Undermining in the Emergency Department

Authors: Dan Darbyshire, Chloe Moran / Editor: Charlotte Davies / Reviewer: Dan Darbyshire / Codes: / Published: 08/03/2022 / Reviewed: 20/03/2026

This is one of three RCEMLearning Blogs on Bullying, Undermining and Incivility in the Emergency Department (ED). Originally published in 2022, these have been updated for 2026.

What is undermining?

Have you ever experienced consistent dismissive tones from that same colleague? Or the predictable sigh whenever you ask a question? What about that person who always talks over you in meetings?

This is undermining: the focus of this RCEM blog.

We can think of undermining as behaviour that subverts, weakens or wears away confidence. Undermining does not necessarily have to be intentional, repeated, or involve a power imbalance.1 Although the boundary is unclear, these features differentiate it from bullying and make it a more common experience. Undermining extends beyond simple feedback and constructive criticism; it intimidates, excludes, and humiliates.2

Examples of undermining include, but are not limited to, the following3:

Fig.1 Examples of undermining – courtesy of the author

In a profession that values resilience, enduring difficult situations and colleagues is often seen as part of the job. However, this should not be accepted. Undermining can harm morale, damage relationships, and reduce confidence. Such behaviour benefits no one, weakens team cohesion, and hampers individual performance.

What does the data show?

Data from the EMTA 2024 training report, along with similar findings from the GMC annual training survey, indicate that undermining is very common within the NHS. Of a cohort of 1045 staff members in emergency medicine, 262 were affected by undermining. 75% reported this to be by a senior and 56% reported it to be within the department. 24% shared that they experienced undermining by someone of the same grade and 18% reported that this was by a junior colleague. Bullying, harassment and incivility are reported beneath for comparison.

Action	Number affected	In department	Outside department	By patient	By senior	By same grade	By junior
Undermining	262	148	147	30	198	67	48
Bullying	56	35	25	8	46	10	8
Harassment	52	19	16	25	24	7	8
Incivility	384	128	284	187	196	177	109

When asked the question: The way I have been treated by other staff has negatively impacted the care I can offer patients, 240 responded with yes.

What can you do if you are being undermined?

Communication

Although it might feel scary or difficult, open communication can be beneficial if you feel comfortable with it. Initiating a private conversation with the individual may reduce misunderstandings and create transparency.4 The discussion should not directly target and should not accuse. Instead, it should focus on behaviours and situations and how they made you feel. Make sure to actively listen to hear the individual’s perspective and what you can do to alleviate any tension or miscommunications.5

Reach out to a trusted colleague

Speaking to someone you trust or have designated as a mentor or tutor is also an effective way of seeking guidance. Some options include clinical supervisors, educational supervisors, Wellbeing Champions, Freedom to Speak Up Guardians, a senior buddy (if your hospital has a buddy scheme) or simply reaching out to a trusted colleague. It is worth noting that these individuals may have faced similar challenges and can provide valuable advice on how to handle such situations.6

What can you do if you are undermining?

Reflect

Reflection as a leader and colleague is important.7 Recognising that you are undermining someone can often be hard to accept. You probably dont do it deliberately. It is helpful to reflect on past feedback or seek new feedback from colleagues.8 Are your more junior colleagues turning to others to discuss their patients? Sometimes observing interactions with a variety of colleagues might give you insight into how they perceive you.

Change your mindset

Consistently pointing out shortcomings may be perceived as undermining and does not exude encouragement. Offering support when someone is uncertain or still developing their skills demonstrates effective leadership and optimal use of seniority.9 Medical professionals have a responsibility to educate their teams and mentor their juniors.10 These tasks can be demanding, time-consuming, and challenging, but it is also important to remember that they present an opportunity to inspire, support, and guide. If you have the capacity to consistently address negative areas, then you have the capacity to acknowledge and reinforce positive contributions as well.11

Why this blog matters

Undermining is not only unprofessional, but it also creates an unsafe environment.12 Individuals who experience undermining do not feel psychologically safe in their workplace and are therefore less likely to question uncertainties, escalate concerns, or admit mistakes.13 While the NHS operates under numerous policies and guidelines, there are no formal regulations governing how to be a considerate colleague or effective leader. The GMC, however, does state that it is a professional standard for doctors to treat colleagues with kindness and respect.14 This is a core aspect of creating a psychologically safe working environment.15 These are qualities that maintain the basis of integrity, morale and respect, that definitely do not undermine.

Resources

• RCSEd Anti-Bullying and Undermining Campaign.The Royal College of Surgeons of Edinburgh.
• RCOG Workplace Behaviour Toolkit. The Royal College of Obstetricians and Gynaecologists.

References

1. Riding D. Bullying and undermining in the NHS: A threat to staff and patient safety. HCSA – the Hospital Doctors’ Union, 2022.
2. Society for Cardiothoracic Surgery in Great Britain and Ireland (SCTS). Bullying, Harassment and Undermining.
3. NHS, Health Education England. Undermining in the Workplace. Online Learning Programme.
4. Medical Protection Society. Communication an essential guide: communication with patients and colleagues. UK: Medical Protection Society; 14 Nov 2025 [cited 2026 Jan 22].
5. Moberly T. I am being undermined by a colleaguewhat should I do? BMJ. 2025;389:r948. doi:10.1136/bmj.r948
6. NHS Lothian. Undermining. Concerns about Bullying and Harassment.
7. Gregg T. Five ways leaders can practise self-reflection and why its important for business growth. People Management. 2023 Feb 21.
8. Royal College of Obstetricians and Gynaecologists. 7.2 How do you recognise bullying and undermining? In: Workplace Behaviour Toolkit Module 7: I want to learn more about workplace behaviour. London: RCOG; [cited 2026 Jan 22].
9. Schwartz R, et al. Developing a feedback-rich culture in academic medicine: the effect of coaching and 360-feedback on physician leadership. BMC Med Educ 22, 733 (2022).
10. General Medical Council. Employment professional standards GMC. [cited 2026 Jan 22].
11. Lysfjord EM, Skarstein S. Empowering Leadership: A Journey of Growth and Insight Through a Mentoring Program for Nurses in Leadership Positions. J Healthc Leadersh. 2024 Nov 1;16:443-454. doi: 10.2147/JHL.S482087.
12. The Royal College of Surgeons of Edinburgh and the National Freedom to Speak Up Guardian. Bullying. 2019.
13. Remtulla R, et al. Exploring the barriers and facilitators of psychological safety in primary care teams: a qualitative study. BMC Health Serv Res. 2021 Mar 24;21(1):269.
14. General Medical Council. Domain 3: Colleagues, culture and safety. 2024 December 13.
15. Edmondson A. Psychological safety and learning behavior in work teams. Adm Sci Q. 1999;44(2):35083.