Bullying: a hidden threat to patient safety.

Patient safety is a crucial element for quality care in hemodialysis facilities. When evaluating possible threats to safety, an important factor to consider is the behavior of the healthcare staff. Inappropriate behaviors, such as bullying, have been associated with poor clinical outcomes. In addressing inappropriate behaviors, it is necessary to consider the role of the work environment. Healthy work environment initiatives provide a possible strategy to prevent and/or address the behaviors.