When respect deteriorates: incivility as a moderator of the stressor-strain relationship among hospital workers

Advancing Workplace Civility: a systematic review and meta-analysis of definitions, measurements, and associated factors

This research article focuses on the significance of Workplace Civility, defined as the respectful and courteous behavior exhibited by individuals toward their colleagues in the workplace. The primary objective of this study is to conduct a systematic review and a meta-analysis that synthesizes existing research by: (1) identifying operational definitions of the construct, (2) underlying the strongest correlations with other variables, (3) summarizing the effective strategies for promoting Workplace Civility, and (4) highlighting gaps in the literature, using the theory-characteristics-context-methodology (TCCM) framework. Multiple databases were meticulously searched, yielding 691 results, and ultimately 51 documents were included in the systematic review final sample following the application of predefined exclusion criteria. Then, a meta-analysis has been conducted including those studies with sufficient statistical data (k = 24) which allowed us to calculate 45 Effect Sizes. The review findings expose a notable dearth of research on Workplace Civility when compared to studies on incivility. This dearth highlights the pressing need for additional research endeavors to precisely define Workplace Civility, establish a robust theoretical framework, and develop reliable scales for its measurement. Related to the desirable correlates, organizational commitment, job satisfaction and mental health showed a high ES value, and for undesirable correlates, intention to quit showed a high ES value, while Emotional exhaustion only reached a medium ES value and physical symptoms showed a low ES value. Importantly, this study emphasizes that fostering civility in the workplace can yield significant benefits such as improved physical and mental well-being for workers, reduced burnout, and absenteeism rates. Thus, the promotion of civility in the workplace not only leads to healthier organizations but also enhances cost-efficiency, effectively averting the loss of both human and economic capital.

The mediating role of life satisfaction in the relationship between depression, anxiety, stress and burnout among Portuguese nurses during COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic had a large consequence on healthcare systems, increasing the risks of psychological issues in health professionals. Nurses, in particular, have been exposed to multiple psychosocial stressors and struggled with intensive work, insufficiency of resources and uncertainty in the face of an unknown disease. Life satisfaction might protect nurses from the consequences of chronic stress. The aim of this study was to explore the mediating role of satisfaction with life in the relationship between depression, stress, anxiety and burnout (personal, work-related, and client-related).

METHODS

A cross-sectional, descriptive, correlational study design was performed, using an online questionnaire distributed via social networks. A total of 379 nurses completed the survey, comprising standardized measures of satisfaction with life, resilience (Resilience Scale), depression, anxiety, stress (Depression Anxiety Stress Scales), and burnout (Copenhagen Burnout Inventory Scale). A hierarchical regression model was estimated for each burnout dimension.

RESULTS

Participants showed high levels of work, personal and client-related burnout, 57.3%, 57%, and 35.1%, respectively. More than 70% of the respondents had a normal level of depressive symptoms, 66.8% presented normal level of anxiety and 33.5% of the respondents reported mild, moderate, severe or extremely severe symptoms of stress. The results revealed that life satisfaction partially mediated the association between stress and personal burnout, depression and work-related burnout, and the association between anxiety and client-related burnout in nurses.

CONCLUSIONS

The COVID-19 pandemic brought added difficulties for nurses' work conditions, whereby it became necessary to develop adaptative measures that reduce stressors in work environment and promote nurses' life satisfaction.

The relationship between workplace incivility and turnover intention in nurses: A cross-sectional study

AIM

The aim of this study was to examine the relationship between workplace incivility and the turnover intention in nurses.

BACKGROUND

Studies assessing the association between nurses' turnover intention and workplace incivility are limited.

METHODS

The research was carried out on a total of 250 nurses working in three private hospitals in Antalya, Turkey. The data were collected using a Demographic Questionnaire, the Workplace Incivility Scale and the Turnover Intention Scale.

RESULTS

The mean workplace incivility scores of the nurses were determined to be 6.68±7.96. The mean turnover intention scores of the nurses were 6.38±3.44. A statistically significant positive relationship was found between workplace incivility scores and turnover intention scores (r = 0.632, p = 0.0001). The linear regression model showed that workplace incivility, working in the emergency or intensive care unit, and dissatisfaction with the current institution were independent factors of turnover intention.

CONCLUSIONS

The results of the study demonstrated a significant relationship between workplace incivility and turnover intention in nurses. Nurses who are less exposed to workplace incivility were seen to have a lower turnover intention.

IMPLICATIONS FOR NURSING MANAGEMENT

Simple measures that organizations may take to reduce workplace incivility may increase nurses' workplace satisfaction, reduce turnover intention, and enable them to work more efficiently. It would be useful for nursing managers to lead initiatives in institutions to reduce workplace incivility and improve the culture of civility.

Incivility and Knowledge Hiding in Academia: Mediating Role of Interpersonal Distrust and Rumination

Workplace incivility is under investigation for the last three decades, and it holds a central position in organizational behavior literature. However, despite the extensive investigations in the past, there exists a missing link between workplace incivility and knowledge hiding in academia. This study aims to tap this missing link for which data were collected from the universities staff. Data were collected in two waves to reduce the common method biases. In the first wave, questions were asked from the respondents regarding their demographic characteristics and exposure to workplace incivility. At this stage, 400 questionnaires were floated and 355 completely filled responses were received back, while in the second wave, those respondents were approached for data collection who have completely filled questionnaires in the first wave. The time interval between the two waves was 1 month. In the second wave, questions related to distrust and knowledge hiding behavior were asked from the respondents. At this stage, 323 questionnaires were received back out of which 290 were filled and these were considered for final data analysis. Collected data were analyzed by applying structural equation modeling (SEM) through SmartPLS. Results indicated that employees tend to hide knowledge when they experience incivility at workplace. Moreover, they develop a sense of distrust in response to workplace incivility which further triggers them to hide knowledge. Limitations and future directions are also discussed.

Witnessed Incivility and Perceptions of Patients and Visitors in Hospitals

Research has examined instances of incivility witnessed by physicians, nurses, or employees in hospitals. Although patients and visitors are members in hospitals, witnessed incivility from their perspective has rarely been empirically investigated. The aims of the current study are 2-fold: (1) to investigate the forms of incivility patients/visitors witness in hospitals and (2) to examine whether these patients/visitors believe these incivilities impact the target’s sense of perceived control. An integration of interpretative phenomenological analysis and thematic analysis was used to code qualitative data (N = 77). Eight themes of witnessed incivility and 3 themes for impact on perceived control were identified. The results illuminate patterns of incivility targeted at marginalized groups, historically underrepresented in hospital-focused incivility research (eg, homeless individuals, incarcerated individuals, the elderly individuals). The majority of witnesses believed the incident of incivility would negatively impact the target’s perception of control, possibly affecting their experience and health. The current study demonstrates that empirically investigating witnessed incivility from the patient/visitor perspective provides critical information about the unique patterns of mistreatment occurring within hospital contexts.

The Effects of the Civility, Respect, and Engagement in the Workplace (CREW) Program on Social Climate and Work Engagement in a Psychiatric Ward in Japan: A Pilot Study

Background: Good social climate and high work engagement are important factors affecting outcomes in healthcare settings. This study observed the effects of a program called Civility, Respect, and Engagement in the Workplace (CREW) on social climate and staff work engagement in a psychiatric ward of a Japanese hospital. Methods: The program comprised 18 sessions installed over six months, with each session lasting 30-min. Participation in the program was recommended to all staff members at the ward, including nurses, medical doctors, and others, but it was not mandatory. A serial cross-sectional study collected data at four time-points. Nurses (n = 17 to 22), medical doctors (n = 9 to 13), and others (n = 6 to 10) participated in each survey. The analysis of variance was used to evaluate the changes in the following dependent variables, the Essen climate evaluation schema (EssenCES), the CREW civility scale, and the Utrecht work engagement scale (UWES) over time. Result: We found no significant effects. The effect size (Cohen’s d) for EssenCES was 0.35 from baseline to post-installation for all staff members. Effect sizes for EssenCES for medical doctors and UWES for nurses were 0.79 and 0.56, respectively, from baseline to post-program. Conclusions: Differences in social climate and work engagement among Japanese healthcare workers between the baseline and post-installation of the CREW program were non-significant.

Job Demand-Control-Support Latent Profiles and Their Relationships with Interpersonal Stressors, Job Burnout, and Intrinsic Work Motivation

In the Job Demand-Control-Support (JDCS) model, the combination of job demands, job control, and social support was hypothesized to lead to eight different constellations of job types. According to the model, these constellations are linked to wellbeing/health and learning outcomes. In the last three decades, these constellations of job types have been investigated by adopting a variable-centered perspective. However, latent profile analyses (LPA) enable a person-centered approach and empirically capture constellations of job types. In the present study, we used LPA to empirically identify distinct profiles of JDCS among Italian healthcare workers. Furthermore, we investigated the role of social stressors (workplace relationships and coworkers’ incivility) as antecedents of these profiles and the association of these profiles with job burnout and work motivation. Results from LPA (n = 1671) revealed four profiles: Isolated Prisoner, Participatory Leader, Moderate Strain, and Low Strain. Negative relationships at work and coworkers’ incivility increased the chances of being included in both Isolated prisoner and Participatory Leader profiles. Finally, the Isolated Prisoner and Moderate Strain profiles showed the highest levels of emotional exhaustion and cynicism and the lower levels of intrinsic work motivation. This study extends previous JDCS research, highlighting that researchers should consider empirically identified profiles rather than theoretically defined subgroups. Implications for stress theory, future research, and practice are discussed.

The prevalence and impact of unprofessional behaviour among hospital workers: a survey in seven Australian hospitals

OBJECTIVE

To identify individual and organisational factors associated with the prevalence, type and impact of unprofessional behaviours among hospital employees.

DESIGN, SETTING, PARTICIPANTS

Staff in seven metropolitan tertiary hospitals operated by one health care provider in three states were surveyed (Dec 2017 - Nov 2018) about their experience of unprofessional behaviours - 21 classified as incivility or bullying and five as extreme unprofessional behaviour (eg, sexual or physical assault) - and their perceived impact on personal wellbeing, teamwork and care quality, as well as about their speaking-up skills.

MAIN OUTCOME MEASURES

Frequency of experiencing 26 unprofessional behaviours during the preceding 12 months; factors associated with experiencing unprofessional behaviour and its impact, including self-reported speaking-up skills.

RESULTS

Valid surveys (more than 60% of questions answered) were submitted by 5178 of an estimated 15 213 staff members (response rate, 34.0%). 4846 respondents (93.6%; 95% CI, 92.9-94.2%) reported experiencing at least one unprofessional behaviour during the preceding year, including 2009 (38.8%; 95% CI, 37.5-40.1%) who reported weekly or more frequent incivility or bullying; 753 (14.5%; 95% CI, 13.6-15.5%) reported extreme unprofessional behaviour. Nurses and non-clinical staff members aged 25-34 years reported incivility/bullying and extreme behaviour more often than other staff and age groups respectively. Staff with self-reported speaking-up skills experienced less incivility/bullying (odds ratio [OR], 0.53; 95% CI, 0.46-0.61) and extreme behaviour (OR, 0.80; 95% CI, 0.67-0.97), and also less frequently an impact on their personal wellbeing (OR, 0.44; 95% CI, 0.38-0.51).

CONCLUSIONS

Unprofessional behaviour is common among hospital workers. Tolerance for low level poor behaviour may be an enabler for more serious misbehaviour that endangers staff wellbeing and patient safety. Training staff about speaking up is required, together with organisational processes for effectively eliminating unprofessional behaviour.

A bibliometric analysis of workplace incivility in nursing

AIM

This research aims to present a general summary of researches on workplace incivility in nursing using bibliometric indicators.

BACKGROUND

Nurses regularly experience incivility from their working environment. However, evidence shows that it has significant potential for harmful consequences, both in terms of their health and in terms of productivity. Therefore, nursing and hospital managers have a crucial role in creation and maintenance of civil behaviour.

METHOD(S)

This research reports on a bibliometric analysis using a systematic review of academic literature on workplace incivility in nursing. A search of Web of Science databases was performed, and a total of 269 abstracts were investigated. Calculation of bibliometric indicator was done in Excel, and tag clouds had been created in VOSviewer.

RESULTS

Nursing incivility literature is growing, and the United States contributed the largest number of papers. Studies have been carried out on nurses working in hospitals and nursing students in general. Topics are mainly focused on the organisational consequences of uncivil behaviour.

CONCLUSION(S)

This study reveals that there are not enough studies on workplace incivility in nursing.

IMPLICATIONS FOR NURSING MANAGEMENT

As a result obtained from this research, it especially recommends health care and nursing managers to research some risky groups and subject less studied yet.

Facilitating Eudaimonic Well-Being in Mental Health Care Organizations: The Role of Servant Leadership and Workplace Civility Climate

Demanding and complex work within mental health care organizations places employee well-being at risk and raises the question of how we can positively influence the psychological well-being and functioning of these employees. This study explores the role of servant leadership and workplace civility climate in shaping eudaimonic well-being among 312 employees in a Dutch mental health care organization. The findings showed that servant leadership had a stronger relationship with eudaimonic well-being when workplace civility climate was high. Furthermore, the results showed that servant leadership was positively related to workplace outcomes, partially through eudaimonic well-being, and that this mediating process varied across different levels of workplace civility climate. This study contributes to the scholarly understanding of the role of servant leadership and a positive work climate in shaping psychological well-being at work.

Workplace-Based Organizational Interventions Promoting Mental Health and Happiness among Healthcare Workers: A Realist Review

Mental illness, deemed globally to account for 32% of years lived with a disability, generates significant impacts on workplaces. In particular, healthcare workers experience high rates of mental ill health such as burnout, stress, and depression due to workplace conditions including excessive workloads, workplace violence and bullying, which also produces negative effects on patients as well as on the happiness and wellbeing of those who remain at work. This review was undertaken to synthesize the evidence on workplace-based interventions at the organizational level promoting mental health and wellbeing among healthcare workers, to identify what has been receiving attention in this area and why, especially considering how such positive effects are produced. A search of three premier health-related databases identified 1290 articles that discussed healthcare workers, workplace interventions, and mental health. Following further examination, 46 articles were ultimately selected as meeting the criteria specifying interventions at the organizational level and combined with similar studies included in a relevant Cochrane review. The 60 chosen articles were then analyzed following a realist framework analyzing context, mechanism, and outcome. Most of the studies included in the realist review were conducted in high-income countries, and the types of organizational-level interventions studied included skills and knowledge development, leadership development, communication and team building, stress management as well as workload and time management. Common themes from the realist review highlight the importance of employee engagement in the intervention development and implementation process. The literature review also supports the recognized need for more research on mental health and happiness in low- and middle-income countries, and for studies evaluating the longer-term effects of workplace mental health promotion.

Experiences of Patient Incivility: A Qualitative Study

Background:

Incivility is one of the most prevalent forms of interpersonal mistreatment. Although studies have examined the full range of experiences of incivility against nurses and other hospital personnel, very few studies examined the forms of incivility that patients face in a hospital.

Objective:

To empirically investigate the range of uncivil experiences targeted against patients. Our study furthers our understanding of the phenomenology of incivility from the patients’ perspective.

Method:

We used interpretative phenomenological analysis to analyze participant’s (n = 173) experiences of incivility in a hospital.

Results:

We identified 6 major themes of incivility, namely Insensitivity, Identity Stigma, Gaslighting, Infantilization, Poor Communication, and Ignored.

Conclusion:

The findings highlight that instances of incivility are present in almost all aspects of the patient experience and take on unique forms, given the patient’s role in the hospital. Implications for health consequences are discussed.

Workplace ostracism and discretionary work effort: A conditional process analysis

Drawing on affective events theory (AET) and workplace incivility spiral, this study tested a conditional process model to explain, when and how, affective workplace events (workplace ostracism and workplace incivility) affect employees’ emotions and work effort. Data for this cross-sectional study were collected via an online survey from 251 employees at three public sector universities in Quetta, Pakistan. Results indicated that both ostracism and incivility encumber work effort, and that one way via which ostracism negatively affects work effort is by provoking targets’ negative affect (NA). Results also revealed that workplace incivility exacerbated positive relationship of ostracism and NA such that this relationship was stronger when incivility was high and weaker when incivility was low. Moreover, the indirect effects of ostracism on work effort were also contingent on workplace incivility. Practical implications are discussed at the end.

The Relationship between Workplace Incivility and Helping Behavior: Roles of Job Dissatisfaction and Political Skill

This article investigates the mediating role of job dissatisfaction in the relationship between employees' perceptions of workplace incivility and their helping behavior, as well as the buffering role of political skill in this process. Three-wave, time-lagged data collected from employees and their supervisors revealed that employees' exposure to workplace incivility diminished their helping behavior through their sense of job dissatisfaction. This mediating role of job dissatisfaction was less salient, however, to the extent that employees were equipped with political skill. For organizations, this study accordingly pinpoints a key mechanism-namely, unhappiness about their job situation-through which rude coworker treatment links to lower voluntary workplace behaviors among employees, and it reveals how this mechanism can be better contained in the presence of political skill.

Psychometric Properties of the German Version of the Workplace Incivility Scale and the Instigated Workplace Incivility Scale

Abstract. The quality of workplace social environments has been widely recognized as having an important role in employees’ experience of their workplace, which is confirmed by recent research. The greater frequency of incivility, in contrast to the more intense forms of negative workplace interactions, expands opportunities for understanding the social dynamics of workplaces. Important aspects of this research are potential cultural variations in workplace social behavior. Valid translations of measures for the core constructs are part of the essential infrastructure to support such research endeavors. To assess uncivil behavior at the workplace, we prepared a German translation of the Workplace Incivility Scale and the Instigated Workplace Incivility Scale. Our analysis of the responses from 2,168 Austrian workers indicated that the translation of both scales into German was successful, and that the concept of incivility can indeed be transferred to the German-speaking population. The factor solution was comparable to the original version of the scales. Criterion validity coefficients lay in a similar range as the coefficients found in previous studies with Canadian samples. The availability of the scales should stimulate research on incivility among the German-speaking population and can help in organization-diagnostic processes.

What's in an eye roll? It is time we explore the role of workplace incivility in healthcare

A recent study of patient violence toward hospital physicians and nurses offers a welcome perspective in its classifying of aggressive behaviors as workplace violence. While patients and families are widely recognized as sources of rude behaviors, we need to shed light on passive aggressive and other low-level rude behaviors that take place frequently amongst hospital personnel as well. Studied under the term “workplace incivility,” these seemingly insignificant behaviors that show lack of regard for colleagues have far reaching negative consequences. Examples of such consequences include intentionally reducing work effort, spending time worrying, and taking frustration out on customers. In addition, incivility creates a spiral effect, where one type of incivility breeds other forms of same. In healthcare, rudeness plays a pivotal role due to its negative impact, which goes to the heart of service delivery. For example, healthcare professionals who are exposed to incivility, even when not directed specifically at them, are at risk of inflicting iatrogenic injury. Within the complexity of hospital environments, incivility gets fueled and maintained by underlying beliefs such as “because we work in a high-pressure environment, it’s okay to skip the niceties.” Tackling these beliefs is key to taming workplace incivility. This article poses questions worthy of further scientific inquiry. Finally, Israeli researchers and practitioners are advised to find a better term for workplace incivility to replace the currently used, excessively negative term gasut ruach.

Respect in the workplace: an evaluation of a short online intervention program

Purpose

The purpose of this paper is to evaluate the effectiveness of a short, online training program focused on respect in the workplace.

Design/methodology/approach

Using a wait-list control design the authors collected measures of workplace behaviors prior to, immediately following and six weeks following the training from a sample of long-term care employees.

Findings

The training was associated with a small increase in reported civility. Post hoc subsample analyses suggested that the training was particularly effective in increasing civility and efficacy perceptions among those respondents who had themselves reported engaging in incivility.

Practical implications

The data offer support for the effectiveness of the training but suggest that more intensive interventions may be necessary. Results also suggest that the effects of training may vary across subgroups of employees.

Originality/value

Training is one of the most frequently advocated solutions to incivility in the workplace. The findings offer support for a short, online training program.

Time to change: a review of organisational culture change in health care organisations

Purpose

The culture of an organization shapes the attitudes and behaviors of employees and plays a key role in driving organizational outcomes. Yet, it is enormously challenging to manage or change. The purpose of this paper is to review the recent literature on culture change interventions in health care organizations to identify the common themes underpinning these interventions.

Design/methodology/approach

The paper is developed from an extensive review of the literature on culture change interventions in health care from 2005 to 2015, building on previous reviews and highlighting examples of good practice.

Findings

All culture change interventions included in the review used processes and techniques that can be classified into Lewin’s (1951) three stage model of change. These include providing evidence for the need for change through data, a range of successful change strategies, and strategies for embedding the culture change into business as usual.

Practical implications

There is no “one size fits all” recipe for culture change. Rather, attention to context with key features including diagnosis and evaluation of culture, a combination of support from leaders and others in the organization, and strategies to embed the culture change are important for the change process to happen.

Originality/value

The authors provide an important insight into the key principles and features of culture change interventions to provide practitioners with guidance on the process within health care and other organizations.

Perceived incivility during emergency department phone consultations

OBJECTIVE

Perceived incivility during ED medical phone consultations is poorly researched. We aimed to determine frequency and factors influencing perceived incivility during ED phone consultations.

METHODS

We conducted a prospective self-reported survey of 40 consecutive phone consultations for 21 ED volunteer doctors. Consultations were classified based on the aim of consultation and deemed as 'positive', 'neutral' or 'negative' based on the perceptions of the consulting doctor. Training levels, time bands and specialty data were collected for both consulting and consulted parties.

RESULTS

Fifty-seven of 714 included consultations (7.98%, 95% CI 6.2-10.2%) were reported as negative by ED medical staff. Factors associated with significant incidence of negative grading of consultation involved requests for investigations (19.3% vs 5.3%, P < 0.01), consultations with specialist trainees postgraduate year > 4 (9.1% vs 3.8%, P < 0.01) and those involving radiology specialty (18% vs 5.32%, P < 0.01). The risk was lower when the consulted professional was a specialist medical practitioner as compared to specialist trainee (4.1% vs 9.4%, P = 0.02). Multiple logistical modelling suggests that female (adjusted OR 2.4, 95% CI 1.1-5.2) medical staff are more likely to report perceived incivility during ED phone consultations.

CONCLUSIONS

Perceived incivility occurs infrequently during ED phone consultations. ED female medical staff are at an increased risk of perceived incivility during phone consultations with non-ED medical professionals. Health organisations should actively pursue programmes to investigate the occurrence of incivility during healthcare consultations and implement programmes to mitigate the risk of developing a negative workplace culture.

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

AIM

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

BACKGROUND

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

METHOD

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

RESULTS

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

CONCLUSION

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

IMPLICATIONS FOR NURSING MANAGEMENT

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

Demographic, health-related, and work-related factors associated with body mass index and body fat percentage among workers at six Connecticut manufacturing companies across different age groups: a cohort study

BACKGROUND

Effective workplace interventions that consider the multifactorial nature of obesity are needed to reduce and prevent obesity among adults. Furthermore, the factors associated with obesity may differ for workers across age groups. Therefore, the objective of this study was to identify demographic, health-related, and work-related factors associated with baseline and changes in body mass index (BMI) and body fat percentage (BFP) and among Connecticut manufacturing workers acrossage groups.

METHODS

BMI and BFPof 758 workers from six Connecticut manufacturing companies were objectively measuredat two time points approximately 36 months apart. Demographic, health-related, and work-related factors wereassessed via questionnaire. All variables were included in linear regression models to identify factors associated with baseline and changes in BMI and BFP for workers in 3 age groups: <45 years (35 %), 45-55 years (37 %), >55 years (28 %).

RESULTS

There were differences in baseline and changes in BMI and BFP among manufacturing workers across age groups. Being interested in changing weight was significantly (p < 0.01) associated with higher baseline BMI and BFP across all age categories. Other factors associated with higher baseline BMI and BFP differed by age group and included: male gender (BMI p = 0.04), female gender (BFP p < 0.01), not having a college education (BMI p = 0.01, BFP p = 0.04), having childcare responsibilities (BMI p = 0.04), and working less overtime (p = 0.02) among workers in the <45 year age category, male gender (BMI p = 0.02), female gender (BFP p < 0.01) and reporting higher stress in general (BMI p = 0.04) among workers in the 45-55 year age category, and female gender (BFP p < 0.01) and job tenure (BFP p = 0.03) among workers in the >55 year age category. Few factors were associated with change in BMI or BFP across any age category.

CONCLUSIONS

Among manufacturing workers, we identified associations between individual, health-related, and work-related factors and baseline BMIand BFP that differed by age. Such results support the use of strategies tailored to the challenges faced by workers in specific age groups rather than adopting a one size fits all approach. Effective interventions should consider a full range of individual, health-related, and work-related factors. More work must be done to identify factors or strategies associated with changes in obesity over time.

The mental health of nurses in acute teaching hospital settings: a cross-sectional survey

Background

Nursing is an emotionally demanding profession and deficiencies in nurses’ mental wellbeing, characterised by low vitality and common mental disorders, have been linked to low productivity, absenteeism and presenteeism. Part of a larger study of nurses’ health, the aim of this paper was to describe the mental health status and related characteristics of nurses working in two acute metropolitan teaching hospitals.

Methods

A cross sectional survey design was used.

The Registered and Enrolled Nurse workforce, employed on any form of contract, at two teaching hospitals in Sydney Australia were invited to participate. The survey tool was compiled of validated tools and questions. Family and medical history and health risk-related characteristics, current psycho-active medications, smoking status, alcohol intake, eating disorders, self-perceived general health, mental health and vitality, demographic, social and occupational details were collected.

Results

A total of 1215 surveys were distributed with a usable response rate of 382 (31.4%). Altogether 53 nurses (14%) reported a history of mental health disorders, of which n = 49 (13%) listed diagnoses of anxiety and/or depression; 22 (6%) were currently taking psychoactive medication. Symptoms that could potentially indicate a mental health issue were more common, with 248 (65.1%) reporting they had experienced symptoms sometimes or often in the last 12 month.

Nurses had better mental health if they had better general health, lived with a spouse/ partner rather than alone, had fewer symptoms, sleep problems or disordered eating behaviours, were not an informal carer and did not work nights. Nurses had greater vitality if they were male, had better general health, fewer sleep problems or symptoms generally and lived with a spouse/ partner rather than alone; less vitality if they were an informal carer or had disordered eating.

Conclusion

Nurses and their managers should strive to create workplaces where working practices promote nurses’ health and wellbeing, or at least are configured to minimise deleterious effects; where both nurses and their managers are aware of the potential for negative effects on the mental health of the workforce; where cultures are such that this can be discussed openly without fear of stigma or denigration.

Effects of incivility in clinical practice settings on nursing student burnout

AIMS

To examine the relationship between nursing students' exposure to various forms of incivility in acute care practice settings and their experience of burnout.

BACKGROUND

Given that staff nurses and new nurse graduates are experiencing incivility and burnout in the workplace, it is plausible that nursing students share similar experiences in professional practice settings.

DESIGN AND SAMPLE

A cross-sectional survey design was used to assess Year 4 nursing students' (n=126) perceptions of their experiences of incivility and burnout in the clinical learning environment.

METHODS

Students completed instruments to assess frequency of uncivil behaviors experienced during the past six months from nursing staff, clinical instructors, and other health professionals in the acute care practice setting and to measure student burnout.

RESULTS

Reported incidences of incivility in the practice setting were related to burnout. Higher rates of incivility, particularly from staff nurses, were associated with higher levels of both components of burnout (emotional exhaustion and cynicism).

Disruptive staff interactions: a serious source of inter-provider conflict and stress in health care settings

This study sought to explore the prevalence of workplace stress, gender differences, and the relationship of workplace incivility to the experience of stress. Effects of stress on performance have been explored for many years. Work stress has been at the root of many physical and psychological problems and has even been linked to medical errors and suboptimal patient outcomes. In this study, 617 respondents completed a Provider Conflict Questionnaire (PCQ) as well as a ten-item stress survey. Work was the main stressor according to 78.2% of respondents. The stress index was moderately high, ranging between 10 and 48 (mean = 25.5). Females demonstrated a higher stress index. Disruptive behavior showed a significant positive correlation with increased stress. This study concludes that employees of institutions with less disruptive behavior exhibited lower stress levels. This finding is important in improving employee satisfaction and reducing medical errors. It is difficult to retain experienced nurses, and stress is a significant contributor to job dissatisfaction. Moreover, workplace conflict and its correlation to increased stress levels must be managed as a strategy to reduce medical errors and increase job satisfaction.

[Nurses' experience of incivility in general hospitals]

PURPOSE

This study was done to describe nurses' experience of incivility in hospitals and to consider nurses' work environment.

METHODS

Data were collected through in-depth interviews and analyzed using Colaizzi' phenomenological analysis methodology. Participants were seven experienced clinical nurses working on a general ward (2 nurses), or in an intensive care unit (2 nurses), emergency room (2 nurses), or operating room (1 nurse).

RESULTS

The incivility that nurses experienced was categorized as follows: 'being afflicted as a weak person', 'being treated as less than a professional', 'being overwhelmed by shock and anger', 'experiencing an untenable situation', 'struggling to survive', and 'pursuing professional growth'.

CONCLUSION

Behavior guidelines should be developed to reduce incivility, and incivility cases should be continuously monitored by the nursing department. Also, to handle incivility problems in clinical nursing areas, a reporting and counseling system and education programs are needed.

Demoralization in mental health organizations: leadership and social support help

Demoralization is a commonly observed feeling state that is characterized by a sense of loss of or threat to one's personal values or goals and a perceived inability to overcome obstacles toward achieving these goals. Demoralization has features in common with burnout and may precede or accompany it. Psychiatrists working in many mental health care organizational settings, be they in the public or private sectors, may be at particular risk for demoralization. This is due partly to stressors that threaten their own professional values because of factors such as programmatic cut backs, budgetary reductions and changing social emphases on the value of mental health treatments. They also may be at risk for demoralization because of the effects on them of the governance styles of the agencies in which they are employed. The leadership or governance style in large organizational settings often is authoritarian, hierarchical and bureaucratic, approaches that are antithetical to the more participative leadership styles favored by many mental health professionals in their clinical activities. Clinical leaders in mental health organizations must exhibit various competencies to successfully address demoralization in clinical staff and to provide a counterbalance to the effects of the governance style of many agencies in which they are employed. Appropriate leadership skills, sometimes too simplistically termed "social support", have been found to reduce burnout in various populations and are likely to lessen demoralization as well. This paper reviews these important leadership issues and the relationship of social support to recognized leadership competencies.

Strengthening communication to overcome lateral violence

AIM

This quality improvement project aims to reduce nurse-to-nurse lateral violence and create a more respectful workplace culture through a series of workshops.

BACKGROUND

Lateral violence is common and pervasive in nursing, with detrimental physical, psychological and organizational consequences.

METHODS

This project describes the organization-wide pre- and post-intervention survey of registered nurses' perception of lateral violence and turnover.

RESULTS

After the workshop series, nurses who reported experiencing verbal abuse fell from 90 to 76%. A greater percentage of nurses perceived a workplace that was respectful to others and in which it was safe to express opinions. After the workshop series, a greater percentage of nurses felt determined to solve the problem after an incident of lateral violence, while a smaller percentage felt powerless. Nursing turnover and vacancy rates dropped.

CONCLUSIONS

Educational workshops that enhanced awareness of lateral violence and improved assertive communication resulted in a better working environment, reduction in turnover and vacancy rates, and reduced incidence of lateral violence.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers must raise awareness of lateral violence with individual and organizational consequences. Nursing leadership can effect organizational change to lesson lateral violence and enhance a healthy workplace culture by replicating our intervention or components of our workshops.