Bullying of staff registered nurses in the workplace: a preliminary study for developing personal and organizational strategies for the transformation of hostile to healthy workplace environments

Clinician responses to disruptive intraoperative behaviour: patterns and norms identified from a multinational survey

PURPOSE

Disruptive intraoperative behaviour can have detrimental consequences for clinicians, institutions, and patients. The way victims and witnesses respond to disruptive behaviour can ameliorate or exacerbate consequences. Nevertheless, previous research has neither described the responses of a multinational sample of clinicians nor developed tools to recognize and evaluate responses.

METHODS

After obtaining ethics committee approval, 23 perioperative organizations distributed a survey evaluating clinician responses to disruptive behaviour. We grouped responses into four response strategies: passive, assertive, manipulative, and malicious. Thereafter, we derived norms (i.e., percentile distributions) for each response strategy using empirical distribution functions. Latent profile analysis identified groups of clinicians balancing their use of the four response strategies differently (i.e., response pattern groups). We used Chi square tests to examine associations between response pattern groups and respondent demographics.

RESULTS

We analyzed 4,789 complete responses. In response to disruptive behaviour, 33.7% of clinicians altered medical care in ways that were unindicated, 54.6% avoided communication with team members, and 12.1% misled the offender. Profile analysis identified five response pattern groups: extreme passive-predominant (30.5% of clinicians), extreme assertive-predominant (20.5%), moderate passive-predominant (18.9%), moderate assertive-predominant (26.5%), and a disparate pattern (greater use of manipulative and malicious responses) (3.5%). Profession, sex, management responsibilities, and sexual orientation predicted the response pattern group (all, P < 0.001).

DISCUSSION

The responses of thousands of clinicians involved passivity, manipulativeness, or maliciousness. We present norms and a response pattern classification to help organizations evaluate responses, recognize response patterns, and provide tailored support to victims and witnesses.

Bullying and burnout in critical care nurses: A cross-sectional descriptive study

BACKGROUND

Employee bullying and burnout are two crucial, prevalent and challenging concepts that adversely affect organizational staff behaviours. Also, adverse patient care is associated with nurse bullying and burnout.

AIM

This study aimed to assess the incidence and association between workplace bullying and occupational burnout among nurses in critical care units in Iran.

STUDY DESIGN

A cross-sectional descriptive study.

METHODS

The subjects were 184 nurses from critical care units in 6 teaching hospitals in Iran. Three questionnaires were distributed among the study population; (a) demographic characteristics questionnaire, (b) Maslach Burnout Inventory (MBI) and (c) bullying at Workplace Questionnaire. Descriptive statistics were used to present the workplace bullying and occupational burnout status among nurses. Linear and logistic regression analyses were conducted to estimate the relationship between workplace bullying with MBI and nurses' demographic characteristics, respectively.

RESULTS

62% of the nurses had moderate emotional exhaustion, 59.8% had moderate depersonalization and 46.2% had a moderate individual achievement. 75.5% faced workplace bullying. There was a positive and significant association between bullying scores and burnout in total (Pearson's r = 0.598, p < 0.001). Linear regression test showed a positive and significant relationship between bullying with MBI dimensions (R = 0.613, p < 0.001) for emotional exhaustion, (R = 0.679, p < 0.001) for depersonalization and (R = -0.417, p < 0.001) for individual achievement.

CONCLUSIONS

Among Iranian nurses, bullying is a prominent and substantial issue that significantly correlates with their negative performance by enhancing job burnout.

RELEVANCE TO CLINICAL PRACTICE

It is suggested that some measures are adopted to avoid workplace bullying and to reduce occupational burnout for nurses. Managers should create an environment that encourages nurses to voice their concerns - informing nurses about their rights and creating a positive atmosphere in the hospital.

Workplace Bullying in Pathology and Laboratory Medicine

OBJECTIVES

The specific aims of the study are to explore the prevalence of workplace bullying and to understand the impact of bullying on individual wellness in order to facilitate the development of future organizational solutions to mitigate workplace incivility.

METHODS

Cross-sectional data were collected via a web-based survey to gather exploratory demographic information and to assess the relationships between intensity of the exposure to the negative acts with laboratory productivity. Associations between laboratories offering resources to employees and their impacts on productivity and professional job fulfillment were also explored.

RESULTS

Results of the survey showed that over two-thirds of laboratorians (68.56%) were classified as victims of workplace bullying, and the perpetrator is most likely a peer of the victim (55.3%). The study revealed the intensity of workplace incivility was positively correlated with the number of sick days taken by the laboratory practitioner (F(2, 217) = 24.245, P < .001). Facilities with a supportive work environment were also associated with a reduction in the number of sick mental days taken (P < .001), a proxy for improved work and health outcomes.

CONCLUSIONS

The results of this study shed light on the prevalence of incivility at the workplace and offer evidence on the importance of providing a supportive work environment toward reducing workplace bullying.

Supporting Bystanders and Other Staff Exposed to Negative Workplace Behaviour: Developing and Testing the IMO Intervention Framework in the Clinical Workplace

BACKGROUND

Medical student and health-care staff bullying remain international concerns. Our understanding about what might solve such problems is still developing. A common approach suggested for bystanders to bullying is that they challenge or "stand up" to the bully. At the same time, the considerable risks should they act (eg, verbal rebuke) are rarely acknowledged, and neither is the potential for considerable cognitive dissonance should they choose not to.

METHODS

Drawing on a substantial literature review, we developed an interventional program, initially with medical student bullying in mind, that generally employed a discourse for values cultivation. We implemented and evaluated this program through 6 cycles of action research methodology in 6 different departments of one tertiary teaching hospital. Data include individual interviews, discussions with key participants plus freehand comments from wider staff's workshop evaluations.

RESULTS

Alongside others, an early serendipitous finding was the "IMO" [Indirect, focus on Me, focus on Outcome] framework, intended for bystanders to student bullying. From using this framework, participants reported developing confidence in tackling negative behaviours, that interactions had better outcomes and that the workplace atmosphere felt more relaxed. It's use also significantly reduced cognitive dissonance. Encouragingly, participants went on to use IMO for staff-staff bullying incidents, and other common negative behaviours. We attribute IMO's utility to its memorability, simplicity and for catering to the many possible causes of bullying, including values issues, without perpetuating or creating conflict.

CONCLUSION

The IMO framework is offered as a widely usable framework for all staff in a clinical environment - a useful addition to popular frameworks used in the clinical workplace, ideas from which might also help these be further refined. Further evaluation would establish whether IMO invites long-term change and its utility in other contexts.

Nurse-to-nurse horizontal violence in Chinese hospitals and the protective role of head nurse's caring and nurses' group behaviour on it: A cross-sectional study

AIMS

This study aimed to analyse the prevalence of nurse-to-nurse horizontal violence in Chinese hospitals and examine the effects of head nurse's caring and nurse's group behaviour on horizontal violence.

BACKGROUND

Horizontal violence is a serious global problem affecting the nursing profession, but little is known of the issue in Chinese hospitals. Increasing evidence has showed that leadership and group factors are important in facilitating horizontal violence. Whether the head nurse's caring and group behaviour perceived by nurses has protective effects against horizontal violence remains unclear.

METHODS

A cross-sectional online-based questionnaire study was performed in seven general hospitals in Hubei Province, China. Data related to the demographic information, horizontal violence, head nurse's caring and group behaviour were collected. Descriptive analyses, chi-squared tests and logistic regression were used for data analysis.

RESULTS

In total, 1942 valid questionnaires were collected, with a 92.70% effective response rate (1942/2095). Of those, 59.1% (1148/1942) of respondents had experienced horizontal violence at least once in the previous 6 months. Covert negative behaviours were more frequently reported. Compared with the low level, moderate and high levels of the head nurse's caring showed a lower risk of horizontal violence (odds ratio [OR] = 0.400, p < .001; OR = 0.128, p < .001); moderate and high levels of group behaviour also showed a reduced risk (OR = 0.601, p < .001; OR = 0.221, p < .001).

CONCLUSION

Horizontal violence is common among Chinese nurses. The head nurse's caring and maintaining a good climate of nurses' group behaviours could serve as protective factors for preventing horizontal violence.

IMPLICATIONS FOR NURSING MANAGEMENT

This study helps nursing managers identify which specific negative behaviours occur frequently and require special attention. It suggests that nursing managers attach importance to improving their caring ability towards nurses and to creating an amicable climate of group behaviour to buffer against horizontal violence.

Quality and Safety in Healthcare, Part LXXVIII: Expected Competencies of the Chief Nursing Officer and Most Other Healthcare Executives

ABSTRACT

Numerous expected competencies of a chief nursing officer are outlined in this article including communication, ability to build relationships, expertise about the environment of healthcare and its future directions, leadership, expertise in business matters, combating bullying, encouraging shared decision making, and optimizing interdisciplinary teams and the use of advanced practice providers. These skills are also expected of most other healthcare executives, whether or not they are nurses, because using these competencies increases quality, safety, and value for the patients and improves conditions for the healthcare organization and those who work there.

Prevalence of lateral violence in nurse workplace: a systematic review and meta-analysis

BACKGROUND

The prevalence of inter-nurse lateral violence (LV) reported in current studies is inconsistent, ranging from 7% to 83%. The purpose of this study is to quantify the prevalence of LV in nurses' workplaces.

METHODS

Systematic review and meta-analysis. Cochrane, PubMed, Embase, CINAHL, CNKI and Wanfang databases were searched for relevant studies (up to 27 January 2021). We included cross-sectional, case-control or cohort studies in which both abusers and victims were nurses. Studies that did not provide specific data on abusers were excluded. Stata V.16.0 was used for statistical analysis. Fixed-effect or random-effect model was adopted according to heterogeneity, which was evaluated by Cochran's Q and I² values. The main indicator was LV prevalence. Sensitivity analysis, subgroup analysis and meta-regression were performed to investigate the sources of heterogeneity.

RESULTS

A total of 14 studies with 6124 nurses were included. Further, 13 articles with 5745 nurses were included in the meta-analysis, and the pooled prevalence of LV among nurses was 33.08% (95% CI: 23.41% to 42.75%, p<0.05; I²=99.0%). The remaining one study containing 370 samples reported that the prevalence of inter-nurse LV was 7.92%. Subgroup analysis showed that region, sample size, sampling, study's quality, response rate and publication time might not be the sources of heterogeneity. Meta-regression indicated that sample size had the main influence on model heterogeneity. Egger's test showed the existence of publication bias (p=0.03).

DISCUSSION

The prevalence of inter-nurse LV is high in nurse workplace. It is suggested that scholars pay more attention to the cultural differences of inter-nurse LV between regions in the future. This study has the following limitations: there is a lack of studies on LV prevalence in many countries; lack of standard assessment tools; no grey literature was searched.

‘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.

Effect of treatment adherence training given to patients with bipolar disorder on treatment adherence, social functioning and quality of life: A pilot study

BACKGROUND

and purpose: Treatment non-adherence is quite common among patients with bipolar disorder, negatively affects the social functioning of patients and reduces the quality of life. This pilot study aims to measure the effect of treatment adherence training given to patients with bipolar disorder on treatment adherence, social functioning and quality of life.

MATERIALS AND METHODS

The pilot study was conducted with 40 bipolar disorder patients, 19 in the intervention group and 21 in the control group, using a quasi-experimental research design. The data were collected using the Participant Information Form, Medication Adherence Rating Scale, Social Functioning Scale and Short Form of the World Health Organization Quality of Life Questionnaire. Treatment adherence training was given once a week individually for a total of five sessions.

RESULTS

There was no significant difference between the demographic characteristics and pre-test scale scores of the patients in the intervention and control groups before the treatment adherence training (p > 0.05). The mean treatment adherence, social functioning and quality of life scores of the patients in the intervention group were higher in the post-test and follow-up test compared to the patients in the control group (p < 0.001).

CONCLUSION

The intervention had a positive effect on treatment adherence, social functioning and quality of life of patients. Considering the promising results of this pilot study, treatment adherence training should be studied further in the patients with biplor disorder.

Development of Survey Scales for Measuring Exposure and Behavioral Responses to Disruptive Intraoperative Behavior

OBJECTIVES

Disruptive intraoperative behavior has detrimental effects to clinicians, institutions, and patients. How clinicians respond to this behavior can either exacerbate or attenuate its effects. Previous investigations of disruptive behavior have used survey scales with significant limitations. The study objective was to develop appropriate scales to measure exposure and responses to disruptive behavior.

METHODS

We obtained ethics approval. The scales were developed in a sequence of steps. They were pretested using expert reviews, computational linguistic analysis, and cognitive interviews. The scales were then piloted on Canadian operating room clinicians. Factor analysis was applied to half of the data set for question reduction and grouping. Item response analysis and theoretical reviews ensured that important questions were not eliminated. Internal consistency was evaluated using Cronbach α. Model fit was examined on the second half of the data set using confirmatory factor analysis. Content validity of the final scales was re-evaluated. Consistency between observed relationships and theoretical predictions was assessed. Temporal stability was evaluated on a subsample of 38 respondents.

RESULTS

A total of 1433 and 746 clinicians completed the exposure and response scales, respectively. Content validity indices were excellent (exposure = 0.96, responses = 1.0). Internal consistency was good (exposure = 0.93, responses = 0.87). Correlations between the exposure scale and secondary measures were consistent with expectations based on theory. Temporal stability was acceptable (exposure = 0.77, responses = 0.73).

CONCLUSIONS

We have developed scales measuring exposure and responses to disruptive behavior. They generate valid and reliable scores when surveying operating room clinicians, and they overcome the limitations of previous tools. These survey scales are freely available.

Workplace Incivility and Job Satisfaction: Mediation of Subjective Well-Being and Moderation of Forgiveness Climate in Health Care Sector

Our study investigates the role of subjective well-being and forgiveness climate between workplace incivility and job satisfaction. Drawing on conservation of resource theory, we proposed a model in which workplace incivility is associated with job satisfaction through subjective wellbeing, and forgiveness climate moderates this association. Data was collected through a survey method from 672 nurses and doctors in the health care sector at two different times. Respondents completed workplace incivility and subjective well-being scale at Time 1, and a forgiveness climate and job satisfaction scale at time 2. Findings through PROCESS Macros (Model 5) show that workplace incivility has a negative influence on job satisfaction and subjective well-being. Subjective well-being plays a mediating role in the negative effect of workplace incivility on job satisfaction. Moreover, forgiveness climate moderates the relationship between workplace incivility and job satisfaction. The implications for practice and research are discussed.

An Exploratory Study of Bullying Directed Toward Clinical Nursing Faculty: Prevalence and Impact

BACKGROUND

Clinical education is an integral component of nursing education and relies heavily on clinical nursing faculty (CNF). However, there are not enough nurses seeking CNF positions to meet the current demand of the nursing workforce.

PURPOSE

The purpose of this study was to examine the prevalence and impact of workplace bullying directed toward CNF.

METHODS

For this exploratory cross-sectional study, a web-based survey was distributed to CNF working in New England states.

RESULTS

A total of 76 participant responses were analyzed. Eighteen percent of the participants met the criteria for being either occasionally or frequently bullied. Nursing staff in the clinical agencies and colleagues and administrators in the nursing program where CNF teach were identified as the most frequent perpetrators.

CONCLUSIONS

Understanding the prevalence and impact of bullying of CNF helps inform the development of strategies to support and retain these essential members of the nursing education workforce.

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.

Incidence and impact of incivility in paramedicine: a qualitative study

BACKGROUND

Incivility or rudeness is a form of interpersonal aggression. Studies suggest that up to 90% of healthcare staff encounter incivility at work with it being considered 'part of the job'.

METHODS

Qualitative, in-depth, semistructured interviews (n=14) undertaken between June and December 2019. Purposive sampling was used to identify front-line paramedics working for one NHS Ambulance Trust. Interviews lasted between 16 and 45 min, were audiorecorded, verbatim transcribed and analysed using thematic analysis.

RESULTS

Four themes were identified: paramedics reported a lack of respect displayed both verbally and non-verbally from other professional groups. The general public and interdisciplinary colleagues alike have unrealistic expectations of the role of a paramedic. In order to deal with incivility paramedics often reported taking the path of least resistance which impacts on ways of working and shapes subsequent clinical decision-making, potentially threatening best practice. Finally paramedics report using coping strategies to support well-being at work. They report that a single episode of incivility is easier to deal with but subsequent episodes compound the first.

CONCLUSIONS

This study highlights the effect incivility can have on operational paramedics. Incivility from the general public and other health professionals alike can have a cumulative effect impacting on well-being and clinical decision-making.

Taking a Stand Against Workplace Incivility

BACKGROUND

Workplace incivility is a common problem in nursing, and novice nurses are particularly vulnerable to incivility.

METHOD

Cognitive rehearsal training to defend against incivility was presented to resident nurses.

RESULTS

Three months after the educational intervention, 55% of nurses reported that they had witnessed incivility in the past month and 45% reported that they had responded to the incivility when it occurred.

CONCLUSION

Most of the nurses expressed that the training improved their ability to manage incivility. Responses to open-ended comments revealed that incivility adversely affects the workplace and that leaders also may benefit from education on incivility and cognitive rehearsal. [J Contin Educ Nurs. 2021;52(5):232-239.].

Stepping out of the shadows: Creating a graphic novella to address bullying in nursing education

The prevalence of bullying in nursing and nursing education is of serious concern. Not only is bullying an issue at the interpersonal level, it is also pervasive at structural and institutional levels. Addressing bullying requires attention to all levels. In previous published work, we emphasized the importance of transparent and easily accessible processes and reporting mechanisms for students if or when they witness or experience bullying in nursing education. In this paper, we describe one of a number of education initiatives designed to inform stakeholders (students, faculty members, clinical instructors, registered nurses, clinical education leaders) about the prevalence of bullying, the nature of bullying, the consequences of bullying, and some strategies to address bullying in nursing education. We chose a creative approach in the form of a graphic novella (aka comic) because we believed that this medium would be visually appealing and user friendly and would therefore draw stakeholders, especially students, to the sensitive nature of the content embedded within it.

Measuring workplace bullying in a U.S. nursing population with the Short Negative Acts Questionnaire

Efforts to decrease nurse-reported workplace bullying (WPB) is an interest among researchers, nursing leaders, and healthcare organizations. Varying conceptual definitions and measurement approaches of WPB, however, have created barriers for researchers to provide reliable and consistent information regarding WPB. In this paper, the authors aim to (1) evaluate the reliability and construct validity of the Short Negative Acts Questionnaire (SNAQ) in a sample of U.S. nurses working in hospitals located throughout Alabama, (2) determine targets and non-targets of WPB, and (3) evaluate the criterion validity of the SNAQ based on WPB classification. The internal consistency reliability and construct validity of the SNAQ in 943 Alabama registered nurses was evaluated using Cronbach's α and confirmatory factor analysis. An exploratory factor analysis was conducted to explore the underlying structure of the SNAQ. Targets and non-targets of WPB were identified using latent class analysis of the SNAQ and by the self-labeling item. Agreement between the two methods was evaluated with Cohen's κ. Using both methods, the association between WPB classification and outcomes empirically associated with nurse-reported WPB was evaluated with random effects multiple logistic regression to determine criterion validity. The results indicate that the SNAQ is a reliable and valid instrument to explore WPB in a sample of U.S. registered nurses working in hospitals throughout Alabama.

The relationship between workplace bullying and professional self-concept in Iranian nurses

Aim

To determine the level of workplace bullying among Iranian nurses and its relationship with their professional self-concept.

Design

This was a descriptive correlational study.

Methods

This study was performed on 200 nurses working in the emergency departments and intensive care units of Imam Khomeini Hospital Complex affiliated to Tehran University of Medical Sciences, Iran, in 2020. The participants were chosen using the simple random sampling method and data collection tools were Negative Acts Questionnaire-Revised and Nurse Self-Concept Questionnaire. The Pearson correlation coefficient was used to determine the relationship between workplace bullying and professional self-concept.

Results

Based on the experience of daily or weekly workplace bullying, the mean scores of workplace bullying in nurses in terms of work-related bullying, person-related dimension and physical intimidation were 10.11%, 4.27% and 5.66%, respectively, and the overall mean score was 6.68%. The results of this study also showed that workplace bullying is inversely related to professional self-concept and almost all of its dimensions (p = .002, r = -.219).

Addressing Bullying and Lateral Violence in the Workplace: A Quality Improvement Initiative

BACKGROUND

Bullying and lateral violence are pervasive in the nursing workforce and have profound psychosocial, physical, safety, and financial consequences for nurses, their patients, and the overall health care organization.

PROBLEM

Unit-based nursing leaders may be aware of bullying and lateral violence but be unsure of the best approaches to address it.

APPROACH

An iterative, multimodal quality improvement initiative was crafted on the basis of the available evidence and principles of transformational, adult learning. Six units were designed to foster didactic, affective, and psychomotor learning specific to bullying and lateral violence and their prevention. Each unit consisted of formal lecture content, practice exercises, and reflection.

OUTCOMES

This quality improvement project was well received by participants; a unit-based action plan resulted. Project materials are being reworked and new evidence integrated for deployment across the department.

CONCLUSIONS

This initiative has demonstrated the necessary properties and is appropriate for adoption by other nursing units.

Association Between Workplace Bullying Occurrence and Trauma Symptoms Among Healthcare Professionals in Cyprus

Workplace bullying/mobbing is an extreme work-related stressor, but also a severe hazard for physical, mental and psychological health in healthcare employees, including nurses. A range of trauma-related symptoms has been linked with bullying victimization. The aim of the study was the investigation of workplace bullying/mobbing-related trauma symptoms in Greek-Cypriot nurses working in emergency and critical care settings, as well as of potential correlations with demographic and occupational variables. A descriptive, cross-sectional correlational study was performed in a convenience sample of 113 nurses. A modified version of the Part B.CII of The Workplace Violence in the Health Sector-Country Case Studies Research Instrument (WVHS-CCSRI Part C.II-M) and the modified Secondary Traumatic Stress Scale (STSS-M) were used for the assessment of bullying/mobbing frequency and workplace bullying/mobbing-related trauma symptoms, respectively. A total of 46.9% of the sample reported experiences of both bullying/mobbing victimization and witnessing of bullying/mobbing to others (VWB subgroup), 21.2% reported solely bullying/mobbing victimization (SVB subgroup) and 10.6% reported witnessing of bullying/mobbing to others (SWB subgroup). A total of 22.3% did not experience or witness any bullying/mobbing at the workplace. Trauma symptoms intensity (STSS-M total score) was more severe in the participants a) with a high frequency of workplace bullying/mobbing experiences compared to those with a moderate frequency of such experiences (p = 0.018), b) of the VWB subgroup compared to those of the SWB subgroup (p = 0.019), c) employed in Emergency Departments compared to those employed in ICUs (p = 0.03), d) who had considered resigning due to bullying/mobbing experiences compared to those who had never considered resigning (p = 0.008), e) who had been punished for reporting a bullying/mobbing incident compared to those who had not (p = 0.001), and f) who considered the incident unimportant to be reported compared to those who avoided reporting due to other causes (p = 0.048). This data highlights the need to establish effective and safe procedures for bullying/mobbing reporting, aiming to support bulling/mobbing victims and witnesses, and further to protect their legal rights. Both victims and witnesses of workplace bullying/mobbing need to be assessed by mental health professionals for PTSD symptoms in order to have access to effective treatment.

Effects of a Workplace Violence Intervention on Hospital Employee Perceptions of Organizational Safety

OBJECTIVE

To examine hospital employee perceptions of organizational safety one-year following a workplace violence intervention and to evaluate perceptions based on violence exposure status.

METHODS

In 2014, 343 employees across 41 hospital units (N = 21 control units, N = 20 intervention units) completed a questionnaire capturing organizational safety perceptions and violence exposure.

RESULTS

Intervention unit employees reported more positive perceptions of organizational safety compared to control unit employees. However, intervention group employees who experienced patient-to-worker violence (Type II) had significantly more positive perceptions than those who experienced worker-to-worker violence (Type III).

CONCLUSIONS

Organizational safety perceptions improved following a violence-prevention intervention, especially among employees who reported Type II violence. Certain employees report worsened safety perceptions. Hospitals and units that implement violence prevention interventions should strive to address all types of violent behavior.

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.

When leader is morally corrupt: interplay of despotic leadership and self-concordance on moral emotions and bullying behavior

Purpose

This study investigates despotic leadership (DL) as an antecedent to bullying behavior with a mediating role of moral emotions at work. Another aim is to study the moderating role of self-concordance to buffer the relationship between DL and arousal of moral emotions.

Design/methodology/approach

The authors collected two-source (self-reported and supervisor reported) time-lagged data in the shape of a three-wave survey (i.e. one month time interval for each time) from 242 dyads in the health sector of Pakistan.

Findings

The results revealed that moral emotions mediated the relationship between DL and bullying behavior. Furthermore, self-concordance moderates the relationship between DL and moral emotions, such that the relationship will be stronger in the case of low self-concordance.

Research limitations/implications

Managers need to promote a culture that accommodates diversity of opinion at the organization so that everyone is able to express and share their views openly. Organizations should encourage supervisors to participate in leadership development programs aimed at eliminating DL.

Originality/value

This study establishes the role of self-concordance and moral emotions in the relationship between despotic leadership DL and bullying behavior.

Newly graduated nurses’ experiences of horizontal violence

Background:

Horizontal violence, defined in the literature as ‘interpersonal conflict between two nurses at the same hierarchical levels in organizations’, often associated with bullying, affects the well-being of nurses, care recipients and the professional image of nursing and the organization due to increased turnover. One in every three newly graduated nurses is a victim of horizontal violence, although they do not always know how to define it.

Aim:

To investigate the direct and indirect experiences of horizontal violence in newly graduated nurses as well as to shed light on the phenomenon, on its awareness and recognition.

Methods:

A qualitative phenomenological study was conducted between September and October 2018 with newly graduated nurses, with a work experience ranging between 6 months and 3 years. The interviews were conducted face-to-face, consisting of a first open general question, followed by semi-structured questions.

Ethical considerations:

The study was conducted in accordance with the Declaration of Helsinki, and the protocol was approved by the Institution Review Board.

Results:

From the analysis of the interviews of the 21 participants, four main themes were identified: the ‘enemies’, that is those who exercised violence, the ‘weapons’ used by them to exercise violence, the ‘effects’ and the types of ‘armor’ identified to protect themselves.

Discussion:

Horizontal violence is rarely recognized by newly graduated nurses, even though our sample had directly or indirectly experienced horizontal violence. Tackling the phenomenon starting from the undergraduate degree courses, focusing on effective support and more protection by the organization leaders were the silent requests that emerged from this study.

Conclusion:

Preventing horizontal violence is important for nurses’ professional and private well-being, for professional conduct and for the quality of care provided to patients.

Workplace bullying in the nursing profession: A cross-cultural scoping review

BACKGROUND

Globally, nurses are at high risk of exposure to workplace bullying, and there is a growing body of literature addressing bullying in the nursing profession. Yet, our understanding of cross-cultural variations in bullying among nurses is lacking. An analysis of what is currently known about bullying in different parts of the world is critical for our understanding of cross-cultural effects of bullying among nurses.

OBJECTIVES

We aimed to examine workplace bullying research among nurses with the focus on sources, antecedents, outcomes and coping responses from a cross-cultural perspective during the years 2001-2019.

DESIGN

This is a scoping review of published literature on workplace bullying among nurses.

DATA SOURCES

A literature search was conducted using the CINAHL, PubMed, PsychINFO and Web of Science databases. A total of 166 articles provided data from the following cultural clusters: Anglo, Latin Europe, Eastern Europe, Nordic Europe, Middle East, Latin America, Confucian Asia, Southern Asia and Sub-Saharan Africa.

PROCEDURE

Studies were identified through a database search. Relevant data were extracted using a narrative approach. Categories were thematically organized according to the study topics. Cultural differences regarding the variation in the perceptions of and responses to bullying were analysed in relation to the cultural dimensions: power distance, assertiveness, in-group collectivism and performance orientation.

RESULTS

Research was mostly conducted in the Anglo cluster. Antecedents and outcomes of bullying were the most often studied topics across all cultural clusters. Vertical bullying was most prevalent in higher power distance cultures, whereas horizontal bullying was either more or equally prevalent in lower power distance cultures. The risk of bullying decreased as nurses' length of service and age increased in most of the clusters. Individual antecedents were more frequently reported in high in-group collectivist cultures. Organizational antecedents such as lack of bullying prevention measures, unsupportive leadership and stressful work characteristics were frequently reported across different cultural clusters. Yet, an organizational culture that tolerates bullying was most commonly addressed in Anglo, a highly performance-oriented culture. Negative outcomes of bullying were very similar across the world. Nurses used emotion-focused coping strategies more frequently almost in all clusters; yet, there were reports of problem-focused coping strategies especially in relatively higher assertiveness cultures.

CONCLUSIONS

Analysis revealed both similarities and differences in the nurses' reports of bullying by world region. Cultural factors were found to be important for understanding the variation in the nurses' perceptions of and responses to bullying.

Interrupting the cycle of bullying witnessed or experienced by nursing students: An ethical and relational action framework

BACKGROUND

The prevalence of bullying experienced by nursing students continues to be a substantial concern for the profession, especially for nurse educators. It is also an issue in other health care professional programs.

OBJECTIVES

To explore how educational institutions address bullying experienced by nursing and other health care professional students, with the goal of creating a set of procedures for reporting bullying if students witness or experience it during their education.

DESIGN

Qualitative Description. Our central question was "What processes and resources do faculty members use when students disclose an experience related to bullying?"

SETTINGS

Educational institutions in Western Canada.

PARTICIPANTS

Nine faculty members and one staff member with a student service role from nursing and other health care profession programs.

METHODS

Semi-structured interviews.

RESULTS

We found significant variation in interviewees' conceptions of bullying and the policies, processes, and resources for addressing bullying within programs. We adopted an existing definition of bullying; designed a set of procedures focused on reporting mechanisms; and developed a guiding framework entitled Addressing Bullying in Nursing Education: An Ethical and Relational Action Framework.

CONCLUSIONS

Nursing and other health care professional programs should ensure they have 1) clear and transparent procedures to report bullying 2) education about bullying for students and faculty.

Accumulated Long-Term Exposure to Workplace Bullying Impairs Psychological Hardiness: A Five-Year Longitudinal Study among Nurses

Personality has been hypothesized to act as antecedent as well as an outcome of workplace bullying. Still, investigations on the longitudinal relationship between bullying and personality are scarce. We investigated the relationship between accumulated exposure to bullying at work and subsequent changes in psychological hardiness. Additionally, we examined whether hardiness predicted subsequent exposure to bullying. The data were based on the Survey of Shiftwork, Sleep, and Health (SUSSH), a cohort study with annual surveys among Norwegian nurses. The participants who completed standardized instruments measuring exposure to bullying behavior at T1 (2008/09) to T4 (2012) and psychological hardiness at T1 (2008/09) and T5 (2012) were included (n = 938). The results showed that accumulated exposure to bullying (sum of exposure from T1-T4) was associated with reduced psychological hardiness at T5, adjusted for age, sex, and hardiness at baseline (β = -0.16, t = -5.70, p < 0.001). Accumulated exposure to bullying behaviors explained 2.3% of the change in hardiness. Less hardy individuals experienced higher levels of subsequent exposure to bullying behaviors, adjusted for age, sex, and bullying at baseline (β = -0.04, t = -2.21 p < 0.05). Long-term accumulated exposure to bullying behaviors seemed to be a stronger predictor for changes in hardiness as compared to hardiness in predicting exposure to bullying.

Employing newly qualified nurses to work in hospices: A qualitative interview study

AIM

To establish an understanding of the experiences of newly qualified nurses' working in hospices from the perspective of both newly qualified and senior nurses.

DESIGN

A qualitative interview study.

METHODS

Semi-structured interviews with six newly qualified nurses and five senior nurses from four UK hospices were conducted between March - July 2017.

RESULTS

The hospices involved in this study were among the first to recruit newly qualified nurses. Participants believed that newly qualified nurses coped well with hospice working and received unique opportunities for professional development. Participants identified the value of formal and informal support, however, newly qualified nurses faced negative attitudes from some established staff. Newly qualified nurses expressed concerns about a perceived lack of technical clinical skills training, however, they highlighted gaining end-of-life care and communication skills that would be transferrable to other settings. Participants highlighted the need to allocate more time for education and formal support including preceptorship. Senior staff did not necessarily expect newly qualified nurses to remain in long-term hospice employment suggesting that they could disseminate their hospice learning to future workplaces.

CONCLUSION

This study supports recruitment strategies that increasingly target newly qualified nurses to work in hospices with findings suggesting that hospices can be a suitable environment for recent graduates to work in. The senior nurses in this study viewed the employment of newly qualified nurses in a positive light but shared the concerns of newly qualified nurses regarding skills training.

IMPACT

At a time when hospices need to expand if they are going to meet demand for their services, they along with most areas of healthcare face difficulties recruiting and retaining registered nurses. To increase the appeal of hospice employment, recruitment campaigns aimed at newly qualified nurses should emphasize the transferability of skills gained in hospice settings.

Disruptive behaviour in the operating room is under-reported: an international survey

PURPOSE

The purpose of this study was to investigate the reporting habits of clinicians who have been exposed to disruptive behaviour in the operating room (OR) and assess their satisfaction with management's responses to this issue.

METHODS

Ethics committee approval was obtained. This was a pre-specified sub-study of a larger survey examining disruptive behaviour, which was distributed to OR clinicians in seven countries. Using Likert-style questions, this study ascertained the proportion of disruptive intraoperative behaviour that clinicians reported to management, as well as their degree of satisfaction with management's responses. Binomial logistic regression identified socio-demographic, exposure-related, and behavioural predictors that a clinician would never report disruptive behaviour.

RESULTS

Four thousand, seven hundred and seventy-five respondents were part of the sub-study. Disruptive behaviour was under-reported by 96.5% (95% confidence interval [CI], 95.9 to 97.0) of respondents, and never reported by 30.9% (95% CI, 29.6 to 32.2) of respondents. Only 21.0% (95% CI, 19.8 to 22.2) of respondents expressed satisfaction with management's responses. Numerous socio-demographic, exposure-related, and behavioural predictors of reporting habits were identified. Socio-demographic groups who had higher odds of never reporting disruptive behaviour included younger clinicians, clinicians without management responsibilities, both anesthesiologists and surgeons (compared with nurses), biological females, and heterosexuals (all P < 0.05).

CONCLUSIONS

Disruptive behaviour was under-reported by nearly all clinicians surveyed, and only one in five were satisfied with management's responses. For healthcare systems to meaningfully address the issue of disruptive behaviour, management must create reporting systems that clinicians will use. They must also respond in ways that clinicians can rely on to affect necessary change.

Health consequences of bullying in the healthcare workplace: A systematic review

AIMS

To review both mental and physical health consequences of bullying for healthcare employees.

DESIGN

Systematic literature review.

DATA SOURCES

EMBASE, MEDLINE, PsycINFO, PUBMED and Web of Science Core Collection were searched for articles published between 2005 - January 2017.

REVIEW METHODS

This review was conducted using the framework described by Khan and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Two independent reviewers performed systematic data extraction and appraised the methodological quality of included articles. A pooled mean prevalence of bullying was estimated.

RESULTS

Forty-five papers met inclusion criteria. Bullying prevalence ranged from 3.9% to 86.5%, with a pooled mean estimate of 26.3%. Perceived bullying was associated with mental health problems including psychological distress, depression and burnout, and physical health problems including insomnia and headache. Bullied staff took more sick leave.

CONCLUSION

Bullying occurs frequently amongst healthcare staff and is deleterious to health and occupational functionality.

Incivility in nursing: Implementing a quality improvement program utilizing cognitive rehearsal training

BACKGROUND

Workplace incivility can be a factor in unhealthy work environments. Addressing unit culture improves job satisfaction and organizational commitment.

AIM

The purpose of this quality improvement program was to educate nurses to identify and respond to hospital incivility.

SETTING

A community hospital in the Northeastern United States. Participants-A convenience sample of nurses.

METHODS

A quality improvement program was conducted, which included an incivility education module and cognitive rehearsal training. The nursing incivility scale (NIS) was used to evaluate the effectiveness of the educational module. Participants completed the NIS before, immediately after, and 1 month after the program. Cognitive rehearsal training included role playing using scripted responses to uncivil behavior.

RESULTS

A one-way repeated measures analysis of variance was conducted to compare total score and eight subscale scores on the NIS before, after, and 1 month after implementation of the intervention. There was a statistically significant difference for effect of total time as well as for five of the eight subscales.

CONCLUSIONS

Incivility programs can provide nurses with the needed tools to identify uncivil behaviors and react in a proactive, professional manner; this promotes a safe working environment for nurses and their patients.

Workplace bullying and its preventive measures and productivity among emergency department nurses

Background

Workplace bullying has adverse effects on nurses’ productivity and emotional well-being and increases nurses’ desire to leave their jobs. Bullying is a common phenomenon that has been reported worldwide. Emergency Department (ED) nurses are particularly exposed to bullying as a result of their job stressors and demands.

Purposes

To examine the prevalence of bullying and the impact of preventive measures on productivity among Jordanian ED nurses; and to examine bullying in relation to personal and organizational factors.

Methods

We surveyed ED nurses in five hospitals in Amman, Jordan – two government hospitals and three private hospitals. The eligibility criteria for the study, met by 134 persons, were having at least an associate degree and having worked in the ED for at least six months. We used a four-part questionnaire that included demographic data, the Negative Acts Questionnaire, questions on prevention of bullying, and a health and productivity survey. Data analysis included descriptive and inferential statistics.

Results

A total of 120 ED nurses joined the study, an 89.6% response rate. The majority of participants were male (65%) and their mean age was 29.4 years. Ninety percent of the participants reported being bullied. Nurses with less experience in the ED were exposed to more bullying compared to other nurses. Of nurses who reported being bullied, 61.7% reported associated decreased productivity, including the ability to respond to cognitive demands, provide support, appropriate communication, safe care, and competent care. The overall mean score for the prevention of bullying questionnaire was 94.51 out of 168 (SD = 23.43). Drilling down, the highest mean score was for the “Individual sub-scale”, and the highest item mean score was for “I know the process of how to report bullying”.

Conclusion

Bullying is prevalent among ED nurses in Jordan; it has significantly influenced the nurses’ perception of their productivity and the quality of care they provide. Although nurses reported adopting measures to prevent bullying, they were insufficient to address this widespread problem.

Implications for nursing and health policy

Bullying is a common occurrence in nursing practice in Jordan, as in other places. It has a detrimental effect on the quality of health care. Accordingly, interventions, which we describe, should be undertaken to minimize the incidence and impact of bullying.

Interventions addressing student bullying in the clinical workplace: a narrative review

BACKGROUND

Student bullying in the clinical environment continues to have a substantial impact, despite numerous attempts to rectify the situation. However, there are significant gaps in the literature about interventions to help students, particularly a lack of specific guidance around which to formulate an intervention program likely to be effective. With this narrative review about student bullying interventions in the clinical learning environment, we examine and draw together the available, but patchy, information about 'what works' to inform better practice and further research.

METHODS

We initially followed a PICO approach to obtain and analyse data from 38 articles from seven databases. We then used a general inductive approach to form themes about effective student bullying intervention practice, and potential unintended consequences of some of these, which we further developed into six final themes.

RESULTS

The diverse literature presents difficulties in comparison of intervention efficacy and substantive guidance is sparse and inconsistently reported. The final analytical approach we employed was challenging but useful because it enabled us to reveal the more effective elements of bullying interventions, as well as information about what to avoid: an interventionist and institution need to, together, 1. understand bullying catalysts, 2. address staff needs, 3. have, but not rely on policy or reporting process about behaviour, 4. avoid targeting specific staff groups, but aim for saturation, 5. frame the intervention to encourage good behaviour, not target poor behaviour, and 6. possess specific knowledge and specialised teaching and facilitation skills. We present the themed evidence pragmatically to help practitioners and institutions design an effective program and avoid instigating practices which have now been found to be ineffective or deleterious.

CONCLUSIONS

Despite challenges with the complexity of the literature and in determining a useful approach for analysis and reporting, results are important and ideas about practice useful. These inform a way forward for further, more effective student bullying intervention and research: an active learning approach addressing staff needs, which is non-targeted and positively and skilfully administered. (331w).

Workplace bullying and its preventive measures and productivity among emergency department nurses

BACKGROUND

Workplace bullying has adverse effects on nurses' productivity and emotional well-being and increases nurses' desire to leave their jobs. Bullying is a common phenomenon that has been reported worldwide. Emergency Department (ED) nurses are particularly exposed to bullying as a result of their job stressors and demands.

PURPOSES

To examine the prevalence of bullying and the impact of preventive measures on productivity among Jordanian ED nurses; and to examine bullying in relation to personal and organizational factors.

METHODS

We surveyed ED nurses in five hospitals in Amman, Jordan - two government hospitals and three private hospitals. The eligibility criteria for the study, met by 134 persons, were having at least an associate degree and having worked in the ED for at least six months. We used a four-part questionnaire that included demographic data, the Negative Acts Questionnaire, questions on prevention of bullying, and a health and productivity survey. Data analysis included descriptive and inferential statistics.

RESULTS

A total of 120 ED nurses joined the study, an 89.6% response rate. The majority of participants were male (65%) and their mean age was 29.4 years. Ninety percent of the participants reported being bullied. Nurses with less experience in the ED were exposed to more bullying compared to other nurses. Of nurses who reported being bullied, 61.7% reported associated decreased productivity, including the ability to respond to cognitive demands, provide support, appropriate communication, safe care, and competent care. The overall mean score for the prevention of bullying questionnaire was 94.51 out of 168 (SD = 23.43). Drilling down, the highest mean score was for the "Individual sub-scale", and the highest item mean score was for "I know the process of how to report bullying".

CONCLUSION

Bullying is prevalent among ED nurses in Jordan; it has significantly influenced the nurses' perception of their productivity and the quality of care they provide. Although nurses reported adopting measures to prevent bullying, they were insufficient to address this widespread problem.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Bullying is a common occurrence in nursing practice in Jordan, as in other places. It has a detrimental effect on the quality of health care. Accordingly, interventions, which we describe, should be undertaken to minimize the incidence and impact of bullying.

Workplace Bullying Among Nurses: Developing a Model for Intervention

Workplace bullying is endemic to the nursing profession and it threatens nurses' health and ability to work safely. However, effective interventions to prevent workplace bullying are lacking. A sample of hospital nurses (n = 15) explored experiences of bullying and ideas for intervention via four focus groups in 2016. Four main themes emerged from the qualitative content analysis: (a) characteristics that define bullying behavior; (b) facilitators of bullying; (c) consequences of bullying; and (d) possible interventions. Although personal characteristics played a role, bullying was primarily facilitated by workplace and organizational factors that hindered the establishment of collegiality and team trust among nurses. Findings have informed a conceptual model for prevention of nurse-to-nurse bullying with ethical leadership and communication, trust, and social cohesion in work teams as key elements.

Prevalence and predictors of exposure to disruptive behaviour in the operating room

PURPOSE

Disruptive intraoperative behaviour ranges from incivility to abuse. This behaviour can have deleterious effects on clinicians, students, institutions, and patients. Previous investigations of this behaviour used underdeveloped tools or small sampling frames. We therefore examined the prevalence and predictors of perceived exposure to disruptive behaviour in a multinational sample of operating room clinicians.

METHODS

A total of 134 perioperative associations in seven countries were asked to distribute a survey examining five types of exposure to disruptive behaviour: personal, directed toward patients, directed toward colleagues, directed toward others, or undirected. To compare the average amount of exposure with each type, we used a Friedman's test with select post hoc Wilcoxon tests. A negative binomial regression model identified socio-demographic predictors of personal exposure.

RESULTS

Of the 134 organizations approached, 23 (17%) complied. The total response rate was estimated to be 7.6% (7465/101,624). Almost all (97.0%; 95% confidence interval [CI], 96.6 to 97.4) of the respondents reported exposure to disruptive behaviour in the past year, with the average respondent experiencing 61 incidents per year (95% CI, 57 to 65). Groups reporting higher personal exposure included clinicians who were young, inexperienced, female, non-heterosexual, working as nurses, or working in clinics with private funding (all P < 0.05).

CONCLUSION

Perceived exposure to disruptive behaviour was prevalent and frequent, with the most common behaviours involving speaking ill of clinicians and patients. These perceptions, whether accurate or not, can result in detrimental consequences. Greater efforts are required to eliminate disruptive intraoperative behaviour, with recognition that specific groups are more likely to report experiencing such behaviours.

Effects of nursing organisational culture on face-to-face bullying and cyberbullying in the workplace

AIMS AND OBJECTIVES

To investigate the current state of face-to-face bullying and cyberbullying among nurses in the workplace and to identify the effects of nursing organisational culture on face-to-face bullying and cyberbullying.

BACKGROUND

It is important to accurately examine the current state of workplace bullying to acknowledge the gravity of the situation faced by nurses and devise prevention strategies. Electronic communication by computer or smartphone is widely used as a prompt and efficient means of facilitating nursing work; however, this leads to the possibility of cyberbullying as well as face-to-face bullying among nurses.

DESIGN

Descriptive cross-sectional study.

METHODS

A total of 226 staff nurses working in one of five upper tertiary hospitals in Korea with a career of 10 years or shorter were surveyed using a self-reported questionnaire. The collected data were evaluated using various statistical analyses, including hierarchical regression. Our study was applied to the STROBE checklist of items.

RESULTS

The mean face-to-face bullying score was 1.32 ± 0.53 and the cyberbullying score was 1.14 ± 0.37 (possible range: 1-5); most were work-related negative experiences. The explanatory power of nursing organisational culture for face-to-face bullying was 6.3%, and relation-oriented culture and hierarchy-oriented culture were major factors affecting face-to-face bullying. The explanatory power of nursing organisational culture for cyberbullying was 4.3%, and relation-oriented culture was a major factor affecting cyberbullying.

CONCLUSIONS

Relation-oriented culture had a significant effect on both face-to-face bullying and cyberbullying. Therefore, organisations should strive to foster a relation-oriented nursing organisational culture in order to prevent and resolve workplace bullying among nurses.

RELEVANCE TO CLINICAL PRACTICE

Cyberbullying should be addressed as an important type of workplace bullying in nursing, which occurs via various information and communication devices. To prevent workplace bullying among nurses, various strategies that promote relation-oriented nursing organisational cultures should be considered.

Workplace Bullying and Newly Licensed Registered Nurses: An Evolutionary Concept Analysis

Workplace bullying (WPB) among nurses, especially newly licensed registered nurses (NLRNs), negatively affects nurse, patient, and organizational outcomes. Despite empirical evidence addressing the prevalence and impact of WPB, the behavior continues to persist within nursing work environments. Increased conceptual clarity of WPB is needed for interventions to be developed, executed, and evaluated. The purposes of this concept analysis, in which we used Rodgers’ evolutionary method, were to obtain a clearer understanding of WPB, to differentiate the concept from other forms of workplace violence, and to describe a definition of WPB consistently used in the literature. Three attributes specific to WPB included negative behaviors directed toward an individual who perceives themselves to be a target, a time frame of experiencing these negative behaviors (e.g., daily or weekly) for a prolonged period (e.g., several weeks), and the inclusion of a power gradient or hierarchy between the bully and target. Antecedents identified for WPB included a scarcity of resources and poor leadership and management. Consequences associated with WPB included adverse nurse, patient, and health care organizational outcomes. WPB was conceptually defined as any negative behavior, exhibited by a nurse of either perceived or actual power, that was repeatedly (i.e., daily or weekly) and persistently directed toward NLRNs who have difficulty defending themselves against the behavior. Implications for researchers, health care organizations, nurse leaders, and nurses are included.

An evaluation of the "BE NICE Champion" programme: A bullying intervention programme for registered nurses

AIM

To explore the experiences, perceptions and attitudes of registered nurses (RNs) who completed the BE NICE Champion training programme; a home-grown programme that provides RNs tools to intervene when bullying is observed; using the "4S's": Stand by, Support, Speak up, and Sequester.

BACKGROUND

The growing body of literature surrounding the negative impact bullying has on individuals and organizations suggests the need to develop more effective prevention and intervention programmes.

METHODS

A qualitative focus group approach utilizing a purposive sample of 25 RNs who participated in the training programme.

RESULTS

Three consistent themes emerged from a content analysis of the transcripts: (a) awareness and understanding, (b) applying the 4S's and (c) feeling prepared, and empowered. Additional themes included impact on the work environment and additional programme recommendations tailored to nursing leadership.

CONCLUSION

The programme and use of the 4S's adequately provided RNs with confidence to intervene when bullying was observed. RNs felt better equipped to respond due to the techniques learned and appreciated our organizational commitment to address bullying. Furthermore, the programme may be strengthened by incorporating recommendations discussed.

IMPLICATIONS FOR NURSING MANAGEMENT

Leaders need to demonstrate a commitment to address bullying. Implementing this programme can positively impact their environment.

Medpoklicno nasilje v operativni dejavnosti

Uvod: V operativni dejavnosti heterogena skupina strokovnjakov z različnimi osebnostmi in vrednostnimi sistemi, značilnimi za vsako profesijo, deli odgovornost do enega pacienta, kar lahko sproži napetost v odnosih in se stopnjuje v nasilje. Namen raziskave je bil prikazati razširjenost tega fenomena ter opredeliti z njim povezane dejavnike in posledice.Metode: Izvedena je bila sistematična iskalna strategija v bazah podatkov CINAHL, Medline, Academic Search Elite, ProQuest in COBIB.SI z datumom objave od januarja 2008 do vključno decembra 2017. Uporabljeni so bili iskalni pojmi v angleščini aggressive behavior, disruptive behavior, operating room, perioperative, violence, verbal abuse, bullying, surgeon in v slovenščini zdravstvena nega, nasilje. Podanih je bilo 735 zadetkov, glede na naslov in izvleček smo za ustrezne določili 68 virov, po vsebinskem pregledu smo jih izločili še 47.Rezultati: Zaključki pregleda literature so temeljili na 22 referencah. Oblikovanih je bilo 6 kategorij: (1) povzročitelji in nivoji nasilja, (2) vrste (tipi) nasilja, (3) neposredni vzroki za pojav nasilja v operacijski dvorani, (4) dejavniki, povezani s pojavom in prepoznavnostjo nasilja, (5) posledice nasilja ter (6) individualni in sistemski organizacijski ukrepi za obvladovanje posledic nasilja.Diskusija in zaključek: Najpogostejši izvajalci nasilja v operativni dejavnosti so kirurgi in zaposleni v operacijski zdravstveni negi, najpogostejši vzroki pa hierarhija, nepredvidljive situacije, kadrovski in materialni deficit, medosebni odnosi, delovna obremenitev,  organizacijska kultura. Izkazuje se potreba po tovrstni reprezentativni raziskavi v Sloveniji.

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.

Negative behaviours in health care: Prevalence and strategies

AIM

To evaluate the effectiveness of a professionalism taskforce and the prevalence of negative behaviours across interdisciplinary groups at a south-eastern US academic medical centre.

BACKGROUND

Negative behaviours within health care organisations may undermine patient safety. These behaviours are associated with decreased productivity, increased turnover, and poor patient and staff outcomes.

METHODS

A pre-post study design using an adapted instrument, the Negative Behaviors in HealthCare (NBHC) survey, assessed perceptions of negative behaviours by physicians, clinical, and managerial staff both before and after a professionalism taskforce was convened in 2012 to identify and promulgate key strategies to improve behaviours.

RESULTS

The 1,980 respondents completed the pre-survey in January 2012 and 1,423 completed the post-survey in 2014. Significant reductions in use of lateral aggression (LA) and vertical aggression (VA) (χ²  = 5.65, p < 0.017), observation of LA and VA (χ²  = 4.90, p < 0.027), and experience with contributing factors associated with negative behaviours (χ²  = 9.03, p < 0.003) were identified.

CONCLUSIONS

Findings suggest that a professionalism taskforce guiding key strategies to elevate professionalism significantly affected beliefs about lateral and vertical aggression.

IMPLICATIONS FOR NURSING MANAGEMENT

Decreasing negative behaviours in health care will require additional strategies and consistent implementation. Additional research addressing fear, retaliation, and job stress, and linking these behaviours to patient safety outcomes, is required.