Bullying in the Emergency Department

Authors: Dan Darbyshire / Editor: Liz Herrieven, Charlotte Davies / Reviewer: Dan Darbyshire, Babajide Adenekan / Codes: SLO12, SLO7, SLO8, SLO9 / Published: 07/12/2021 / Reviewed: 07/03/2026

This is one of three RCEMLearning Blogs on Bullying, Undermining and Incivility in the Emergency Department (ED). Originally published in 2022, these have been updated for 2026.

Introduction

Emergency Medicine prides itself on a culture of teamwork, a flattened hierarchy, and open communication on the shop floor. These values are essential in a speciality that manages high acuity, time‑critical decision‑making, and significant emotional labour. However, despite these ideals, bullying and harassment continue to be reported by staff working in emergency departments across the UK.

The General Medical Council (GMC), in its Dignity at Work guidance, makes it clear that everyone has the right to be treated with respect and dignity at work. Bullying undermines this principle, causing harm not only to individuals but also to teams, departments, and ultimately to patient safety.

Why bullying matters in Emergency Medicine

Emergency Medicine consistently reports high workload intensity and a high risk of burnout. The GMC National Training Survey 2025 highlighted that a significant proportion of emergency medicine trainees felt apprehensive, hesitant, or uncomfortable raising concerns with supervising clinicians about patient care. This reluctance was linked to unhealthy workplace cultures, including bullying and harassment.

Similarly, the EMTA 2024 survey found that most reported bullying was perpetrated by individuals working day‑to‑day in the emergency department, with a smaller but notable proportion coming from outside the department. When those expected to provide supervision, mentorship, and support contribute to a hostile environment, the impact on learning, confidence, and well-being can be profound.

What do we mean by bullying?

The Anti‑Bullying Alliance defines bullying as repeated and intentional behaviour that causes harm, where there is an imbalance of power. Bullying may be verbal, psychological, or physical.

Fig.1 – RCEMLearning infographic

While harassment is unlawful under the Equality Act 2010, bullying itself often falls into a grey legal area. Nonetheless, bullying is fundamentally incompatible with professional values in healthcare and directly contradicts our duty to “do no harm”. Employers may still face significant legal and financial consequences through claims related to mental ill health or constructive dismissal. Examples of bullying behaviours include:

• Spreading malicious rumours
• Persistent undermining or intimidation
• Unfair or inconsistent treatment
• Denial of training or development opportunities

Harassment occurs when unwanted behaviour is linked to a protected characteristic under the Equality Act 2010, including age, sex, disability, race, religion, sexual orientation, pregnancy and maternity, and gender reassignment.

Bullying in the emergency department

In a speciality that promotes a flattened hierarchy, bullying may be subtle and difficult to identify. It can manifest as repeated micro‑aggressions, exclusion from learning opportunities, or the withdrawal of support without transparent discussion or objective justification.

Bullying in medicine is not a new phenomenon. In 2019, the British Medical Association reported that two in five junior doctors considered bullying and harassment a problem in their workplace, with one in five experiencing it directly. More recent GMC reports continue to highlight how unhealthy workplace cultures can compromise staff wellbeing and patient safety.

The high‑pressure environment of the emergency department may allow bullying behaviours to go unchallenged or become normalised, particularly when service pressures are intense and staffing is stretched.

The silent impact

Bullying is often hidden and under-reported. The consequences, however, are significant. Poor communication, reduced teamwork, and fear of speaking up all increase the risk to patient safety. NHS Staff Survey data show that bullying is experienced from both managers and colleagues, reinforcing that this is a systemic issue rather than isolated incidents.

On an individual level, bullying is associated with anxiety, depression, reduced confidence, disengagement, and social isolation. These effects frequently extend beyond work into home and family life.

At the departmental and organisational levels, bullying contributes to low morale, increased sickness absence, staff turnover, and reduced efficiency, all of which ultimately affect patient care.

Fig. 2 – Infographic courtesy of the author

Calling it out and taking action

Despite national and local initiatives, bullying persists within NHS organisations. Addressing it requires action at individual, departmental, and organisational levels.

If you witness or experience bullying, consider the following options:

• Access free online CPD from the Anti‑Bullying Alliance on recognising and responding to bullying
• Contact your Trust’s Freedom to Speak Up Guardian for confidential advice
• Speak with your Clinical or Educational Supervisor, if appropriate
  Follow your Trust’s bullying and harassment policy, which outlines informal and formal routes for resolution

Organisations and directorates must respond promptly to concerns, ensure timely wellbeing conversations, and provide regular training on professional behaviour and its impact. Clear policies that promote psychological safety and a positive workplace culture are essential.

A cultural challenge for Emergency Medicine

Emergency Medicine trainees continue to report disproportionately high levels of bullying. Whether this reflects systemic pressure, cultural norms, or our own expectations remains unclear. What is clear is that ownership of the problem is essential.

RCEM has recognised this challenge and established an anti‑bullying task and finish group to better understand the issue and drive meaningful change. Central to this work is acknowledging that bullying exists and committing to honest, sometimes uncomfortable, conversations in every emergency department.

The RCEM RespectED campaign and its accompanying video resource aim to support these conversations and to encourage reflection and action at all levels.

Conclusion

Bullying in the emergency department is neither inevitable nor acceptable. Creating a culture of respect, kindness, and psychological safety is a shared responsibility. By recognising the problem, supporting one another, and using available resources, we can protect staff wellbeing, strengthen teams, and improve patient care.

Editor’s Note: Bullying is one of those difficult topics where the label is attributed by the recipient, whether according to a definition or not. I’ve seen it a few times where negative feedback has been given to a doctor, and they’ve responded with a bullying allegation which is difficult for everyone and is why educationalists ask for regular and detailed documentation of such feedback. But bullying does exist, and hopefully this blog has provided you with some discussion and consideration points. 

Useful resources:

• Anti-Bullying Alliance
• RCEM RespectED campaign
• GMC – Policy document: Dignity at Work. 
• GMC – National Training Survey 2025 results 
• RCEM – Position statement: Anti-bullying and harassment. RCEM, 2019.
• BMA – Policy report: Bullying and harassment:
  how to address it and create a supportive and inclusive culture. BMA , 2018.
• NHS Employers – Tackling bullying in the NHS infographic. NHS, 2025.
• EMTA 2024 Survey