Workplace Bullying in Healthcare Organisations: A Scoping Review of the Systematic Reviews and Meta‐Analyses on Workplace Bullying of Healthcare Workers

ABSTRACT

Aims

There is an increased focus on healthcare workers' bullying due to various individual, organisational, and social factors that may elevate the risk of bullying among healthcare employees. This scoping review aims to identify knowledge gaps regarding the theorising of bullying and the prevention and management of bullying in healthcare settings.

Design

A scoping review of systematic reviews and meta‐analyses was conducted using PRISMA guidelines.

Data Sources

Systematic reviews and meta‐analyses (N = 18) involving healthcare workers (i.e., doctors, nurses, and allied health professionals) were identified through a vigorous search of ProQuest Central, PubMed, PubMed Central, Google Scholar, Scopus, PsycINFO (PsycNet), and Web of Science databases.

Review Methods

The included reviews were explored to identify theoretical explanations of bullying and strategies for bullying prevention and management. Thematic analysis was applied to synthesise findings.

Results

The results indicated that workplace culture, hierarchy within healthcare organisations, inactive institutional power, and conflict are key theoretical constructs that may explain bullying among healthcare workers. Further, a comprehensive approach of individual and organisational‐level factors, involving organisational policies and procedures, creating awareness to promote effective reporting of bullying, and the role of leaders and managers, was identified as critical for preventing and managing bullying.

Conclusion

The scoping review emphasises the need for integrating theoretical frameworks that consider both individual and systemic aspects of bullying in healthcare organisations. Addressing these aspects can improve the effectiveness of strategies for bullying prevention and management.

Impact

Understanding the theoretical approaches to explain bullying of healthcare employees can provide a concrete foundation for targeted interventions and organisational policies that address bullying at multiple levels, therefore improving healthcare workers' wellbeing and workplace culture.

Patient or Public Contribution

No direct patient or public contribution was related to the scoping review.

1. Introduction

Bullying in healthcare contexts has significant consequences for the organisation, employees, and patients (Ariza‐Montes et al. ²⁰¹³; Olender ²⁰¹⁷). Despite strong evidence of the antecedents and consequences of workplace bullying in the healthcare sector, there is a lack of focus on the theoretical explanations of bullying (Goh et al. 2022; Hoel and Salin ²⁰⁰²; Notelaers et al. ²⁰¹⁰). Scholars have identified antecedents as explanatory factors for bullying but have failed to systematically theorise these explanations. Theoretical explanations help to systematically coordinate and link particular structures, behaviours, and contexts to the bullying of healthcare workers. These explanations can also contribute to the successful prevention and management of bullying by identifying the critical mechanisms for its occurrence. While there are individual studies using theories (often in a post hoc manner), currently there is not a comprehensive review of theorising on workplace bullying or the successful prevention and management of bullying (Branch et al. 2013; Hoel and Cooper ²⁰⁰¹). In the context of the healthcare workforce and bullying literature specifically, several systematic reviews and meta‐analyses address single‐focused issues about workplace bullying definitions, antecedents, and the consequences of bullying (Boudrias et al. 2021; Gupta et al. ²⁰²⁰; Nielsen et al. ²⁰¹⁵). However, none of these provide an overarching view of workplace bullying to illustrate how it is explained or prevented and managed. To address this issue and gain a deeper understanding of the theoretical explanation of workplace bullying in the healthcare sector, a scoping review of systematic reviews was undertaken.

Workplace bullying is a global problem in healthcare organisations, emphasised by studies across Asia, Oceania, Europe and North America that illustrate that bullying crosses cultural and organisational boundaries, with sustained adverse impacts on workers' wellbeing, patient safety and organisational outcomes (Einarsen et al. 2002; Nielsen and Einarsen ²⁰¹⁸). In resource‐constrained regions, for example, Africa and Latin America, bullying may result in workforce shortages and health inequities; while in adequately resourced systems, it influences safety culture and quality of care (Branch et al. 2013; Hoel and Cooper ²⁰⁰¹; Gupta et al. ²⁰²⁰). Most importantly, the global mobility of healthcare workers also facilitates the transfer of bullying norms across borders, highlighting the need for theoretical explanations that can inform prevention and management strategies worldwide (Zapf et al. 2020).

Thus, this scoping review focused on identifying knowledge gaps related to the theorising of bullying and mapping the systematic reviews and meta‐analyses studies on the workplace bullying of healthcare workers (i.e., doctors, nurses, allied health professionals, and first responders or emergency services workers). The review answers the following research questions: (a) how is workplace bullying theoretically explained in systematic reviews of bullying of healthcare workers? (b) how are prevention and management of workplace bullying discussed in systematic reviews of healthcare workers?

2. Methods

2.1. Protocol Registration

Following suggestions for developing a scoping review protocol (Lockwood et al. 2019) and registering a protocol (Peters et al. 2020), the scoping review protocol was registered on the Open Science Framework (OSF) as a public access document and is accessible through the link: https://osf.io/cuwsd/?view_only=a19a5890c3704fb09386786778ce3fdf.

Two features framed the scoping review protocol. First, the Joanna Briggs Institute (JBI) suggested that scoping review protocols' questions can be formulated by considering the mnemonic “PCC” (Pollock et al. 2021). PCC stands for the population (or participants), concept, and context. This scoping review is about exploring bullying (concept) in various healthcare occupations (population and context). By breaking down or aligning the research question with the PCC approach, the potential to miss exclusion and inclusion criteria can be avoided (Khalil et al. 2021). Second, the protocol follows the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses extension for scoping reviews (i.e., PRISMA‐ScR) checklist as a guideline (Tricco et al. 2016).

2.2. Eligibility Criteria

Systematic reviews and meta‐analyses involving healthcare workers were included (relating to doctors, nurses, allied health professionals, and emergency medical workers or first responders) because they are the critical components of the healthcare system. All eligible systematic reviews and meta‐analyses published between 1 January 2005 and 31 December 2024 were considered to cover relatively recent research contributions and knowledge gaps. The inclusive years represent the years of literature included rather than the year of the search. Non‐peer‐reviewed literature and narrative reviews were excluded. All reviews were peer‐reviewed and in English.

2.3. Information Sources and Search Strategy

The searches involved ProQuest Central, PubMed, PubMed Central, Google Scholar, Scopus, PsycINFO (PsycNet) and Web of Science databases for published systematic reviews and meta‐analyses on workplace bullying of healthcare workers. These databases were selected because of their relevance to studies involving healthcare and clinical workers. The search was carried out by using the keywords in the combination of terms from three groupings (using Boolean operations): (1) systematic reviews and meta‐analysis, (2) workplace bullying or employee abuse or employee mistreatment, and (3) healthcare workers, healthcare employees, doctors, nurses, allied health, first responders, and emergency workers.

2.4. Study Selection

After completing the search, the bibliography and duplicates from all database searches were managed through EndNote software. Duplicate entries were removed. Following this, studies were initially screened for eligibility using the inclusion criteria by keywords in titles and abstracts. After the removal of entries using this initial screen, full texts of the articles were accessed and screened for the final decision on eligibility. The bibliographic content of the articles meeting the inclusion criteria was read to further search for additional reviews meeting the inclusion criteria.

The inclusion of systematic reviews and meta‐analyses strengthened the synthesis by offering comprehensive and methodologically rigorous evidence that combines findings from multiple studies. Unlike narrative reviews or single‐study reports, these evidence syntheses follow structured protocols and include quality assessments, demonstrating the scope and reliability of the studies while minimising bias.

2.5. Data Extraction and Data Items

A data charting form or extraction table was developed by identifying essential items related to the research question. The mapping process was aligned with the research question following a thematic analysis. After charting characteristics of the included studies (e.g., healthcare discipline, aims and purposes, key findings, etc.), the extracted data were coded to identify similar patterns in the data and any divergences. Codes were refined and grouped into various themes and sub‐themes that linked to the conceptual basis of the scoping review. Reviewers met regularly during this process to discuss independently interpreted codes and address any discrepancies to ensure qualitative rigour during the analysis. The resulting thematic structure was then organised into an evidence map that illustrates how existing knowledge clusters around specific issues, where conceptual connections occur, and where gaps remain for future research. An Excel sheet was used to develop an extraction table for coding the data. Following the aims of this scoping review and the JBI general principles, the specific data extraction table or an Excel spreadsheet included the following information: (a) citation; (b) country of origin of the articles included; (c) healthcare discipline, aim(s) and purposes, number of articles, type of review, methodology/methods and key findings (i.e., definitions, the terminology used for workplace bullying, antecedents and consequences of workplace bullying, theoretical explanation of workplace bullying, prevention, management of bullying, and the type of critical appraisal for the review) (Data S1). The data extraction table can be accessed on OSF through the link: https://osf.io/cuwsd/?view_only=a19a5890c3704fb09386786778ce3fdf.

A critical appraisal of methodological quality is not required for a scoping review, but it was noted whether the original authors carried out a critical appraisal when conducting their systematic reviews (Peters et al. 2021). The inclusion of systematic reviews and meta‐analyses strengthens the knowledge base and reduces uncertainty in comparison to other evidence types. This ensures that the strengths of these studies are clearly reflected in both the mapping process and the interpretation of the findings.

2.6. Synthesis of Results

Studies were sorted into several categories of similar concepts. To analyse the data, the thematic analysis technique was used (Clarke et al. 2015). The findings from the analysis were coded and discussed in relation to the aims of the scoping review and the research questions (Braun and Clarke 2006, 2012).

3. Results

In total, the search strategy identified 1148 articles from the listed databases. Articles were downloaded to EndNote, and 82 duplicates were removed. A review of the titles and abstracts of the 1073 articles using the inclusion criteria resulted in 55 articles being identified for the full‐text review. Thirty‐seven papers were removed after additional screening, resulting in 18 articles for analysis. The study selection is shown in Figure 1.

FIGURE 1.

Study selection: PRISMA flow diagram. Source: (Tricco et al. 2016).

This scoping review was thus based on 18 studies including 11 systematic reviews and seven systematic reviews and meta‐analyses. The key theoretical accounts identified across all the included studies are summarised in Table 1. Of the 18 included reviews, four involved varied or general healthcare sector employees from all units of healthcare organisations without focusing on a particular speciality or profession. The remaining studies included nurses (n = 9), surgery units (n = 2), midwifery students and midwives (n = 1), junior doctors and medical residents (n = 2) and other allied health (n = 1). Regions (or countries of origin) of the studies included in the reviews included countries in Europe, the Middle East, South Asia, Africa, Oceania, North America and South America.

TABLE 1.

Summary of the key theoretical accounts identified across the included studies.

Source	Healthcare discipline	Total articles	Review type	Critical appraisal	Countries of included studies	Aims/purposes
Averbuch et al. (2021)	Medical	68	Systematic review	Yes (Y)	USA, Canada, Australia, Asia, Europe, Middle East	To define and classify patterns of academic bullying of medical interns, assess the characteristics of perpetrators and victims. To describe the impact of bullying, review institutional barriers and facilitators of bullying, and identify possible solutions.
Capper et al. (2020)	Midwifery/midwifery students	9	Systematic review and meta‐analysis	Y	Australia, Iran, UK, Finland, Slovenia, Turkey	To identify what is currently known through literature about workplace bullying and violence of midwifery students.
Chadwick and Travaglia (2017)	Varied healthcare context	62	Systematic review and meta‐analysis	No (N)	International and Australian	To capture a range of international and Australian literature regarding bullying behaviours in Australian health context from the management point of view and identify gaps in literature.
Galanis et al. (2024)	Nursing	9	Systematic review and meta‐analysis	Y	China, Republic of Korea, Italy and Israel, Slovenia, Turkey	To summarise data on the association between workplace bullying, job stress and professional quality of life of nurse.
Halim and Riding (2018)	Medical/surgery	32	Systematic review	Y	Australia, New Zealand, UK, USA, China and International	To define prevalence and effects of bullying behaviour in the surgical workplaces internationally and to explore strategies against bullying.

Source	Explanation of bullying	Prevention and management
Averbuch et al. (2021)	The cycle of bullying prevails and continues due to power structures and hierarchical systems. A fear of reprisal, ineffective implementation of anti‐bullying measures by institutions, and perceptions of hopelessness can escalate bullying. In addition, individual barriers to bullying management can increase bullying, such as concerns about privacy, lack of awareness, and fear of futility.	To prevent and manage bullying, an effective reporting system and ensuring privacy of victims is essential. Anti‐bullying committees can help prevent bullying. Additionally, professionalism must be critical for career progression without bullying. Encouraging anti‐bullying, gender and power abuse prevention committees is useful. Effective policies, education about stopping bullying, providing institutional support and running internal reviews to create solutions for the environment can also be beneficial Organisation‐level steps, for example, workshops to help workers identify bullying may also help manage bullying.
Capper et al. (2020)	The role of power and its misuse of midwives and students make them feel less valued. Mentors had the upper hand over juniors which manifested in the reports of bullying in the healthcare setting. A culture of complying with bullying where bullying was acceptable as normal teaching practices escalated bullying.	Knowledge about sensitive cultural aspects in the workplace may help prevent bullying. For example, workplace support for the mentors in conducting teaching responsibilities and education in particular about identifying bullying behaviours might help prevent and manage bullying.
Chadwick and Travaglia (2017)	Academic bullying resulted from fear of reprisal, perceived hopelessness and institutional nonenforcement of anti‐bullying policies.	Anti‐bullying committees and ensuring professionalism as a requirement for career advancement may prevent bullying. Promoting anti‐bullying policies, offering education to prevent academic bullying of healthcare employees, establishing an anti‐bullying oversight committee, and institutional support for victims may lead to prevention and effective bullying management.
Galanis et al. (2024)	Higher levels of bullying were associated with job stress and worse professional quality of nurses' life. A positive correlation was found between workplace bullying, job stress, and burnout.	Bullying traits developed early in a surgeon's career, which may lead to bullying behaviours toward others. The scale of bullying problem propagated and affecting other healthcare professionals in the workplace.
Halim and Riding (2018)	No clear explanation of the bullying process is given. The review points out that contextual factors such as workload, stress, long working hours and workplace may be the reasons behind bullying of staff.	Focus on prevention, rather than mitigating strategies, may help in prevention and management of bullying. Early education in medical schools, training about professional behaviours, methods for tackling mistreatment are perceived as ineffective and potentially damaging to victims. Early work into cognitive rehearsal programmes and operating room simulation may be useful, but their ability to improve the work culture in surgical departments has not been practically demonstrated.

Source	Healthcare discipline	Total articles	Review type	Critical appraisal	Countries of included studies	Aims/purposes
Huang et al. (2018)	Surgery	8	Systematic review and meta‐analysis	Y	International countries are not specified	To collate prevalence and impacts of discrimination, bullying, and harassment in surgical practices and trainings.
Jeong et al. (2024)	Hospital nurses	9	Systematic review and meta‐analysis	Y	South Korea, USA	To evaluate the impacts of cognitive rehearsal programmes on workplace bullying of hospital nurses.
Johnson and Benham‐Hutchins (2020)	Varied healthcare. Nursing, emergency, inpatient, and critical‐care units	14	Systematic review	Y	International countries are not specified	To examine the influence of bullying behaviours on nursing practice errors.
Lever et al. (2019)	Healthcare and allied health workers overall	45	Systematic review	Y	UK, Australia, Turkey, Italy, Portugal Norway, Denmark, Canada, Germany, USA, Bosnia and Herzegovina, China, Japan, Sweden	To review both mental and physical health consequences of bullying for healthcare employees.
MacMillan et al. (2022)	Osteopathic, Chiropractic and Physiotherapy professions	17	Systematic review with critical synthesis	Y	Nigeria, Sweden, UK	To chart, appraise, review and synthesise the evidence of discrimination, harassment and bullying in undergraduate manual therapy education.

Source	Explanation of bullying	Prevention and management
Huang et al. (2018)	Culture of bullying and hierarchy in the surgical workplaces are associated with bullying. A training apprenticeship approach that fosters certain bullying practices that are believed to be effective teaching and training strategies for apprentices may lead to bullying.	Emphasis on processes, implementation of a code of conduct and policies to prevent bullying of trainees by seniors may result in effective bullying management. Non‐judgmental support at the workplace and skill assessment of supervisors are also critical for prevention and bullying management. Culture of bullying can be mitigated by creating awareness about bullying and offering online resources that provide knowledge to surgical trainees about bullying prevention and management.
Jeong et al. (2024)	Culture of bullying and hierarchy in the surgical workplaces were discussed in relation to bullying. Bullying is not considered bullying due to vertical culture of the workplace.	Health policymakers must implement cognitive rehearsal programmes in a policy manner to address the problems of bullying in the workplace.
Johnson and Benham‐Hutchins (2020)	Work‐environment, lack of communication and barriers to effective teamwork due to oppression of powerless individuals escalates bullying by causing anger which manifests bullying behaviours toward other members of group.	No specific prevention and management were discussed. Some suggestions regarding understanding bullying so as to create effective strategies and introduce interventions for mitigating bullying are noted.
Lever et al. (2019)	The review did not directly discuss the explanation of bullying behaviours but discussed the impacts of bullying.	Raising awareness about bullying issues can encourage effective reporting, which helps in both its prevention and management. Senior leaders and management should focus on multiple measures including anti‐bullying policies and effective reporting systems.
MacMillan et al. (2022)	Discrimination and bullying were found to be associated with cultural practices of institutions, normative behaviours, assumptions, lack of accessibility to socioeconomic resources and barriers to participation for some marginalised groups of manual therapy students.	No specific suggestions regarding bullying prevention and management were stated in the study.

Source	Healthcare discipline	Total articles	Review type	Critical appraisal	Countries of included studies	Aims/purposes
Samsudin et al. (2018)	Medical/	18	Systematic review	Y	USA, Canada, India, Ireland, New Zealand, Japan, Pakistan, Canada, Turkey, Australia, Oman, Saudi Arabia, UK	To explore bullying operation and measurement. To explore the impacts of bullying operations and measurement on prevalence rates. To explore the possibility of certain target characteristics and organisational factors associated with an increased risk of exposure to bullying. To study the impacts of bullying on victims and organisations.
Serafin et al. (2020)	Nursing	31	Systematic review and meta‐analysis	Y	Poland, Jordan, Turkey, USA, Taiwan, Greece, South Korea, Canada, Norway, Japan, Italy, Israel, Spain	To synthesise empirical studies which used Negative Act Q questionnaire (NAQ) to assess bullying of nurses by evaluating psychometric properties. To identify variables that are related to the bullying of nurses.
Shorey and Wong (2021)	Nursing	27	Qualitative systematic review	Y	USA, Australia, UK, Pakistan, Iran, South Africa, Italy	To explore nurses' experiences of workplace bullying and prevention and the type of bullying which nurses face. To explore drivers of bullying and the impacts on bullied individuals. To explore how do nurses cope with bullying behaviours.
Stagg and Sheridan (2010)	Nursing	18	Systematic review	N	Australia, USA, International, Netherland	To identify strategies and effective practices for preventing and managing workplace bullying of staff nurses.
Vijayakumar and Rajagopal (2024)	Nurses	202	Systematic review	N	International UK, USA, Europe, Middle East	To evaluate the efficacy of interventions designed to reduce workplace bullying or incivility to inform future practice.

Source	Explanation of bullying	Prevention and management
Samsudin et al. (2018)	Bullying is influenced by multiple individuals (e.g., age, gender, and ethnicity) and occupational factors (e.g., clinical specialty). Power and hierarchy in the medical settings job‐demands and lack of resources may cause bullying.	Awareness of bullying among junior doctors may prevent and manage bullying. Bullying prevention and management is possible through creating an understanding of job demands and the burden on doctors, bullying predictors and the impact of bullying on doctors.
Serafin et al. (2020)	Individual characteristics, job stress, hierarchy, work environment, intent to quit nursing, and mental and physical health‐related problems were identified as explanatory factors concerning bullying.	Supportive leaders and managers and educating nurses can prevent and manage bullying. Enhancing nurses' skills and offering knowledge that will help them successfully navigate the hierarchy and work environment may lead to prevention and management of bullying.
Shorey and Wong (2021)	A lack of leadership skills for managing bullying, a tendency to practice power and control, competitive and hierarchal nature of the nursing profession may explain bullying. In addition, the oppression of nurses, toxic work environment, and the difference in generational cultural beliefs, resilience and acceptance of the bullying culture may escalate bullying behaviours.	Prevention and management may involve managerial support to new nurses. Bullying can be prevented by education and awareness about bullying issues. Organisational focus on ensuring that nurses' code of conduct is practicing effectively may offer a safe environment for reporting bullying. Team building activities and regular unit‐level group discussions to create anti‐bullying strategies, education about conflict management in nurses' courses and curriculum are some other ways bullying may be prevented and managed.
Stagg and Sheridan (2010)	An absence of a healthy work environment may escalate bullying behaviours.	Improved workplace culture, supportive leadership, effective communication and antibullying training can help. Cognitive rehearsal programmes that are designed based on nurses' responses may be effective in bullying prevention and management. Bullying behaviours may be managed through practicing the techniques learned during the cognitive rehearsal programmes.
Vijayakumar and Rajagopal (2024)	Inferior working conditions may potentially increase workplace bullying. The major themes associated with bullying were found to be individuals' behaviours and conflict.	Workplace bullying could be prevented or management by focusing on the areas of social support, psychological safety climate and affective commitment.

Source	Healthcare discipline	Total articles	Review type	Critical appraisal	Countries of included studies	Aims/purposes
Villalobos et al. (2023)	Medical residents/surgery	13	Systematic review and meta‐analysis	Y	USA, Australia, New Zealand, India, Pakistan, Latin American countries	To assess the prevalence of bullying in medical residents and factors associated with bullying.
Yang et al. (2024)	Nursing	21	Systematic review	Y	Australia, Iran, New Zealand, UK, Egypt, Saudi Arabia, Sri‐Lanka, Canada, Italy, China, Oman, Israel	The review aimed to explore the factors influencing the non‐reporting of workplace bullying incidents among nursing students during clinical practice.
Zhou et al. (2024)	Nursing	28	Systematic review and meta‐analysis	Y	South Korea, Egypt, Canada China, UK. Countries from Oceania, Europe, Asia and North America	This meta‐analysis aimed to estimate the global prevalence of bullying among nursing students during clinical practice and identify associated factors.

Source	Explanation of bullying	Prevention and management
Villalobos et al. (2023)	Bullying was inflicted by people in the hierarchy on female residents. Gender was identified as a reason for bullying. Being racial/ethnic minorities was found to be associated with frequent bullying experiences.	A need for effective interventions and preventative measures was indicated in teaching hospitals but no specific strategies about prevention and management were given. Authors indicated that bullying prevention programmes could be useful.
Yang et al. (2024)	Fear of retaliation, perceived power imbalances, concerns about future job opportunities, and barriers to reporting were associated with increased bullying. A lack of awareness of reporting processes, an absence of supportive systems, and the normalisation and acceptance of bullying within the culture were also some of the explanations of bullying.	No specific prevention and management were identified but a need for comprehensive reforms for a safe environment, an effective reporting system, disciplinary measures, and a zero‐tolerance policy were discussed with other literature.
Zhou et al. (2024)	Hierarchical authority influenced by national cultures could potentially contributing to a culture of bullying and tolerance of bullying behaviours. Resource shortages and constraints could trigger bullying.	Fostering a culture of safety, providing effective training, and promoting individual resilience can prevent and mitigate bullying. A supportive learning environment. Clear policies and reporting processes, and systematic training programmes for handling workplace bullying can also address bullying.

3.1. Assessment of Bias

This review assessed whether the included systematic reviews had performed a critical appraisal of the studies included in each review. Of the 18 systematic reviews included in this scoping review, 15 reviews had assessed bias. Chadwick and Travaglia (2017), Stagg and Sheridan (2010) and Vijayakumar and Rajagopal (2024) did not perform an assessment of bias in their reviews.

A risk of bias (RoB) tool developed by the Cochrane Bias Method Group and RoBANS 2.0 developed by the Korea National Evidence‐based Healthcare Collaborating Agency was used in one review (Jeong et al. 2024). The AXIS tool was employed by Villalobos et al. (2023) to evaluate the risk of bias. The National Heart, Lung and Blood Institute quality assessment tools were used in two reviews (Averbuch et al. 2021; Capper et al. ²⁰²⁰). A mixed method assessment tool (MMAT) for quality assessment for each study was used in one review (Capper et al. 2020). The Newcastle Ottawa or modified Ottawa Scale was used in two reviews (Huang et al. 2018; Samsudin et al. ²⁰¹⁸). Quality assessment of the methodological validity of papers using the standard JBI's Critical Appraisal method was used in seven reviews (Averbuch et al. 2021; Capper et al. ²⁰²⁰; Galanis et al. ²⁰²⁴; MacMillan et al. ²⁰²²; Serafin et al. ²⁰²⁰; Yang et al. ²⁰²⁴; Zhou et al. ²⁰²⁴). One review performed quality appraisal based on the methodological validity and quality of the studies (Serafin et al. 2020). The Critical Appraisal Skills Checklist was used in one review (Shorey and Wong 2021). A predetermined assessment criterion of independently reviewing included studies and discussing any disagreements was used by Halim and Riding (2018). A guiding framework for critical appraisal based on sampling, sample size, rate of responses, reliability and validity, and use of statistical methods was used by Lever et al. (2019). A similar technique of critical appraisal was used by Johnson and Benham‐Hutchins (2020) to assess risk of bias. They performed quality assessment considering sampling size, response rate, reliability, validity, and whether a conceptual model guided the qualitative studies in their systematic review.

The included systematic reviews and meta‐analyses provide cumulative and methodologically rigorous evidence. They differentiate from narrative or single‐study reviews, which we have not included in this scoping review. The methodological and conceptual strengths of the included studies in this scoping review lie in their variety of assessment tools used, multi‐analytical approaches and robust longitudinal designs that offer efficient theoretical explanations for bullying of healthcare workers. This means that the mapping process effectively captures the theoretical and empirical contributions of studies to meet the purpose of the scoping review. It explicitly addresses the research question and provides a clear view of the evidence for policy and practice. This emphasises that the strength of this scoping review is the clear picture it offers regarding existing research on bullying of healthcare workers, rather than a critical assessment of its included studies.

3.2. Research Question 1: Theoretical Explanations of Bullying

Four theoretical factors were presented in the literature to explain what contributes to the presence and process of bullying in the healthcare sector: (1) culture of the workplace; (2) hierarchy in the healthcare organisations; (3) inactive institutional power; and (4) conflict in teams.

3.2.1. Culture of the Workplace

Workplace culture involves shared values, beliefs and norms held by the individuals in an organisation. These shared values and beliefs govern how the members of the organisation behave and practice (Chalmers and Brannan 2020). Eleven reviews included in this scoping review considered how cultural practices in organisations shape and affect bullying in healthcare organisations (Averbuch et al. 2021; Capper et al. ²⁰²⁰; Chadwick and Travaglia ²⁰¹⁷; Halim and Riding ²⁰¹⁸; Huang et al. ²⁰¹⁸; Jeong et al. ²⁰²⁴; Johnson and Benham‐Hutchins ²⁰²⁰; MacMillan et al. ²⁰²²; Shorey and Wong ²⁰²¹; Yang et al. ²⁰²⁴; Zhou et al. ²⁰²⁴). For example, Huang et al. (2018) emphasised that bullying can emerge due to prior teachings and may be accepted as a common tradition in the workplace; bullying issues are endemic to the workplace culture and are normalised. Yang et al. (2024) also found that nurses' workplace culture encouraged acceptance and normalisation of bullying which served as a barrier to reporting bullying further exacerbating the issue.

Three studies point more to a specific theoretical explanation of safety culture (Chadwick and Travaglia 2017; Johnson and Benham‐Hutchins ²⁰²⁰; Zhou et al. ²⁰²⁴). Safety culture relates to the behaviours, attitudes, and beliefs of the individuals in an organisation regarding practices that involve the health and safety of the employees (Antonsen 2017). For example, Chadwick and Travaglia (2017) and Zhou et al. (2024) found that the safety of employees could be compromised due to cultural practices related to bullying management. For example, management attitudes and behaviours toward employees' safety, such as ignoring employees' complaints and ineffective management of safety issues such as bullying, can lead to employees perceiving management's lack of interest in supporting employees. These cultural practices in the workplace have adverse impacts on employees' safety and may result in workplace bullying.

3.2.2. Hierarchy in Healthcare Organisations

Several studies noted that workplace bullying can happen due to the hierarchies resulting from the bureaucratic structure of the healthcare setting. Twelve systematic reviews indicated that healthcare professions such as medicine, nursing, midwifery have robust hierarchal systems based on an imbalance in power that can lead to bullying (Averbuch et al. 2021; Capper et al. ²⁰²⁰; Chadwick and Travaglia ²⁰¹⁷; Galanis et al. ²⁰²⁴; Halim and Riding ²⁰¹⁸; Huang et al. ²⁰¹⁸; Jeong et al. ²⁰²⁴; Samsudin et al. ²⁰¹⁸; Shorey and Wong ²⁰²¹; Villalobos et al. ²⁰²³; Yang et al. ²⁰²⁴; Zhou et al. ²⁰²⁴). Subthemes identified include bullying of healthcare workers in training, power imbalance and misuse of power.

Bullying of apprentices by those in the hierarchy is a common phenomenon experienced by junior healthcare employees. Shorey and Wong (2021) found in their systematic review that nurses bully each other to move to higher positions of power in organisations. Three other reviews suggested that the medical and allied health professions are hierarchical and competitive due to training based on an apprenticeship approach which can trigger bullying behaviours because those in positions of power and educators may use their authority to intimidate and bully their juniors or subordinates (Huang et al. 2018; MacMillan et al. ²⁰²²; Villalobos et al. ²⁰²³).

Bullying also arises because of power imbalance and inequity in the medical training systems. Halim and Riding (2018) explored bullying behaviours in surgical workplaces and found that bullying behaviours develop early in a surgeon's career, and with time, as surgeons move up in their positions, bullying behaviours become a pattern because of strict supervision involving unwarranted efforts to improve the performance of medical trainees. Serafin et al. (2020) stated that perpetrators are viewed as having more power due to a higher position or knowledge, and they mostly target subordinates who are considered weak.

Some reviews suggested that the hierarchical system of healthcare organisations leads to misuse of power by people in the hierarchy. Shorey and Wong (2021) stated that bullying behaviours arise due to an inclination toward control and power by ineffective healthcare leaders. They indicated that older nurses who were higher in the positions and structure oppressed, silenced, and threatened those in lower ranks to instil fear. Similarly, Johnson and Benham‐Hutchins (2020) noted in their review that oppression of individuals through the misuse of power over less powerful individuals leads to anger and frustration, which may manifest as bullying of other members of the group.

These previous studies mention power and control and abuse of power generally. One study included a specific theory to explain power abuse. Johnson and Benham‐Hutchins' (2020) systematic review, which explored the influence of bullying on nursing practice, reinforced explanations of workplace bullying through ‘oppression theory’. They stated that nursing is an undervalued profession, and oppression theory illustrates that a lack of independence and power may result in individuals behaving badly or bullying others. Johnson and Benham‐Hutchins (2020) further described that oppressing powerless parties decreases individuals' self‐esteem, considers them weak, and causes fright and anger in groups, which may emerge as bullying of one's group over time.

3.2.3. Inactive Institutional Power

Three reviews suggested that bullying can happen due to a lack of management and leadership support (Averbuch et al. 2021; Capper et al. ²⁰²⁰; Shorey and Wong ²⁰²¹). Although no particular theories are presented regarding inactive institutional power, there are some explanations of how certain factors contribute to bullying when employees do not feel supported by leaders and those in power due to ineffective institutional policies. For example, Averbuch et al. (2021) noted the gaps in the governance system, structures and processes. They mentioned that not reinforcing antibullying policies in institutions results in workers' states of despair and fear of retaliatory consequences, which can lead to bullying. Capper et al. (2020) emphasised that most midwifery students tried to seek support from other individuals, such as family, friends, academic staff and counselling professionals, regarding bullying rather than seeking advice from individuals in their hospital unit because seeking support from managers was seen by victims as inadequate. Victims did not feel supported due to a lack of managerial focus on solving their issues. Shorey and Wong (2021) stated that some managers did not address the issue of bullying because managers lacked the abilities and knowledge to address bullying behaviours, resulting in an environment where bullying escalated. They pointed out that in such institutions where bullying escalated, people were uninterested in acting because they lacked the necessary knowledge to address the issues. A lack of governance, including inadequate systems and processes, as well as an inability to maintain accountability, supported those who encouraged bullying and ‘slipped’ under the official radar to avoid getting themselves ‘dirty’ or wrapped up in the issues.

3.2.4. Conflict in Teams

The final theme is that workplace bullying of healthcare workers correlates with conflict and negative team dynamics in the healthcare sector. Six reviews (Chadwick and Travaglia 2017; Halim and Riding ²⁰¹⁸; Johnson and Benham‐Hutchins ²⁰²⁰; Samsudin et al. ²⁰¹⁸) emphasised that healthcare workers may experience bullying due to conflict. The specific nature of work in healthcare settings involves working in teams, and this may cause interpersonal issues and conflicts. For example, Huang et al. (2018) noted that bullying may result from conflict due to group norms because some employees may challenge certain attitudes or complain about others' behaviours and thus, they may be victimised by their group.

One study considered a specific theoretical explanation of conflict in teams and subsequent bullying (Johnson and Benham‐Hutchins ²⁰²⁰). Johnson and Benham‐Hutchins (2020) noted that Structuration Divergence Theory may be relevant in the context of workplace bullying, and exploring it further may be beneficial in explaining the bullying process in healthcare settings. Healthcare workers work in teams involving various departments and therefore, there is a possibility of counterproductive attitudes or conflicts in the organisation. Nurses may face situations that pose contradictions between different work structures and units in healthcare organisations which may inhibit nurses' abilities to comprehend social and work situations, and act accordingly (Johnson and Benham‐Hutchins ²⁰²⁰). Underproductive work behaviours resulting from the contradictions between nurses' intended work practices and their actual work practices which may be called structurational divergence can potentially result in conflicts (Johnson and Benham‐Hutchins ²⁰²⁰). These contradictions usually emerge as observable patterns or interpersonal conflicts and studying these contradictions and patterns may explain bullying (Johnson and Benham‐Hutchins ²⁰²⁰).

In sum, across the included studies, workplace culture, hierarchical power relations, inactive institutional power illustrating inadequate governance systems, and team conflicts were consistently highlighted. They were frequently described as influencing both the occurrence of bullying and the capacity of the healthcare organisations to prevent and manage bullying. While these explanations were common across healthcare settings and various professions (e.g., medicine, nursing, midwifery, etc.), the scoping review found limited variability in how they were conceptualised, likely reflecting the similarities in institutional and regulatory environments within which most healthcare organisations operate.

3.3. Research Question 2: Prevention and Management

The second research question (RQ2) focused on the prevention and management of bullying identified in systematic reviews in healthcare settings. Four themes were identified: (1) a comprehensive approach to managing bullying; (2) awareness and effective reporting of bullying; (3) workplace support against bullying; and (4) institutional policies and enforcement of practices.

3.3.1. Comprehensive and Multilevel Approaches to Prevent and Manage Bullying

The findings of eleven reviews emphasised that to prevent and manage bullying, a multilevel and/or comprehensive approach should be applied rather than focusing on an individual level or a single aspect (Capper et al. 2020; Chadwick and Travaglia ²⁰¹⁷; Galanis et al. ²⁰²⁴; Halim and Riding ²⁰¹⁸; Huang et al. ²⁰¹⁸; Lever et al. ²⁰¹⁹; Samsudin et al. ²⁰¹⁸; Serafin et al. ²⁰²⁰; Shorey and Wong ²⁰²¹; Vijayakumar and Rajagopal ²⁰²⁴; Yang et al. ²⁰²⁴). Galanis et al. (2024) in their review of workplace bullying among nurses suggested that institutions must take an approach that focuses on multiple levels. They noted that at the organisational level, aspects such as creating a healthy workplace environment by reducing job stress and providing material and human resources can help with the issue of bullying. At the individual level, intrinsic coping mechanisms and resilience building, and strong managerial support provided to victims can alleviate workplace bullying.

Approaches based on taking several different steps or comprehensive actions simultaneously, for example, awareness about bullying, effective practices and procedures, and support from managers and leaders have also been identified in some reviews (Averbuch et al. 2021; Stagg and Sheridan ²⁰¹⁰; Vijayakumar and Rajagopal ²⁰²⁴). Averbuch et al. (2021) pointed out an approach based on multidisciplinary staff committees, policies, and procedures to curb bullying and develop effective reporting processes, and an education campaign to create awareness about bullying. Stagg and Sheridan (2010) mentioned that there is no single solution, but several different or comprehensive approaches can be useful in preventing and managing bullying. However, they also emphasised the need for a standardised approach for mitigating bullying to ensure the consistency of preventive measures.

3.3.2. Awareness and Effective Reporting of Workplace Bullying

Twelve reviews noted that awareness is a crucial step in preventing and managing bullying. Awareness about bullying behaviours helps bullied workers identify and successfully report bullying behaviours (Averbuch et al. 2021; Capper et al. ²⁰²⁰; Chadwick and Travaglia ²⁰¹⁷; Galanis et al. ²⁰²⁴; Halim and Riding ²⁰¹⁸; Huang et al. ²⁰¹⁸; Lever et al. ²⁰¹⁹; Shorey and Wong ²⁰²¹; Stagg and Sheridan ²⁰¹⁰; Villalobos et al. ²⁰²³; Yang et al. ²⁰²⁴; Zhou et al. ²⁰²⁴). Four reviews proposed that institutions can enhance employees' understanding of bullying through awareness campaigns, and prevention programmes such as cognitive rehearsal programmes and programmes informed by policies and processes educating employees about how to prevent bullying because using legal knowledge to create awareness can change the bullying culture (Galanis et al. 2024; Huang et al. ²⁰¹⁸; Stagg and Sheridan ²⁰¹⁰; Yang et al. ²⁰²⁴). Shorey and Wong (2021) and Halim and Riding (2018) reinforced that bullying could be prevented by creating awareness through offering education about bullying and conflict management and introducing practical suggestions about addressing bullying in undergraduate curricula for nurses and doctors.

Some reviews indicated a need for effective reporting of bullying to prevent bullying. Lever et al.'s (2019) review suggested that effective reporting can be made possible through awareness about bullying issues. Yang et al. (2024) and Averbuch et al. (2021) stated that underreporting results when victims perceive bullying prevention and management initiatives as useless. Thus, it is crucial to facilitate reporting processes for effective management of bullying. They argued that the victim's concerns about maintaining confidentiality while reporting bullying must be addressed to avoid underreporting and consequently ineffective prevention and management of the bullying.

3.3.3. Workplace Support Against Bullying

Nine reviews on workplace bullying emphasised the need for support from leaders in preventing and managing bullying effectively (Averbuch et al. 2021; Capper et al. ²⁰²⁰; Chadwick and Travaglia ²⁰¹⁷; Galanis et al. ²⁰²⁴; Halim and Riding ²⁰¹⁸; Huang et al. ²⁰¹⁸; Serafin et al. ²⁰²⁰; Shorey and Wong ²⁰²¹; Stagg and Sheridan ²⁰¹⁰). Halim and Riding (2018) suggested that to handle the issue of bullying, offering workplace support in an accessible manner to bullied employees is essential. Shorey and Wong (2021) stated that nurses suggested providing support against bullying to new nurses who face managers' lack of support and lack the necessary knowledge and skills to deal with bullying behaviours. Chadwick and Travaglia (2017) emphasised that workplace support must be actively provided to all employees, as not all employees will ask for support in cases of bullying. Additionally, some managers may be unable to manage bullying and provide support because of their lack of understanding of the interpersonal issues of employees.

3.3.4. Institutional Policies and Enforcement of Practices and Procedures

Six reviews pointed out that an emphasis on institutional policies and enforcement of practices and procedures can assist in preventing and managing bullying (Averbuch et al. 2021; Chadwick and Travaglia ²⁰¹⁷; Galanis et al. ²⁰²⁴; Huang et al. ²⁰¹⁸; Jeong et al. ²⁰²⁴; Shorey and Wong ²⁰²¹). Averbuch et al. (2021) pointed out a need to focus on effective policies and procedures because workplace bullying may be promoted by normalising it in the absence of proper implementation of institutional procedures and policies. Shorey and Wong (2021) reported that to prevent bullying in organisations, relevant codes of conduct, policies and procedures must be implemented and followed. Huang et al. (2018) emphasised that surgical trainees should take guidance from policies and codes of conduct before reporting bullying. They further indicated that establishing standards and procedures to assess consultants for their skills will address the issue of dealing with those seniors who lack the essential skills and attributes for effectively supervising trainees.

4. Discussion

This scoping review aimed to answer two research questions about how workplace bullying is theoretically explained and how prevention and management of workplace bullying are discussed in systematic reviews. The results indicated that workplace bullying may be explained from several theoretical perspectives. Further, prevention and management were suggested to be a multi‐level approach to match the complexity of bullying.

4.1. Theories and Theoretical Constructs

The findings of this scoping review illustrate that bullying may exist as part of the culture in healthcare professions and organisations where bullying is normalised. The extant literature suggests that the bullying phenomenon cannot be studied separately without considering the organisational cultures where healthcare employees operate (Bren and McNamara ²⁰⁰⁴; Rahm et al. ²⁰¹⁹). Scoping review findings also indicate that safety culture can explain the phenomenon of bullying. Organisations with poor safety cultures, where employees' safety is not considered a priority, foster a toxic work environment and bullying behaviours may frequently emerge (Johnson 2009). However, it is to be noted that bullying can also escalate due to the inconsistencies in workplace culture resulting from differences in individual beliefs and values around safety. Differences in individual beliefs and values impact how leaders and managers in the same organisation view bullying. They may take different approaches to bullying prevention and management, depending on their values, thus making it a more complex phenomenon—difficult to identify, prevent, and manage bullying (Walker and Stones 2020).

Further, the healthcare sector is hierarchical with power imbalances: senior staff, supervisors, and those further up in the hierarchy may abuse their powers as part of the training process for junior staff. These findings are similar to what other studies have found (Fnais et al. 2014; Recupero et al. ²⁰⁰⁵; Subramaniam et al. ²⁰¹⁵; Wright ²⁰²⁰). Oppression theory may be relevant in the context of hierarchy and complex systems in healthcare institutions because it can explain how some workplaces encourage bullying through the oppression of individuals (Griffin and Clark 2014; Johnson and Benham‐Hutchins ²⁰²⁰; Randle ²⁰⁰³). The hierarchical system of healthcare organisations promotes abuse of power from seniors, encouraging oppression, causing frustration and anger in oppressed individuals that eventually manifests as bullying behaviour toward other individuals (Ferguson and Anderson 2021; Hinchberger ²⁰⁰⁹; Johnson and Benham‐Hutchins ²⁰²⁰). However, it is crucial to also consider that oppression theory may not effectively shed light on lateral aggression among peers. This is because although bullying behaviours are typical characteristics of an oppressed group of individuals, bullying may result from the oppression of individuals in any position, regardless of their place in the hierarchy—thus, bullying can be seen both as a result of oppression within the same group or from those in the ranks of power (e.g., seniors, mentors and supervisors) (Edmonson et al. 2017).

Although the findings of this review revealed no particular theories concerning inactive institutional power, there were some explanations of bullying based on how some factors may lead to bullying. These findings of the scoping review are consistent with the views of some researchers who suggest that healthcare institutions with ineffective antibullying institutional policies and regulations are more prone to exhibiting workplace bullying (Alahmari et al. 2020; Tuckey et al. ²⁰²²). Antibullying institutional policies and procedures may be in place, but bullying still continues if the policies fail to address the issue due to nonenforcement or improper implementation (Bambi et al. 2017; Coursey et al. ²⁰¹³; Difazio et al. ²⁰¹⁹). While there is some evidence describing the role of inactive institutional power as an explanation of bullying, the deeper aspects of inactive institutional power remain under‐theorised, emphasising a further examination of how policy inefficacy triggers toxic work environments and bullying.

Some reviews (e.g., Chadwick and Travaglia ²⁰¹⁷; Samsudin et al. ²⁰¹⁸) indicated that structural contradictions and interpersonal dynamics in healthcare organisations cause conflicts and even bullying. Structurational Divergence (SD) theory may explain conflicts related to these interpersonal issues (Nicotera and Clinkscales 2010). SD theory states that structures in organisations have different rules and regulations which may negatively impact interpersonal communication causing conflict in teams potentially leading to bullying (Nicotera and Mahon 2013). Some other scholars also suggest conceptual links between conflicts, bullying and structurational divergence, so identifying where conflict and bullying diverge, and most importantly converge, may offer beneficial insights into the bullying process and its management (Baillien et al. 2017; Keashly et al. ²⁰²⁰; Malterud and Nicotera ²⁰²⁰; Nicotera et al. ²⁰¹⁴; Zapf and Gross ²⁰⁰¹). SD theory may be beneficial in explaining bullying that results from conflicts and structurational divergence; however, it may have its limitations. It may identify drivers of conflict in healthcare organisations where the nature of the work revolves around teamwork, overlooking systemic inertia that reinforces a bullying culture.

Workplace bullying in the healthcare sector is deeply ingrained in organisational culture, power dynamics within hierarchies, and institutional inefficacy. Theoretical frameworks such as safety culture, oppression theory, and structurational divergence can offer valuable insight into the bullying phenomenon, but a more unified and cohesive theoretical conceptualisation that efficiently captures the bullying dynamics remains underdiscussed. These theories offer some explanations but individually, they tend to offer fragmented descriptions of the bullying phenomenon because they fail to account for the multifaceted nature of the bullying process in complex healthcare organisations. Thus, to advance our understanding of the bullying process, the theoretical direction must transition from a compartmentalised lens to a synthesised, unified, and inclusive theorising. Theorising by incorporating integrative and interdisciplinary approaches that synthesise macro (at the institutional level), meso (organisational level), and micro (individual/interpersonal) dimensions can help construct a dynamic, more predictive model of explaining workplace bullying (Courgeau 2012). Such approaches would not only shed light on the structural, cultural or behavioural aspects of bullying but also lay the groundwork for evidence‐based, more actionable interventions that may target bullying at its core.

4.2. Prevention and Management of Bullying

RQ2 aimed to explore how the prevention and management of bullying were discussed in the literature on healthcare workers. The identified themes included a comprehensive approach to managing bullying, awareness and effective reporting of bullying, workplace support, and enforcement of organisations' policies, practices and procedures.

This review showed a need for comprehensive interventions including multilevel interventions at individual, organisational and institutional levels. The extant literature illustrates that antecedents of bullying exist at multiple levels (Chipps and McRury ²⁰¹²; Pope and Burnes ²⁰⁰⁹). However, some interventions focus solely on the behaviours of individuals, including coping strategies or emotional management techniques for perpetrators and victims (Aquino and Thau 2009). In a hierarchical workplace where bullying is normalised, interventions that aim to change or target individuals' negative behaviours may not be an effective approach to prevention and management. This is because such approaches may not address the root cause but only the symptoms of bullying, such as stress and mental health challenges of the victims (Nielsen and Einarsen 2012). They may not necessarily address systemic issues, such as lack of organisational support or hierarchy‐related power imbalances (Sheehan et al. 1999). Effective prevention and management, therefore, can involve strategies that focus on both addressing misconduct or changing abusive behaviours and offering a safe work environment where employees are supported and respected (Vessey et al. 2009).

The scoping review noted that workplace support from leaders and managers may help to prevent and manage bullying. This is consistent with other literature (Cleary et al. 2010; Djurkovic et al. ²⁰²¹; Sullivan ²⁰¹⁰). However, some scholars have argued that organisations may not be able to support bullying victims because of the leaders' and managers' lack of training in preventing and managing bullying (Gardner and Cooper‐Thomas ²⁰²¹; Sullivan ²⁰¹⁰; Vartia and Tehrani ²⁰¹²). Workplace support can be ensured in such circumstances by training staff and management around bullying prevention and management so they can identify and address bullying (Gardner and Cooper‐Thomas ²⁰²¹; Macintosh ²⁰⁰⁶; Randle et al. ²⁰⁰⁷; Sullivan ²⁰¹⁰). Leaders must consider bullying reports as a means of understanding the issue, rather than perceiving them as a ‘waste of time’ (Crawford 2001). Organisations must respond to bullying reports to create a supportive workplace (Bentley et al. 2012; Randle et al. ²⁰⁰⁷).

Another finding furthering the view of workplace support for prevention and management is awareness and effective reporting of bullying. Awareness of bullying behaviours may potentially assist workers in recognising bullying (Samsudin et al. 2018). It is to be noted that bullying prevalence rates may be seen as low because bullying remains unidentified and under‐reported (Allen 2015). This likely results in poor bullying management. Effective antibullying interventions can only be designed and introduced if there is a thorough awareness of what may cause bullying and what steps need to be taken by organisations to address bullying (Allen 2015; Georgakopoulos et al. ²⁰¹¹). Further, and linking with the first theme, awareness campaigns, cognitive programmes, and measures must be introduced at multiple levels (i.e., at organisational, social and individual levels) to effectively reduce bullying (Han and Ha 2016).

The literature points out that while policies and procedures are present in organisations, these policies and procedures must be aligned with the prevention and management of bullying for eliminating bullying (Pope and Burnes 2009). Thus, effective implementation of policies and procedures is the responsibility of both healthcare institutions and workers (Majrabi 2022). Although crafting effective policies is critical, implementation of these policies is a challenge that organisations must address to successfully prevent and manage bullying (Sheehan et al. 2020). Human resource (HR) departments and personnel can play a significant role in effective policy implementation (Cowan et al. 2021; Fox and Cowan ²⁰¹⁵; Salin ²⁰⁰⁸). Managers must also have expertise in understanding and interpreting policies to ensure procedures are followed promptly and policies are implemented accurately (Cowan et al. 2021; Fox and Cowan ²⁰¹⁵).

Regardless of a significant body of literature on bullying, the strategies on prevention and management are fragmented, often relying on a solitary approach such as individual coping mechanisms. Concrete measures regarding effective policy implementation, leadership accountability, and institutional interventions are compulsory, yet they remain underdeveloped in the literature. Further, barriers to reporting, including fear of reprisal and leadership complicity require further investigation to propose a more unified approach to prevention and management. Recently, the impact of rapidly transforming work environments on bullying prevention and management, such as the changing dynamics of remote and hybrid settings, also points to a need for further investigation. Researchers, therefore, must consider multidisciplinary approaches, investigating the effectiveness of governance systems, reporting channels, policy implementation, and cultural changes to offer more sustainable preventive strategies and interventions.

5. Limitations and Conclusions

This review has some limitations because the search was restricted to systematic reviews and meta‐analyses, articles published in English only, and peer‐reviewed studies. Non‐peer‐reviewed studies may offer additional insights and theoretical explanations.

The variability across studies was primarily qualitative regarding the diversity of healthcare settings, including the different types of healthcare services (medicine, surgery, nursing, midwifery, etc.) provided and the diversity of the healthcare workforce. Despite this, there was a notable consistency in the structural explanations of bullying, suggesting possible similarities in the institutional and regulatory environments of healthcare organisations globally, which may limit the range of theorising about bullying explanations. This constrained variability raises the question for further exploration: how current conceptualisations of bullying are influenced by the governance logics of healthcare systems, rather than by local or cultural differences in the healthcare settings.

There are significant gaps in the literature regarding the explanation of workplace bullying of healthcare workers. Further exploration is required to understand how the theories, theoretical constructs, and explanatory factors indicated by this scoping review relate, complement, and overlap with each other. Governance systems (i.e., systems, processes and structures related to antibullying policies and measures) act as a key factor influencing bullying dynamics and responses. Reporting systems are shaped by institutional policies, accountability systems, and regulatory mechanisms, which determine the resources available for the prevention and management of bullying. Governance systems can act as both enablers and barriers. This is because they can not only sanction a framework for prevention and management through antibullying policies, but in the absence of effective implementation can reinforce hierarchical dynamics that sustain bullying behaviours. Future theorising and practice should therefore focus on embedding antibullying measures within broader governance structures across the institution, rather than viewing the problem solely as an interpersonal or workplace issue. We recommend further research that can compare healthcare settings with a variety of frameworks regarding governance and accountability. This will help explore whether variations in the healthcare settings, different systems, and institutional structures can offer a platform for more effective prevention and management of bullying. An effective implementation of anti‐bullying policies must be a priority because policies that merely exist on paper without actual enforcement can foster an environment for toxic behaviours such as bullying to remain unaddressed.

Workplace bullying is triggered by culture or hierarchy and by the systems that regulate or fail to regulate institutional conduct. Thus, reporting systems, formal complaint mechanisms, or whistle‐blower protections should be safe platforms for effective reporting. Inefficient reporting systems, stemming from a culture that ignores the problem, may prevent healthcare workers from sharing their concerns. Leadership accountability should be prioritised, as senior management and leadership must model healthy behaviours. Managers should attend to bullying complaints and respond decisively. This strategy can set explicit norms to address bullying. When leaders minimise bullying, they may indirectly signal tacit acceptance. In sum, governance structures, reporting systems, policy implementation and leadership accountability act as institutional elements that can either trigger or mitigate bullying, further highlighting the need for comprehensive strategies in healthcare organisations.

The scoping review aimed to address two research questions relating to theoretical explanations of bullying in healthcare workers and the prevention and management of bullying. The workplace culture, hierarchy in healthcare organisations, inactive institutional power, and conflict may potentially provide an explanation of bullying behaviours in healthcare workers. A comprehensive approach involving both individual and organisational level factors can be adopted to prevent and effectively manage workplace bullying. This comprehensive approach may include a greater focus on addressing the root cause of bullying by creating a safe work environment for healthcare workers through providing organisational support, addressing bullying through the implementation of policies and procedures, creating awareness about bullying to promote effective reporting of bullying behaviours, and running programmes and training that could help raise awareness around workplace bullying. The role of leaders and managers is also critical in ensuring that healthcare settings are bullying‐free.

Author Contributions

Authors have agreed on the final version and meet at least one of the following criteria (recommended by the ICMJE): (1) substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; (2) drafting the article or revising it critically for important intellectual content.

Conflicts of Interest

The authors declare no conflicts of interest.

Supporting information

Data S1: Data extraction table indicating data items and characteristics of the included studies.

Bashir, S. , and Oetzel J. G.. 2026. “Workplace Bullying in Healthcare Organisations: A Scoping Review of the Systematic Reviews and Meta‐Analyses on Workplace Bullying of Healthcare Workers.” Journal of Advanced Nursing 82, no. 8: 7668–7687. 10.1111/jan.70339.

Data Availability Statement

Data supporting the findings of this study is available through Open Science Framework (OSF) repository.