At Pines, Molly did not believe that Juliette’s size was the reason the clique excluded her. Juliette was the type of person whom you had to get to know in order to love, and some people didn’t look past their first impression. Juliette could say something completely benign, but her tone of voice could make it sound negative, and her blunt mannerisms could seem abrasive. Molly tried to persuade her to leave Pines and work for the agency instead; the agency would hire her back without question. She thought Juliette would be happier outside of Pines’ strange social bubble.

Molly had befriended Juliette when they were both new nurses. She came to know her as funny, outgoing, loving, kind, and generous. Juliette had a handful of close friends for whom she would do anything, and she often let them know how much she cared for them. She was much softer than people realized. If Molly were to play armchair psychologist, she would guess that Juliette was the way she was because she had a difficult childhood with an alcoholic mother who chose booze over her daughter. Molly believed Juliette had constructed a tough exterior to protect her feelings but at the same time was desperate for approval. It was a combination that unintentionally could come across as simultaneously harsh and needy.

The traits that nettled Juliette’s colleagues were some of the same characteristics that made her an excellent nurse. Juliette was fiercely loyal to her patients, standing up for them no matter the cost. Patients also appreciated that she was straightforward; she told them the real scoop and then did everything in her power to help make them better. It was a mistake to dismiss Juliette without giving her a chance.

Nurse on Nurse

Nurse-to-nurse bullying has been called “a silent epidemic,” “professional terrorism,” “insidious cannibalism,” and “the dirty little secret of nursing.” And it is crucial that the public learns about it—and hospitals eradicate it—because it affects patient care.

Workplace bullying can happen in any profession. It may come as more of a surprise from nurses, who are expected to be nurturing, empathetic, and caring. But the numbers are staggering. In the United States, a Journal of Nursing Management study found that 75 percent of nurses had been verbally abused by another nurse. It is so pervasive that even the American Nurses Association observed, in literature for its members, “Most of us could probably recount at least one story in which we as nurses encountered or witnessed workplace bullying.”

Nurse bullying is a significant problem in many corners of the world, in countries as diverse as England, Japan, Portugal, Finland, Australia, New Zealand, Ireland, Taiwan, Poland, Canada, and, a country with particularly high rates, Turkey. Worldwide, experts have estimated that one in three nurses quits her job because of it, and that bullying—not wages—is the major cause of a global critical nursing shortage. “We are not ‘angels in white,’” a Japanese nurse told me.

One of the most sobering statistics comes from Boston Medical Center’s director of nursing education and research, Martha Griffin, who found that nurse bullying is responsible for 60 percent of new nurses leaving their first jobs within six months and 20 percent leaving the profession entirely within three years. “It is destroying new nurses,” a Kansas nursing instructor told me. “I have five students who graduated less than a year ago who quit the nursing profession because of this behavior. It makes me very sad.”

It is tempting to attribute nurses’ hostility to their high-stakes work environment. But studies show that more nurses experience bullying from peers than do doctors or other healthcare staff. And nurses are verbally abused more frequently by each other than by patients, patients’ families, and physicians.

As distressing as it is for a nurse to be bullied by a physician, disruptive-behavior expert Alan Rosenstein reported that nurses are more upset by nurse-on-nurse “backbiting and unnecessary scrutiny.” As one nurse wrote him, “I expect that behavior from the surgeons, not the nurses, because I rely on them as my peers.”

In 1986, nursing professor Judith Meissner coined the phrase “nurses eat their young” as a call to action for nurses to stop ripping apart inexperienced coworkers. Nearly thirty years later, the practice festers, and while younger nurses may more often be targeted, no nurse is immune. As a Washington State Post-Anesthesia Care Unit nurse said, “There is a culture of treating other nurses like dirt.” The mystery is why this behavior continues.

Bullying among nurses goes by several names, including nurse-on-nurse hostility and lateral aggression. Rosenstein noted that nurse bullying is usually less direct than doctor bullying; it is more frequently behind-the-back “undermining, clique formation, and other types of passive-aggressive behaviors.” Indeed, a Research in Nursing & Health survey found that the most common bullying methods are, as Juliette experienced, “being given an unmanageable workload (71 percent) and being ignored or excluded (58 percent).” Nurse bullies have admitted to other researchers that their most frequent weapon was “to stop talking when others entered the room.”

According to Griffin, the five most frequent forms of lateral aggression among nurses, in order of frequency, are: “Nonverbal innuendo (raising of eyebrows, face-making), verbal affront (covert or overt, snide remarks, lack of openness, abrupt responses), undermining activities (turning away, not available), withholding information . . . , [and] sabotage (deliberately setting up a negative situation).”

Several other behaviors fall under the bullying umbrella, including when nurses gossip; ignore; condescend; belittle; humiliate; in-fight; unjustly criticize; fail to support a coworker because of dislike; give the silent treatment; make slurs or jokes about race, religion, appearance, demeanor, gender, or sexual orientation; or exclude a nurse from socializing. Bullying includes giving hints that a coworker should quit his or her job and excessively monitoring a peer’s work. Pennsylvania State professor Cheryl Dellasega has written that other common relationally aggressive behaviors include “manipulating or intimidating another nurse into doing something . . ., teasing another nurse about lack of skill or knowledge, running a smear campaign, or otherwise trying to get others to turn against a nurse.”

Verbal sexual harassment, unwanted touching, and physical intimidation also feature in the nurse bullying landscape, though less prominently. Canadian researcher Brian McKenna learned about incidents among nurses such as “sexual harassment with the promise of employment for compliance” and “colleagues ‘setting up’ a nurse to be exposed to sexually inappropriate behavior from patients.”

The Workplace Bullying Institute reported that nurses regularly call its help line. Founder Gary Namie has said, “The same people tasked with saving lives of strangers turn on their own if they don’t like someone’s makeup or the car she drives.” Nurses told me of coworkers they call “the Troll” or “Bitch on wheels.”

Studies support Molly’s observation that nurses “eat their fat;” Finnish researchers found that bullying victims have a higher body mass index than other nurses. But nurses of all shapes and ages shared stories about other nurses making fun of their clothes, gossiping, berating peers until they quit, and purposely withholding information to embarrass them in front of doctors and other nurses. A Virginia ER nurse said that when she was a new graduate, older nurses tried to humiliate her in front of the attending, took credit for her work, told physicians that she didn’t know what she was doing, and changed her charting to sabotage her career. A Michigan nurse manager’s director forced her to retire because she refused to bully staff like her predecessor did. Bullying behavior happens, the nurse said, “because when there is little support for nurses, they make themselves feel better by making someone else look worse.”