Conversations About Workplace Abuse and Our Glossary of Violence

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 bullying behaviors are taking their toll on quality, safety and job satisfaction.

Not long ago, I attended a meeting of Holistic Health Nurses 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 discussed my work, which includes speaking, training, coaching and writing about respectful communication and positive workplace cultures. 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 inspired me to compile and share this list of common terms I’ve come across over the past few years.

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.”

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.

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 that 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.

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, go to to learn more about this form of abuse from Patricia Evans, a pioneer in studying and writing about verbal abuse.

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

I believe that talking, listening and reflecting about abusive behavior will help us to create and maintain workplace cultures where respectful behavior is the norm. Not easy, but a vast potential of positive effects on every single problem we face in healthcare!

By Beth Boynton, RN, MS