The Influence of Bullying on Nursing Practice Errors: A Systematic Review

Consequences and coping strategies of nurses and registered nurses perceiving to work in an environment characterized by workplace bullying

Aim

The aim of this study was to analyze the well-being and coping strategies of nurses working in an organizational setting perceived as characterized by workplace bullying. The innovative aspect of this study is that we considered only those who perceive to work in an organizational environment characterized by workplace bullying, and not those who see themselves as victims and those who perceive they work in an organizational environment not characterized by workplace bullying.

Method

A questionnaire with the NAQ-R, PGWBI, Val.Mob. and Brief COPE scales was administered to nurses. To better understand this phenomenon, a comparison was made between 331 nurses and 166 workers in other professions who also work in an organizational environment perceived to be characterized by workplace bullying.

Results

In both groups (nurses and workers), the results were approximately the same in terms of personal bullying and workplace bullying episodes and the number of physical and emotive symptoms. The PGWBI score was lower for nurses than for workers in other fields. Among the individual symptoms, nurses and registered nurses were more likely to report gastritis, insomnia and heartburn than workers in other contexts. Workers in other contexts were more likely than nurses to report symptoms of anxiety, fear, feelings of insecurity, inferiority and guilt. In terms of coping strategies, nurses were more likely than other workers to report distraction, substance use, emotional support, disengagement, venting, positive reframing, humor, and religion. Workers in other professional context were more likely than nurses to report active coping, denial, instrumental support, planning, acceptance, and self-blame.

Conclusion

Results suggest that the consequences of working in a perceived organizational environment characterized by workplace bullying are similar for both groups of workers, with nonstatistical differences in perceived workplace bullying episodes and sum of physical and emotive symptoms.

Implication

Overall, findings suggest that workplace bullying prevention is a fundamental element in training workers in all types of workplaces and should be an integral part of curriculum activities.

Impact of workplace bullying on job burnout and turnover intention among nursing staff in Greece: Evidence after the COVID-19 pandemic

Introduction

The prevalence of workplace bullying, job burnout, and turnover intention among nursing staff increased during the COVID-19 pandemic. However, to the best of our knowledge, there are no studies that have measured the relationships among variables of interest after the pandemic.

Objective

Our intention is to investigate the effect of workplace bullying on job burnout and turnover intention in nursing staff.

Methods

We conducted a cross-sectional study during January-February 2024 in Greece. We obtained a convenience sample of 450 nurses. We used the 22-item Negative Acts Questionnaire-Revised to assess workplace bullying. We measured job burnout with the single-item burnout measure. We measured nurses' turnover intention with a valid 6-point Likert scale.

Results

The study sample included 450 nurses with the mean age of 39.1 years (standard deviation [SD] = 10.2). The mean workplace bullying score was 7.7 (SD = 2.0), while the mean job burnout score was 7.7 (SD = 2.0). Among our nurses, 57.3% showed a high level of turnover intention. After eliminating confounders, we found that increased workplace bullying (adjusted beta = 0.031, 95% confidence interval [CI] = 0.023 to 0.039, p < 0.001) was associated with increased job burnout. Moreover, multivariable logistic regression analysis showed that increased turnover intention was more common among nurses who experienced higher levels of workplace bullying (adjusted odds ratio = 1.057, 95% CI = 1.043 to 1.071, p < 0.001).

Conclusion

We found a positive relationship between workplace bullying, job burnout, and turnover intention. Nurse managers, organizations, and policy-makers ought to consider such findings to intervene and decrease workplace bullying by improving working conditions.

Impact of Workplace Bullying on Quiet Quitting in Nurses: The Mediating Effect of Coping Strategies

Workplace bullying is common among nurses and negatively affects several work-related variables, such as job burnout and job satisfaction. However, no study until now has examined the impact of workplace bullying on quiet quitting among nurses. Thus, our aim was to examine the direct effect of workplace bullying on quiet quitting and to investigate the mediating effect of coping strategies on the relationship between workplace bullying and quiet quitting in nurses. We conducted a cross-sectional study with a convenience sample of 650 nurses in Greece. We collected our data in February 2024. We used the Negative Acts Questionnaire-Revised, the Quiet Quitting Scale, and the Brief COPE to measure workplace bullying, quiet quitting, and coping strategies, respectively. We found that workplace bullying and negative coping strategies were positive predictors of quiet quitting, while positive coping strategies were negative predictors of quiet quitting. Our mediation analysis showed that positive and negative coping strategies partially mediated the relationship between workplace bullying and quiet quitting. In particular, positive coping strategies caused competitive mediation, while negative coping strategies caused complimentary mediation. Nurses' managers and policy makers should improve working conditions by reducing workplace bullying and strengthening positive coping strategies among nurses.

Role of workplace bullying and workplace incivility for employee performance: Mediated-moderated mechanism

Workplace events play a significant role in shaping the performance of employees and organizations. Negative events, in particular, require careful attention due to their severe impact on employee wellbeing and performance. Workplace bullying and incivility are two negative events that can cause significant harm to employees and contribute to poor performance. This study examines the effects of workplace bullying and incivility on employee performance in the presence of perceived psychological wellbeing (PWB), with the moderating role of perceived organizational support (POS) considered for both independent variables and employee performance (EP). The study focuses on female nurses working in the healthcare sector of Azad Jammu and Kashmir. The results of the study indicate that workplace bullying and incivility have adverse effects on employee performance and that PWB mediates these relationships. Moreover, perceived organizational support moderates the relationship between both predictors and the employee performance criterion. In conclusion, the findings of this study highlight the importance of creating a positive and supportive work environment to mitigate the negative effects of workplace bullying and incivility on employee performance.

Bullying behaviors and intention to drop-out among nursing students: the mediation roles of sense of belonging and major satisfaction

Bullying in academic settings has long-lasting implications on students' well-being and career prospects, particularly in fields like nursing that require a high level of interpersonal skills and emotional resilience. This study explored the relationships between experiences of bullying and intentions to drop out among Iranian nursing students, with major satisfaction and a sense of belonging serving as mediating factors. A cross-sectional research design was employed from April to June 2023. Undergraduate nursing students (n = 386) filled out a five-part questionnaire namely demographic and educational information, bullying behaviors in nursing education environments, the Belongingness scale, intention to drop out, and academic major satisfaction scale. The study confirmed that experiences of bullying positively correlated with intentions to drop out, negatively affected students' sense of belonging and major satisfaction, and established that course satisfaction and a sense of belonging acted as mediators between bullying and intentions to drop out. The findings show the urgent need for anti-bullying interventions targeting faculty behavior and educational strategies aimed at fostering a sense of belonging and course satisfaction among nursing students.

Exploring the aftermath: Work demands, workplace violence, and job satisfaction among nurses in a public hospital in the post-COVID-19 era

Background

Despite the shift from the COVID-19 pandemic to an endemic phase, many individuals, including nurses, may still be facing psychosocial challenges after enduring three years of the pandemic. Although the anticipation that psychosocial issues, such as work demand and workplace violence, have diminished and nurses' job satisfaction has improved, there is a scarcity of studies in Indonesia investigating this matter.

Objective

This study aimed to 1) explore the current state of nurses' work demands, workplace violence, and job satisfaction and 2) examine the relationships between work demands, workplace violence, and respondents' characteristics with nurses' job satisfaction.

Methods

The study employed a cross-sectional survey design involving 247 nurses from a regional general hospital in Jakarta, Indonesia. Simple random sampling was used to select the participants, and the Copenhagen Psychosocial Questionnaire (COPSOQ) III was used for data collection. Data were analyzed using multiple linear regression.

Results

The types of cognitive demands (M = 12.46, SD = 3.461), demands for hiding emotion (M = 11.66, SD = 3.554), and work pace (M = 9.87, SD = 2.847) scored an average close to or within the "sometimes/quite extensive" range on the scale. All types of workplace violence and conflicts occurred among nurses (Mean range = 1.21-2.57). Nurses perceived themselves as fairly satisfied with their job (M = 18.47, SD = 3.18). The results of the multiple linear regression indicated that nurses' job satisfaction was predominantly influenced by workplace violence (β = -0.191), followed by the type of care unit (β = -0.167) and work demands (β = -0.126). These factors collectively accounted for 9.1% of the variance in the job satisfaction variable (R2 = 0.091, p <0.005).

Conclusion

Despite the decreasing number of COVID-19 cases, nurses still experience high work demands and continue to face workplace violence. These factors, as well as the type of care unit, influence nurses' job satisfaction. Therefore, further actions need to be taken by hospital management to address these psychosocial conditions. It is recommended that future research explore the role of nurse managers in managing the psychosocial factors associated with these three factors.

Discriminatory practices and poor job performance: A study of person-related hostility among nursing staff

This study highlights the organisational-level factors that become the reason for propagating hostile behaviours among female nurses. Freire's theory of oppression has been used as an underpinning theory for developing the conceptual framework. This study empirically verifies the conceptual framework of the study that gender discrimination and lack of administrative support are the antecedents of person-related hostility, which is the reason for poor job performance in the healthcare sector. We applied a quantitative research approach, using questionnaires to collect data. Total of 707 survey forms were collected from female nurses working in public sector hospitals in four main cities of Pakistan. The software SPSS 20 and SmartPLS 3 were used for the final data analysis. All hypotheses regarding the direct and indirect relationship of variables were accepted. Gender discrimination and lack of administrative support were positively associated with person-related hostility. Moreover, person-related hostility also mediated the relationship between independent variables (gender discrimination, lack of administrative support) and dependent variable (poor job performance). Future research is directed to study person-related hostility among nursing staff of semi-urban areas and small towns with low literacy rates, considering other dependent variables like burnout, mental well-being, and mental health. HR strategies and policies for fair performance evaluation and timely promotions of nursing professionals are proposed in the study for building an overall healthy environment.

Effects of Personality Traits and Mentalization on Workplace Bullying Experiences among Intensive Care Unit Nurses

Aim. This study aimed to investigate the effects of intensive care unit nurses’ personality traits and mentalization on workplace bullying after controlling for organizational culture. Background. Nurses’ personality traits and mentalization may significantly influence workplace bullying. Methods. This cross-sectional study collected data from 416 nurses using an online survey in July 2022. Major variables were evaluated using the Pathological Narcissism Inventory, Perfectionistic Self-Presentation and Psychological Distress Scale, Short Dark Triad, Mentalization Scale, Positive Nursing Organizational Culture Measurement Tool, and the Negative Acts Questionnaire-Revised. . A multiple regression analysis was performed. Results. Narcissistic vulnerability, mentalization, and perfectionistic self-presentation significantly influence workplace bullying (victim aspect). Dark personality, mentalization, and perfectionistic self-presentation significantly influence workplace bullying (perpetrator aspect). Conclusions. Individual nurses could become either victims of bullying or perpetrators according to their personality traits. Therefore, it is necessary to determine their personality traits, so that they do not become influencing factors in workplace bullying. Implications for Nursing Management. Efforts at a nursing organization level are crucial to understand nurses’ personality traits, enhance their mentalization, minimize the manifestations of the negative aspects of their traits, and positively affect the prevention and alleviation of workplace bullying.

A conflicted tribe under pressure: A qualitative study of negative workplace behaviour in nursing

AIM

This study explored workplace interactions of Australian nurses in regional acute care hospitals through an examination of nurses' experiences and perceptions of workplace behaviour.

DESIGN

This research is informed by Social Worlds Theory and is the qualitative component of an overarching mixed methods sequential explanatory study.

METHODS

Between January and March 2019, data were collected from 13 nursing informants from different occupational levels and roles, who engaged in semi-structured, in-depth, face-to-face interviews. Data analysis was guided by Straussian grounded theory to identify the core category and subcategories.

RESULTS

Theoretical saturation occurred after 13 interviews. The core category identified is A conflicted tribe under pressure, which is comprised of five interrelated subcategories: Belonging to the tribe; 'It's a living hell'; Zero tolerance-'it's a joke'; Conflicted priorities; Shifting the cultural norm.

CONCLUSION

This study provides valuable insight into the nursing social world and the organizational constraints in which nurses work. Although the inclination for an individual to exhibit negative behaviours cannot be dismissed, this behaviour can either be facilitated or impeded by organizational influences.

IMPACT

By considering the nurses' experiences of negative workplace behaviour and identifying the symptoms of a struggling system, nurse leaders can work to find and implement strategies to mitigate negative behaviour and create respectful workplace behaviours.

PATIENT OR PUBLIC CONTRIBUTION

This study involved registered nurse participants and there was no patient or public contribution.

CLINICAL TRIAL REGISTRATION

Study registration Australian New Zealand Clinical Trials Registry (Registration No. ACTRN12618002007213; December 14, 2018).

How are witnessed workplace bullying and bystander roles related to perceived care quality, work engagement, and turnover intentions in the healthcare sector? A longitudinal study

BACKGROUND

Workplace bullying is widespread in the healthcare sector and the negative effects are well known. However, less attention has been paid to bystanders who witness bullying in the workplace. Bystanders can affect the bullying process by engaging in active, passive, or destructive behaviors. There is a need to study work-related and organizational consequences of witnessing bullying and bystander behaviors.

OBJECTIVE

The aim was to explore how witnessed workplace bullying and bystander behaviors are associated with work-related and organizational consequences, such as perceived quality of care, work engagement, and turnover intentions, among healthcare workers over time.

DESIGN

Longitudinal design. An online questionnaire was administered twice over the course of six months.

SETTING(S)

Employees in the healthcare sector in Sweden, such as physicians, nurses, and assistant nurses, responded to the questionnaire.

PARTICIPANTS

1144 participants provided longitudinal data.

METHODS

Structural equation modeling was used to explore the associations between witnessed bullying, bystander behavior, work-related and organizational factors over time.

RESULTS

Witnessed workplace bullying (B = -0.18, 95 % CI [-0.23 to -0.12]) and the bystander outsider role (B = -0.24, 95 % CI [-0.29 to -0.19]) were statistically significantly related to a decrease in perceived quality of care. Work engagement was statistically significantly predicted by all three bystander roles over time; positively by the defender role (B = 0.11, 95 % CI [0.05-0.17]), and negatively by the outsider role (B = -0.23, 95 % CI [-0.29 to -0.16]), and the assistant role (B = -0.32, 95 % CI [-0.41 to -0.24]). The outsider role (B = 0.12, 95 % CI [0.02-0.22]), the assistant role (B = 0.17, 95 % CI [0.03-0.30]), and witnessed workplace bullying (B = 0.18, 95 % CI [0.08-0.29]), all positively predicted increased turnover intentions at a subsequent time point.

CONCLUSIONS

In addition to the direct negative impact workplace bullying has on those targeted by it, witnessing bullying and taking different bystander roles can have work-related and organizational consequences by influencing perceived care quality, employees' work engagement, and their intention to leave the organization.

Facilitation of Forgiveness: Impact on Health and Well-being

Although the practice of forgiveness is encouraged, the healing properties of this virtue by health care professionals are often overlooked. Forgiveness is the voluntary, conscious decision to abandon negative feelings toward another who has caused hurt and replacing those feelings with unconditional love and compassion. It is not about forgetting the hurt or ignoring the pain; it is an actual transformation of the heart. The Enright Forgiveness Process Model and the Pyramid Model of Forgiveness are 2 models that facilitate the forgiveness process. By utilizing either of these pathways, the forgiver ultimately experiences peace of mind and a "release from emotional prison" that leads to holistic healing. As a result, the forgiver experiences lower levels of depression, anxiety, and aggression, which improves quality of life. In addition, physiological benefits such as decreased stress levels, lower blood pressure, and a lower heart rate have also been reported. Throughout the course of their careers, nurses encounter patients and families in acute or end-of-life care situations who want to forgive or be forgiven. As holistic health care providers, nurses should be able to facilitate and close this gap in patient care. This article attempts to raise awareness to the importance of forgiveness in health and well-being among nurses and other health care professionals.

Impact of Cognitive Rehearsal Training Over Time for New Registered Nurses

Background New RNs are most at risk for being bullied in health care. Cognitive rehearsal training (CRT) as an anti-bullying intervention is a novel approach to address the issue using role-play to respond to scenarios involving bullying. Previous studies (Griffin, 2004; O'Connell et al., 2019) show that students find the CRT strategy useful to increase their confidence and competence when managing a bullying situation. Method New RNs (N = 15) who had attended a CRT workshop 1 to 2 years previously answered an in-depth survey as to how they had used the training in the interim period. Results Seventy-one percent of the participants were able to recognize bullying behavior, and 64% had been able to stop from reacting immediately. Half of the participants reported taking time to reflect on the context of the bullying and manage their emotions and then respond in a professional manner. Conclusion Nurses in this study requested further CRT to solidify their learning, which could result in more prosocial responses to bullying. [J Contin Educ Nurs. 2022;53(5):203-211.].

Intervention types and their effects on workplace bullying among nurses: A systematic review

AIM

To integrate the literature on workplace bullying among nurses and identify characteristics of anti-bullying interventions.

BACKGROUND

Workplace bullying in nursing is a major concern, potentially affecting nursing practice, patient outcomes, and nurses' health.

EVALUATION

PubMed, Cochrane Library, CINAHL, EMBASE, and PsychINFO were searched for English articles published between December 2020 and January 2021 on workplace bullying among nurses. Eight articles were selected, and a quality assessment and data extraction followed.

KEY ISSUES

While the studies employed various intervention approaches, their workplace bullying conceptualizations and instruments varied, as did the outcome variables selected to assess the effects of the intervention.

CONCLUSION

Anti-bullying interventions were effective, and the methods of their delivery have diversified. However, issues such as the lack of conceptual clarity, intervention specificity, and elaboration remain unaddressed. Further studies are needed to develop updated and standardized instruments to tailor anti-bullying interventions.

IMPLICATIONS FOR NURSING MANAGEMENT

Upgraded intervention strategies that reflect the contemporary nursing context and participant characteristics are warranted to ensure workplace bullying prevention. Active intervention by upper management is essential to develop and implement effective workplace bullying interventions.

Association of stress, resilience, and nursing student incivility during COVID-19

Although incivility in nursing education is linked with negative physical and psychological effects on students, it is unclear how resilience and stress interact and relate to student incivility. The purpose was to understand the role of resilience and stress with peer incivility in a sample of prelicensure nursing students during coronavirus disease 2019. The study design was cross-sectional and correlational. Data were from an online survey administered to undergraduate nursing students of one college of nursing in a southwestern US state during September-October 2020. In a sample of 490 students, ordinal regression model results supported that including a stress and resilience interaction term resulted in a nonsignificant effect of stress and resilience, as the main effect correlates on low-level uncivil student behavior. More research is needed to understand the prevalence of stress and resilience at different points in prelicensure nursing education so that targeted interventions can be developed and deployed to assist students.

Validation of a grounded theory of nurse bullying in emergency department settings

BACKGROUND

Workplace bullying in health care settings, including emergency departments (EDs), is a significant and negative factor in the dynamics of patient care, nursing work culture, and nurse retention. Specifically, workplace bullying has a significant and negative effect on patient care, with both direct (errors and substandard care) and indirect sequelae (high turnover and inexperienced nursing staff hired to replace those nurses who have left to escape bullying behavior). The purpose of this study was to determine the theoretical coherence of the ENA model of nurse bullying in emergency department and its impact on emergency nurses' intent to leave their job.

METHODS

Correlational study using the Practice Environment Scale of the Nursing Work Index (PES-NWI), the Secondary Traumatic Stress Scale (STSS), and the Short Negative Acts Questionnaire (SNAQ) in a cross-sectional sample of emergency nurses working in the United States.

RESULTS

Extremely high intent to leave the current ED (PD1) rates were associated with nurses' reported exposure to daily bullying (PD1 rate = 67.6%, zero-order OR = 4.77, Nr² = 3.2%, p < .001) and bullying multiple times per week (49.1%, zero-order OR = 2.31, Nr² = 2.6%, p < .001). Nurses who reported no exposure to bullying at work had a distinctly below average PD1 rate (22.9%, OR = 0.47, Nr² = 3.9%, p < .001).

CONCLUSIONS

The relationships between the tested elements of the model (specifically, the influence of bullying on nurse intent to leave) as constructed appear to adequately reflect the phenomenon of workplace bullying and its effects on nurse retention in emergency care settings.