Bullying and employee turnover among healthcare workers: a three-wave prospective study

Occupational Stress in United Kingdom Audiologists

PURPOSE

Occupational stress is known to have detrimental effects on health care professionals worldwide. This study aimed to address a research gap by investigating sources and levels of occupational stress in U.K. audiologists.

METHOD

A mixed-methods cross-sectional design and convenience sampling were utilized. The study used the Audiologist Occupational Stress Questionnaire (AOSQ) and an audiological working practices questionnaire. The study included 100 registered U.K. audiologists.

RESULTS

The research revealed that over a third of participants reported experiencing moderate or higher levels of occupational stress. Pediatric audiologists and those with a high daily patient load reported significantly higher stress scores than other specialties and those seeing fewer patients per day. Identified sources of stress for U.K. audiologists included clinical demands and time constraints, staffing issues, leadership in the workplace, and equipment availability. Reported impacts of stress encompassed mental health issues, fatigue, social life disruptions, and physical health concerns.

CONCLUSIONS

The research validated the use of the AOSQ in a U.K. setting, and the findings provided insights into the sources and levels of occupational stress experienced by U.K. audiologists, supporting existing research on occupational stress in audiologists in other countries. The identification of consistent stress themes across the literature underscores the need for targeted support and interventions to ensure the well-being of audiologists and empower them in maintaining their pivotal role in health care.

Prevalence and nature of workplace bullying and harassment and associations with mental health conditions in England: a cross-sectional probability sample survey

BACKGROUND

Evidence on workplace bullying and harassment (WBH) in the UK has not used probability-sample surveys with robust mental health assessments. This study aimed to profile the prevalence and nature of WBH in England, identify inequalities in exposure, and quantify adjusted associations with mental health.

METHODS

Data were from the 2014 Adult Psychiatric Morbidity Survey, a cross-sectional probability-sample survey of the household population in England. Criteria for inclusion in the secondary analysis were being aged 16-70 years and in paid work in the past month (n = 3838). Common mental disorders (CMDs) were assessed using the Clinical Interview Schedule-Revised and mental wellbeing using the Warwick-Edinburgh Mental Wellbeing Scale. Analyses were weighted. We examined associations between past-year WBH and current CMD using multivariable regression modelling, adjusting for sociodemographic factors. Interaction terms tested for gender differences in associations. The study received ethical approval (ETH21220-299).

RESULTS

One in ten employees (10.6%, n = 444/3838) reported past-year experience of WBH, with rates higher in women (12.2%, n = 284/2189), those of mixed, multiple, and other ethnicity (21.0%, n = 15/92), and people in debt (15.2%, n = 50/281) or living in cold homes (14.6%, n = 42/234). Most commonly identified perpetrators of WBH were line managers (53.6%, n = 244/444) or colleagues (42.8%, n = 194/444). Excessive criticism (49.3%, n = 212/444), verbal abuse (42.6%, n = 187/444), and humiliation (31.4%, n = 142/444) were the most common types. WBH was associated with all indicators of poor mental health, including CMD (adjusted odds ratio [aOR] 2.65, 95% CI 2.02-3.49), and 11 of 14 mental wellbeing indicators, including lower levels of confidence (aOR 0.57, 0.46-0.72) and closeness to others (aOR 0.57, 0.46-0.72). Patterns of association between WBH and mental health were similar in men and women.

CONCLUSIONS

These findings reinforce a need for more cohesive UK legislation against WBH; guidance on recognition of bullying behaviours for employees, managers, and human resources, focusing on prevention and early intervention, and increased awareness of the impact of WBH on mental health among health service practitioners. Limitations include reliance on cross-sectional data collected before pandemic-related and other changes in workplace practices. Longitudinal data are needed to improve evidence on causality and the longevity of mental health impacts.

Registered nurses' exposure to workplace aggression in Norway: 12-month prevalence rates, perpetrators, and current turnover intention

BACKGROUND

Identifying occupational health hazards among Registered Nurses (RNs) and other health personnel and implementing effective preventive measures are crucial to the long-term sustainability of health services. The objectives of this study were (1) to assess the 12-month prevalence rates of exposure to workplace aggression, including physical violence, threats of violence, sexual harassment, and bullying; (2) to identify whether the perpetrators were colleagues, managers, subordinates, or patients and their relatives; (3) to determine whether previous exposure to these hazards was associated with RNs' current turnover intention; and (4) to frame workplace aggression from an occupational health and safety perspective.

METHODS

The third version of the Copenhagen Psychosocial Questionnaire (COPSOQ III) was used to assess RNs' exposure to workplace aggression and turnover intention. A national sample of 8,800 RNs in Norway, representative of the entire population of registered nurses in terms of gender and geography, was analysed. Binary and ordinal logistic regression analyses were conducted, and odds for exposure and intention to leave are presented, with and without controls for RNs' gender, age, and the type of health service they work in.

RESULTS

The 12-month prevalence rates for exposure were 17.0% for physical violence, 32.5% for threats of violence, 12.6% for sexual harassment, and 10.5% for bullying. In total, 42.6% of the RNs had experienced at least one of these types of exposure during the past 12 months, and exposure to more than one of these hazards was common. Most perpetrators who committed physical acts and sexual harassment were patients, while bullying was usually committed by colleagues. There was a strong statistical association between exposure to all types of workplace aggression and RNs' intention to leave. The strongest association was for bullying, which greatly increased the odds of looking for work elsewhere.

CONCLUSIONS

Efforts to prevent exposure to workplace aggression should be emphasised to retain health personnel and to secure the supply of skilled healthcare workers. The results indicate a need for improvements. To ensure the sustainability of health services, labour and health authorities should join forces to develop effective workplace measures to strengthen prevention, mitigation, and preparedness regarding incidents of workplace aggression in health services and the response and recovery regarding incidents that could not be prevented.

Organizational Challenges in Healthcare Services Providers for Individuals with Autism Spectrum Disorder (ASD) Considering Personnel Turnover Rate

The organizational strategy and environment of the healthcare systems influence the turnover rate among healthcare provider personnel. These critical factors have received scant attention in the literature and particularly in the healthcare systems of the Kurdistan Region of Iraq (KRI) as one low-income country with a lack of infrastructural health provision foundations. In this cross-sectional study with qualitative synthesis, the turnover rate of a population consisting of 115 (85 “74%” rehabilitation and training personnel) members of a daycare center for individuals with autism spectrum disorder (ASD) during eight years in the city of Erbil was considered. The aim was to understand the organizational strategy and its impacts on the personnel turnover rate, particularly among healthcare providers. The analysis was conducted utilizing collective data over an eight-year period of service provisions. A qualitative methodological approach was adopted to understand the different aspects of turnover among the staff. The finding indicated a general turnover rate of 87% for the entire personnel and 72% for the rehabilitation and training service providers. This rate imposes considerable costs on the system. Interview analysis also yields supporting evidence for the desire of the staff to change jobs and the lack of understanding of the turnover among system authoritarians resulting in unpredictable changes and staff displacement. Further investigations are needed to understand different contributing factors to imposed or desired turnover rates among healthcare providers in KRI. The turnover over the years has imposed different challenges for the center where the data was collected and imposes unwanted negative impacts on healthcare organizations.

Prevalence of Workplace Bullying Among Healthcare Professionals in Tertiary Care Hospitals in Pakistan

Workplace bullying (WPB) in the healthcare system (HCS), whether perpetrated by healthcare professionals (HCPs) or patients, is a serious problem. The goal of this research study was to find out how common WPB is among HCPs. We conducted a questionnaire-based cross-sectional study in the three public tertiary care hospitals of Karachi, Pakistan from May to October 2020. A validated Negative Acts Questionnaire-Revised (NAQ-R) was used to measure WPB prevalence. The final sample size was 449, out of which 72.4% were females and 27.6% were males. The majority of respondents were house officers or 1st-year trainees who had completed their MBBS (n = 252, 56.1%). Residents (n = 197, 43.9%) who were pursuing specialty training made up the remainder of the respondents. As per NAQ-R cut-offs, the prevalence of bullied, being bullied, and not bullied was 41, 29, and 30%, respectively. WPB prevalence was higher in males (53%) than females (38%), whereas it occurred more often in residents (48%) than house officers (36%). We found similar findings while using the self-reported definition for WPB. Based on our findings, we conclude that WPB is pervasive among HCPs, particularly for males and residents in tertiary care hospitals in Pakistan.

Last in, first out? Length of service as a moderator of the relationship between exposure to bullying behaviors and work-related outcomes

In the present study, we proposed and tested a conceptual model of length of service in the organization as a moderator of the relationship between exposure to workplace bullying behaviors and turnover intention, as mediated through job dissatisfaction. Specifically, based on the conservation of resources theory and organizational socialization research, we hypothesized that bullying exposure would be more detrimental to employees relatively new to the organization, and less so to those with a long length of service. We employed a probability sample from the Norwegian workforce (N = 1003), with data collected at two time-points separated by six months. In line with previous research, we found that exposure to workplace bullying behaviors predicts increased levels of stability-adjusted turnover intentions, and, that job dissatisfaction mediates this association. Moreover, the mediation effect was dependent on length of service, such that it only was present at average (50th percentile; 8.5 years) and short employment length (16th percentile; 2.5 years), and was significantly stronger for the latter group. Additionally, a Johnson-Neyman test of significance regions revealed that the moderation effect became non-significant at the 69th percentile (14.6 years of length of service) in the present sample. This indicates that while short length of service represents a risk condition for work-related outcomes of bullying exposure, long length of service may represent a resource relating to individual resilience that accumulates over long time-spans.

School-Based Nursing Interventions for Preventing Bullying and Reducing Its Incidence on Students: A Scoping Review

Incidents of bullying have increased on students in schools. This has a negative impact such as mental health problems and risk of suicide. Interventions related to bullying are still focused on being carried out independently. Meanwhile, collaborative interventions between nurses and the school are needed to acquire maximum results in preventing and reducing the incidence of bullying. The purpose of this study is to describe school-based nursing interventions in preventing and reducing the incidence of bullying among students at school. This study used scoping review with a search strategy using the PRISMA Extension for Scoping Review process to find the articles. The PubMed, CINAHL, and Scopus electronic databases were searched. We found 12 articles from 594 articles in 3 databases which discussed nursing interventions based on school to prevent and reduce incidence of bullying in students. The studies included are design randomized control trials and quasi experiments. The samples with the range of 40-7121 respondents. We classified the school-based nursing interventions being three methods, there are Game programs, physical activity programs, training programs, and peer-group programs. The content of interventions are psychoeducation, empathy training, counseling, and self-management. This study shows that school-based nursing interventions can be an option in preventing and reducing the incidence of bullying among students at school.

Effets de la violence verticale sur le travail d’infirmières soignantes exerçant en milieux hospitaliers : une étude exploratoire

Introduction : more than 39.7% of nurses report being victims of psychological harassment in the workplace. In 60% of cases, the abuse is vertical, involving a person in a position of authority.Context : few studies have examined this phenomenon without conflating it with other forms of workplace violence.Objective : the purpose of this study was to shed light on cases of vertical violence experienced by nurses working in hospitals.Method : data was collected by means of semi-structured interviews with six nurses working in hospitals in the province of Quebec (Canada). Descriptive phenomenology was used to analyze the collected data.Results : the overall effects of the vertical violence experienced by nurses in hospital settings resulted in less diligent and individualized nursing care.Discussion : it is recommended that organizational policies against vertical violence put in place in hospital be enforced in a rigorous and transparent manner. Further investigation is needed to identify the organizational factors that contribute to vertical violence in hospital settings.

Types of Nursing Intervention to Reduce Impact of Bullying and Aggression on Nurses in the Workplace

The bullying of nurses in the workplace hurts the individuals and the work environment. Bullying can cause mental health problems, reduces the quality of nursing services, and reduces patient safety. The purpose of this study was to describe types of nursing interventions to reduce impact of bullying on nurses in the workplace. This study used the scoping review method to examine literature from the CINAHL, PubMed, and ProQuest databases. The keywords used in English are “bullying OR cyberbullying” AND “nurse” AND “workplace OR work-place” AND “nursing care OR nursing intervention”. The inclusion criteria were full text, randomized control trial or quasi-experiment design, English language, population of nurses, and the publication period of the last 10 years (2013–2022). We found nine articles that discussed nursing interventions designed to reduce the impact of bullying on nurses in the workplace. The sample in the study was in the range of 26–97 respondents. Most of the articles in this review used the quasi-experiment method. The study showed that nursing interventions to heal had negative effects on the bullying on nurses. There are three types of interventions employed to reduce the impact of bullying and aggression on nurses in the workplace, namely training programs, cognitive rehearsal programs, and education programs.

Workplace bullying in surgical environments in Saudi Arabia: A multiregional cross-sectional study

BACKGROUND

Workplace bullying (WPB) is any sort of repeated and unjustified verbal, sexual, or physical intimidation that a person is exposed to by a group or another person in the workplace. In healthcare environments, practitioners are occasionally victims of WPB incidents. Bullying in surgical environments is an important issue that needs attention as it could affect patient care either directly or indirectly. The objective of this study was to assess the prevalence of bullying in surgical environments in multiple regions in Saudi Arabia.

MATERIALS AND METHODS

This cross-sectional study was conducted among surgeons, trainees, interns, nurses, and students in surgical specialties in multiple Saudi regions. The survey was designed by Survey Monkey and posted online. The data were analyzed through SPSS Version-21 by computing descriptive statistics as frequency and percentages with graph construction.

RESULTS

About two-thirds (65.2%) of the 788 study participants were male and were between the age of 20 and 29 years (67.8%). Consultants came first as perpetrators of bullying in the past 12 months (44.3%) and residents and interns were the major victims. The NAQ-R score ranged from 22.00 to 110.00, with a mean score of 42.47 (SD=17.9). Statistically significant association was found between mean NAQ-R score and age (P = 0.007), specialty (P = 0.002), and position (P < 0.001).

CONCLUSION

WPB is a pervasive problem in surgical environments in multiple regions of Saudi Arabia. Consultants and specialists are the primary offenders in bullying, which makes the hospital an environment for bullying behaviors.

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.

Reasons PAs leave their jobs

PURPOSE

Employee turnover is an important indicator that carries a heavy financial cost for healthcare organizations. Although previous research has highlighted some factors associated with turnover, the reasons physician assistants (PAs) leave their jobs are not fully understood. This study aimed to determine the most common reasons behind PA turnover.

METHODS

In 2019, the American Academy of PAs (AAPA) distributed a survey to all PAs with an eligible email address. The survey included a question asking respondents if they had left or changed their job in the past year. Respondents answering this question in the affirmative were asked a follow-up multiple-choice question to determine the reason behind this change.

RESULTS

A total of 13,088 PAs responded to the AAPA salary survey; of these, 1,261 reported leaving a job within the past year. The most common reasons provided for leaving a job were: better work/life balance (n = 209, 16.8%), moved (n = 208, 16.7%), better management/leadership/environment (reasons related to toxic/abusive environment) (n = 170, 13.6%), and better compensation/benefits (n = 148, 11.9%).

CONCLUSION

Employers should focus on common reasons for turnover that can be reasonably addressed. Of the top three reasons behind PA turnover, those related to toxic/abusive work environments may be the most practical and important to address.

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.

Psychosocial work characteristics associated with distress and intention to leave nursing education among students; A one-year follow-up study

BACKGROUND

Dropout in later years of the nursing degree programme involves lost investment and is a particular problem for both students and educators. Reasons for late dropout seem to be related to the work and learning environment of the clinical placement.

OBJECTIVES

The aim of this study was to investigate associations between psychosocial work characteristics and distress and intention to leave nursing education among third-year nursing students.

DESIGN

A prospective cohort study.

SETTING

A Bachelor of Nursing programme of a University of Applied Sciences in the Netherlands.

PARTICIPANTS

363 third-year nursing students.

METHODS

Baseline and one-year follow-up measurements were used from a prospective cohort study. Third-year nursing students were invited annually in May between 2016 and 2018. Psychosocial work characteristics were psychological demands, supervisor and co-worker support, and acts of offensive behaviour. Logistic regression analyses were used to build multivariate models.

RESULTS

Frequent exposure to violence (OR = 2.52, 95% CI: 1.29-4.92) was univariately associated with distress. In the multivariate model for distress, psychological demands (OR = 1.63, 95% CI: 1.05-2.52) and frequent exposure to violence (OR = 3.02, 95% CI: 1.48-6.19) were associated with distress. Supervisor support (OR = 0.54, 95% CI: 0.36-0.80) and co-worker support (OR = 0.41, 95% CI: 0.24-0.72) were negatively associated with intention to leave (i.e. were protective) in the univariate model. In the adjusted multivariate model, only co-worker support (OR = 0.50, 95% CI: 0.25-0.97) was a protective factor for an intention to leave.

CONCLUSION

Psychological demands and frequent exposure to violence are risk factors for distress, and co-worker support is a protective factor reducing the intention to leave nursing education in the last stage of the programme. Improving the psychosocial working climate of nursing students may reduce the intention to leave at a late stage in nursing education, and hence actual late dropout.

Impact of bullying on occupational commitment in young nursing professionals: the mediating role of emotional labour and emotional exhaustion

BACKGROUND

Nurses are often exposed to workplace bullying, which leads to their burnout and leaving the profession. However, the processes by which workplace bullying leads to such outcomes are not clear.

AIMS

This study investigates how work-related and personal-related bullying affect nurses' occupational commitment by integrating emotional labour and emotional exhaustion.

METHOD

This study employs a cross-sectional design. The model was tested using structural equation modelling with a sample of 245 Chinese nurses.

RESULTS

Work-related bullying is positively related to both surface acting and deep acting, and a negative relationship exists between deep acting and emotional exhaustion. Personal-related bullying is not related to either surface acting or deep acting, but is positively related to emotional exhaustion. Emotional exhaustion is negatively related to affective occupational commitment.

CONCLUSIONS

This study implies that bullying behaviours should be distinguished with work-related bullying and personal-related bullying, and emotional regulation strategies are meaningful in managing the negative impact of work-related bullying.

IMPLICATION FOR NURSING MANAGEMENT

Policymakers and managers need to distinguish two types of bullying behaviour and manage them accordingly with different strategies. For nursing schools it is important to prepare nursing students with not only professional skills but also social competence and emotional management skills.

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

AIMS

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

DESIGN

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

METHOD

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

RESULTS

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

CONCLUSION

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

IMPACT

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

Co-Creating and Evaluating an App-Based Well-Being Intervention: The HOW (Healthier Outcomes at Work) Social Work Project

Stress and mental health at work are the leading causes of long-term sickness absence in the UK, with chronically poor working conditions impacting employee physiological and psychological health. Social workers play a significant part in the fabric of UK society, but have one of the most stressful occupations in the country. The aim of this project was to work with UK social workers to co-develop, implement, and evaluate a series of smartphone-based mental health initiatives. A Participatory Action Research (PAR) approach, consisting of semi-structured interviews and focus group and steering group discussions, was utilized to design the mental health and well-being interventions. Study efficacy was evaluated via a pre- and post-intervention survey and post-intervention semi-structured interviews. Interventions developed were psycho-educational, improved top-down and bottom-up communication, and provided access to a Vocational Rehabilitation Assistant for those struggling and at risk of sickness absence. Six months following dissemination, surveys demonstrated significant improvements in communication, and mean score improvements in four other working conditions. This project, therefore, demonstrates that co-developed initiatives can be positively impactful, despite post-intervention data collection being impacted by COVID-19. Future studies should build upon these findings and broaden the PAR approach nationally while taking a robust approach to evaluation.

Labour market affiliation among non-bullied colleagues at work units with reported bullying

AIM

This study investigates if non-bullied employees in Work units (WUs) where bullying occur, are more prone to leave the WUs than employees in WUs with no bullying, and if the prevalence of workplace bullying had an impact on leaving the WUs. Leaving the workplace was defined by unemployment or change of workplace at follow-up.

METHODS

We had data from 8326 Danish public health invited employees from 302 WUs. Of these 3036 responded to a questionnaire on working conditions and health in 2007. WUs were classified into three categories of WUs: (1) no bullying (0% bullied), (2) moderate prevalence of bullying (< 10% bullied), and (3) high prevalence of bullying (≥ 10% bullied). Bullied respondents were used to classify the WUs and excluded in the analyses.

RESULTS

We found odds ratios (ORs) for unemployment 1 year later of 1.27 [95% CI 0.69-2.37] in WUs with moderate prevalence of bullying and 1.38 [95% CI 0.85-2.23] among employed in WUs with high prevalence of bullying, adjusted for size of WUs, age, sex, and job category. For turnover 1 year later the ORs were 1.27 [95% CI 0.78-2.15] and 1.46 [95% CI 0.99-2.15] in WUs with moderate and high prevalence of bullying, respectively.

CONCLUSION

We did not find that non-bullied employees leave the WUs with moderate and high prevalence of bullying more than employees in WUs with no bullying behaviour 1 year later. Leaving the workplace tended to be higher among employees in WUs with high prevalence of bullying compared to no and moderate bullying.

Personal Bullying and Nurses' Turnover Intentions in Pakistan: A Mixed Methods Study

In this study, quantitative and qualitative data are presented to examine the direct and mediated effect of personal bullying on nurses' turnover intentions via job stress. The study also investigates the moderating role of political skill on the association between personal bullying and job stress. The study employed an explanatory sequential mixed methods design. In the first, quantitative phase of the study, data were collected from a sample of 324 registered nurses working in public sector hospitals of Pakistan using a self-administered questionnaire. Results from variance-based structural equation modeling showed that personal bullying has a direct as well as an indirect effect on nurses' turnover intentions through job stress. Furthermore, results showed that political skill attenuates the effect of personal bullying on job stress. The second, qualitative phase was conducted as a follow-up to the quantitative results involving individual interviews from 11 nurses. Overall, the qualitative data validated the key quantitative results. The study is among the first to employ a mixed methods design to investigate the direct and mediated effects of personal bullying on nurses' turnover intentions and the stress-buffering role of political skill.

Prevalence of Workplace Bullying and Its Associated Factors at a Multi-Regional Saudi Arabian Hospital: A Cross-Sectional Study

Background

Workplace bullying (WPB) refers to any form of repeated and unreasonable verbal, physical or sexual harassment that an employee endures by a person or a group. In healthcare settings, practitioners are occasionally victims of WPB incidents. The aim of this study was to survey victims of WPB and determine factors associated with being a victim of WPB at a multiregional health care facility in Saudi Arabia.

Methods

This cross-sectional study was conducted in 2018, by distributing a self-administered questionnaire via a private electronic mail to all fulltime healthcare practitioners within a multi-regional hospital in Saudi Arabia. Healthcare practitioners included physicians, nurses, allied healthcare professionals and pharmacists who reported being exposed to WPB in the past year. Study outcomes were the prevalence rate ratio of WPB and its associated factors, such as victim, perpetrator and incident characteristics.

Results

WPB has been reported by 684 participants. Perpetrators were mainly patients (36.1%), their families/relatives (29.5%), and hospital staff (27.2%) or managers/supervisors (7.2%). The type of WPB incident was mostly verbal abuse (98.1%) followed by physical harassment (11.8%) and sexual connotations (5.8%). WPB was 30% more prevalent among younger nurses and 24% less prevalent among higher educated nurses compared to their counter groups, P<0.001 each. Among technicians and administrative employees, WPB was 54% more prevalent among females, 36% more prevalent among the younger group, and 25% more prevalent among expatriate workers compared to their counter groups P<0.014, P<0.001 and P=0.017, respectively. WPB was 20% less prevalent among higher educated allied health professionals, P=0.002. Among physicians, WPB was 33% more prevalent among females, P=0.041 and was 47% more prevalent among higher educated physicians compared to their counter groups, P=0.018.

Conclusion

WPB might occur any time, anywhere and by any person within health care facilities. The prevalence of WPB varies within health occupational groups. Gender, age, educational level, and nationality were significantly associated factors with WPB.

Sexual harassment of nurses by patients and missed nursing care-A hidden population study

AIM

To raise awareness of a patient-related antecedent of missed nursing care.

BACKGROUND

Missed nursing care is negatively associated with patient outcomes; accordingly, hospitals employ strategies to mitigate missed care. While antecedents of missed nursing care resulting from the work environment of nurses are recognized, sexual harassment by patients is not.

METHODS

This study is a hidden population study using respondent-driven sampling. We analysed data from thirty letters of frontline nurses from a tertiary Israeli hospital using the six steps of Aronson's thematic analysis.

FINDINGS

Six themes emerged. Nurses (a) felt objectified and that the sacred nurse-patient therapeutic space was desecrated; (b) felt a lack of support from ward managers; (c) felt unprotected, lonely, and alienated; (d) did not share the experience with managers; (e) coped with sexual harassment by ending treatment quickly and later realized they missed some tasks; and (f) considered leaving nursing.

CONCLUSION (S)

Policymakers are called upon to adopt the eight steps suggested for effectively coping with sexual harassment by patients and thus to reduce missed nursing care.

IMPLICATIONS FOR NURSING MANAGEMENT

Managers are called upon to modify their management style and to provide support to nurses who experience sexual harassment in order to alleviate their stress, which is an also antecedent of missed nursing care.

Occupational stress and the risk of turnover: a large prospective cohort study of employees in Japan

Background

Although several studies have examined the association between occupational stress and turnover, these studies relied on cross-sectional designs, subjects’ self-report, healthcare workforce, or small sample sizes. This study aimed to confirm whether occupational stress increases the risk of turnover in a large-scale prospective cohort study using actual turnover data from company records.

Methods

The participants were 3892 male and 5765 female employees aged 20–49 years in a financial service company. We followed them from October 2012 until April 1, 2016 and used company records to identify employees who resigned. We identified employees with high and low stress using the Brief Job Stress Questionnaire. Hazard ratios for turnover in high-stress employees were estimated using Cox proportional hazards models, and population attributable risks were calculated separately for men and women.

Results

During 11,475,862 person-days, 122 men and 760 women resigned. After adjustment for age, length of service, job type, and position, the hazard ratios (95% confidence intervals) for turnover in high-stress employees were 2.86 (1.74–4.68) for men and 1.52 (1.29–1.78) for women. The corresponding population attributable risks for high stress were 8.2% for men and 8.3% for women. The component scores, i.e., job stressors, psychological/physical stress response, workplace social support, and job strain (the combination of high job demands and low job control) were also significantly associated with turnover (p < 0.05).

Conclusions

Occupational stress increases the risk of actual turnover. Measures to prevent occupational stress may be useful to prevent employee turnover.

The Effect of Bullying Vignettes on Negative Affect

The purpose of this study was to examine the influence of reading workplace bullying vignettes on negative affect. A within-subjects descriptive design and convenience sample was used. Fifty participants completed the Negative Affect Scale after reading written bullying vignettes and completed the Transportation Narrative questionnaire. Results provide evidence that the participants were transported into the vignettes. Additionally, descriptive statistics and a repeated measure ANOVA revealed a significant increase in negative affect over time. Written vignettes can provide a means to better understand how workplace events can impact cognitive performance. Practical and theoretical implications are discussed.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Prevalence of bullying in the nursing workplace and determinant factors: a nationwide cross-sectional Polish study survey

OBJECTIVES

In the present study, we aimed to investigate the prevalence of bullying among Polish nurses, and to identify the most common negative acts, as well as individual and work-related risk factors for workplace bullying.

METHODS

Cross-sectional study designed using an online survey. The total study sample was 404 nurses, each having over 6 months of working experience. Data were collected using the Polish version of the Negative Act Questionnaire-Revised. Linear stepwise regression analysis and logistic regression analysis were performed to assess predictors of greater reporting of perceived workplace bullying RESULTS: Bullying was experienced by 65.84% of participants. Perceived workplace bullying was associated with sex (p=0.043), age (p=0.003), seniority (p=0.006), number of working hours per week (p=0.010) and position (p=0.029). Logistic regression analysis with the dependent variable of bullying according to Leymann's rigorous criteria revealed that the model could include four variables: age from 50 to 59, seniority of 11-15 years,>45 working hours per week and a bachelor's degree in nursing.

CONCLUSIONS

An alarming percentage of nurses were victims of bullying. Among all variables included in the regression model, the most significant predictors of perceived workplace bullying were age, seniority, work overtime and bachelor's degree education. Bullying prevention and improvement of well-being at work must be addressed as part of an overall strategy to deal with turnover.

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

AIMS

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

DESIGN

Systematic literature review.

DATA SOURCES

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

REVIEW METHODS

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

RESULTS

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

CONCLUSION

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

Workplace Bullying Among Nurses: Developing a Model for Intervention

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

Assessment of workplace bullying: reliability and validity of an Arabic version of the Negative Acts Questionnaire-Revised (NAQ-R)

INTRODUCTION

Interest in workplace bullying has been steadily growing since the 1990s, focusing on understanding its driving factors, prevalence rates in different occupations and countries, its consequences, as well as the characteristics of the typical bully and victim. Currently, the Negative Acts Questionnaire-Revised (NAQ-R) is the most frequently used questionnaire to assess workplace bullying. Studies in the Arab world are scarce and to date the NAQ-R has not been validated in Arabic, the official or co-official language in around 25 countries in the Middle East and Asia. The aim of this study was therefore to develop an Arabic version of NAQ-R.

MATERIALS AND METHODS

447 participants aged 18-70 years were recruited through convenient sampling. Exclusion criteria were illiteracy and employment for less than 6 months. Participants were recruited from shops, banks, travel agencies and restaurants in an area in central Beirut around a tertiary care medical centre.A two-stage process was employed to translate the original version of NAQ-R to Arabic. This translated version along with validated Arabic versions of the Satisfaction with Life Scale and the Beck Depression Inventory II were distributed to participants.

RESULTS

A 14-item two-factor NAQ-R, with subscales of person-related and work-related bullying, was supported. Reliability coefficients for total and subscale scores of the NAQ-R ranged from 0.63 to 0.90. The Arabic NAQ-R had good concurrent validity as indicated by significant correlations with depression and satisfaction with life (p < 0.05).

CONCLUSION

NAQ-R was translated to Arabic and adapted. The results revealed acceptable levels of reliability and construct validity. As for the underlying factor structure, it needs to be further supported.

Mental Health Expenditures: Association With Workplace Incivility and Bullying Among Hospital Patient Care Workers

OBJECTIVE

Bullied workers have poor self-reported mental health; monetary costs of bullying exposure are unknown. We tested associations between bullying and health plan claims for mental health diagnoses.

METHODS

We used data from 793 hospital workers who answered questions about bullying in a survey and subscribed to the group health plan. We used two-part models to test associations between types of incivility/bullying and mental health expenditures.

RESULTS

Workers experiencing incivility or bullying had greater odds of any mental health claims. Among claimants, unexposed workers spent $792, those experiencing one type of incivility or bullying spent $1557 (P for difference from unexposed = 0.016), those experiencing two types spent $928 (P = 0.503), and those experiencing three types spent $1446 (P = 0.040).

CONCLUSION

Workplace incivility and bullying may carry monetary costs to employers, which could be controlled through work environment modification.

Abusive Coworker Treatment, Coworker Support, and Employee Turnover

Hostile treatment from others at work can have undesirable consequences. The present study aims to validate this proposition by examining whether abusive coworker treatment is a significant predictor of employee turnover among entry-level employees in the hospitality industry. With a sample of 979 restaurant servers, this research examined the impact of abusive coworker treatment along with coworker emotional and instrumental support on turnover over a 6-month period. Abusive coworker treatment was significantly related to higher turnover among newcomers but not among experienced employees. Furthermore, coworker emotional support was related to lower turnover among all employees in the sample. These findings provide a more nuanced perspective on the role of abusive coworker treatment and coworker support in combating the perennial turnover challenge in the hospitality industry.

Assessing the impact of workplace bullying on nursing competences among registered nurses in Jordanian public hospitals

AIM

To assess the impact of nursing competences on workplace bullying among registered nurses in Jordanian public hospitals.

BACKGROUND

Workplace bullying has serious organizational and health effects on nursing staff. Little is known about the relationship between bullying and nursing competence worldwide.

METHOD

A cross-sectional descriptive study using a quantitative method was adopted for this study. The Negative Act Questionnaire-Revised (NAQ-R) and Nurse Professional Competence (NPC) questionnaire were used. A convenience sample of 272 nurses completed the study questionnaires.

RESULTS

The results revealed that there were negative correlations between all NAQ scales and all NPC scales. The higher scores indicated better degrees of perceived competency, while the lower scores indicated the frequency of bullying reported by nurses. These results suggest that nurses who have more clinical competencies are less likely to experience work-related bullying.

CONCLUSION

The study found that workplace bullying against nursing staff is still a considerable problem in participating Jordanian hospitals.

IMPLICATIONS FOR NURSING MANAGEMENT

To prohibit bullying behavior, nurse administrators have to construct a work environment that demonstrates respect and fairness and which is transmitted through nurses' communication pathways.

Relationship Between Changes in Workplace Bullying Status and the Reporting of Personality Characteristics

OBJECTIVE

To examine whether a shift in work-related bullying status, from being non-bullied to being bullied or vice versa, was associated with changes in reporting of personality characteristics.

METHODS

Data on bullying and personality (neuroticism, extraversion, and sense of coherence) were collected in three waves approximately 2 years apart (N = 4947). Using a within-subjects design, personality change scores that followed altered bullying status were evaluated with one-sample t tests. Sensitivity analyses targeted depressive symptoms.

RESULTS

Shifts from non-bullied to frequently bullied were associated with increased neuroticism or decreased sense of coherence manageability scores. Shifts from bullied to non-bullied were associated with decreasing neuroticism and increasing extraversion scores, or increasing sense of coherence meaningfulness and comprehensibility scores. Excluding depressive cases had minor effects.

CONCLUSIONS

Bullying seems to some extent to affect personality scale scores, which thus seem sensitive to environmental and social circumstances.

Prevalence, causes and mental health impact of workplace bullying in the Neonatal Intensive Care Unit environment

OBJECTIVES

The aim of this study is to examine the prevalence, to report barriers and mental health impact of bullying behaviours and to analyse whether psychological support at work could affect victims of bullying in the healthcare workplace.

DESIGN

Self-administered questionnaire survey.

SETTING

20 in total neonatal intensive care units in 17 hospitals in Greece.

PARTICIPANTS

398 healthcare professionals (doctors, nurses).

MAIN OUTCOME MEASURES

The questionnaire included information on demographic data, Negative Act Questionnaire-Revised (NAQ-R) behaviour scale, data on sources of bullying, perpetrators profile, causal factors, actions taken and reasons for not reporting bullying, psychological support and 12-item General Health Questionnaire (GHQ-12) scores to investigate psychological distress.

RESULTS

Prevalence of bullying measured by the NAQ-R was 53.1% for doctors and 53.6% for nurses. Victims of bullying differed from non-bullied in terms of gender and job experience, among demographic data. Crude NAQ-R score was found higher for female, young and inexperienced employees. Of those respondents who experienced bullying 44.9% self-labelled themselves as victims. Witnessing bullying of others was found 83.2%. Perpetrators were mainly females 45-64 years old, most likely being a supervisor/senior colleague. Common reasons for not reporting bullying was self-dealing and fear of consequences. Bullying was attributed to personality trait and management. Those who were bullied, self-labelled as a victim and witnessed bullying of others had higher GHQ-12 score. Moreover, psychological support at work had a favour effect on victims of bullying.

CONCLUSIONS

Prevalence of bullying and witnessing were found extremely high, while half of victims did not consider themselves as sufferers. The mental health impact on victims and witnesses was severe and support at work was necessary to ensure good mental health status among employees.

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

AIMS

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

IMPLICATIONS FOR NURSING MANAGEMENT

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

Bullying and incivility in higher education workplaces

Purpose

The purpose of this paper is to explore the lived experiences of workplace ill-treatment of administrative and technical staff in the higher education sector, with a particular focus on organisational response.

Design/methodology/approach

A qualitative interpretative phenomenological research design was employed. Using non-random, purposive sampling strategies nine self-selecting participants from three of the seven universities in the Republic of Ireland were interviewed in person. Data were analysed thematically employing the Pietkiewicz and Smith’s (2012) four-stage data analysis model.

Findings

Thematic analysis yielded four main themes: micro-political nature of bullying, cynicism about the informal response, the formal procedures exacerbate the problem and significant and adverse health impact. Participant narratives engender the lived experience for the reader.

Research limitations/implications

As participants were self-selecting respondent bias is acknowledged.

Practical implications

The findings of this study add to the accumulating evidence that organisations are failing to address workplace bullying.

Social implications

In failing to protect employees, the adverse health difficulties experienced by targets of bullying are further exacerbated.

Originality/value

While the literature yields much in terms of types of behaviours and impact, and argues for anti bullying policies and procedures in the workplace, what is evident is the selective organisational use of policy and procedures and inherent biases in place which expose a reluctance to effectively protect dignity and respect in the workplace.