Bullying, Mobbing, and Harassment in O&P: Results of a Negative Acts Survey

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By Thomas Karolewski, CP, FAAOP


First and foremost, you are not alone.

This is probably the most encouraging statement I can provide for those that have experienced workplace bullying, mobbing, or harassment. According to a 2017 Workplace Bullying Institute survey, when asked about their experience in the past year, 9 percent of workers were currently being bullied, 10 percent had been bullied, and 19 percent witnessed a coworker being bullied.3 That's a dizzying 37 percent of the workforce affected by the behavior in a single year. According to the same survey, 60 million workers were affected over the last six to 12 months, and the percentages grow higher the longer the time duration used in any study. As an example, a 2014 Forbes magazine article cited a Vital Smarts study that surveyed 3,000 workers, and 96 percent stated they experienced workplace bullying at some point in their careers.6

 These numbers are not restricted to the United States; research performed in other areas of the world list similar data patterns. Psychologist Morton Birkeland Nielsen, PhD, performed a meta-analysis of research outside the US and the findings suggested an average of 10-15 percent of workers were affected by bullying, mobbing, and harassment in the last six to 12 months.4 This is in spite of the fact that European countries have laws in place to prevent such behaviors, while nothing similar exists in the United States.

The O&P profession, which started as a trade, has worked hard over the last few decades to progress as a medical profession by increasing the educational standards and improve clinical business models, yet in many ways, older behavior patterns still seem to persist. "Apprentice bullying," or ritual hazing as a rite of passage in a male-dominated profession, still shows signs of existence.5

Since no peer-reviewed literature on the topic exists for O&P, it is necessary to establish a baseline upon which to build future research, and reveal the cause and effect of bullying, mobbing, and harassment in the profession. This research should appeal to business owners and managers to show that a positive work environment equals profit. The first step is to recognize the behavior patterns, so an explanation of terms is necessary.



The first term that needs defining is bullying. Although the term has variances around the globe, one of the most complete and descriptive definitions comes from Gary Namie, PhD, and Ruth Namie, PhD, cofounders of the Workplace Bullying Institute. They define bullying as "The repeated, health-harming mistreatment of one or more persons (the targets) by one or more perpetrators." The key word is "repeated." Everyone has a bad moment; bullying behavior reflects a consistent repetitive negative behavior pattern.

The second term is mobbing, and this term is more common outside of the United States. Mobbing was originated from the studies of the animal kingdom by zoologist Konrad Lorenz, MD, PhD, in reference to the behavior of animal packs attacking a single animal. Swedish psychologist Heinz Leymann, PhD, used this information in his research of human mobbing, applying the term "psychological terrorism" to workplace situations that involve multiple workers behavior against one person. His definition of mobbing is "The repetition of hostile behavior and unethical conduct carried out by a superior, subordinate, or co-worker against other workers." The difference from bullying being multiple actors targeting a single person.

The last term, harassment, involves negative behavior against individuals of protected classes as outlined by the Civil Rights Act of 1964. Race, religion, ethnicity, gender, and age are among the classes mentioned, however older literature has used the term harassment to describe ­bullying and mobbing. My research has led me to believe there are distinct differences in the terms.


My 35-plus years of experience caused me to consider possible reasons for these negative behaviors in O&P. The first hypothesis was about the change to the gender makeup that has occurred in the profession in the past decade. The transition from a male-dominated profession to one with a growing proportion of female members can cause an environment of bullying, mobbing, and harassment. Do male practition­ers resent the increase of females in the profession? The second hypothesis is about generational differences. Are baby boomers or the Generation X population resentful of millennials? Lastly, the third hypothesis was related to educational level. Is there a possibility that graduates of an O&P certificate program are unhappy with graduates of a master's degree program? The curriculum has changed over the years, and is the reduced emphasis on fabrication in the schools causing problems? To establish data toward these hypotheses, I conducted a survey on Survey Monkey using the Negative Acts Questionnaire-Revised (NAQ-R) survey and posting to the OANDP-L listserv.



The survey was designed to be a mixed-method philosophy using quantitative descriptive questions for gender, generation, and education completion. The NAQ-R survey was presented along with an opportunity for a qualitative response to add emotions behind the responses.


Descriptive Questions

The gender question revealed 188 men and 138 women completed the O&P-related NAQ-R survey. The generation question revealed 66 baby boomers, 145 Generation Xers, and 116 millennials responded. Lastly, the education level question revealed 12 responses for no formal education, six responses for a technician program, 22 responses for high school/associate degree program, 39 responses for a bachelor's degree in orthotics and prosthetics, 80 responses for a master's degree in orthotics and prosthetics, and 167 responses for a certificate program.



The NAQ-R survey was developed by Staale Einarsen, Helge Hoel, and Guy Notelaers in 2001 and used in various countries as a standard metric to measure workplace bullying.1 The NAQ-R measures behavior that was experienced or observed in the past six months. Two questions were added to the original 22 items in the NAQ to cover the themes of work-related bullying, person-related bullying, and physically intimidating behavior. The reliability factor of the survey has been measured to be .90 on the Cronbach's alpha test, indicating excellent internal consistency as a reliable instrument.


The O&P survey was open for one month and 341 participants took the survey. Of the 341 participants, two people did not complete any of the NAQ-R questions and instead wrote in the comment section and 13 people chose not to answer all the questions, leaving 326 completed surveys. Those numbers were used for the breakdown.

The 24 questions were analyzed by percentage of responses and the top five questions to show the most activity in the past six months are as follows:


The results of the NAQ-R by itself were revealing, and the information provided in the comments requires that we acknowledge that bullying, mobbing, and harassment exist in our profession.

Breaking down all the percentages (monthly, weekly, daily) of the responses, the female population (37 percent) appears to have experienced more negative behavior in the past six months than the male population (30.5 percent). Examining the generational percentages, it appears that the millennials (37.2 percent) recorded more negative behavior than the previous generations (Gen X 33.1 percent, boomers 27.1 percent). Finally, the educational level revealed that the technician graduates recorded the highest level of negative behavior (26.2 percent) followed by those with no formal training recorded (20 percent), associate degrees (16.7 percent), master's graduates (16.6 percent), bachelor's degrees in O&P (12 percent), and the certificate graduates (8.8 percent).

The comment section was by far the most enlightening part of the survey and yielded more information than the quantitative part of the survey. Sixty-five men and 81 women left comments. Of the comments from women, 22 percent can be described as sexual harassment while multiple comments related to pregnancy. Some reported they were asked during an interview if they planned to start a family and others were criticized for adjusting a schedule to care for a child. Most men reported never having been bullied but had observed others being bullied. There were multiple reports from both genders undergoing counseling to get past the episodes of marital distress caused by work-related stress. There were multiple reports of faculty members mistreating students, yelling at them, or embarrassing them in front of other students and patients. Lastly, there was mention of racial gaslighting (emotional abuse) on a daily basis for two respondents.


While this topic could cover an entire series of articles (emotional fallout, bully characteristics, etc.), this report addresses the fact that the behavior exists. It is an attempt to bring awareness to negative behavior that needs to be addressed if O&P is to be taken seriously as a medical profession. Aside from the personal damage caused by and to our colleagues, this behavior is costly to businesses in various ways: sick time by the target, staff turnover, the time and financial cost of hiring, and perhaps even loss of patients if they pick up on the negative atmosphere in a facility. Lastly, the comments in the survey relating to sexual harassment and racial slurs could cost a business if the target were to pursue a lawsuit. A happy work environment promotes a productive worker and productive company. O&P EDGE


Thomas Karolewski, CP, FAAOP, has been an educator for more than 40 years.



Einarsen, S., H. Hoel, G. Notelaers. 2009. Measuring exposure to bullying and harassment at work: Validity, factor structure and psychometric properties of the Negative Acts Questionnaire-Revised. Work & Stress 23(1): 24-44.

Leymann, H. 1996. The content and development of mobbing at work. European Journal of Work and Organizational Psychology 5:2, 165-84, DOI: 10.1080/13594329608414853.

Namie, G. 2017. Workplace Bullying Institute. U.S. workplace bullying 2017 survey.

Nielsen, M., S. Matthieson, S. Einarsen. 2009. The impact of methodological moderators on prevalence rates of workplace bullying: A meta-analysis. Journal of Occupational and Organizational Psychology, 83: 955-79. DOI: 10.1348/096317909X481256.

Riggall, S. 2017. Apprenticeship bullying in the building and construction industry. Education & Training (London) 59(5), 502–515. https://doi.org/10.1108/ET-09-2016-0150

Shavin, N. 2014. What workplace bullying looks like in 2014: And how to intervene. Forbes/Leadership.