quiet but when I did speak he either ignored me or said things like “be quiet, you are just a barrack-room lawyer” in a nasty and accusing tone. After about four years of this it all came to a head when we were at a large management meeting. His superiors were present, as well as about 12 other people. I was asked for my opinion about something by the meeting chairman, and when I gave my reply my boss leant forward, pointed a finger at me and said threateningly: “You, you, I will get you outside afterward.”

There was a stony silence in the room for several seconds. I could take no more and left the meeting in tears. The HR director saw me later and asked me to go home and write down everything I could remember. It took me the whole weekend to compile my dossier of all that had happened in the previous four years. It was then I realised I had been bullied for all that time.

Name and address supplied

Case Study 2 – I knew I was being bullied

I was working in a senior management position and found myself on the receiving end of bullying behaviour by my immediate boss. My confidence and self-esteem fell to an all-time low, so much so, that I developed an acute stressor reaction with associated physical symptoms.

These feelings became so intense that the very sight of her or smell of her perfume sent me into a classic “fight or flight” mode. I felt very angry with her and myself for allowing this to happen. But I was in a position where to have fought back could have been disruptive for the working environment and for my staff, and I put their needs and that of the organisation before mine. We no longer work together but I can never forgive her.

Name and address supplied.


About Caroline Whittaker, Lyndon Davies and Glyn Morris

Caroline Whittaker is academic manager at the University of South Wales, Lyndon Davies is OH nurse manager at Cardiff Council, and Glyn Morris MSc is managing director of Mind Health Development.
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