Effects of Workplace Bullying on Employees’ Mental Health and Well-Being Among Hospital Staff in Ho, Volta Region of Ghana

Abstract

Introduction

Workplace bullying is one of the serious workplace challenges that has recently gained much consideration in organizational research and management due to the rise in its prevalence and tremendous negative impacts on the mental health and general well-being of employees. Nevertheless, it is a subject that has been given less attention in many developing countries, including Ghana. As a result, there is limited information on the magnitude of the effects of workplace bullying on the well-being of workers and their professional performance.

Objective

This study explored the effects of workplace bullying on employees’ mental health and well-being among hospital staff in Ho Teaching Hospital and Ho Municipal Hospital in the Volta Region of Ghana.

Methods

The study employed a qualitative phenomenological descriptive study design to explore the effect of workplace bullying among healthcare workers, whereby 24 participants were recruited purposively to reach saturation. Interview guides were used to collect data, which was audio recorded and transcribed verbatim. The data underwent thematic analysis.

Result

This study's findings revealed that participants experienced defamation of character, exclusion, and seasons of payback. These have affected their health as some fell ill repeatedly, while others grew lean and tired, as well as became disturbed emotionally. Participants fall on confronting the bully, setting boundaries, leaning on friends, and reporting the bully as coping mechanisms.

Conclusion

The various effects of workplace bullying among healthcare workers, as highlighted by the study, need urgent proactive measures to combat workplace bullying in healthcare settings. Addressing workplace bullying not only benefits individual well-being but also enhances organizational performance and the quality of patient care.

Introduction

Workplace bullying among healthcare workers is a global, pervasive phenomenon with potentially serious consequences on both the healthcare workers and the quality of treatment provided to their patients (Karatuna et al., 2020; Österman & Boström, 2022; Rahm et al., 2019). It encompasses repeated, hostile behaviors such as verbal abuse, intimidation, exclusion, or sabotage that undermine an individual's dignity and professional performance (Chatziioannidis et al., 2018; Sansone & Sansone, 2015). While workplace bullying occurs worldwide, its prevalence and impact are often underestimated, particularly in developing countries where hierarchical work cultures and weak institutional frameworks normalize such behaviors (Darko et al., 2019; Pheko et al., 2017). In Ghana, workplace bullying is recognized as a significant challenge in healthcare settings, yet comprehensive research exploring its effects on workers’ experiences, emotions, and coping mechanisms remains limited.

Given its widespread nature and consequences, understanding workplace bullying in healthcare is critical. Bullying not only affects the psychological and physical well-being of healthcare workers but also compromises teamwork, job satisfaction, and the quality of patient care (Lever et al., 2019; White & Saran, 2022). The present study seeks to explore the experiences, consequences, and coping strategies of healthcare workers who have encountered workplace bullying in selected hospitals in the Ho Municipality, Ghana.

Literature Review

Globally, workplace bullying among healthcare workers is highly prevalent. The World Health Organization reports that 39.5% of healthcare workers in Brazil, 52% in South Africa, 40.9% in Lebanon, and nearly 67% in Australia have experienced bullying (Al Omar et al., 2019; Al-Ghareeb & Al-Wotayan, 2021). Other studies indicate prevalence rates of 33.4% in Saudi Arabia and 39.1–58.9% in Cyprus and Hong Kong (Chang, 2021). In Africa, reported rates range widely from 9% to 77.8%, reflecting variations in reporting practices and cultural acceptance of hierarchical authority (Ciby & Raya, 2015; Cunniff & Mostert, 2012). In Ghana, empirical studies suggest that workplace bullying is common but often underreported due to normalization and lack of formal reporting mechanisms (Amoo et al., 2021; Boafo et al., 2016; Doe, 2016)

Bullying in healthcare can take multiple forms, including verbal abuse, humiliation, threats, social exclusion, unreasonable workloads, and sabotage of work tasks (Chatziioannidis et al., 2018; Sansone & Sansone, 2015). Subtle forms of bullying, such as withholding information or resources, may go unrecognized, preventing victims from reporting incidents and perpetuating the cycle of abuse (Sepler, 2015). In Ghanaian healthcare settings, studies have documented verbal abuse, intimidation, exclusion, and humiliation as the most common forms of bullying experienced by workers (Amoo et al., 2021; Doe, 2016).

Workplace bullying arises from a combination of psychosocial, cultural, and individual factors. Psychosocial factors include high-stress environments, power disparities, and inadequate support systems (Yun & Kang, 2018). Cultural factors involve workplace norms, hierarchical expectations, and communication styles (Tsuno & Tabuchi, 2022). Individual factors pertain to a worker's vulnerability, coping mechanisms, and personality traits (Al-Ghabeesh & Qattom, 2019). The interplay of these factors often results in bullying becoming a normalized experience, particularly for less privileged or junior staff members (Al-Ghabeesh & Qattom, 2019; Yun & Kang, 2018).

The impact of workplace bullying extends to both individuals and organizations. For healthcare workers, it has been linked to stress, burnout, absenteeism, psychological distress, and physical illness (Awai et al., 2021; White & Saran, 2022). For healthcare organizations, bullying undermines teamwork, communication, and morale, leading to reduced job satisfaction and compromised quality of care (Lever et al., 2019). Studies indicate that bullying can increase the risk of medical errors, negatively affect patient outcomes, and impair overall healthcare delivery (Karatuna et al., 2020; Rahm et al., 2019).

Previous research in Ghana has examined workplace bullying in specific healthcare professions and settings. Duah et al. (2025) focused exclusively on medical laboratory professionals, Tawiah et al. (2024) assessed prevalence, risk factors, and psychological consequences, and Agbornu et al. (2022) evaluated the impact of workplace violence on nurses’ quality of care using quantitative methods. While these studies highlight the presence and negative effects of workplace bullying, they fail to capture the lived experiences, emotional implications, and coping strategies of affected healthcare workers across different hospital settings.

Although prior studies provide valuable insights into prevalence, forms, and consequences of bullying, there is limited qualitative research in Ghana exploring healthcare workers’ lived experiences, coping mechanisms, and emotional responses to bullying. Understanding these dimensions is critical for developing effective interventions and workplace policies to mitigate bullying and protect the well-being of healthcare staff.

Methods

Design

This study employed a qualitative phenomenological design. Phenomenological design is a label suitable for studies that are descriptive in nature, revealing the “essence” of any phenomenon under investigation, and particularly acceptable for examining healthcare-related phenomena (Alhazmi & Kaufmann, 2022). This research design allowed researchers to delve into the depths of physicians, Nurses, Midwives, and cleaners’ experiences of workplace bullying from their colleagues and the associated effects it has on them.

Study Area

This study was conducted in selected public hospitals in the Ho Municipality. These hospitals have been in operation for several years and offer healthcare services to all categories of patients in the Volta region, other regions in Ghana, as well as clients from neighboring countries such as Benin, Nigeria, and Togo (Dartey et al., 2023). The hospitals include a diverse range of healthcare workers, making them well-suited for the study.

Sample Size and Sample Population

The study recruited 24 participants through purposive and snowball sampling from the selected hospitals until data saturation was reached. This is the point in data collection when new data gathered by conducting further interviews no longer brings additional insights to the research questions (Saunders et al., 2018). Eligible participants included physicians, nurses, midwives, and cleaners employed for at least six months and who self-reported experiences of bullying. They were identified with the help of unit heads, who distributed information sheets and verbally informed staff about the study. Snowball referrals were used to reach additional participants. Allied health professionals were excluded from the study in order to focus on core clinical staff, while cleaners were included due to their frequent interaction with clinical teams and vulnerability to power imbalances. All interviews were conducted face-to-face in private spaces within the hospitals at times convenient to participants. All interviews were conducted face-to-face in private spaces within the hospitals at times convenient to participants using the interview guide (see Supplementary file).

Data Collection Procedure and Analysis

All ethical procedures were observed before data collection. In-depth, face-to-face interviews were conducted with eligible healthcare workers in April 2024 using a semistructured interview guide that included open- and closed-ended questions, with probes used where necessary. Each interview lasted 40–45 min, was audio-recorded, and transcribed verbatim. In addition to the recordings, the researcher kept a field note diary throughout the data collection process. These notes captured contextual details, nonverbal cues, and the researcher's immediate reflections after each interview. The diary served as a reflexive tool, enabling the researcher to document personal assumptions, emotional responses, and emerging insights, which were revisited throughout the analytic process (Dartey et al., 2022). During analysis, thematic content analysis was conducted using Colaizzi's seven-step framework, and reflexive notes were used to deepen interpretation, enhance sensitivity to participants’ lived experiences, and ensure transparency in decision-making as described by Morrow and colleagues to formulate key themes from the data (Morrow et al., 2015). To minimize the influence of bias, all the members of the research team reviewed each step independently, as listed by (Wiggins & Stevens, 2020), and all differences of opinion were discussed until a clear consensus was reached.

Rigor/Trustworthiness

Implementing the principles of authenticity, reliability, confirmability, and transferability ensured the data's trustworthiness (Wiggins & Stevens, 2020). To ensure confirmability and authenticity, member checking was employed by returning transcripts and descriptive summaries to participants to verify the accuracy of the data. All participants were interviewed using the same semistructured interview manual, which ensured consistency in the questions posed and allowed for comparability across responses. The guide was developed based on existing literature and expert input, and it was pilot-tested to ensure clarity and appropriateness, guarantee reliability. A detailed explanation of the research method has been provided to replicate the analysis in a similar environment by other researchers. Peer debriefing with experienced qualitative researchers was conducted to critically reflect on emerging themes, address potential researcher biases, and ensure the credibility and trustworthiness of the findings. Transferability was confirmed by using a detailed description and documentation of all phases of the research process so that a similar study can be carried out by other researchers (Maher et al., 2018).

Results

Characteristics of the Study Participants

A total of 24 study participants were included in this study. The majority (62.5%) were females. Nurses made up the majority (45.8%) of the participants. The majority (66.7%) of participants were married; 75.0% of participants were Christians, as shown in Table 1.

Table 1.

Sociodemographic Characteristics of Participants.

Variable	Frequency	Percentage
Sex
Female	15	62.5%
Male	9	37.5%
Age
25–30	7	29.1%
31–35	6	25%
36–40	5	20.8%
41–45	6	28%
Category of health worker
Physician	5	20.8%
Nurse	11	45.8%
Midwife	6	25%
Cleaner	2	8.3%
Marital status
Not married	16	66.7%
Married	8	33.3%
Religion
Christianity	16	75%
Islam	8	25%
Traditional	0	0
Total	24	100

Field Survey, (2024).

Identified Themes

Thematic content analysis revealed four prominent themes. Theme A explored the specific bullying experiences among healthcare workers. Theme B delved into the result of workplace bullying among healthcare workers. Theme C delved into the individual coping mechanisms, while Theme D delved into the health system support for healthcare workers experiencing bullying. A total of 11 subthemes were identified from the data, as shown in Table 2.

Table 2.

Identified Themes and Subthemes.

Theme	Subthemes
Theme A: Hostility in Healthcare System	1. Defamation of Character 2. Exclusion 3. Retaliatory behaviors
Theme B: Psychosocial and Professional Impact of Workplace Bullying	1. Ill Health 2. Emotional distress 3. Strained Relationships 4. Decreased Job Satisfaction and Productivity
Theme C: Individual Coping Responses to Bullying	1. Confronting the Bully 2. Leaning on Friends and Family 3. Setting Boundaries
Theme D: Meaningful Institutional Support	1. Confidential Reporting Systems

Theme A1. Different Experiences of Workplace Bullying

This theme reflects how bullying manifests as structured power dynamics, subtle control, and interpersonal domination rather than isolated behaviors. Participants’ accounts reveal diverse forms of bullying within their workplaces, which are presented in the subthemes: defamation of character, exclusion, and retaliatory behaviors. These subthemes illustrate the ways in which hierarchical pressures and interpersonal conflicts create a hostile work environment for healthcare staff.

Subtheme 1: Defamation of Character

Participants informed of how they were bullied in terms of propagating a wrong identity of them to other people. This bullying has tarnished the image of some participants. The following quotes represent their voices:

“I had an issue with someone who was my superior. Even though I apologized, he was constantly calling me names in front of my colleagues or other staff members. He considered me disrespectful and wanted every other person to consider me as such. Frequently scolding me for the same offense and tagging me with unpleasant names nearly caused me to stop work. I became quiet at work and did not want to involve myself in anything aside from my duties.” (Participant 13, Male)

“It is a usual thing here for senior staff to talk anyhow to their juniors, intimidating them now and then just to see how they will react. A senior staff member can base on an issue and insult even your family members, and expect you not to react to the insult. If you do, they will consider you bad, and begin spreading your bad side to fellow colleagues. They paint you all black to others. It is very unhealthy.” (Participant 12, Female)

Subtheme 2: Exclusion

With a comprehensive understanding of the diverse expressions of bullying, numerous participants shared experiences of exclusion from programs they were entitled to attend, coupled with a pervasive sense of insignificance in decision-making processes. This exclusionary behavior not only undermines their professional contributions but also fosters feelings of alienation and disempowerment. Participants said the following.

“…There have been times in my current role when I felt the pain of exclusion and being downgraded. For instance, when I was not being involved in events and meetings that I could have taken part in, ….” (Participant 21, Male)

When you notice the bullying lifestyle of management and you are trying to get it dealt with, they will speak to you anyhow, like you have no value and that your contribution in the facility does not amount to anything. They will begin excluding you from meetings, programs because they know you'll raise concerns. We need to recognize and openly discuss these behaviors, but everyone is afraid to be the one to voice it out for fear of being used as a scapegoat.” (Participant 17, Female)

I have been excluded you from programs or meetings before. Day in and day out such incidents happen, and nobody is ready to talk about it because they are all afraid…” (Participant 12, Female)

Subtheme 3: Retaliatory Behaviors

Another form of bullying reported by participants in this study is retaliatory behavior, where a wrong or mistake is often met with payback. This suggests a toxic cycle of retribution within the workplace, where individuals feel compelled to retaliate against perceived wrongs, further perpetuating a culture of hostility and conflict.

“…Unfortunately, I became the subject of bullying at work. I do not know if that is the case with everyone. I realized that the work I was not supposed to do, I was tasked to do, I tried to question, and it became a big problem. Little mistakes were taken as big deals, and while other people did worse, but were taken lightly. I began to suspect that this person was doing it intentionally just to hurt my feelings as a payback….” (Participant 2, Female)

…bullying behaviors are rampant within this facility, with many people not ready to accept it because of the fear of either being threatened further or tagged. It often happens in a way that you will not suspect the person is putting up such behaviors intentionally. But as one who has been in the system for a while, I know some specific ones to be a retaliation for something that happened in the past. (Participant 9, Male)

Theme B: Psychosocial and Professional Impact of Workplace Bullying

The study found out that bullying had serious negative impact on the victims. These include physical health effects, psychological impacts, strained relationships, and the decreased job satisfaction of the study participants.

Subtheme 1: Ill Health

The study also shed light on the physical health consequences of bullying experienced by participants. Many reported a higher frequency of illness, noticeable weight loss, and increased physical exhaustion.

“… I was faced with a persistent state of stress, where I found myself falling ill more frequently with a series of health challenges that were previously uncommon in my life. Even from work, when I get home, I find it very difficult to sleep.” (Participant 16, Female)

“For me, just the thought of knowing that someone at work does not like me or is only there to disgrace me affects me very badly. All of these gradually affected me and within that period, I felt I had lost weight. It was evident to my colleagues.” (Participant 10, Female)

“When I had issues with a senior staff member and felt her actions towards me were mean and intentional, and that I could not do anything about it, I was always restless at work. I could not sit in one place provided she was around. I always sought to avoid her, and this drained me physically. At the end of my shifts, I would feel physically exhausted, but on days that she is not at work, I feel so fine without any stress…” (Participant 6, Female)

Subtheme 2: Emotional Distress

Through analyzing interview responses, researchers identified a notable emotional toll suffered by those who had experienced bullying in the workplace. This emotional distress manifested in various ways, reflecting the profound impact that such mistreatment can have on individuals’ well-being and mental health.

“…Enduring workplace bullying left me in a state of emotional depletion, struggling with a relentless sense of fear and frustration that permeated both my professional and personal circles. In the workplace, this emotional strain manifested as a persistent sense of anxiety, preventing my ability to perform to the best of my abilities and diminishing the joy I once found in my responsibilities. Beyond the facility, my personal life was affecting my relationships and overall quality of life.” (Participant 23, Male)

“One main aspect of my life that bullying at work affected was my emotions. Because I found myself emotionally distressed. Having gone through the traumatic event of being bullied at work left me with a lasting emotional scar that caused me to become extremely stressed and demoralized all the time. The psychological fallout was severe; I was left to struggle with a lasting feeling of hopelessness as the workplace's negativity affected how I saw myself and my potential.” (Participant 6, Female)

“The mental strain that experiencing bullying at work caused was extremely high, leaving a lasting cloud of hopelessness and constant self-doubt over my career. I struggled with a sense of helplessness in the face of the toxic circumstances as a result of the constant psychological pain caused by the mistreatment. These feelings destroyed my confidence and led to a generalized self-doubt that affected both my personal and professional life in different ways.” (Participant 22, Female)

Subtheme 3: Strained Relationships

The participants in the quote below discussed how bullying jeopardizes their relationships. Their interactions with others outside of work are affected by the emotional load they are carrying. Some have reported that they unintentionally react to their family members in light of their professional experiences.

“The unfortunate thing about bullying at work is that the effects that it has on you do not remain at the facility, but it also impacts other parts of your life. If you are not careful, it will influence your relationship with your children, husbands, and parents. In my instance, the way I interacted with my family at home changed. Though I did not mean it, it was happening. By the time I realized everyone in the house was complaining about how I am changing, particularly with the way I talk or respond to matters in the house.” (Participant 8, Female)

“Right now, people see me as a quiet person, but I used not be this quiet. I actually liked talking. But I experienced some sort of behavior from some of my seniors that made me dislike talking to people. False information was spread at the workplace after I had confined a colleague. With this, I blamed myself for talking to them in the first place. I decided not to meddle in people's matters unless it directly involves me…..” (Participant 23, Female)

Subtheme 4: Decreased Job Satisfaction and Productivity

While some study participants described how workplace bullying affected them physically and psychologically, few described the effects of workplace bullying on their decreased job satisfaction and productivity.

“As for me, I was always tired because someone at work was teasing me. I tried to focus on my daily duties, but I couldn’t function as I should. I realized my interest in the work, too, was decreasing because I don’t see why your fellow colleagues should be teasing you at work. I nearly quit the job, but I didn’t have any other option.” (Participant 19, Male)

“The imagination of what you suffer, like the exclusions and other forms of verbal bullying, affects my work here. I was not enjoying the work anymore, especially the times that he was around. My confidence was severely impacted by the buildup of these mistreatments, which resulted in a pervasive sense of self-doubt that affected many aspects of my work life. (Participant 17, Female)

Theme C: Individual Coping Responses to Bullying

In response to workplace bullying, healthcare workers that fell victim to bullying employed various strategies to minimize the effects of bullying on their physical, mental, and general well-being. Confronting the bully, setting boundaries and leaning on friends and family emerged as subthemes.

Subtheme 1: Confronting the Bully

The study found out that healthcare workers who experienced various forms of bullying at their workplaces develop personal ways of coping with the incident by taking it upon themselves to confront the bully or speak to colleagues who could give them valuable tips in dealing with the awkward experience of workplace bullying.

“When things were becoming worse, I knew I had to do something other than just letting myself and my career be drowned by another person at work. I discovered a source of strength by taking up a positive individual approach, where instead of allowing the negativity to take hold of me internally, and also sought the advice of trusted colleagues. I engaged them in conversations about my experiences, and this not only provided valuable insights but also allowed me to build a network of allies who understood and empathized with my situation” (Participant 20, Male)

“The approach I took was quite risky, but it turned out to be effective. Its wall aimed at letting the bully know that I was not scared, and I was courageous enough to take responsibility when I had to. The approach was that once I was intimidated or mistreated, I would personally confront the person in an open yet honest conversation. I took the problem head-on and voiced my concerns to the person involved.” (Participant 13)

“I knew some coworkers who had experienced similar things. So, I approached them and sought their advice on how they were able to overcome their experiences. They became my support network, which I depended on anytime I was faced with an experience of bullying. It was not long, and I was completely resistant to bullying like never before in this facility.” (Participant 18)

Subtheme 2: Leaning on Friends and Family

Also, participants shared how family and friends showered their unwavering support when they experienced bullying at the workplace. This is what they say;

“When I experienced bullying during my nursing shifts, knowing that I could come home to a supportive family and friends made all the difference. They gave me a secure area where I could express my annoyance and look for answers. They gave me their undying support and listened to me without passing judgment. Their support kept me going and prevented the bullying from impairing my ability to operate as a healthcare professional, even on my worst days.” (Participant 5, Male)

“The high levels of stress in a medical setting may render handling bullying particularly difficult. It feels good to have someone to turn to outside of the workplace. My family and friends gave me the strength to see past the negative and affirmed my value as a medical professional. Throughout the worst moments, their support and affection acted as a lighthouse.” (Participant 2, Male)

Subtheme 3: Setting Boundaries

Another strategy of personal coping strategy that was employed among the healthcare workers who suffered from workplace bullying was setting boundaries as described in the lines. One participant said:

“… One of my senior colleagues bullied me at work by continuously criticizing my work and undermining my authority in front of patients and other staff members. I had to set limits to protect my profession and my sense of self-worth from bullying. I began by letting the offender know exactly what behavior I found inappropriate and making this obvious to them. I had to firmly stand my ground and make my demands known, even though it wasn't easy. They stopped being bullies and finally started treating me with more respect. Setting boundaries gave me the power to take charge of the circumstance and shield myself from abuse in the future.” (Participant 6 Female)

Theme D: Meaningful Institutional Support

Participants described structured and collaborative support pathways that helped them navigate bullying experiences. Unlike environments where bullying is minimized or ignored, respondents highlighted the presence of friendly reporting structures, proactive leadership, and strong peer networks. These systems not only protected them emotionally but also reinforced a sense of fairness and professional safety, enabling recovery and empowerment after bullying incidents.

Subtheme 1: Confidential Reporting Systems

Participants highlighted the importance of confidential reporting mechanisms in empowering staff to report bullying without fear of retribution. These systems provided a sense of security and encouraged transparency in addressing workplace concerns. Additionally, institutional responsiveness particularly from matrons, HRs, and colleagues at the workplace reinforced trust, as timely investigations and resolutions demonstrated a commitment to safeguarding staff well-being and maintaining a respectful work environment.

“In addition to rules, our facility has procedures in place for confidential reporting of incidents of bullying. Because I knew that my name would be protected, I felt comfortable speaking up as a result. Additionally, a well-established procedure for advancement is in place to address bullying at work.” (Participant 1 Male)

“After adhering to the protocol for reporting workplace bullying, I was pleasantly surprised by HR's handling of my grievance. They conducted a thorough investigation, interviewing witnesses and taking down additional evidence. It offered me confidence that the issue would be resolved appropriately. Frequent training sessions on identifying and preventing bullying in the workplace are very important. Our business also offers seminars on responsibility and respect for staff members.” (Participant 16 Female)

“In my situation, I spoke to the matron about the issues, and after a few weeks, the issue was resolved. However, in a situation involving a colleague, she was referred to the mental health departments for counseling since the matron was unable to handle the situation at hand. (Participant 21 Female)

“I had a support system in my situation. My coworkers defended me against bullying and informed the nursing manager of the situation when the person in charge took no action. Our nursing manager took initiative, and the issue was resolved immediately.” (Participant 3 Male)

It is important to note that, despite the availability of reporting systems and institutional support, one participant expressed concern about potential negative consequences of reporting. As a result, she chose to remain silent and ignore the bullying behavior. She said:

“At first, I honestly felt scared to report the bullying. I didn’t want any backlash or to be seen as a troublemaker, so I just kept quiet and tried to make peace with myself by ignoring it. After some time, I realized it wasn’t worth stressing over, so I decided to focus on my work and let it go instead of pursuing the case further.” (Participant 6 Female)

Discussion

Participants reported various forms of bullying, including intentional disrespect, intimidation, and humiliation, which often went unreported due to fear of retaliation or being labeled as troublemakers. These are in line with the studies of Ross (2023) and Awai et al. (2021). Similarly, to Batchelor (2019), the participants reported various forms of bullying, including verbal abuse, exclusion, and being downgraded. These experiences have had a significant impact on their mental health and job performance. Participants reported experiencing a range of physical health issues due to workplace bullying. Symptoms included increased stress leading to frequent illnesses, sleep disturbances, weight loss, fatigue, and physical exhaustion. The persistent state of stress caused by bullying resulted in various health challenges and affected the overall well-being of the victims (Harrington et al., 2012). The emotional toll of workplace bullying was significant, leading to emotional depletion, anxiety, stress, depression, adjustment disorders, and feelings of hopelessness. The negative impact extended beyond the workplace, affecting personal relationships and overall quality of life (Sansone & Sansone, 2015).

The narratives from participants highlight the tangible toll that workplace bullying takes on individuals’ physical well-being and describe experiencing increased stress and illness, leading to difficulties in sleeping and dizziness (Kemp, 2014). The effects of bullying were not limited to the workplace but spilled over into other aspects of their lives. Workplace bullying led to decreased job satisfaction and productivity among healthcare workers. They articulate feelings of fear and frustration, leading to persistent anxiety and diminished joy both at work and in personal life (Nielsen & Einarsen, 2012). Similarly, there is a recount of struggles with hopelessness, self-doubt, and declining mental health, ultimately impairing their ability to provide quality healthcare as pointed out by Einarsen & Nielsen, (2015). These accounts underscore the pervasive psychological distress inflicted by workplace bullying, affecting individuals’ confidence, self-worth, and overall well-being (Kemp, 2014). The study participants also reflect on how workplace bullying adversely impacts their relationships (Conway et al., 2021). Some highlight the spillover effect of workplace bullying on personal relationships, noting changes in communication patterns with family members due to heightened stress and tension (Høgh et al., 2021).

In the face of workplace bullying, healthcare workers have employed various personal coping mechanisms to mitigate its effects on their well-being. These include confronting the bully, engaging in open yet assertive conversations with the bully, boundary-setting. Researchers postulated that mitigating workplace bullying's impact on nurses’ well-being required proactive decisions (Jiao et al., 2023; Lever et al., 2019; Peng et al., 2022). Positive coping styles can enhance job satisfaction and reduce burnout caused by bullying. Taking proactive approaches by engaging in open yet assertive conversations with the bully are done to understand the behavior while expressing concerns (Baek & Trinkoff, 2022; Kim & Hwang, 2019). Boundary-setting is a coping strategy to protect one's professional integrity and self-worth from workplace bullying (Brewer et al., 2020). By clearly articulating their boundaries, victims asserted control over the situation and ultimately influenced the bully's behavior positively (Giorgi et al., 2016; Jang et al., 2023).

Participants in the study emphasized the significance of having clear procedures for confidentially reporting incidents of bullying. This confidentiality allowed victims to speak up without fear of reprisal, ensuring their concerns were addressed effectively (Murphy, 2013). Also, well-established procedures for advancement were crucial in addressing workplace bullying. If informal resolutions failed, employees had the option to escalate the issue to senior management or external authorities, ensuring accountability within the organization (Antoine, 2018). Participants’ narratives highlight the role of clear policies, confidential reporting mechanisms, and ongoing training in addressing workplace bullying and promoting accountability within healthcare organizations (Khairallah et al., 2023). Addressing workplace bullying at an organizational level is crucial. Implementing antibullying policies that demonstrate management's commitment to a safe work environment is essential (Samnani & Singh, 2012). Creating a culture where all employees feel comfortable speaking up against bullying is key to prevention. Boss (2020) asserted that training sessions on identifying and preventing bullying, along with promoting an inclusive and respectful work environment, are vital steps in combating workplace bullying.

Strengths and Limitations

The use of a qualitative phenomenological design allowed for an in-depth exploration of participants lived experiences, providing rich, detailed insights into the effects of workplace bullying on healthcare workers. Also, the inclusion of various healthcare roles, such as nurses, midwives, physicians, and cleaners, ensures a broad spectrum of experiences and enhances the study's applicability across different occupational categories.

The study, however, was conducted in two hospitals in a single municipality, which may limit the generalizability of the findings to other regions or countries. Future studies should take a multisite strategy by adding hospitals from varied locations and healthcare levels, such as district, regional, and teaching hospitals, to capture a greater diversity of experiences and institutional cultures.

Implications for Practice

The critical need for focused interventions to address workplace bullying among healthcare workers is highlighted by this study. Beyond validating previously published research such as (Fleming, 2019; Rees et al., 2022), this study offers context-specific insights that call for antibullying strategies tailored to the local institutional and cultural dynamics. Clear definitions, zero-tolerance policies, and easily accessible, private reporting tools should all be part of this. Educating employees on how to use these tools can encourage early reporting and cultivate a safety and accountability culture.

Nurses should be empowered through training in assertive communication, conflict resolution, and emotional intelligence to respond appropriately to bullying behaviors and support colleagues who experience them. Nursing managers, matrons, and unit heads must take proactive roles by establishing unit-level zero-tolerance cultures, conducting routine checks for early signs of bullying, and responding promptly to complaints to prevent retaliation or escalation. Nursing education programs should integrate bullying recognition, reporting pathways, and mental-health self-care modules into their curricula to prepare future nurses for real-world challenges.

Furthermore, healthcare organizations must provide priority to peer support groups and counseling services for mental health, particularly for impacted employees. Reducing power disparities and enhancing team dynamics can be achieved by mandatory training in communication, emotional intelligence, and conflict resolution. Institutions can foster a more courteous and encouraging work atmosphere by focusing these initiatives on the actual context of healthcare settings.

Conclusions

This study is one of the first to look into workplace bullying in Ghana's healthcare industry, and it reveals important systemic and cultural elements such as a lack of reporting channels and fear of reprisals. Our findings highlight the significance of informal hierarchies and insufficient organizational support, in contrast to high-income country studies that prioritize legal and institutional remedies. These findings underscore the need for context-specific interventions such as clear policies and procedures for reporting bullying, alongside training on prevention and inclusivity that promote respectful work environments, transparent communication, and robust support systems, ultimately enhancing employee well-being.