Patient Safety and Workplace Bullying: An Integrative Review

The relationship between organizational justice and bullying behaviors among nurses: the role of nurse managers' caring behaviors

BACKGROUND

Organizational justice is pivotal in fostering a fair and supportive workplace culture, which strengthens the connections between managers and nurses, among nurses themselves, and ultimately, between nurses and their patients. Assessing the perceived levels of organizational justice and managerial behaviors can identify key areas for improving nurses' commitment and loyalty, while simultaneously reducing incidents of workplace bullying.

PURPOSE

This study aims to investigate how bedside nurses perceive organizational justice, nurse managers' caring behaviors, and their exposure to workplace bullying. Additionally, it seeks to explore the relationship between organizational justice, nurse managers' caring behaviors, and nurses' perceived exposure to workplace bullying.

METHODS

A descriptive-correlational study was conducted in the inpatient care unit of a Saudi hospital. A convenience sample of 256 nurses participated, completing the Organizational Justice Questionnaire (OJQ), the Caring Factor Survey: Caring of the Manager (CFS-CM), and the Negative Acts Questionnaire-Revised (NAQ-R). The collected data were analyzed using descriptive statistics and regression analysis.

RESULTS

Descriptive statistics revealed moderate levels of perceived organizational justice and managerial caring behaviors among nurses, alongside low reported exposure to workplace bullying. Significant correlations were found among the studied variables, indicating that higher perceived organizational justice was associated with higher managerial caring and lower workplace bullying (p < 0.05). Mediation analysis demonstrated a significant indirect effect of organizational justice on workplace bullying through the mediating role of nurse managers' caring behaviors (a×b = -0.0652, p < 0.001). Furthermore, the direct effect of organizational justice on workplace bullying remained significant even when accounting for the mediator (c = -0.5509, p < 0.001).

CONCLUSION

This study highlights the vital role of organizational justice and managerial caring in cultivating a positive work environment and mitigating workplace bullying. Implementing clear policies and procedures while promoting fairness and equality in resource allocation, decision-making processes, and interactions are essential strategies for fostering positive attitudes and work behaviors among nurses.

Global prevalence of bullying and associated factors among nursing students during clinical practice: A systematic review and meta-analysis

OBJECTIVE

This meta-analysis aims to estimate the global prevalence of bullying among nursing students during clinical practice and identify associated factors.

DESIGN

Systematic review and meta-analysis.

REVIEW METHODS AND DATA SOURCES

We conducted a comprehensive literature search across ten databases (PubMed, Cochrane, Web of Science, Embase, CINAHL, PsycINFO, Scopus, Chinese Biomedical, China National Knowledge Internet, and WANFANG) from their inception to January 3, 2023. Two researchers independently screened potentially eligible studies, extracted data, and assessed study quality. Data were analyzed using random-effects or fixed-effects models. Subgroup analyses and meta-regression explored the influence of participant and study characteristics on bullying prevalence. Publication bias and sensitivity analyses were also performed.

RESULTS

We included 28 studies (N = 9511) from 13 countries on five continents. The pooled estimate of bullying prevalence among nursing students during clinical practice was 65.60 % (95 % CI 55. 75 to 74.27), with no evidence of publication bias (t = 1.51, p-value = 0.14). Subgroup and moderator analyses highlighted the impact of country, continent, publication year, and assessment tool on bullying prevalence.

CONCLUSION

Nursing students face a high prevalence of bullying during clinical practice. Addressing this issue in nursing education requires prioritizing associated factors, fostering a culture of safety, providing effective training, and promoting individual resilience. These actions can prevent and mitigate bullying, creating a supportive and empowering learning environment for future 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.

System justification theory as a foundation for understanding relations among toxic health care workplaces, bullying, and psychological safety

BACKGROUND

Toxic work environments and bullying are rampant in health care organizations. The Joint Commission asserted that bullying is a threat to patient safety, and furthermore, it implied that bullying affects clinician psychological safety. However, after decades of trying to reduce bullying, it persists.

PURPOSE

The purpose of this study was to determine if system justification (SJ) theory can help explain the persistence of bullying in health care organizations. SJ theory posits that people are motivated to justify the systems with which they are embedded, even if those systems are dysfunctional or unfair.

METHOD

A cross-sectional survey of health care workers ( n = 302) was used to test a moderated mediation model to examine relations between instrumental work climate perceptions and psychological safety, as mediated by SJ and moderated by experiences of workplace bullying.

RESULTS

Analysis revealed that SJ fully mediated negative relations between instrumental climate and psychological safety; because of SJ the instrumental climate no longer had a direct negative association with psychological safety. Furthermore, bullying was found to play a moderating role in the instrumental climate-SJ relationship.

CONCLUSION

This study found some support for the role of SJ in perpetuating instrumental workplaces and workplace bullying in health care.

PRACTICE IMPLICATIONS

Some scholars have proposed that a focus on disrupting workplace contexts that trigger SJ in workers could help break patterns of behavior that enable toxic work environments and bullying to persist.

Effectiveness of a workshop-based intervention to reduce bullying and violence at work: A 2-year quasi-experimental intervention study

INTRODUCTION

Bullying and violence at work are associated with reduced wellbeing of the victims, but few evidence-based interventions are available to prevent these offensive behaviours. We developed and examined the effectiveness of an intervention aimed at prevention of bullying and violence at work through modifications in psychosocial work environment.

METHODS

In accordance with pre-published protocol, employees and supervisors of 12 work units in 3 cities (intervention group A: n = 315; intervention group B: n = 271) received a workshop-based intervention on organizational practices to prevent bullying and violence, including supervisor support, supervisor justice, workplace social capital, and psychological safety and were compared to a reference group (n = 2310) which did not receive the intervention. Latent change score modelling (LCSM) was used to estimate between- and within-individual differences in changes of organizational practices and prevalence of bullying and violence from baseline (2020) to follow-up (2022).

RESULTS

No direct or indirect effects of intervention were observed. Of the potential mediator variables, supervisor support (B = 0.04; 95% confidence interval 0.006, 0.07) and supervisor justice (0.04; 0.01, 0.08) improved in the intervention group B between the measurements and compared to control group, but the result was not replicated in intervention group A. No changes were observed between the measurement points in bullying or violence at work.

CONCLUSIONS

No intervention effects on bullying and violence at work were observed. It may be worthwhile to develop the intervention further to focus more on supervisor and co-worker relationships and on psychosocial resources of work team.

Development of the Workplace Interpersonal Problems Scale for Care Workers (WIPS) and examination of its reliability and validity

Introduction

The turnover rate of care workers has remained high by global standards, with previous studies showing an association between workplace interpersonal relations and care worker turnover and turnover intentions. This study details the development of the Workplace Interpersonal Problems Scale for Care Workers (WIPS) and examines its reliability and validity according to the COSMIN guidelines.

Methods

A total of 476 care workers employed by elder care facilities participated in the study. This study examined the reliability and validity of the WIPS after its development. Reliability was evaluated using Cronbach's α, test reliability with the standard error of measurement, and test-retest reliability with the intraclass correlation coefficient. Content validity, construct validity, and structural validity were examined to evaluate validity.

Results

Both total and subscale scores of the WIPS had a Cronbach's α coefficient >0.75 and high test-retest reliability (intraclass correlation coefficient, 0.75). Content validity analysis showed the item-content validity index of ≥0.90 for all WIPS items, confirming 100% of the hypotheses for testing construct validity. Confirmatory factor analysis showed an acceptable fit for the hypothesized six-factor construct (CFI = 0.92, TLI = 0.91, RMSEA = 0.07, SRMR = 0.05).

Conclusions

The WIPS was found to be a valid and reliable instrument. With the growth of the elderly population worldwide, we believe that the WIPS will be a useful quantitative measure to assess workplace interpersonal problems affecting care workers in various aspects.

Workplace bullying and violence in health sector in Saudi Arabia

Workplace bullying violence (BV), with psychological and physical impacts, is increasing globally. However, studies from Saudi Arabia investigating which specialties are most exposed, and linking them with other factors, such as sociodemographic conditions, are scarce. This study aimed to estimate the prevalence of workplace BV over a 12-month period and determine the circumstances related to the event, consequences for the attacker, and targeted personnel among all healthcare providers in the Kingdom of Saudi Arabia (KSA). This analytical cross-sectional study included all health providers registered with the Saudi Commission for Health Specialties who worked for more than 1 year in the healthcare sector (governmental or private) in the KSA until May 2019. In total, 7398 healthcare workers were electively enrolled in the study; 51.3% were men, and 48.7% were women, with a mean age of 40 ± 8.62 years. They were mostly (60%) non-Saudi. Overall, 26.6% encountered BV. Those who worked in the private sector, in shifts, especially evening shifts, were significantly more exposed. Furthermore, pharmacists had the highest prevalence of workplace violence. The prevalence of BV is moderately high; however, it is a serious issue faced by healthcare workers, especially those working night shifts. Pharmacists were more likely to experience bullying. This demonstrates that more support, specific strategies, and policies are required to reduce the occurrence of workplace BV, protect healthcare providers, and prevent attacks. Underreporting these situations may give an incorrect indication of the magnitude of the problem; thus, more education and further studies in the KSA are needed.

Nursing students' experiences of unprofessional behaviours and associations with guideline compliance: A multicenter survey

AIMS

To assess the reported prevalence of unprofessional behaviours, including incivility and bullying, experienced by nursing students during their clinical practice. To assess the prevalence of students' abilities to speak up about unprofessional behaviours encountered and infection control concerns; their compliance with standard precautions and COVID-19 guidelines; and their perceived responsibility for infection prevention. Lastly, to describe the potential impact of unprofessional behaviour on compliance with these guidelines.

BACKGROUND

Unprofessional behaviours in healthcare settings are associated with a wide range of individual and organisational negative outcomes for nurses and nursing students, which may affect patient safety. The COVID-19 pandemic created new challenges for clinical education and for infection control.

DESIGN

A descriptive cross-sectional design.

METHODS

A multi-centre survey was carried out in six academic universities and colleges in Israel. The research study involved 369 undergraduate nursing students during 2022. Their clinical experiences were assessed using an online questionnaire. The STROBE guideline was used for accurate reporting.

RESULTS

301 (81.6%) students reported experience of unprofessional behaviour while undertaking clinical practice. Students with reported skills to speak up about unprofessional behaviour were less likely to report having experienced these behaviours (p = 0.003). Students who did not experience unprofessional behaviours were more likely to report higher compliance with standard and COVID-19 precaution guidelines (OR 3.624, 95% CI 1.790-7.335, p < 0.001). These students also had a higher perception of personal responsibility toward patient safety (OR 1.757, 95% CI 1.215-2.541, p = 0.003).

CONCLUSIONS

Nursing students experiencing unprofessional behaviours in the clinical setting reported lower compliance with standard and COVID-19 precautions. In addition, cultivating personal responsibility towards patients' safety may have a positive impact on guidelines compliance. Nursing educators and leaders should develop strategies to enable students to better cope with unprofessional behaviours. Closer cooperation between all stakeholders may promote civility among nurses and nursing students in the clinical setting.

The Relationship Between Workplace Incivility and Patient Safety in Pediatric Nurses

BACKGROUND

Workplace incivility may directly influence nurses' involvement in patient safety; however, research on this topic in the pediatric setting has yet to be established.

PURPOSE

The purpose of this study was to address the prevalence of workplace incivility in pediatric settings in Saudi Arabia (SA) and examine its impact on patient safety culture.

METHODS

A cross-sectional study design was used. Surveys, including the Nursing Incivility Scale and Hospital Survey on Patient Safety Culture, were sent to nurses across 6 pediatric units in Taif, SA.

RESULTS

A total of 300 nurses completed the surveys. A significant negative modest correlation was found between incivility and patient safety domains ( P < .05). A higher stress score was associated with older age (>35 years), Saudi nationality, and subdegree education.

CONCLUSION

This study found that pediatric nurses experience high rates of incivility, mostly originating from patients and their families.

Pilot Study Using Cognitive Rehearsal, Simulation, and Biomarker Data to Address Workplace Incivility

BACKGROUND

Workplace incivility poses a threat to patient safety. This intervention pilot study used simulation and biomarker data with newly graduated nurses to explore the impact of incivility on patient care and tested whether cognitive rehearsal could mitigate the effects of workplace incivility.

METHOD

A clinical scenario and script were used by actors to deliver either an uncivil or a hurried but not uncivil handoff report to participants before they conducted a focused patient assessment and administered medications to a standardized patient.

RESULTS

Participants identified gaps in understanding of both handoff reports that resulted in compromised patient care. Quantitative trends showed lower resilience scores and higher stress appraisal scores for participants who received the uncivil handoff report.

CONCLUSION

Although participants expressed confidence using cognitive rehearsal as an intervention before the simulation, responses indicated that a 60-minute session was insufficient to adequately prepare them to effectively address an uncivil nurse encounter. [J Contin Educ Nurs. 2023;54(2):79-88.].

Prediction of bullying at work: A data-driven analysis of the Finnish public sector cohort study

AIM

To determine the extent to which change in (i.e., start and end of) workplace bullying can be predicted by employee responses to standard workplace surveys.

METHODS

Responses to an 87-item survey from 48,537 Finnish public sector employees at T1 (2017-2018) and T2 (2019-2020) were analyzed with least-absolute-shrinkage-and-selection-operator (LASSO) regression. The predictors were modelled both at the individual- and the work unit level. Outcomes included both the start and the end of bullying. Predictive performance was evaluated with C-indices and density plots.

RESULTS

The model with best predictive ability predicted the start of bullying with individual-level predictors, had a C-index of 0.68 and included 25 variables, of which 6 remained in a more parsimonious model: discrimination at work unit, unreasonably high workload, threat that some work tasks will be terminated, working in a work unit where everyone did not feel they are understood and accepted, having a supervisor who was not highly trusted, and a shorter time in current position. Other models performed even worse, either from the point of view of predictive performance, or practical useability.

DISCUSSION

While many bivariate associations between socioeconomic characteristics, work characteristics, leadership, team climate, and job satisfaction were observed, reliable individualized detection of individuals at risk of becoming bullied at workplace was not successful. The predictive performance of the developed risk scores was suboptimal, and we do not recommend their use as an individual-level risk prediction tool. However, they might be useful tool to inform decision-making when planning the contents of interventions to prevent bullying at an organizational level.

Association between nurses' experiences of workplace incivility and the culture of safety of hospitals: A cross-sectional Study

AIM AND OBJECTIVES

This article examined the association between workplace incivility experiences of nurses and patient safety (PS) culture in hospitals.

BACKGROUND

Workplace incivility, which is characterised by low-intensity behaviours with unclear intention to harm and disruption of workplace ambiance of mutual respect, may threaten the work environment, resulting in an unhealthy and unsafe workplace.

DESIGN

Cross-sectional study.

METHOD

This study surveyed 261 nurses in Saudi Arabia from June 2019 to August 2019 using the 'Hospital Survey of Patients' Safety Culture' and the 'Nurse Incivility Scale'. A multiple linear regression was performed with unit- and hospital-level PS culture as the dependent variables.

RESULTS

'Organizational learning-continuous improvement' and 'Teamwork within units' were recognised as PS culture strengths. The nurses reported workplace incivility from patient/visitor as the most frequently experienced (mean = 2.27, standard deviation = 0.88). Working in Hospital B (ß = 0.24, p < .001, 95%CI = 0.15, 0.33) and having a baccalaureate degree in nursing (ß = 0.13, p = .014, 95%CI = 0.03, 0.23) were associated with better perceptions of unit-level PS, whereas working in medical-surgical wards (ß = -0.16, p = .002, 95%CI = -0.26, -0.06) and in intensive care units (ß = -0.19, p = .002, 95%CI = -0.32, -0.07) and experiencing patient/visitor incivility (ß = -0.09, p = .004, 95%CI = -0.15, -0.03) were associated with poor unit-level PS culture perceptions. Experiences of general incivility (ß = -0.24, p < .001, 95%CI = -0.35, -0.13) and supervisor incivility (ß = -0.26, p = .011, 95%CI = -0.46, -0.06) were associated with poor hospital-level PS culture perceptions.

CONCLUSIONS

Workplace incivility from patients/visitors had a negative association with unit-level PS culture perceptions, whereas experiences on general and supervisor incivilities had an adverse relationship with hospital-level PS culture perceptions.

RELEVANCE TO CLINICAL PRACTICE

The study emphasises the call to eradicate any form of incivility in healthcare settings to guarantee a PS culture. Hospital and nursing managers should prioritise the creation and implementation of policies aimed at eliminating uncivil behaviours in clinical settings to ensure that unit- and hospital-level PS culture are above standards.

Associations among the nursing work environment, nurse-reported workplace bullying, and patient outcomes

BACKGROUND

Bullying may undermine patient safety in healthcare organizations threatening quality improvement and patient outcomes.

PURPOSE

To explore the associations between the nursing work environment, nurse-reported workplace bullying, and patient outcomes.

METHOD

Cross-sectional analysis of nurse survey data (N = 943). The Practice Environment Scale of the nursing work index was used to measure the work environment, nurse-reported bullying was measured with the short negative acts questionnaire, and single items measured care quality and patient safety grade. Random effects logistic regressions were used to determine associations controlling for individual, employment, and organizational factors.

FINDINGS

Fourty percent of nurses reported experiencing bullying. A higher work environment composite score was significantly associated with a lower risk of bullying (OR = 0.16 [0.12, 0.22], p < .0001). Nurses experiencing bullying were less likely to report good/excellent quality of care (OR = 0.28 [0.18, 0.44], p < .0001) or a favorable patient safety grade (OR = 0.36 [0.25, 0.51], p < .0001).

DISCUSSION

The nursing work environment influences the presence of bullying, which can negatively impact patient outcomes. Improving nurse work environments is one mechanism to better address nurse bullying.

A Time to Speak: When Incivility Injures Patients

ABSTRACT

Incivility continues to create challenging work environments for healthcare workers. Nurses who experience incivility related to patient concerns or treatment often must confront power differentials and the fear of consequences if they speak up on behalf of the patient. This case report of a family's labor and delivery experience demonstrates the potential of harm to patients and long-term consequences of workplace incivility for the patient and the nurse. Moral courage and biblical insights to strengthen nurses' commitment to speak up for patients are discussed.

Bullying experience and the work environment in nurses: a cross-sectional data analysis

AIMS

This study aimed to examine the degree and severity of workplace bullying in nurses, and to assess the relationship between bullying and work environment factors.

BACKGROUND

Workplace bullying occurs in nursing at an alarming rate and may escalate with more adverse working conditions.

METHODS

Online survey data from a nationally representative sample of 1170 US registered nurses, collected between 2019-20 were analyzed. Five items measuring workplace bullying were used to identify bullying subgroups: unbullied, bullied but unrecognized, moderate bullying, severe bullying) using latent profile analysis. Ordinal logistic regression examined relationships between workplace factors and bullying, RESULTS: Over 40% of nurses reported being bullied in the past year. Four bullying subgroups were distinguished. Inadequate staffing, lack of time to get the job done, and lack of breaks away from the work area were all significantly associated with severe bullying.

CONCLUSION

Ensuring adequate staffing based on patient needs and nurse competency can mitigate workplace bullying in nurses. Further studies are needed to examine the effectiveness of stress reduction programs on bullying using longitudinal designs.

IMPLICATIONS FOR NURSING MANAGEMENT

This result indicates a critical need to improve nursing work environments, which could provide many benefits for nursing workforces, including potential to lessen bullying severity that adversely affects nurse well-being.

Effectiveness of a workplace intervention to reduce workplace bullying and violence at work: study protocol for a two-wave quasi-experimental intervention study

INTRODUCTION

Bullying and violence at work are relatively common in Finnish public sector workplaces. Previous research has demonstrated their association with increased risk of poor health and well-being, but only few intervention studies exist. The aim of this protocol paper is to describe the development and assessment of the effectiveness of a workplace intervention aimed at reducing these harmful phenomena.

METHODS AND ANALYSIS

This protocol describes a two-wave quasi-experimental intervention. Each of the three participating Finnish public sector organisations (cities) will select four work units (a total of 450-500 employees) to participate in an intervention including 2-3 workshops for the work unit, 2-3 consultative meetings with the supervisor of the work unit, a follow-up meeting for the entire work unit (a maximum of 6-month time lag) and online meetings with the supervisor to monitor achievements and discuss about difficult cases, if any. Three age-matched, sex-matched and occupation-matched controls for each participants of the intervention group will be randomly selected, a total 1350-1500 individuals in the control group. For intervention and control groups, premeasurement is based on responses to a survey that was conducted in 2020. Postintervention measurement will be based on survey responses in 2022. Data will be analysed using latent change score modelling or difference-in-difference analysis.

ETHICS AND DISSEMINATION

Ethics approvals are from the Ethics committees of the Helsinki and Uusimaa hospital district and the Finnish institute of Occupational Health. Results will be made available to participating organisations and their employees, the funder and other researchers via open access article in a peer-reviewed journal and subsequent reporting of the results via social media channels and press release to the public.

Incivility in practice - incidence and experiences of nursing students in eastern Canada: A descriptive quantitative study

BACKGROUND

Incivility within nursing is professionally unacceptable. Little research exists regarding student nurses' experiences with incivility from healthcare professionals and others within the clinical environment and particularly within a Canadian context.

AIM

To describe the incidence and perceptions of incivility experienced by undergraduate nursing students from healthcare professionals and others within clinical practice.

METHOD

This descriptive study used an electronic survey and was conducted at an eastern Canadian university. Descriptive statistics were applied.

RESULTS

Of 650 nursing students invited to participate in the study, 260 surveys were fully completed. Of these, 70% of respondents indicated experiencing incivility, mostly in acute care settings. Registered nurses and licensed practical nurses were the major offenders. Discourteous gestures and condescending remarks were the most frequently experienced uncivil acts, resulting in feelings of high anxiety and inadequacy. Participants coped by avoiding communication with the perpetrator. Incivility was rarely reported because of a belief it would be fruitless to do so, lack of awareness of policies and fear of retaliation.

CONCLUSIONS

Nursing students experience incivility frequently in clinical practice with serious consequences. Recommendations arising from this study encourage educators and healthcare leaders to collaborate to review, implement and evaluate curricula, policies and processes to address incivility.

Addressing Mistreatment of Providers by Patients and Family Members as a Patient Safety Event

OBJECTIVE

Mistreatment of health care providers (HCPs) is associated with burnout and lower-quality patient care, but mistreatment by patients and family members is underreported. We hypothesized that an organizational strategy that includes training, safety incident reporting, and a response protocol would increase HCP knowledge, self-efficacy, and reporting of mistreatment.

METHODS

In this single-center, serial, cross-sectional study, we sent an anonymous survey to HCPs before and after the intervention at a 213-bed tertiary care university children's hospital between 2018 and 2019. We used multivariable logistic regression to examine the effect of training on the outcomes of interest and whether this association was moderated by staff role.

RESULTS

We received 309 baseline surveys from 72 faculty, 191 nurses, and 46 residents, representing 39.1%, 27.1%, and 59.7%, respectively, of eligible HCPs. Verbal threats from patients or family members were reported by 214 (69.5%) HCPs. Offensive behavior was most commonly based on provider age (85, 28.5%), gender (85, 28.5%), ethnicity or race (55, 18.5%), and appearance (43, 14.6%) but varied by role. HCPs who received training had a higher odds of reporting knowledge, self-efficacy, and experiencing offensive behavior. Incident reporting of mistreatment increased threefold after the intervention.

CONCLUSIONS

We report an effective organizational approach to address mistreatment of HCPs by patients and family members. Our approach capitalizes on existing patient safety culture and systems that can be adopted by other institutions to address all forms of mistreatment, including those committed by other HCPs.

The Prevalence and The Relationship of Workplace Bullying and Nurses Turnover Intentions: A Cross Sectional Study

Introduction: Sustaining a healthy work environment is a major challenge for health care organizations worldwide. Nursing professionals are often exposed to workplace bullying, which imposes serious challenges to nursing retention. Objectives: To determine the prevalence of workplace bullying and turnover intention among nurses, and to investigate the relationship between workplace bullying and nurse turnover. Methods: A cross-sectional correlational design. Convenience sampling was applied, whereby 347 nurses working in a tertiary medical city in Riyadh, Saudi Arabia, were recruited. Data were collected using the Negative Acts Questionnaire and the Anticipated Turnover Scale. Results: The rate of workplace bullying was high, bullying occurred at a cumulative rate of 33.4% (n = 116). Work related bullying behaviors formed the most common bullying acts with (34.5%) followed by personal bullying with (31.1%) meanwhile physical intimidating accounted by (25.6%). Among the participants, 31.7% exhibited a high turnover intention. The demographic variable age was revealing an inverse correlation with workplace bullying. There was a positive significant correlation between workplace bullying and turnover intentions (r = .24, p < 0.01). Conclusion: The alarming prevalence of both bullying and turnover intention among participants confirms that when nurses are exposed to workplace bullying, they are more likely to demonstrate an increased intention for turnover. Managers are urged to use proper enforcement of anti-bullying policies along with education and training to create a healthy environment and mitigate workplace bullying.

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.

The parents are watching: Midwifery students' perceptions of how workplace bullying impacts mothers and babies

PROBLEM

Bullying in the midwifery profession has been documented and the problem is now known to extend to the poor treatment of midwifery students. In nursing, research has shown that bullying in the clinical workplace can adversely impact on quality of care. To date, no research has explored whether the bullying of midwifery students has secondary impacts on the experiences and care of mothers, babies, and their support persons.

AIM

To examine how midwifery students, who self-identify as having been bullied, perceive the repercussions on women and their families.

METHODS

This qualitative descriptive study explored 120 Australian and United Kingdom (UK) based midwifery students. Data were collected using an anonymous online qualitative survey and were thematically analysed.

FINDINGS

The findings suggest that the bullying of midwifery students impacts women and their families in a number of ways. Midwifery students perceive that mothers and babies are frequently implicated either directly or indirectly in the enactment of bullying. This can impact their safety, fractures relationships, and impairs the women's confidence in the student and the profession. Students additionally reported that women and/or their support persons can feel compelled to step in to defend and protect the student.

CONCLUSIONS

The bullying of midwifery students is perceived to place women at risk, in uncomfortable situations, damage rapport and undermines their confidence in students and the profession. This also impacts adversely on the student's ability to provide women centred care as they lose confidence in front of the woman and her family when they are bullied by registered midwives.

Association between workplace bullying and nurses' professional quality of life: The mediating role of resilience

AIM

We aim to determine workplace bullying in relation to the professional quality of life of nurses and the mediating role of resilience between workplace bullying and the professional quality of life.

BACKGROUND

Workplace bullying is an increasingly serious problem worldwide and deleteriously affects the occupational health and quality of life of nurses. However, it has not attracted adequate managerial attention.

METHOD

A cross-sectional study was conducted using a sample of 493 clinical nurses from two tertiary grade A hospitals in Guangzhou, China. Data were collected through an online questionnaire survey in July 2020 and analysed with structural equation modelling.

RESULTS

Workplace bullying had negative and direct effects on the professional quality of life of nurses. Resilience mediated the relationship between workplace bullying and the professional quality of life.

CONCLUSION

Resilience is a protective factor that helps nurses cope with workplace bullying. Managers can improve the professional quality of life of nurses by reducing workplace bullying and strengthening the resilience of nurses.

IMPLICATIONS FOR NURSING MANAGEMENT

Managers must take measures to prevent the workplace bullying of nurses. In addition, nurse supervisors should pay attention to the resilience of nurses and strengthen resilience training to help nurses withstand the pressure of workplace bullying and improve their professional quality of life.

Preserving nurses' professional dignity: Six evidence-based strategies

AIM

This study aimed to develop and refine strategies for preserving nurses' professional dignity.

BACKGROUND

Professional dignity is a non-negotiable nursing professional value. It should at all times be respected because of the worthiness of nurses as professional human beings. They are at the centre of healthcare societies. Their worth and contributions to the health of others should be acknowledged and preserved.

METHODS

Descriptive qualitative research was conducted during the development of the strategies while applying the principles of strategic navigation. The process was guided by the findings of the initial phase of the study and contextualised literature. Focus group discussions were held with healthcare professionals for the refinement of the strategies in two private hospitals in South Africa.

FINDINGS

The strategies unfolded multiple possibilities to value nurses' professional dignity. These were pathways for respecting, appreciating and supporting nurses; honouring nurses' desire to hold the well-being of patients in the highest regard; supporting nurses in fulfilling their professional roles; enabling nurses to take pride in themselves and the nursing profession; supporting nurses in demanding and complex circumstances and supporting nurses in coping with humiliating workplace experiences.

CONCLUSION

Strategies to ensure successful outcomes in preserving nurses' professional dignity were developed and refined. The professional dignity experiences that mattered most were presented.

IMPLICATIONS FOR NURSING/HEALTH POLICY

Valuing nurses' professional dignity promotes respect and support for nurses and their desire to prioritise patient-centred care, contributing to improved nursing practice and nurses' confidence to assert their professional dignity. Preserving nurses' professional dignity is a necessity in healthcare. It should be affirmed in equal standing in nursing codes of conduct, nursing curriculums and healthcare policies.

A qualitative systematic review on nurses' experiences of workplace bullying and implications for nursing practice

AIMS

To explore nurses' experiences of workplace bullying and ways to prevent such occurrences.

DESIGN

A qualitative systematic review was conducted.

DATA SOURCES

Five electronic databases were searched from each database's inception to December 2020.

REVIEW METHODS

Meta-summary and meta-synthesis were conducted using Sandelowski and Barroso's approach.

RESULTS

Twenty-seven studies were included in this review. The overarching theme, 'The Vicious Cycle of Bullying in Nursing', and four themes were synthesized: (a) different 'faces' of bullying, (b) the hidden drivers of bullying, (c) impact of being bullied and (d) responses to bullying.

CONCLUSION

The nursing code of ethics and anti-bullying policies should be consistently enforced by each organization's upper management. Nurses should be provided a safe space to voice their concerns on bullying within the organization.

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.

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.

Exploring the influence of workplace violence and bystander behaviour on patient safety in Korea: A pilot study

AIMS

To explore the influences of clinical nurses' workplace violence and bystander behaviour on patient safety.

BACKGROUND

Bystanders' role in social violence affects the consequences of said violence; however, few studies have explored the relationship between workplace violence and patient safety among nurses working in clinical settings.

METHODS

A cross-sectional survey design was conducted using a structured questionnaire pertaining to workplace violence, bystander behaviour, patient safety culture and nurse-assessed patient safety outcomes. The questionnaire was administered to 185 bedside nurses at a university hospital in a metropolitan city in Korea.

RESULTS

A regression model with department, patient safety culture, workplace bullying, incivility and bystander behaviour explained approximately 34.0% of patient safety. Further, defending bystander behaviour, facilitating bystander behaviour, work-related bullying and co-worker incivility influenced the patient safety.

CONCLUSION

Being a facilitating bystander was a threat to patient safety, while being a defending bystander enhanced patient safety.

IMPLICATIONS FOR NURSING MANAGEMENT

The negative consequences of workplace violence on patient safety may be mitigated by colleagues' reaction to violence; therefore, nursing policymakers should emphasize the role of positive bystanders as an organisational strategy against workplace violence.

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.

Bullying in the Nuclear Medicine Department and During Clinical Nuclear Medicine Education

Workplace bullying (WPB) in the medical field is a significant occupational hazard and health-care safety concern, though many cases go unreported. Often regarded as a rite of passage to desensitize and toughen new employees and students, WPB causes psychologic harm and creates an unsafe working environment resulting in health complications, anxiety, depression, low self-esteem, difficulty concentrating, and self-harm. Decreased productivity, increased absenteeism, high turnover rates, and inappropriate patient care are linked to WPB, perpetrating organizational dysfunction. This research study evaluated WPB (prevalence, frequency, and behaviors; associated characteristics; effects on patient care; and awareness and enforcement of antibullying protocols) in nuclear medicine (NM) departments and clinical education. Methods: A quantitative single-group correlational analysis was used to survey certified NM technologists and students in the Nuclear Medicine Technology Certification Board e-mail database (n = 20,389). The highest response rate for any individual question was 836. Data were collected using the short version of the negative-acts questionnaire along with a researcher-created survey and analyzed using χ² testing and central tendencies. Results: WPB existed in varying degrees (46.8%) within the previous 6 mo, predominantly in the form of being ignored, excluded, and subjected to repeated reminders of errors and having information affecting performance withheld. NM professionals are more likely to witness and experience WPB than students and are more likely to be bullied by a fellow technologist. Some characteristics, such as sex, age, and occupation, were statistically significant, whereas others, such as race, height, body type, experience, and education, showed no significant correlation. Attention to patient care decreased (39.6%) when WPB was present. An 8% variation exists between enforcement and nonenforcement of antibullying policies, with 26% of professionals being unaware of whether antibullying policies exist at their workplace. Conclusion: Explanations for underreported WPB include fear of retaliation, nonenforcement and lack of awareness of antibullying policies, organizational complacency, and perceived hierarchic power. Recommendations to minimize WPB include adopting and publicizing a descriptive definition, implementing antibullying policies, using mediation procedures, and imposing noncompliance penalties. A decrease in the incidence of WPB correlates with an increase in employee satisfaction and retention, patient safety, and student success.

Understanding the peer, manager, and system influence on patient safety

A unique view of the Hospital Survey on Patient Safety Culture.

A hermeneutical study of professional accountability in nursing

AIMS AND OBJECTIVES

This paper presents findings from a hermeneutical study which sought to explore how registered nurses experienced and perceived their professional accountability in clinical settings.

BACKGROUND

Professional accountability encompasses the ideals and standards of nursing practice. Nurses are accountable for their actions under civil, criminal and contract law to their; employing organisation, their regulatory body and the patients for whom they care.

DESIGN

This paper reports on a Heideggerian hermeneutical study involving seven registered nurses, working in clinical practice in the National Health Service in the United Kingdom. Methods The study adopted purposive sampling, collecting data by means of in-depth interviews. Data were analysed using the hermeneutic circle. COREQ checklist was used as a reporting guideline for this study.

RESULTS

The findings suggest that professional accountability in nursing practice is a complex phenomenon, which can be compromised by many factors which are historically, socially or politically driven Participants experienced challenges through a lack of resources and poor managerial support, which compromised their ability to deliver high-quality patient care. However, collegiality strongly impacted upon resilience and positively influenced their well-being.

RELEVANCE TO CLINICAL PRACTICE

Amid the challenges of the clinical workplace, a positive workplace culture with visible managerial support is a fundamental requirement in supporting professional accountability, development and retention of nurses. Findings highlight the view that leadership should be seen as a collective responsibility, which empowers staff to positively change the practice environment.

How does workplace bullying influence nurses' abilities to provide patient care? A nurse perspective

AIMS AND OBJECTIVES

To explore how workplace bullying influences nurses' abilities to provide patient care.

BACKGROUND

Nurses' experiences of workplace bullying undermine nursing work environments and potentially threaten patient care. Although there is a link between nurses' experiences of workplace bullying and poor patient care, additional exploration is necessary as current evidence remains underdeveloped and inconclusive.

DESIGN

Qualitative descriptive study.

METHODS

Fifteen inpatient staff nurses who have experienced workplace bullying while working in one hospital located in the southern region of the USA participated in individual, semi-structured interviews. Inductive thematic analysis was used to analyse interview transcripts in NVivo 12 software. The COREQ checklist for qualitative studies has been used in reporting this study.

RESULTS

Three themes, and respective subthemes, were generated from data analysis: (a) workplace bullying as part of the nursing work environment, (b) workplace bullying's influence on nurses and (c) workplace bullying's influence on patient care. Workplace bullying was perceived to be inherent in the nursing work environment; nurses felt that they were targets of workplace bullying because (a) they were new nurses, (b) there was an abuse of power, or (c) the nature of the work occasioned it. Nurses were mentally and emotionally influenced by the bullying. Some nurses perceived that workplace bullying did influence their ability to provide patient care; however, others did not.

CONCLUSIONS

Organisations must support new nurses and manage relational attributes of the nursing work environment to reduce workplace bullying. Nursing leaders should receive education on fostering and sustaining favourable nursing work environments and be held accountable for behavioural expectations of the organisation.

RELEVANCE TO CLINICAL PRACTICE

Understanding how nurses perceive the work environment to influence their experiences of workplace bullying informs the development of organisational interventions to reduce the behaviour. Furthermore, exploring how nurses' experiences of workplace bullying influences their abilities to provide patient care increases our understanding of workplace bullying implications.

How do aggression source, employee characteristics and organisational response impact the relationship between workplace aggression and work and health outcomes in healthcare employees? A cross-sectional analysis of the National Health Service staff survey in England

OBJECTIVES

To examine the prevalence of aggression in healthcare and its association with employees' turnover intentions, health and engagement, as well as how these effects differ based on aggression source (patients vs colleagues), employee characteristics (race, gender and occupation) and organisational response to the aggression.

DESIGN

Multilevel moderated regression analysis of 2010 National Health Service (NHS) survey.

SETTING

147 acute NHS trusts in England.

PARTICIPANTS

36 850 participants across three occupational groups (14% medical/dental, 61% nursing/midwifery, 25% allied health professionals or scientific and technical staff).

MAIN OUTCOME MEASURES

Employee turnover intentions, health and work engagement.

RESULTS

Both forms of aggression (from patients and colleagues) have significant and substantial effects on turnover intentions, health and work engagement; however, for all three outcome variables, the effect of aggression from colleagues is more than twice the size of the effect of aggression from patients. Organisational response was found to buffer the negative effects of aggression from patients for turnover intentions and the negative effects of aggression from patients and colleagues for employee health. The results also demonstrated that nurses/midwives, women and Black employees are more likely to experience aggression; however, no clear patterns emerged on how aggression differentially impacts employees of different races, genders and occupations with respect to the outcome variables.

CONCLUSIONS

Although aggression from patients and colleagues both have negative effects on healthcare employees' turnover intentions, health and work engagement, these negative effects are worse when it is aggression from colleagues. Having an effective organisational response can help ameliorate the negative effects of aggression on employees' health; however, it may not always buffer negative effects on turnover intentions and work engagement. Future research should examine other approaches, as well as how organisational responses and resources may need to differ based on aggression source.

Nurses' psychological trauma: "They leave me lying awake at night"

OBJECTIVE

To describe nurses' personal and professional psychological trauma.

METHODS

A content analysis of 372 responses surrounding personal and professional trauma was performed.

RESULTS

Five themes emerged. A new type of trauma was uncovered, heretofore undescribed in the literature: insufficient resource trauma caused by a lack of resources and staff needed to render quality, safe care.

CONCLUSION

Nurses' reports were vivid, frequently indicating they were still recovering from traumatic experiences. Professional sources of trauma were categorized as inherent in the role of the nurse and those that could be mitigated through organizational policy, adequate resources, and oversight.

An investigation into the relationships between bullying, discrimination, burnout and patient safety in nurses and midwives: is burnout a mediator?

Background

Bullying and discrimination may be indirectly associated with patient safety via their contribution to burnout, but research has yet to establish this.

Aims

The aims of this study were to investigate the relationships between workplace bullying, perceived discrimination, levels of burnout and patient safety perceptions in nurses and midwives and to assess whether bullying and discrimination were more frequently experienced by Black, Asian and minority ethnic than White nurses and midwives.

Methods

In total, 528 nurses and midwives were recruited from four hospitals in the United Kingdom to complete a cross-sectional survey between February and March 2017. The survey included items on bullying, discrimination, burnout and individual level and ward level patient safety perceptions. Data were analysed using path analysis.

Results

The results were reported according to the STROBE checklist. Bullying and discrimination were significantly associated with higher burnout. Higher burnout was in turn associated with poorer individual- and ward-level patient safety perceptions. Experiences of discrimination were three times more common among Black, Asian and minority ethnic than White nurses and midwives, but there was no significant difference in experiences of bullying.

Conclusions

Bullying and discrimination are indirectly associated with patient safety perceptions via their influence on burnout. Healthcare organisations seeking to improve patient care should implement strategies to reduce workplace bullying and discrimination.

Workplace bullying and its impact on the quality of healthcare and patient safety

BACKGROUND

Workplace bullying (WPB) is a physical or emotional harm that may negatively affect healthcare services. The aim of this study was to determine to what extent healthcare practitioners in Saudi Arabia worry about WPB and whether it affects the quality of care and patient safety from their perception.

METHODS

A cross-sectional study was conducted in 2018. An online survey was distributed among all practitioners at a multi-regional healthcare facility. A previously validated tool was sourced from an integrative literature review by Houck and Colbert. Responses to 15 themes were rated on a 5-point Likert scale, converted to percentage mean scores (PMS) and compared across participants' characteristics using bivariate and regression analyses.

RESULTS

A total of 1074/1350 (79.5%) completed the questionnaire. The overall median [interquartile range] score of worrying about WPB was 81.7 [35.0]. Participants were mainly worried about the effect of WPB on their stress, work performance, and communication between staff members. A significant negative relationship developed between the quality of care and worrying about WPB, P < 0.001. More educated practitioners were 1.7 times more likely to be worried about WPB compared with their counter group, adj.P = 0.034. Junior practitioners were 1.6 times more likely to be worried about WPB, adj.P = 0.017. The group who has not been trained in handling WPB (1.7 times), and those who had been exposed to WPB (2.2 times) were both more likely to be worried about WPB compared with their counter groups, adj.P = 0.026 and adj.P < 0.001 respectively.

CONCLUSIONS

Most healthcare practitioners worry about WPB, especially its negative impact on the quality of care and patient safety. A greater proportion of practitioners with higher levels of education and their less experienced counterparts were more worried about WPB. Previous exposure to a WPB incident amplifies the practitioners' worry, but being trained on how to counteract bullying incidents makes them less likely to be worried.

Civility Mentor: A Virtual Learning Experience

Supplemental digital content is available in the text.

Incivility and disrespect in health care weaken teamwork and collaboration, diminish communication, and can impact an individual's ability and willingness to speak up and advocate for patient care.

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.

Examining the presence and sources of incivility within nursing

AIMS

Examine the presence and various sources of incivility among nursing staff working within an academic medical centre utilizing the Nurse Incivility Scale (NIS).

BACKGROUND

Evidence suggests various forms of negative behaviour including incivility exist among nurses. Established consequences of these behaviours include increased employee turnover rates, decreased job satisfaction, decreased productivity and increased absenteeism.

METHODS

A descriptive survey design was used which included the NIS instrument to measure the presence of incivility within the nursing workforce and specific sources of these behaviours among 414 nurses in an academic medical centre.

RESULTS

Hospital nurses working within the intensive and intermediate care unit experienced significantly greater incivility from patients and families than other participants within the study [F (3, 413) 8.62, p = .001]. No other significant differences existed in sources of incivility between various levels of direct care.

CONCLUSIONS

Nursing staff working within high-risk areas for incivility such as the intensive care and intermediate care units may require additional interventions to reduce perceptions of incivility from patients/families.

IMPLICATIONS FOR NURSING MANAGEMENT

Findings suggest further research is necessary to develop targeted interventions for nurses practicing within intensive care and intermediate units to alleviate the perceived burden of incivility from patients/families.

Individual and Organizational Characteristics Associated With Workplace Bullying of School Nurses in Virginia

The prevalence and contributing factors of workplace bullying (WPB) are unknown among school nurses (SNs) in kindergarten to 12th grade programs. The aim of this cross-sectional study was to examine individual and organizational characteristics of WPB in a sample of SNs in Virginia. Based on the Short-Negative Acts Questionnaire, 40% of nurses did not experience bullying behavior, 34.8% of nurses faced occasional bullying (now and then or monthly), and 25.3% of nurses were frequently bullied (weekly or daily). Backward stepwise regression demonstrated the predictor variables of being non-White, a licensed practical nurse, or not involved in student individual education plans were significantly associated with being bullied. Administrators/supervisors need to be aware of the existence of WPB.

Negative Behaviors among Healthcare Professionals: Relationship with Patient Safety Culture

Behaviors that undermine a culture of safety within hospitals threaten overall wellbeing of healthcare workers as well as patient outcomes. Existing evidence suggests negative behaviors adversely influence patient outcomes, employee satisfaction, retention, productivity, absenteeism, and employee engagement. Our objective was to examine the presence of negative behaviors within a healthcare system and the influence of negative behaviors among healthcare workers on perceptions of patient safety culture. Using a cross-sectional design, the negative behaviors in healthcare survey (NBHC) and selected composites of the Agency for Healthcare Research and Quality (AHRQ) Hospital Survey on Patient Safety Culture (HSOPS) were combined within an electronic survey which was administered to physicians, clinical and managerial staff. Exposure to contributing factors of negative behaviors was moderately correlated with elements of HSOPS, including perceptions of teamwork within units, management response to error, and overall patient safety grade. Use of aggression and fear of retaliation were moderately correlated with HSOPS management response to error. Reducing healthcare worker exposure to contributing factors of negative behavior may result in increased perceptions of teamwork within a hospital unit, while addressing use of staff aggression and fear of retaliation potentially positively influences management response to error.

Systems Perspective for Incivility in Academia: An Integrative Review

AIM

The purpose of this integrative review was to identify evidence of systems thinking on civility in academic settings.

BACKGROUND

Incivility is present in academic systems, including nursing education. What is learned in academia translates to the workplace. Systems-based solutions may promote quality and safety in health care.

METHOD

Whittemore and Knafl's integrative approach guided this study.

RESULTS

Forty-nine articles were reviewed. Themes emerged describing incivility in nursing as embedded within layers of a performance-driven, oppressive hostile bureaucracy, trickling down, instilling fear, and reinforcing uncivil behavior among and between members. Other themes defined faculty-to-faculty and faculty-to-student incivilities, reasons for it, reactions to it, and suggestions for improved civility.

CONCLUSION

The systems awareness model is offered as a means of promoting civility in nursing education. A lack of evidence to support how incivility in academia transfers to quality and safety in practice settings is identified as a gap for future study.

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.