By Dr. Paul Kelly, C.Psych. | Founder & Clinical Director, Nurse Wellness Program | June 9, 2026
You know the unit you trained on. You know what it feels like when a team functions well: the shorthand with your work besties, the backup, the trust that someone has your back when a patient deteriorates at 0300.
You also probably know what it feels like when that isn’t there. When the hierarchy cuts, when a colleague undermines, when the unit’s culture makes a hard job even harder.
Toxic unit culture is one of the least-discussed drivers of burnout in critical care nursing. There are reasons for this minimization: it’s harder to name than a 12-hour shift or a difficult case, and nurses are often told, explicitly or implicitly, that the problem is their sensitivity, not the culture.
It isn’t your sensitivity. And this article is about recognizing it clearly, protecting yourself practically, and knowing when the environment has become something that requires more than individual coping.
Table of contents
- Quick answer (read this first)
- What toxic unit culture looks like
- Why toxic culture drives burnout
- Protection planning: what you can do
- When protection planning is not enough
- When to reach out
Quick answer (read this first)
Toxic unit culture, including bullying, lateral violence, and hierarchical disrespect, is a documented occupational hazard in critical care nursing that contributes directly to burnout, anxiety, secondary traumatic stress, and turnover. It is not caused by individual weakness.
Three things matter most:
- Being able to name what is happening, clearly and without minimizing it
- Building a practical protection plan that does not require the culture to change first
- Knowing when the environment has become unsafe enough to warrant formal escalation or a change in role
What toxic unit culture looks like
Toxic unit culture covers a range of behaviours. Some are obvious, some are subtle. All of them can have a cumulative effect on your well-being and performance.
Lateral violence and bullying
Lateral violence refers to hostile, aggressive, or undermining behaviour between nurses. As you have probably seen yourself, it is most often directed at newer or less senior nurses by more experienced colleagues. The ‘nurses eating their young’ phenomenon is a specific and well-documented form of it.
It helps to understand how these behaviours are defined, because the distinctions matter for naming what is happening and for knowing what protections apply.
Incivility, harassment, and bullying: what is the difference?
Incivility is rude, dismissive, or disrespectful behaviour: eye-rolling, sarcasm, cutting off a colleague mid-sentence, ignoring questions. It may be intentional or unintentional. It tends to be lower in intensity but creates a workplace that feels unwelcoming and demeaning. Left unchecked, incivility escalates.
Workplace harassment is defined under Ontario’s Occupational Health and Safety Act (OHSA) as ‘a course of vexatious comment or conduct against a worker in a workplace that is known or ought reasonably to be known to be unwelcome.’ The behaviour typically happens more than once, over time, and a reasonable person would understand it to be unwelcome. Examples include repeated humiliation, social exclusion, spreading false information, and withholding support or information necessary to do your job.
Bullying is deliberate, purposeful, and intended to control, undermine, or harm. It involves a power imbalance, real or perceived, and repeats over time. It may come from a charge nurse, a physician, a manager, or a peer. Unlike a single difficult interaction, bullying has intensity, repetition, and duration.
Key distinction: Incivility may be accidental. Bullying never is. And under Ontario law, your employer is required to have a written harassment policy and a reporting mechanism, and to investigate complaints. The standard is clear, even when the culture is not.
It can look like:
- Public humiliation or dismissiveness in front of colleagues or patients
- Withholding information needed for safe care
- Eye-rolling, sighing, or non-verbal contempt during handover
- Exclusion from the informal social structure of the unit
- Subtle sabotage: setting up a junior nurse to fail and then criticizing the failure
- Rumour, gossip, or campaigns of social exclusion
Many nurses experiencing this minimize it because it doesn’t look like the dramatic workplace bullying described in training. It is quieter, deniable, and often normalized by the culture as ‘how it is here.’
Hierarchical disrespect
This refers to disrespect directed downward through the hierarchy, from physicians, charge nurses, nurse managers, or administrators. It includes:
- Dismissiveness of nursing observations or clinical concerns
- Public criticism or condescension in front of patients or families
- Being spoken over, interrupted, or treated as procedural rather than clinical
- Retaliatory responses to raising concerns about patient safety
- Demands for compliance that conflict with clinical or ethical judgment
Hierarchical disrespect is particularly damaging in ER, ICU, NICU, and PICU environments because it erodes the psychological safety required for effective interdisciplinary communication. So, this disrespect is also a patient safety issue.
Systemic and structural toxicity
Some unit cultures are toxic not because of specific individuals but because of systemic conditions: chronic understaffing that creates mandatory overtime and inadequate breaks, assignment practices perceived as punitive, cultures of silence around errors, and leadership that responds to concerns with minimization or blame.
These conditions are not personal. But they accumulate in the body, mind and spirit of every nurse who works within them.
Why toxic culture drives burnout
Burnout in high-acuity nursing is often framed as a response to clinical demands: the patient load, the trauma exposure, the shift patterns. Those are real. But the research consistently identifies the relational and cultural environment as an equally significant driver.
- Chronic threat activation. When your unit is a source of social threat (unpredictable criticism, exclusion, disrespect), your nervous system cannot fully downregulate between patients. You are managing clinical load and interpersonal threat simultaneously. That is a significant additional demand on an already high-load system.
- Erosion of meaning. Nursing draws heavily on a sense of purpose and belonging. A toxic culture attacks both directly, severing the relational threads that make difficult work meaningful and replacing them with vigilance, self-protection, and disengagement.
- Suppression of voice. Cultures where it is unsafe to raise concerns, ask questions, or acknowledge difficulty require a form of emotional suppression that is physiologically costly. Over time, suppression contributes directly to both burnout and trauma-spectrum symptoms.
- Moral injury. When the culture prevents you from providing the care you know patients need, or when speaking up about patient safety is met with retaliation, the resulting moral distress accumulates as a specific form of psychological injury distinct from ordinary stress.
These mechanisms are additive. A nurse who is managing clinical trauma exposure, shift-work sleep disruption, and a toxic unit culture is carrying several distinct sources of psychological load simultaneously. The cumulative weight is not a personal weakness. It is arithmetic.
Protection planning: what you can do
The most important thing to say upfront: protection planning is not the same as fixing the culture, and it is not asking you to accept conditions that should not be acceptable. It is about what you can do to reduce your exposure and protect your functioning as you navigate a situation you did not create.
1. Name it clearly
Minimizing toxic behaviour, to yourself or others, increases its psychological cost. Naming it clearly does not mean catastrophizing. It means being accurate and trusting your integrity.
Language for naming it to yourself
- ‘What happened in that handover was disrespectful. That is not a normal standard.’
- ‘That was lateral violence. It happens here regularly and it is affecting me.’
- ‘The culture in this unit is unsafe. That is a factual observation, not an overreaction.’
Note: You do not need to say these things out loud at work. Saying them to yourself, accurately and without minimizing, is the first step in not internalizing the behaviour as your own failure.
2. Identify your allies
Most toxic units contain pockets of safety: colleagues who are trustworthy, a charge nurse who functions with integrity, and a physician who treats nursing staff with respect. Think about your unit. Who are your allies? Who could you build a better relationship with?
You do not need the whole culture to change. You need enough relational safety to function and debrief. One trusted work bestie who will say ‘yes, that was not okay’ is a blessing and meaningful protection for you.
3. Reduce unnecessary exposure
Some exposure is unavoidable. Some is not. Think it through: Where you have discretion, when you go into the breakroom, who do you have conversations with, and how much time you spend with some coworkers after hours?
This is not about isolating yourself. It is about conserving your good heart and energy by avoiding toxic people and situations.
4. Document incidents that cross a line
If you are subjected to toxic behaviour that is escalating, repetitive, or that affects patient care, start documenting it. Keep a factual written record of dates, times, what was said or done, and who was present. Even brief jottings on a notepad or your phone can be the foundation for a formal report. These notes can protect you if the situation escalates further.
You do not need to be planning a formal complaint to start documenting. Documentation is protective regardless of what you decide to do next. Writing things down is also a good way to get it out of your head, so you won’t be ruminating about it as much.
5. Know your escalation pathways: what the ONA can actually do
Most Ontario nurses are ONA members and have access to a set of formal supports that go well beyond a general complaint process. Understanding what is available, even if you choose not to use it immediately, is part of protection planning. You are not trapped.
ONA approaches toxic unit culture as both a human rights issue and an occupational health and safety (OHS) issue. Not a personality conflict. That framing matters, because it means the tools available to you are more substantive than most nurses realise.
What ONA can do for you if you are in a toxic unit
Human rights and anti-harassment support
- ONA has a dedicated Human Rights and Equity Team whose mandate includes supporting members experiencing bullying, discrimination, and harassment, both on protected grounds (race, sex, disability, etc.) and non-Code personal harassment
- They can help you frame what is happening, document it, and decide whether to use internal employer processes, the grievance route, or the Ontario Human Rights Tribunal
- ONA explicitly commits to working toward the elimination of discrimination, harassment, bullying, and workplace violence, grounded in the Ontario Human Rights Code
Occupational health and safety tools
- Toxic culture that affects psychological safety, exposes you to violence, or creates unsafe staffing can be addressed as an OHS hazard. Not just a ‘relationship issue’
- Under the Occupational Health and Safety Act (OHSA), you have three rights: the right to know about hazards, the right to participate (through the Joint Health and Safety Committee), and, in certain circumstances, the right to refuse unsafe work
- ONA supports nurses in using the Internal Responsibility System (IRS): report hazards to your supervisor, then escalate to the JHSC and union if unresolved. ONA’s guidance is to escalate ‘as high as necessary, as fast as necessary’
- If the employer fails to address the hazard, ONA can push for Ministry of Labour involvement: inspections and orders
Union mechanisms
- Grievances and arbitration: ONA can pursue breaches of your collective agreement, including anti-discrimination and anti-harassment provisions. Since the Parry Sound decision, Ontario Human Rights Code protections are effectively part of every collective agreement
- JHSC support: ONA health and safety reps can bring systemic unit culture issues to the Joint Health and Safety Committee as formal hazards
Who to contact at ONA
- Your Bargaining Unit President: first contact for most workplace issues
- Human Rights and Equity Representative: for discrimination, harassment, or bullying
- Labour Relations Officer: for grievances and formal processes
- ONA Health and Safety Representative: for OHS route and JHSC involvement
Reference: ONA Human Rights and Equity Guide (2024): ona.org/wp-content/uploads/2024/10/ona_guide_humanrightsandequity.pdf
What your employer is legally required to do
The ONA tools above describe what your union can do on your behalf. Separate from that, Ontario’s Occupational Health and Safety Act places direct legal obligations on your employer, obligations that exist regardless of whether you are an ONA member or have filed a formal complaint.
Under the OHSA, your employer is required to:
- Have a written workplace harassment policy and a written program to implement it
- Review the policy and program at least annually
- Provide information and instruction to workers on the contents of the policy and program
- Investigate all complaints of workplace harassment, in a manner that is appropriate in the circumstances
- Inform the worker who complained and the alleged harasser of the results of the investigation and any corrective action taken or to be taken
- Take every precaution reasonable to protect workers from workplace violence, which includes violence and harassment from supervisors and colleagues, not only from patients or visitors
If the harasser is your direct manager, your employer must provide an alternative reporting route. If your employer fails to investigate a complaint or takes no corrective action, you can escalate to the Ontario Ministry of Labour, Training and Skills Development, which has the authority to order the employer to act.
The ONA process and the OHSA employer obligation are two parallel tracks, not alternatives. Filing with your union does not relieve your employer of its legal duty to investigate. You can use both simultaneously, and in most serious situations, you should.
When protection planning is not enough
There are situations where the unit culture has become unsafe in ways that require more than your individual protection planning:
- The behaviour is escalating despite any steps you have taken.
- Patient safety is being affected: critical information is being withheld, or the culture is preventing necessary communication.
- You are developing trauma-spectrum symptoms: hypervigilance, intrusive thoughts about specific interactions, and avoidance of certain colleagues or situations.
- You are dreading every shift in a way that is not recovering on days off.
- Your sense of professional identity: your belief that you are a competent, good nurse, is being eroded by the culture.
- You are seriously considering leaving nursing because of the toxic environment, not the clinical work.
These are not signs of weakness. They are signs that the environment has exceeded what individual coping can manage. And, they are signs that the situation warrants formal escalation, additional support, or a considered decision about your continued role on that unit.
When to reach out
Consider reaching out for professional support if:
- Symptoms of burnout, anxiety, or depression are present and not improving
- Trauma-spectrum symptoms have developed in response to the unit environment
- You are making major career decisions, about leaving the unit, reducing hours, or exiting nursing, while significantly distressed
- You need support navigating a formal complaint or escalation process
- The experience on the unit is affecting your relationships, your sleep, or your sense of self outside of work
- You are not sure whether what is happening is normal or not, and you need someone outside the unit to help you think it through
Toxic culture is not a personal problem, and it does not require a personal solution alone. Support that is specifically familiar with healthcare workplace dynamics can make a significant difference, both in navigating the situation and in recovering from its effects.
Toxic unit culture is a workplace safety issue, not a personal failing. The Nurse Wellness Program at The Mindfulness Clinic works with ER, ICU, NICU, and PICU nurses navigating exactly this.
themindfulnessclinic.ca/therapies/nurse-wellness-program/
About the Author
Dr. Paul Kelly, C.Psych
Founder & Clinical Director, Nurse Wellness Program
The Mindfulness Clinic │ Toronto, Ontario
Dr. Paul Kelly is a Clinical and Health Psychologist and the Founder and Clinical Director of The Mindfulness Clinic’s Nurse Wellness Program. His connection to nursing care is personal: born prematurely, he spent his first weeks in a NICU under the care of nurses who gave his family steadiness in an uncertain time. Hospitalized at age nine after a car accident, he spent a summer being cared for by nurses who were both skilled and kind. And as an adult, after a heart attack, it was ER nurses who were present through the most frightening hours. Before his training in psychology, he worked as an orderly and as an autopsy attendant, and came to understand early what it means to be inside a healthcare system. He later served as a Consulting Psychologist at Toronto General Hospital, working with the Lung Transplant Program and the Inpatient Psychiatry Unit. In the Nurse Wellness Program, he provides clinical oversight and supervision of the therapist team, and leads the development of the program’s modules and resources.
He founded the Nurse Wellness Program because the people who hold others together at their most vulnerable deserve a workplace, and a profession, that holds them in return. No nurse should have to navigate a toxic unit culture alone, and no nurse should have to carry that weight without support that actually understands the environment they work in.
