Group of nurses and doctor talk about nurse bullying at a hospital

Nursing can be a very challenging profession. It often has long hours and, at times, harrowing situations. These circumstances can lead to the formation of deep bonds between nurses that may be even stronger than familial bonds. Often, these bonds can be good, but they can also lead to some tough situations in the nursing profession.  

The negativity surrounding bonds between nurses is centered on the issue of nurse cliques.  When the staff’s focus is on another topic or concern, there is a greater risk of error in patient care, less concentration on nursing duties, and less time delivering quality patient care. In short, where there are nurse cliques, there is risk. 


Two female nurses discuss bullying at work

It's important for nurse managers to understand how this kind of nurse bullying can have an impact on their staff retention, working environment, and patient care. Recognizing clique formation and taking swift action will help nursing staff feel valued and supported.  

This article will help nurse managers understand how to dissolve clique behavior, implement open communication streams, and introduce workforce management solutions that can make a world of difference. 

What is a clique? 

Before we begin, it’s important to understand what exactly is a clique. Cliques in nursing are often an exclusive, tight-knit group that has bonded over shared situations and/or circumstances that are closed off to the possibility of new joiners.  

Often times these cliques can make it challenging for new nurse staff, per diem nurses, and even travel nurses to feel accepted or included in a new unit. This can lead to tensions among the nurse and staff that is not conducive to quality patient care.  

It’s believed that clique behavior is widely accepted in the workplace. And when working environments include high stress, varying levels of training, frequent organizational change, and high patient volumes, cliques form and quickly destroy the working environment.  

The Impacts of Nurse Bullying 

Nurses often form cliques to gain a sense of belonging or in reaction to frustration and stress. But what can this mean for the healthcare facility they work in? 

Uphill Battle for Nurse Retention 

Turnover in hospitals and skilled nursing facilities is at an astounding high. The 2022 Nursing Solutions, Inc. National Healthcare Retention and Staffing report found that since 2021, the RN turnover rate increased by 8.4% and currently stands at 27.1%. Nurse retention and recruitment is a growing and costly problem, which impacts hospital margins profoundly and, according to the report, “Each percent change in RN turnover will cost/save the average hospital an additional $262,300 [per year].” Nurse cliques can have a serious impact on retention and further contribute to the costly nature of their existence in nursing teams. Nurses facing bullying within their unit often have physical symptoms that impact morale and work quality. These experiences with nurse bullying can lead to overall job dissatisfaction, stress, depression, and anxiety. When faced with this environment, nurses leave their jobs or the profession entirely.  

Inadequate Patient Care  

Nursing turnover can also have a negative impact on patient care ranging from loss of continuity of care to simple errors due to stress. When a young nurse is targeted by a clique, they may avoid guidance or assistance from nurses in the clique resulting in potential error. Furthermore, substandard care provided by clique insiders may go unquestioned, or their unsafe practices adopted by those trying to gain admittance to the clique. When the focus is taken off the patient and put onto the dynamics of workplace tensions, nurses are unable to work as a team to deliver the highest quality patient care. 

For nurse managers whose success is measured by turnover rates, callouts, overtime, and budget management, it’s critical to create a clique-free environment.  

Tips to Overcome Challenges of Nurse Cliques   

Nurse managers looking to overcome the challenges of nurse bullying and cliques should consider the following tips: 

  1. Implement Code of Conduct- Whether it’s a code of conduct or a list of guidelines for staff, ensure that the standard is set early on and have something tangible to refer back to should an incident occur.  

  2. Set the Cultural Tone for the Unit- Eventually, the code of conduct will be forgotten, so it’s important that through every aspect of your leadership that you set the tone for how to operate as a successful team and treat others with respect.    

  3. Identify Behaviors- Be sure to investigate the formation of cliques early on, but ensure they align with the identified behaviors of a clique. Are they merely a close group of friends or are they taking things too far?  

  4. Address Unwanted Behaviors- It is crucial to confront unwanted behaviors as soon as possible. The longer tensions have to grow, the more difficult it becomes to course-correct and get back to a strong work environment.  

  5. Be Visible- As the nurse manager, you should be accessible and visible to your nurse staff so you can witness team dynamics first-hand and be there to witness and address unwanted behaviors quickly.  

With the high turnover rates and risk to patient care, it’s no wonder why healthcare organizations seek to thwart the emergence of nursing cliques at work. Often times, the temporary staff of travel nurses and per diem nurses bear the brunt of hostility from nurse cliques. Because they are often paid more and are not long-term, they are considered “outsiders” and have to work harder to seek acceptance or help. 

However, with workforce solutions like ShiftMed, nurses are repeat, per diem workers at most healthcare facilities and become engrained into the fabric of the nursing staff. Our innovative platform seamlessly integrates with existing scheduling systems so that health systems, hospitals, and skilled nursing facilities can leverage their flex employees with our local healthcare professionals to reliably fill shifts. We provide the tools and support healthcare organizations need to optimize labor spending and strengthen recruitment and retention efforts.