Nurse bullying: organizational considerations in the maintenance and perpetration of health care bullying cultures

Role and Training of Emergency Department Charge Nurses: A Mixed Methods Analysis of Processes, Needs, and Expectations

INTRODUCTION

Charge nurses (CNs) are shift leaders who manage resources and facilitate patient care, yet CNs in EDs receive minimal training, with implications for patient safety and emergency nursing practice. The purpose of the study was to describe the experiences of emergency nurses related to training, preparation, and function of the CN role.

METHODS

An explanatory sequential mixed methods design using survey data (n = 2579) and focus group data (n = 49) from both CN and staff nurse perspectives.

RESULTS

Participants reported minimal training for the CN role, with divergent understandings of role, required education and experience, the need for situational awareness, and the acceptability of the CN taking on other duties.

CONCLUSIONS

The ED CN is critical to the safety of both nursing environment and patient care. Nurses in this pivotal role do not receive adequate leadership orientation or formal training in the key areas of nurse patient assignment, communication, and situational awareness. Formal training in nurse-patient assignment, communication, and situational awareness are critical to appropriate patient care and maintenance of interprofessional trust necessary for successful execution of the CN role. ED nurse managers should advocate for this training.

‘You live and breathe it…’: Exploring experiences of workplace cyberbullying among New Zealand nurses

Cyberbullying presents a new workplace issue with initial research demonstrating strong links to negative outcomes for individuals and organisations across a range of sectors. Yet, detailed accounts of target experiences of cyberbullying remain largely unexamined. To address this crucial research gap, this study explores nurses' experiences of workplace cyberbullying – a profession with high rates of workplace bullying. Adopting a work environment perspective, this paper provides an in-depth examination of eight cases of workplace cyberbullying that emphasise the practical and theoretical complexities associated with this emerging workplace hazard. Specifically, workplace cyberbullying is often experienced within a broader pattern of bullying behaviours, leading to a potentially wider scope of harm for those involved. A new typology of cyberbullying based on the source of perpetration is also presented that contributes to our growing understanding of the issue while extending the knowledge base for the effective management of workplace cyberbullying.

Bullying in the clinical setting: Lived experiences of nursing students in the Central Region of Ghana

INTRODUCTION

Nursing students are confronted with bullies in the classroom and during clinical placement. Acquisition of the necessary psychomotor skills intended during clinical placements may be impeded when workplace bullies intimidate students. This study aimed to describe the various bullying behaviours experienced by nursing students and their effects during clinical placement in the Central Region of Ghana.

METHODS

A qualitative phenomenological descriptive approach using a semi-structured interview guide was employed to collect data from nursing students in focus groups. Overall, six (6) focus groups were used, with five (5) students in each group comprising males and females. The sample size was based on data saturation and was saturated on the six focus group discussions giving a sample size of 30. Purposive sampling was used to select students who had been on the ward at least three clinical placements and had experienced bullying in the clinical setting. In-depth interviews were conducted, recorded, transcribed verbatim and analysed using content analysis.

RESULTS

The study revealed that nursing students had experienced bullying practices such as shouting, isolation, humiliation and being assigned tasks below their competency level. In addition, findings showed that bullying led to a loss of confidence and caused stress and anxiety in nursing students.

CONCLUSION

Therefore, it is recommended that nursing students are mentored holistically in a caring and accepting environment where they will be supported to achieve their learning goals, build their confidence, and develop their personal and professional identity.

How workplace bullying affects nurses’ well-being? The roles of burnout and passive avoidant leadership

Purpose

This study aims to investigate individual-related consequences of workplace bullying among the health-care section. Specifically, this study examined the mediating role of burnout between workplace bullying and nurses’ well-being. Moreover, passive avoidant leadership is examined as a conditional variable between workplace bullying and burnout.

Design/methodology/approach

This study collected data from 314 nurses working in various hospitals through a questionnaire-based survey using Google Form in two waves.

Findings

Structural equation modeling confirmed the negative effect of workplace bullying on nurses’ well-being, whereas burnout mediates this relationship. In addition, passive avoidant leadership was identified as a conditional variable that strengthens the positive association between workplace bullying and burnout.

Research limitations/implications

Although data for the study were collected in two waves, still cross-sectional design limits causality.

Practical implications

This study suggests management to focus on developing and implementing counter-bullying rules to avoid the adverse consequences of workplace bullying (e.g. capital loss, recruitment costs, burnout, well-being, etc.). In addition, leaders/supervisors must be trained to fulfill their responsibilities to reduce negative consequences.

Originality/value

Studies on workplace bullying in high-power distance cultures are scant. Therefore, drawing upon conservation of resource theory, to the best of the authors’ knowledge, this is the first study that has investigated the moderating role of passive avoidant leadership on the association between workplace bullying and burnout.

The impacts of organizational culture and neoliberal ideology on the continued existence of incivility and bullying in healthcare institutions: A discussion paper

Countless research studies have demonstrated the detrimental effects of incivility and bullying in healthcare. Despite the abundance of proposed solutions to this issue, many healthcare leaders continue to fail in mitigating the existence of such negative behaviors in the workplace. Personality attributes of perpetrators and victims have received attention, but much less research has examined the organizational and neoliberal causations of incivility and bullying in healthcare. Being the largest occupational group in the health sector, nursing professionals have the greatest influence and are crucial in ending these behaviors. This discussion paper outlines the effects of incivility and bullying in healthcare and provides a critical analysis on how organizational culture and neoliberal ideology influence the pervasiveness and persistence of these negative behaviors. The analysis reveals that organizational cultures that misuse power, disregard equality, and facilitate oppression, foster the existence of incivility and bullying in the workplace. Such cultures permit perpetrators to misuse their authority to control resource allocation, ignorance to social inequalities, and the silence of victims. Furthermore, the neoliberal concept of deregulation, austerity, and individualism further these behaviors. The neoliberal reforms have led to underfunding of anti-bullying programs and policies, use of bullying behaviours as management strategies, and victim-blaming for profit maximization. Financial cutbacks have resulted in denial and acceptance of uncivil and bullying behaviours in healthcare institutions, which endangers the rights of healthcare providers to a safe workplace environment. To curtail these negative behaviors, robust anti-bullying policies and programs must be strictly enforced and sustained in practice. Further exploration on the association of organizational culture and neoliberal principles to incivility and bullying in healthcare is greatly warranted.

When workload predicts exposure to bullying behaviours in nurses: The protective role of social support and job recognition

AIMS

This study examined the moderating role of two resources (social support and recognition) in the longitudinal relationship between workload and bullying behaviours in nurses.

DESIGN

A two-wave (12-month) longitudinal study was conducted.

METHOD

French-Canadian nurses (n = 279) completed an online survey (October 2014 and October 2015) assessing their perceptions of job characteristics within the work environment (workload, social support, job recognition) as well as exposure to negative behaviours at work.

RESULTS

Workload positively predicted exposure to bullying behaviours over time, but only when job recognition and social support were low. Workload was unrelated to bullying when social support was high and was negatively related to bullying when job recognition was high.

CONCLUSION

This study aligns with the work environment hypothesis, showing that poorly designed and stressful job environments provide fertile ground for bullying behaviours.

IMPACT

Bullying is a growing concern in the nursing profession that not only undermines nurses' well-being but also compromises patient safety and care. It is thus important to identify work-related factors that can contribute to the presence of bullying behaviours in nurses in the hopes of reducing their occurrence and repercussions. This study contributes to this endeavour and identifies two key social coping resources that can help manage the stress associated with workload, resulting in less perceived bullying behaviour among nurses.

Ideological tensions amidst rapid and continuous organizational change in healthcare

Purpose

The aim of this study was to explore the nature of frontline nurses' experiences of living with rapid and continuous organizational change.

Design/methodology/approach

A critical hermeneutic approach was utilized. This was a qualitative inquiry theoretically guided by critical management studies.

Findings

Participants recognized that many change initiatives reflected an ideological shift in healthcare that supported a culture of service, whilst sacrificing a culture of care. A culture of service prioritized cost-savings and efficiency, which saw nurses lose the time and resources required to provide quality, safe care.

Practical implications

Nurses felt morally responsible to uphold a culture of care, which proved challenging and at times unobtainable. The inability to provide quality, safe care in light of organizational changes resulted in a multitude of negative emotional repercussions, which fostered moral distress.

Originality/value

The findings from this study bring to light ideological tensions that negatively impact nurses. This study supports the conclusion that the planning, implementation and evaluation of organizational change initiatives must reflect a culture of care in order to alleviate the many negative experiences of organizational change noted in this study.

Nurses' Workplace Bullying Experiences, Responses, and Ways of Coping

Workplace bullying is a serious problem that hinders the provision of quality care services by seriously affecting their physical, psychological, and social health status. Workplace bullying experiences refer to verbal and nonverbal harassment, work-related harassment, and external threats. Workplace bullying responses are negative reactions that occur in individuals who have experienced workplace bullying, while coping is the process by which an individual copes with stress. This study aims to analyze the relationship between nurses’ workplace bullying experiences, responses, and ways of coping. We studied 113 nurses working in hospitals, analyzed the data using SPSS 25.0. We found that the more positive use of the positive viewpoint, the lower the bullying reaction in the workplace (r = −0.268, p = 0.004). Workplace bullying responses were lower as more positive ways of coping were used (r = −0. 268, p = 0.004). In conclusion, nurses who experience bullying in the workplace should be supported by the hospital organization and within the nursing organization, and a receptive nursing culture should be established. There is also a need for an intervention plan that allows nurses to use positive ways of coping with workplace bullying experiences.

Power and inaction: why organizations fail to address workplace bullying

Purpose

Bullying affects at least one-third of the workers through either direct exposure or witnessing, both of which lead to compromised health, and as a result, reduced organizational effectiveness or productivity. However, there is very little evidence that organisations provide effective protection from bullying, and in fact, the converse appears to the case. The purpose of this paper to explore the role of both individual and organisational power in the creation and maintenance of the problem. Such an approach moves away from the specific practice of identifying “bullying” that typically engages targets and perpetrators in a dance that is really just around the edges (Sullivan, 2008) of a larger problem; a culture that permits the abuse of power and ill-treatment of workers, in both practices and through organisational politics.

Design/methodology/approach

This paper elucidates key problems with organisational response as identified in the literature and critically examines weak organisational response to workplace bullying using the power theory, arguing that while overt approaches to addressing bullying appear to be underpinned by a simplistic, functionalist understanding of power, practices on the ground are better explained by more sophisticated “second-dimension” theorists.

Findings

There is a need for organisations to move beyond the current individualistic understanding of bullying towards a more nuanced understanding of how anti-bullying policies and procedures are themselves an exercise in institutional power protecting and reinforcing dominant power structures.

Research limitations/implications

The literature from which this paper is drawn is limited to studies published in English.

Practical implications

The authors advocate a realistic assessment of the role of both individual and organisational power in the creation and maintenance of workplace bullying, as a way forward to plan appropriate intervention.

Social implications

Workplace bullying is problematic for organisations at several levels, and therefore for society.

Originality/value

That power is relevant to workplace bullying has been apparent since the work of Brodsky in 1976 and Einarsen's early work, this paper builds on a the more nuanced work of McKay (2014), D'Cruz and Noronha (2009), Liefooghe and MacDavey's (2010) and Hutchinson et al. (2010), exploring the organisational response to the raising of bullying issues by individual employees as an exercise of power.

Midwifery students' experiences of bullying and workplace violence: A systematic review

BACKGROUND

Workplace violence directed at registered midwives in the maternity setting has been a recognised issue since the early 1990s. More recently it has become evident that midwifery students are also victims of bullying and harassment whilst on clinical placement. Due to the short and long-term impacts this has on students, it is likely to have a detrimental effect on the future and sustainability of the midwifery profession. As a basis for designing a response, it is important to understand what is currently known about this phenomenon.

AIM

To systematically review the literature to identify what is known about workplace violence and bullying experienced by midwifery students whilst on clinical placement.

METHOD

Reporting of this review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search was undertaken of all primary research that focussed upon workplace violence and bullying involving midwifery students whilst on clinical placement, published between January 1990 and December 2019. Pre-defined terms were used to search the following five databases: CINAHL, Web of Science, MEDLINE, Embase, supplemented with Google Scholar. Additional manual searches of reference lists were conducted. An assessment of the quality of each eligible study was then undertaken using an appropriate mixed methods appraisal tool (MMAT). Extracted data were then synthesised using thematic synthesis.

FINDINGS

Nine articles met the criteria for inclusion in the review. Studies were primarily qualitative, with some reporting descriptive statistics that do not enable key issues such as prevalence to be reliably addressed. The synthesis identified four main themes that related to workplace violence and bullying of midwifery students whilst on clinical placement. Results were clustered around the role of power in bullying, prevalence and impacts, the culture of compliance, and the victim's response.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

A broader understanding of the nature of workplace violence and bullying and how it manifests itself is beginning to emerge, but more and higher quality research is required to establish an empirical base on which to design interventions. Studies suggest that bullying is common and has significant impacts at both a personal and professional level.  This strongly reinforces a need for greater policy and organisational responses to bullying in the clinical education context, in order to break the bullying cycle and ensure the midwives of the future remain in the profession and sustain the workforce.

Becoming a midwife: A survey study of midwifery alumni

BACKGROUND

Becoming a competent midwife is a complex process. The aim of midwifery education is to support the development of competence in midwifery skills, knowledge and to prepare graduates to meet the responsibilities inherent in the midwifery role.

AIM

To explore the experiences of our alumni midwives, ask how well they perceived their midwifery programme had prepared them for beginning midwifery practice and to identify any curriculum changes, or postgraduate study topics, that would support the transition to midwifery practice.

METHODS

An online survey was conducted with alumni of a Bachelor of Midwifery programme (New Zealand) who graduated between 2011 and 2014. The quantitative data were analysed using descriptive statistics, and a general inductive approach was used to develop themes from the qualitative data in the comment boxes.

FINDINGS

Forty-two alumni viewed becoming a midwife as a blend/combination of: (1) gaining the knowledge and practical skills required for the profession; (2) management skills in areas of running a business, working with other people, navigating local procedures and processes effectively, and balancing work with personal life; (3) gaining confidence in one's competence, and (4) having support along the way.

DISCUSSION

Competence in current evidence-based midwifery knowledge and practice is important in educating midwifery students. However, to transition to practice, a supportive environment is needed to assist midwives to develop self-management, business skills, and the confidence to negotiate and collaborate with colleagues and other health professionals.

CONCLUSIONS

Not only did midwifery knowledge and practice skills matter for alumni, but also the acquisition of management skills, strategies for building confidence, and ongoing support. Content that facilitates these requirements should be included in midwifery programmes to support the transition from student to practitioner.

The incidence and outcomes of nurse bullying in the Russian Federation

AIM

The aim of this study was to describe bullying experienced by professional nurses working in the Russian Federation. The frequency and type of bullying behaviours experienced, the personal and professional consequences of bullying and the actions taken to address bullying were all examined.

BACKGROUND/INTRODUCTION

Workplace bullying negatively affects nurses, patients and healthcare organizations. To date, no research has been conducted on workplace bullying among nurses in the Russian Federation.

METHODS

This was a descriptive study using survey methodology. Members of the Russian Nurses Association were invited to participate via email and social media. Participants completed the 26-item, web-based Bullying in the Workplace Survey. Data were analysed using descriptive statistics.

RESULTS

Of the 438 participants, 63% reported being bullied at some point during their career. The majority were female and worked fulltime for an average of 20 years. Over half the nurses were working in staff positions when bullying occurred, and administrators were most commonly identified as the bully. Bullying caused moderate to severe distress in 73.5%. Half of the nurses reported that bullying affected their work, and 83.3% reported that it affected their health. Just over 70% took action to address the bullying situation; 59% of those who did were dissatisfied with the outcome.

CONCLUSION

Bullying is prevalent in the nursing workplace in the Russian Federation. The perpetrators were most frequently the nurse administrator or physician administrator. Workplace bullying negatively affects nurses' ability to function and subsequently impacts nursing teamwork and patient care.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Identifying bullying, its antecedents and consequences in the Russian Federation are a requisite for developing meaningful interventions and contributing to shaping local and international policy.

Conceptualizing workplace cyberbullying: Toward a definition for research and practice in nursing

AIMS

To explore nurses' understandings and perceptions of workplace cyberbullying, in order to develop a relevant and meaningful definition of the phenomenon for future research and practice.

BACKGROUND

Although previous research places nurses at an elevated risk of exposure to traditional workplace bullying, there is a notable absence of research investigating workplace cyberbullying within this profession. Considering the detrimental outcomes experienced by the targets of workplace cyberbullying, this is an issue that warrants focus.

METHODS

Utilizing relevant scenarios as prompts, semi-structured interviews were conducted with 16 nurses (practising and in training) to explore their understanding of the concept and dynamics of workplace cyberbullying.

RESULTS

Three high-level themes were identified and discussed: (1) cyber-specific features that make cyberbullying more damaging than traditional bullying; (2) the importance of context; and (3) the work environment factors that facilitate the occurrence of workplace cyberbullying.

CONCLUSIONS

Our refined definition facilitates the investigation of a broader and more inclusive range of behaviours that targets may experience as workplace cyberbullying, and our findings in general highlight potential antecedents in common with traditional workplace bullying.

IMPLICATIONS FOR NURSING MANAGEMENT

Given the work environment and the challenges faced by the nursing profession, a system-wide approach to intervention and management is recommended, along with utilizing a nursing-specific definition.

Effects of ethical leadership on bullying and voice behavior among nurses

PURPOSE

This study aims to investigate the effects of ethical leadership on employee's bullying and voice behavior, considering poor working conditions, organizational identification and workload as mediating variables.

DESIGN/METHODOLOGY/APPROACH

Questionnaire survey design was used to elicit responses of 564 nurses from hospitals located in various cities of Pakistan.

FINDINGS

Analysis through structural equation modeling proved that ethical leadership has a positive and significant impact on both organizational identification and voice behavior, but a negative and significant impact on workload, poor working conditions and bullying at the workplace. Furthermore, organizational identification, poor working conditions and workload proved to be partial mediators.

ORIGINALITY/VALUE

The study adds value to the limited literature on ethical leadership, bullying and voice behavior in nursing. Additionally, organizational identification, workload and poor working conditions have not previously been examined as mediators.

Education as an Intervention Toward Recognizing and Eliminating Incivility

Incivility in nursing is a pervasive and evasive problem that many nurses do not easily recognize or may simply shrug off as "normal." However, incivility produces a hostile work environment and can jeopardize safety. A study was conducted to (a) determine nurses' ability to recognize incivility in nursing after an online educational intervention on incivility, (b) ascertain the effectiveness of online education toward assisting nurses with understanding how to ward off this behavior, and (c) determine the types and effects of incivility participants experienced. Findings suggest that education on incivility may assist nurses with identifying uncivil behaviors exhibited by nurse peers and help them understand strategies to combat it. The types of incivility reported by participants were similar to findings of other studies; effects included unsafe behaviors and somatic consequences.

Charge Nurses' Experiences With Horizontal Violence: Implications for Leadership Development

HOW TO OBTAIN CONTACT HOURS BY READING THIS ISSUE Instructions: 1.2 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded after you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf. In order to obtain contact hours you must: 1. Read the article, "Charge Nurses' Experiences With Horizontal Violence: Implications for Leadership Development," found on pages 493-499, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz. 2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study. 3. Go to the Villanova website to register for contact hour credit. You will be asked to provide your name, contact information, and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated. This activity is valid for continuing education credit until October 31, 2019. CONTACT HOURS This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated. Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. OBJECTIVES Describe types of horizontal violence experienced by charge nurses. Identify the skills needed for charge nurses to combat horizontal violence. DISCLOSURE STATEMENT Neither the planners nor the author have any conflicts of interest to disclose.

BACKGROUND

A safe work environment is a prerequisite for the provision of high-quality patient care. Horizontal violence can undermine the culture of safety and the well-being of the nurses in the work unit. Charge nurses, whose role encompasses both staff and manager responsibilities, play an important role in team building and care delivery. Yet, little is known about their experience with horizontal violence. A lack of adequate leadership education and role delineation may predispose charge nurses to horizontal violence.

METHOD

A descriptive study was conducted to describe the incidence of horizontal violence of charge nurses. The Horizontal Violence Scale was used to collect data from a convenience sample of 366 charge nurses.

RESULTS

Charge nurses reported experiencing horizontal violence with some regularity.

DISCUSSION

Nurse leaders must critically evaluate the work culture and provide appropriate education and support to charge nurses to combat horizontal violence. J Contin Educ Nurs. 2016;47(11):493-499.

The Moderating Effect of Employee Political Skill on the Link between Perceptions of a Victimizing Work Environment and Job Performance

Research has generally revealed only a weak link, if any at all, between victimization-related experiences and job performance. Drawing on the commonly used conservation of resources perspective, we argue that such inconsistent evidence in the organizational literature stems from an over-focus on personal resources at the expense of considering the role of social resources. Victimization is an interpersonal phenomenon with social ramifications. Its effects may be better captured when measured from the standpoint of the social environment, and analyzed relative to an employee’s capacity to effectively regulate those social resources. With the latter capacity being encapsulated by the construct of political skill, we conducted two studies to explore the moderating influence of employee political skill on the relationship between employee perceptions of a victimizing work environment and employee task performance. In Study 1, employees with low political skill exhibited reduced task performance when perceiving a victimizing environment, and this link was found to be mediated by tension in Study 2. Those with high political skill exhibit no change in performance across victimization perceptions in Study 2, yet an increase in performance in Study 1. We discuss our findings relative to the victimization and political skill literatures.

Hospital nurses' attitudes, negative perceptions, and negative acts regarding workplace bullying

BACKGROUND

Workplace bullying is a prevalent problem in today's work places that has adverse effects on both bullying victims and organizations. To investigate the predictors of workplace bullying is an important task to prevent bullying victims of nurses in hospitals.

OBJECTIVE

This study aims to explore the relationships among nurses' attitudes, negative perceptions, and negative acts regarding workplace bullying under the framework of the theory of planned behavior (TPB).

METHODS

A total of 811 nurses from three hospitals in Taiwan were surveyed. Nurses' responses to the 201 items of 10 scales were calibrated using Rasch analysis and then subjected to path analysis with partial least-squares structural equation modeling (PLS-SEM).

RESULTS

The instrumental attitude was significant predictors of nurses' negative perceptions to be bullied in the workplace. Instead, the other TPB components of subjective norm and perceived behavioral control were not effective predictors of nurses' negative acts regarding workplace bullying.

CONCLUSIONS

The findings provided hospital nurse management with important implications for prevention of bullying, particularly to them who are tasked with providing safer and more productive workplaces to hospital nurses. Awareness of workplace bullying was recommended to other kinds of workplaces for further studies in future.

Lateral Violence in Nursing: Implications and Strategies for Nurse Educators

Lateral violence among nurses persists as a prevalent problem, contributing to psychological distress, staff turnover, and attrition. Newly graduated nurses are at particular risk for being targets of lateral violence and experiencing its negative sequelae. Preparing student nurses to respond to lateral violence prior to entering the nursing may alter this scenario. A review of the literature was conducted to determine the potential for nursing faculty to change the cycle of lateral violence. Based on this review, we recommend 3 main strategies, specifically for nursing faculty, aimed at reducing incidences of lateral violence and preparing students to manage this phenomenon. First, curricular content can address integrating lateral violence content into simulation experiences and facilitating this knowledge into clinical experiences. Second, codes of conduct should guide behaviors for both students and faculty. Finally, as role models, faculty should be aware of their own behaviors, role model respectful communication, facilitate a courteous academic environment, and develop nurses capable of identifying and appropriately responding to lateral violence.

Workplace violence experienced by nursing students: A UK survey

AIMS

To appreciate the nature and scope of workplace violence amongst a sample of the UK nursing student population during clinical placement and to recommend strategies universities can implement to successfully manage the impact.

BACKGROUND

Workplace violence is defined as a violent act(s) directed toward workers and can include physical, psychological or verbal behaviour. It is prevalent in nursing and causes victims work-based stress that can affect not only the individual but also the quality of care. Similar negative experiences amongst students can have a direct impact on the development of future professional skills.

DESIGN

This study employed a cross-sectional survey design. Questions were uploaded in the format of a commercial internet survey provider (SurveyMonkey.com) and distributed across a sample of nursing schools in the UK. The survey was voluntary and employed a validated tool to assess workplace violence and was based on a similar study in Australia. The number of respondents was 657. This paper reports on the quantitative results.

FINDINGS

Nearly half of the students (42.18%) indicated they had experienced bullying/harassment in the past year while on clinical placement. One-third (30.4%) had witnessed bullying/harassment of other students and 19.6% of incidents involved a qualified nurse. The unwanted behaviours made some students consider leaving nursing (19.8%). Some respondents said the standard of patient care (12.3%) and their work with others (25.9%) were negatively affected.

CONCLUSIONS

Workplace violence can influence nursing students' attitude toward the profession and their level of satisfaction with the work. Whilst it was reassuring to note that the majority of the participants knew where/how to report, only one fifth had actively reported an episode of bullying/harassment. Current students are the nurses and leaders of the future and have a key role in shaping the culture of generations to come. Universities and clinical providers need to work together to reduce the incidence and impact of workplace violence in order to improve the culture of practice.

A cross-hospital exploration of nurses' experiences with horizontal violence

AIM

To explore nurses' experiences of horizontal violence (HV) in three diverse non-affiliated organisations within a single city in the USA.

BACKGROUND

Horizontal violence, also called workplace bullying or lateral violence, is a long-standing nursing issue.

METHOD

Content analysis was used to analyse open-format textual responses from 126 registered nurses.

RESULTS

A powerful collective story emerged from nurses' shared experiences with HV, describing the characters and the setting in which HV and its consequences exist. Nurses' depictions of HV were consistent despite the different organisational structures of their workplaces suggesting that hospital type is not the explanation for HV, rather the culture of acute care nursing. Nurses want change and asked for tactics to resolve HV within their institutions; some provided specific solutions.

CONCLUSION

Nurse managers must continue to address HV by using a variety of known tactics, as well as adopting new evidence-based interventions as they are identified. The anti-bullying message should be disseminated through professional nursing organisations as well as in local health-care establishments.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers need to be the culture champions who hold individuals accountable for HV and foster professionalism through their leadership.

Bullying and Its Prevention Among Intensive Care Nurses

PURPOSE

International studies report that nurse bullying is a common occurrence. The intensive care unit (ICU) is known for its high stress levels, one factor thought to increase bullying. No studies were found that investigated bullying in this population. The purpose of this study was to describe the prevalence of ICU nurse bullying and what measures were taken to prevent bullying.

DESIGN

This was a descriptive study of a convenience sample of 156 ICU nurses from five medical centers in Israel. Data collection was conducted over a 10-month period in 2012 and 2013.

METHODS

After ethical approval, three questionnaires (background characteristics, Negative Acts Questionnaire-Revised, and Prevention of Bullying Questionnaire) were administered according to unit preference. Descriptive statistics were calculated for all responses and a Pearson product moment correlation was calculated to determine the relationship between bullying and its prevention.

FINDINGS

Most of the nurses in the study were married, female staff nurses with a baccalaureate in nursing. No participant responded that they had been bullied daily, but 29% reported that they were a victim of bullying. The mean bullying score was 1.6 ± 1.4 out of 5. The mean prevention score was 2.4 ± 0.3 out of 4. Significant differences were found between hospitals on bullying, F (4,155) = 2.7, p = .039, and between hospitals, F (4,155) = 2.9, p = .026, and units, F (5,143) = 3.4, p = .006, on prevention. The Prevention Scale significantly correlated with the bullying scale (r = .58, p < .001). No other variables were found to be associated with either bullying or prevention scores.

CONCLUSIONS

An alarming percentage of nurses were victims of bullying. Levels of bullying were low to moderate. Level of prevention was weak or moderate. The higher the level of bullying, the lower the level of prevention. The work environment as opposed to individual characteristics seems to have an impact on bullying and its prevention.

CLINICAL RELEVANCE

More measures must be taken to prevent bullying. Nurses must be educated to accept only a zero tolerance to bullying and to report bullying when confronted by bullying.

Bullying among nurses and its relationship with burnout and organizational climate

Workplace bullying is one of the most common work-related psychological problems. Bullying costs seem higher for organizations composed of health-care workers who perform direct-contact patients-complex tasks. Only a few studies have been carried out among nurses in Italy and integrated models of bullying antecedents and consequences are particularly missing. The aim of this study was to develop a bullying model focused on the interaction between bullying and burnout in the setting of a climate-health relationship. Research involved 658 nurses who completed a survey on health, burnout, bullying and organizational climate. Structural equation modeling was used to test the hypothesis. Results suggest that workplace bullying partially mediates the relationship between organizational climate and burnout and that bullying does not affect health directly, but only indirectly, via the mediation of burnout. Our study demonstrates the key-role of workplace bullying and burnout in the climate-health relationship in order to understand and to improve nurses' health.

Cumulative Effects of Multiple Forms of Violence and Abuse on Women

Little is known about how patterns of workplace bullying contribute to the negative effects of lifetime violence. Analysis of longitudinal data from a study of women's health after separating from an abusive partner revealed that 76% of 229 women had experienced workplace bullying. Workplace bullying was associated with child sexual abuse, adult sexual assault, and ongoing partner abuse. Timing was critical, with those experiencing past workplace bullying having poorer health and fewer personal and social resources than those experiencing none, ongoing, or past and ongoing bullying. Lifetime sexual harassment (54%) was associated with higher posttraumatic stress disorder symptomology and greater likelihood of leaving workplaces and physical bullying (16%) with poorer health and personal, social, and economic resources. These findings highlight the importance of including bullying in studying lifetime violence.

The development and psychometric testing of the horizontal violence scale

Inappropriate behaviors of healthcare workers can threaten the delivery of safe, quality care. The purpose of this research was to develop a research instrument specific to the construct of horizontal violence and conduct foundational psychometric testing of the newly developed instrument. The overall findings on the fit indices suggest that this model does adequately measure the underlying construct of horizontal violence. The instrument can be used as a way to determine the existence and extent of horizontal violence in practice settings and used to augment the study of the work environment, particularly in relation to healthy work environments.

Interventions to reduce bullying in health care organizations: A scoping review

The problem of staff-to-staff bullying and its consequences in the health care sector has given rise to urgent knowledge needs among health care employers, union representatives, and professional associations. The purpose of this scoping review is to increase the uptake and application of synthesized research results of interventions designed to address bullying among coworkers within health care workplaces. The scoping review’s methodology uses an adapted version of the Arksey and O’Malley framework to locate and review empirical studies involving interventions designed to address bullying in health care workplaces. The findings of the review reveal eight articles from three countries discussing interventions that included educative programming, bullying champions/advocates, and zero-tolerance policies. The reported evaluations extend beyond bullying to include organizational culture, trust in management, retention rates, and psychosocial health. The most promising reported outcomes are from participatory interventions. The results of the review make a compelling case for bullying interventions based on participatory principles.

An exploration of relational aggression in the nursing workplace

OBJECTIVE

This study provides a 1st look at relational aggression (RA) and the consequences among nurses.

BACKGROUND

Interpersonal hostility, bullying, and a toxic work environment (WE) can impact patient care delivery as well as nurses' personal health and job satisfaction.

METHODS

The Relational Aggression Assessment Scale, measuring aggressors, victims, and bystanders, was used to measure RA in a sample of 842 nurses. Additional variables measured included a demographic profile, job satisfaction, and intent to leave.

RESULTS

Nurses were most likely to identify with victim behaviors, but a minority of nurses reported relying on aggressor behaviors and bystander behaviors. There was a positive correlation among aggressor, victim, and bystander items, suggesting overlap in roles.

CONCLUSIONS

A few relationally aggressive individuals can create a toxic WE. Interventions to address RA among nurses must be tested, as well as strategies for improving job satisfaction and promoting healthy WEs through positive relationships.

Workplace bullying and incivility: a systematic review of interventions

Purpose

– Workplace mistreatment has a negative impact on the health and well-being of approximately 20 per cent of workers. Despite this, few interventions have been evaluated and published. The purpose of this paper is to address the question “what interventions designed to reduce workplace bullying or incivility are effective and what can be learnt from evaluated interventions for future practice?”

Design/methodology/approach

– A systematic review was undertaken in which 11 electronic databases were searched, yielding 5,364 records. Following screening on abstract and title, 31 papers were retained for detailed review and quality assessment. Subsequently, 12 interventions to address workplace bullying or incivility were critically appraised.

Findings

– The papers spanned a wide range of approaches to and assumptions about resolving the problem of bullying and/or incivility. Half the studies focused on changing individual behaviours or knowledge about bullying or incivility, and duration of intervention ranged from two hours to two years. Only four studies were controlled before-after studies. Only three studies were classed as “moderate” in terms of quality, two of which were effective and one of which was partially effective.

Originality/value

– A final synthesis of results of the review indicate that multi-component, organisational level interventions appear to have a positive effect on levels of incivility, and should be considered as a basis for developing interventions to address workplace bullying.

A comparison of ethical issues in nursing practice across nursing units

BACKGROUND

The complexity and variety of ethical issues in nursing is always increasing, and those issues lead to special concerns for nurses because they have critical impacts on nursing practice.

RESEARCH OBJECTIVES

The purpose of this study was to gather comprehensive information about ethical issues in nursing practice, comparing the issues in different types of nursing units including general units, oncology units, intensive care units, operating rooms, and outpatient departments.

RESEARCH DESIGN

The study used a descriptive research design. Ethics/human rights issues encountered by nurses in their daily nursing practice were identified by using the Ethical Issues Scale.

PARTICIPANTS

The study sample included 993 staff nurses working in a university hospital in South Korea.

ETHICAL CONSIDERATIONS

This study was approved by the University Institutional Review Board. Completed questionnaires were returned sealed with signed informed consent.

FINDINGS

The most frequently and disturbingly encountered issues across nursing units were "conflicts in the nurse-physician relationship," "providing care with a possible risk to your health," and "staffing patterns that limit patient access to nursing care." The findings of this study showed that nurses from different nursing units experienced differences in the types or frequency of ethical issues. In particular, intensive care units had the greatest means of all the units in all three component scales including end-of-life treatment issues, patient care issues, and human rights issues.

DISCUSSION

Nurses experienced various ethical challenges in their daily practice. Of the ethical issues, some were distinctively and frequently experienced by nurses in a specific unit.

CONCLUSION

This study suggested that identifying and understanding specific ethical issues faced by nurses in their own areas may be an effective educational approach to motivate nurses and to facilitate nurses' reflection on their experiences.

Exposure to workplace bullying and post-traumatic stress disorder symptomology: the role of protective psychological resources

AIM

To examine the relationship between nurses' exposure to workplace bullying and Post-Traumatic Stress Disorder symptomology and the protective role of psychological capital (PsyCap).

BACKGROUND

Workplace bullying has serious organisational and health effects in nursing. Few studies have examined the relation of workplace bullying to serious mental health outcomes, such as Post-Traumatic Stress Disorder. Even fewer have examined the effect of intrapersonal strengths on the health impact of workplace bullying.

METHOD

A survey of 1205 hospital nurses was conducted to test the hypothesized model. Nurses completed standardized measures of bullying, Post-Traumatic Stress Disorder and PsyCap.

RESULT

A moderated regression analysis revealed that more frequent exposure to workplace bullying was significantly related to Post-Traumatic Stress Disorder symptomology regardless of the PsyCap level. That is, PsyCap did not moderate the bullying/PTSD relationship in either group. Bullying exposure and PsyCap were significant independent predictors of Post-Traumatic Stress Disorder symptoms in both groups. Efficacy, a subdimension of PsyCap, moderated the bullying/Post-Traumatic Stress Disorder relationship only among experienced nurses.

CONCLUSION

Workplace bullying appears to be predictive of Post-Traumatic Stress Disorder symptomology, a serious mental health outcome.

IMPLICATIONS FOR NURSING MANAGEMENT

Workplace bullying is a serious threat to nurses' health and calls for programmes that eliminate bullying and encourage greater levels of positive resources among nurses.

The bully within and without: strategies to address horizontal violence in nursing

PROBLEM

Pervasive horizontal violence in the nursing profession has bred the aphorism "nurses eat their young." Nurses must make a concerted effort to advocate for change in the existing professional culture. Such change can begin with embracing helpful tips in overcoming bullying and modeling successful positive behaviors. This paper defines horizontal violence in nursing and explores strategies to address it based upon shared information.

METHOD

Multiple workshops across the country have allowed nurses to exchange information about their experiences with horizontal violence. Nurses have examined their roles as bystander, perpetrator, and victim in discussing contemporary perspectives, employing methods of engagement, promoting debate, and using practical resource advice in dealing with the experience and prevention of horizontal violence.

FINDINGS

Workshops, evaluated through pretests/posttests and written evaluations, revealed increased knowledge about concepts of horizontal violence and their application to the workplace, recognition of horizontal violence, and methods of dealing with horizontal violence in nursing.

CONCLUSIONS

Across the profession, nurses need exposure to practical approaches to curtailing horizontal violence in nursing. A similar workshop approach could be adapted across educational programs and workplaces based on the individual needs of each environment.

Building emotional intelligence: a strategy for emerging nurse leaders to reduce workplace bullying

Bullying is one of the most concerning forms of aggression in health care organizations. Conceptualized as an emotion-based response, bullying is often triggered by today's workplace challenges. Unfortunately, workplace bullying is an escalating problem in nursing. Bullying contributes to unhealthy and toxic environments, which in turn contribute to ineffective patient care, increased stress, and decreased job satisfaction among health care providers. These equate to a poor workforce environment, which in turn increases hospital costs when nurses choose to leave. Nurse managers are in positions of power to recognize and address negative workplace behaviors, such as bullying. However, emerging leaders in particular may not be equipped with the tools to deal with bullying and consequently may choose to overlook it. Substantive evidence from other disciplines supports the contention that individuals with greater emotional intelligence are better equipped to recognize early signs of negative behavior, such as bullying. Therefore, fostering emotional intelligence in emerging nurse leaders may lead to less bullying and more positive workplace environments for nurses in the future.