The Nurse & Midwife Survival Guide: Navigating a toxic workplace

Whether it’s clinical nitpicking, being ignored at handover, or feeling like you’re walking on eggshells around a specific colleague, the nurse bullying epidemic and resulting toxic workplaces are a real, documented psychosocial hazard.

Not only does it affect the nurses and midwives on shift, but it can also cause communication break down – a very real threat to patient safety. Navigating a toxic workplace can be extra difficult if you’re also facing workplace bullying. If you’re currently being bullied in the workplace, you can read our 4-step action plan on how to handle the situation. Otherwise, here are 5 essential tips to help protect your practice in a toxic workplace.

The World Health Organization (WHO) defines a healthy work environment as a state of "physical, mental, and social well-being." It isn't just a "nice-to-have"; it's the baseline for safe clinical practice. Does your current ward or unit reflect that standard, or are you simply "getting through" the shift?

It’s not uncommon to hear from clinicians who realised too late that they were drowning in a toxic culture. When you’re in the thick of it, it’s easy to develop a "this is just how it is" mentality. So, how do you know if you’ve crossed the line from a "tough week" into a "toxic environment"? Ask yourself the below questions:

• Is it obvious? (Overt bullying or safety risks).
• Is it subtle? (Persistent dread, denial, or a feeling that you’re "rocking the boat" if you question anything).
• Is it fear? (Staying silent because you don’t want to be targeted).

It can be difficult to see a culture clearly when you’re immersed in it every day. Use this checklist to help identify if your professional environment has crossed the line from "high-pressure" to "toxic."

1. The Culture of Communication

Does management use the right buzzwords (e.g., “well-being,” “resilience”) but fail to implement any tangible changes to staffing or safety? Have you raised legitimate safety concerns and been told that you’re “not being a team player” or that you’re simply “struggling to keep up”? Are important updates about the ward or unit shared via the ‘grapevine’ rather than a transparent and official channel? This illusion of support and closed communication loop is often a key indicator that a workplace has become toxic.

When leadership offers platitudes instead of tangible action, the weight of that disappointment can be heavier than the workload itself. Sometimes, the most professional thing you can do is recognize when it is time to save yourself and move on.

2. Lateral Violence & Peer Dynamics

Have you noticed that new staff or students are hazed or left too ‘sink or swim’ as a rite of passage? Do shift handovers feel like an interrogation or are staff members consistently excluded from professional or social support? Are errors are treated as personal failings to be punished rather than systemic opportunities for learning?

3. Operational Toxicity

It’s not uncommon to feel overworked and underappreciated in healthcare, but operational toxicity can often lead to personal and professional burnout when left unchecked. Chronic understaffing, missed breaks, and staying late are treated as "part of the job" rather than a failure of management. You often feel pressured (explicitly or via guilt) to pick up extra shifts or answer work messages on your days off. You are discouraged from using your clinical judgment and instead forced to follow rigid, inefficient processes without explanation.

4. Your Personal Barometer

Do you experience dread before a shift or are experiencing depersonalisation, increased agitation or loss of job satisfaction? Have you stopped speaking up or suggesting improvements because you know nothing will change and it feels like an endless uphill battle? Have you become hypervigilant and find yourself constantly walking on eggshells, simply waiting for the next conflict or criticism?

Toxic workplaces thrive on isolation and self-doubt. Recognising that horizontal violence is a systemic issue, not a personal failure (or a “bad apple” issue), is essential for effective intervention and management. Systemic factors that can often trigger a toxic workplace culture include understaffing, high workload, lack of leadership support, and a “sink or swim” mentality that forces competition rather than collaboration.

As nursing and midwifery professionals, your primary commitment is to patients. However, that commitment cannot exist in a vacuum. It is the fundamental duty of healthcare employers to provide environments that are safe, supportive, and free from the corrosive effects of lateral violence.

While painful, these experiences often serve as a catalyst for clarity. They help us identify exactly what is broken in the system and, more importantly, what we can control: our mindset, our boundaries, and our future.

Access Support

As Nurse & Midwife Support, we offer a free, anonymous, and confidential national helpline for all nurses and midwives available 24/7 at 1800 667 877.

Nurse Midwife Health Program Australia (NMHPA) provides free and confidential peer support counselling across Australia. Available Monday to Friday from 9am to 5pm across at 1800 001 060.

Employee Assistance Programs (EAP) are internal, confidential, and free short-term counselling provided by Australian health services.

Document Like a Clinician

In nursing and midwifery, the saying: If it isn't documented, it didn't happen is all too common. The same can apply to incidents of a toxic workplace. Start a private Incident Diary (keep this on your personal phone or in a physical notebook at home) and record:

• Dates and times: Be precise.
• Quotes: Use exact words where possible.
• Witnesses: Who else was in the room?
• Impact: How did it make you feel? Did it impact patient care?

This will help support your case if you decide to escalate the issue later.

Master the "Professional Shield"

When dealing with a toxic workplace your goal is to become professionally boring. This is sometimes called the "Grey Rock" method.

• Keep it clinical: Limit interactions to patient-related tasks.
• Don't take the bait: If a colleague makes a snide remark, respond with a neutral, "I hear your feedback, let’s focus on the patient right now."
• Maintain your standards: Don't let a toxic environment tempt you into cutting corners. Your AHPRA registration is your most valuable asset — protect it by staying "by the book."

Note: Sometimes the bullying isn't a person, but a system. If you feel you can't provide the level of care your patients need due to staffing, you could be experiencing moral distress. Learn more about moral distress here.

Build a Professional Support Network

You don't have to fight this alone. Build your professional support board by contacting:

• The Professional: Your union representative for legal and industrial advice.
• The Peer: A trusted colleague (perhaps from a different ward) who understands the clinical context.
• The Neutral Party: Support services and helplines such as Nurse & Midwife Support or

Define Your Exit Strategy

Sometimes these types of environments are able to be navigated through self-advocacy, leveraging effective leadership, and systems change. But other times it may be beyond repair and it's okay to save yourself. You are number one. You are never stuck and your mental health matters. Being healthy in all aspects of your life matters.

Sometimes, the best step is an exit. This isn’t giving up, but an act of professional self-preservation. Survival doesn't always mean "staying and fighting." Sometimes, the bravest thing you can do for your career is to realize that a specific environment is no longer compatible with your wellbeing. Moving to a different ward or facility is often the best way to rediscover your love for the profession.

Reach Out

If you’re currently experiencing workplace bullying or harassment, and need someone to talk to, you can talk to our team of experienced nurses and midwives for free, confidential and anonymous advice. We’re here for you Australia-wide on 1800 667 877 or by email.

Further Resources

• Listen to Episode. 47 or our Nurse & Midwife Support podcast where Nurse Coach and Educator Trina Pitts talks the realities of horizontal violence, the effects of bullying on your mental health and reflects on her own personal experience with a toxic workplace.
• Listen to Episode. 49 of our Nurse & Midwife Support podcast where Nurse Coach and Mentor Liam Caswell explains why it can be difficult to plan an exit strategy when you’re in survival mode – and how to start putting yourself first to get back on track.
• Learn How to Handle Workplace Bullying as a Nurse or Midwife with our 4-step action plan.