ABSTRACTCyber-bullying has become a major issue in many work places, especially in healthcare settings among nurses. This paper will explain what cyber-bullying is and discuss some of the methods that employees use while cyber-bullying. The effects cyber-bullying has on employees can range from stress and headaches to the extreme of post-traumatic stress. The nursing profession is being effected by cyber-bully in a variety of ways, including high stress work environments, high turnover rates, medical errors and poor patient care. The entire profession of nursing may also be losing credibility if many nurses continue to undermine their co-workers and put patient care in question. There are some consequences discussed, along with some methods to reduce and deter cyber-bullying among nurses. Overall, the effects, consequences and some strategies to avoid cyber-bullying will be discussed in depth.There are many variations on the definition of cyber-bullying. Typically, cyber-bullying is classified as an intentional, aggressive act or acts, over a period of time, to inflict harm on the victim by utilizing various electronic forms of expression. (reference 1) Cyber-bullying has three main components, the intent to inflict harm, repetitive attacks over a period of time and frequently involves an imbalance of power. (reference 1)Cyber-bullying in the workplace can include acts of intimidation, gossiping, passively or aggressively refusing to assist a coworker in need, using sarcastic or demeaning tones, withholding critical information, public humiliation or name calling. (reference 2) Cyber-bulling in the workplace can be readily apparent or can be more discrete and less overt, however, either type can impact a person’s emotional status, which then can effect their work performance and even result in health problems. Cyber-bullying can be direct or indirect, direct cyber-bullying is when the victim is directly targeted by either excluding them from a social group, making direct threats or insults or even using a virus to corrupt their computer or phone. Indirect cyber-bullying may occur without the victim having direct knowledge of it, for example, sharing private or confidential information about the person, in an effort to cause harm to the victim. Other indirect methods of cyber-bullying include posting embarrassing photos or images and spreading rumors or hurtful information through a variety of technological platforms. (reference 1)There are many ways that cyber-bullying can be carried out, and with technology expanding at a rapid rate, new ways are always emerging. Some electronic methods that cyber-bullies use are text messaging, email, social media sites including Facebook, Twitter and Instagram, blogs, chat rooms, instant messages and even posting photos, videos or images that are intended to intimidate or undermine a coworker, thus causing harm to the person. Since technology has expanded at such a rapid rate, there are numerous platforms that a cyberbully can utilize to cyber-bully a coworker.Cyber-bullying in the workplace can reduce self-esteem, lower the victim’s overall job satisfaction and cause other physical and emotional health issues. Cyber-bullying can cause a wide variety of problems for an individual in the workplace. Many times cyber-bullying involves an abuse of power, which in turn can cause the victim to feel defenseless and reduce their self-confidence. Reduced feelings of self- confidence over time can result in stress, anxiety, headaches, sleeping problems, irritability, depression and in extreme cases, cause posttraumatic stress disorder.( ref 2)Nurses can be effected by cyber-bullying in a variety of ways, both mentally and physically. Nurses can burn out after prolonged exposure to stress, leading to an increase in medical errors and a decline in job satisfaction. Nurses can begin to doubt their clinical skills and knowledge, which can in turn, increase medication errors, increase errors regarding patient safety, increase patients’ risk of falls and overall, reduce the quality of care provided. (ref 2). Other negative impacts of cyber-bullying in nursing is an overall decline in employee morale, higher rates of absenteeism, increased staff turnover rate and a reduction in the ability to attract new nurses to the profession. In addition, when nurses are viewed in a negative light, it can cause patients to lose confidence in their level of care, to question the integrity of the nursing staff involved in the inappropriate behavior and even question the reputation of the organization providing the patient care. (ref 5)Research has shown that nurses experience bullying and harassment ranging from 27% of the time, to as often as 80% of the time (ref 6) Cyber-bullying among nurses can occur from the top down, from the bottom up and even laterally (ref 2). Although perpetrators can include patients, physician and other healthcare workers, studies have shown that the most frequent professionals utilizing bullying techniques are nurses in leadership roles. (ref 6). In addition, nurses younger than thirty years old and nurses with fewer years of experience were significantly more likely to experience bullying in their workplace than older, more experienced counterparts. (ref 3) There is no specific federal law that applies to cyber-bullying in the nursing profession. (ref. 7) Since cyber-bullying has become such a frequently used and harmful tactic, 49 out of 50 states have adopted some form of adopted various forms of anti-bullying laws, bills and policies. (ref. 8) In 2013 Florida added a cyber-bullying bill that allows schools to impose both school and criminal sanctions on bullies, including cyber-bullying as well as encompassing bullying that happens off campus if it disrupts the learning environment at school. (ref 8)Although many states have started addressing cyber-bullying at grade school levels, there are still many improvements to be made regarding cyber-bullying in the workplace. In 2015 the American Nurses Association (ANA) developed a new position statement regarding bullying in the workplace. The ANA states that it will not tolerate any violence, healthcare professionals must foster respect for each other, utilize strategies to prevent workplace incivility and promote overall safety and all healthcare workers should utilize strategies to create and maintain a workplace that adheres to a culture of respect. (ref 7)Depending on the severity and extent of the cyber-bullying, consequences could range from being formally charged with harassment or stalking down to no criminal charges.  Cyber-bullying is an area that is not fully legally addressed due to the wide span that the cyberbullying can cover. (ref 9). Many healthcare organizations have adopted a zero tolerance policy and are prepared to terminate nurses that have been proven to be bullies to their coworkers. (ref 3) Nurses terminated and deemed “bullies” may have difficulty finding future employment as a nurse. Civil suits can be brought about, however, these can be expensive and often ineffective.As a nurse, there are many things that I believe can be implemented to deter cyber-bullying in the workplace. I believe that all nurses should follow the ANA policies regarding workplace civility. All healthcare workers should address each other with respect and act professionally at all times. I also believe that having a strong support system, both at work and at home can help alleviate some of the stress that may develop from any type of cyber-bullying that may occur. Every nurse should think twice before posting, texting or emailing anything that may hurt someone’s feelings, betray their trust or be an attempt to undermine them. Patient safety should always be a priority and nurses should agree to focus on that and set their personal differences aside. I feel that all new nurses should have a mentor nurse that has been trained on anti-bullying procedures and can offer strategies and ideas to new nurses, in the event that they experience any cyber-bullying behavior. Anonymous support lines that allow reporting of abusive nurses and offer supportive suggestions would also be helpful in reducing bullying among nurses. Lastly, I feel that all health workers should be required to attend continuing education courses that focus on supporting other nurses and how to avoid becoming a bully.REFERENCES#1 https://doi.org/10.1371/journal.pone.0203794#2 2015 American Nurses Association- position statement- incivility, bullying & workplace violence#3 https://dx/doi.org/10.1016/j.ijnssNO REFERENCE #4 IT WAS THE SAME ARTICLE AS #2, fix the ref #s so you have a #4#5 The Joint Commission, Division of Health Care Improvement- Quick Safety issue 24, June 2016#6 https://doi.org/10.15344/2394-4978/2017/246#7 https://www.nursingworld.org/practice-policy/work-environment/violence-incivility-bullying/#8 http://cyberbullying.org/bullying-laws/florida/#9 International Journal of Environmental Research and Public Health2017,14,1449;doi:10.3390/ijerph14121449 www.mdpi.com/journal/ijerph