Categorizing the Magnitude and Frequency of Exposure to Uncivil Behaviors: A New Approach for More Meaningful Interventions

Nursing students' experience of bullying and/or harassment during clinical placement

PROBLEM OR BACKGROUND

Bullying is a recognised problem in nursing. Nursing students are particularly vulnerable. Bullying and harassment of nursing students can be detrimental to both students and recipients of care.

AIM

This study aims to identify the incidence and nature of bullying and/or harassment experienced by nursing students in Sri Lanka.

METHODS

A cross-sectional survey consisting of eight demographic questions and 15 items specific to the experience of bullying and harassment was administered to nursing students online.

FINDINGS

A total of 656 students from 26 nursing education institutions in Sri Lanka participated. The majority were female with a mean age of 24.4 years. More than a quarter of respondents reported that they had experienced bullying and/or harassment while on clinical placement, with a further 16.7 % being unsure. Most bullying or harassment (55 %) occurred in hospitals with 29 % experienced in community settings. Registered nurses, including nurse managers and clinical facilitators were the most common perpetrators. Verbal abuse was the most frequent type of behaviour reported.

DISCUSSION

These findings support existing literature that indicates that bullying of nursing students is an international phenomenon. The context of this study provides clues as to how culture may influence the problem. There is a need to better understand bullying and harassment in the environments in which it occurs, in order to identify strategies that can bridge cultures and settings.

CONCLUSION

The incidence of bullying and harassment of nursing students in Sri Lanka is concerning. Further research is needed to identify and evaluate targeted strategies to help prevent negative outcomes in all nursing contexts.

Newly qualified graduate nurses' experiences of workplace incivility in healthcare settings: An integrative review

AIM

To explore, identify and integrate the existing knowledge to categorise the characteristics, likelihood, and consequences of workplace incivility among newly qualified graduate registered nurses. A particular focus of this review is on the experiences of new nurses related to these negative workplace behaviours and the strategies employed by these nurses and their organisations to manage workplace incivility.

BACKGROUND

Workplace incivility has been widely recognised as a global problem in healthcare settings and is known to affect nurses in all facets of their professional and personal life. This might be particularly harmful for newly qualified graduate nurses, as they are unprepared to deal with this uncivil culture.

DESIGN

An integrative review of the global literature, conducted according to the Whittemore and Knafl framework.

METHODS

Database searches (CINAHL, OVID Medline, PubMed, Scopus, Ovid Emcare and PsycINFO), and manual searching generated an aggregate of 1904 articles, which were further screened based on inclusion criteria and eligibility using the Mixed Methods Appraisal Tool (MMAT). Peer-reviewed empirical studies that explored the workplace incivility experiences of new graduate nurses were included in this review. Extracted data were grouped to develop themes and sub-themes.

RESULTS

This review included 14 studies in total with seven quantitative and seven qualitative studies. The data collected from these studies were categorised according to the research questions into a) expectations of civility, b) experiences and exposure to workplace incivility, c) forms and characteristics of incivility, d) sources of incivility, e) consequences of incivility, and f) managing and coping with incivility. Across studies, graduate nurses' views about the prestige and power of the nursing profession are conflicted due to experiences of incivility in clinical practice. New graduate nurses experienced a high but variable prevalence of incivility from their co-workers (25.6-87 %), with manifestations of incivility varying greatly, including eye rolling, yelling, exclusion and sexual harassment. Included studies primarily focused on professional and organisational effects and their outcomes relative to the physical and psychological effects on new nurses.

CONCLUSION

Findings from the literature demonstrate that incivility directed toward newly qualified graduate nurses is prevalent and can have significant negative impact on their self-esteem and confidence, which may ultimately impact on their workforce participation decisions and the quality of patient care. Supportive and empowering work environments are vital not only for improved nurse health and well-being, but also to retain new graduate nurses. The current nursing shortage emphasises the need for such conditions.

Factors influencing the behavior of bystanders to workplace bullying in healthcare—A qualitative descriptive interview study

Workplace bullying is a severe problem that affects individuals, organizations, and society. Although there is a growing research interest in bystanders of workplace bullying, the rationale underlying bystanders' behavior in healthcare settings requires further investigation. The aim of the current study is to explore factors that influence the behavior of bystanders to workplace bullying in the healthcare sector. Qualitative semistructured interviews were conducted with 32 staff members in the healthcare sector in Sweden. Data were collected between March 2019 and September 2020 and were analyzed with thematic analysis. The participants experienced that bystanders of bullying, both colleagues and managers, were in many situations acting in a passive way. Organizational factors such as dysfunctional organizational culture and deficiencies in management affected how actively the bystanders could intervene. Additionally, a fear of negative consequences, lack of awareness of what was going on, bullying behavior being excused, and the bystander not being a member of the dominant group were social factors contributing to bystanders' passive behavior. For bystander intervention to be successful, the organization must consider bullying as a serious issue, take action, and show support for both the target and the bystander.

Relationship between Psychological Ownership of the Nursing Profession and Turnover Intention: A Correlational Survey among Taiwanese Nurses

AIMS

To examine the relationship between psychological ownership of the nursing profession and turnover intention.

BACKGROUND

There is a severe shortage of nurses worldwide. Research is needed to understand how nurses' intention to leave hospitals and the nursing profession can be alleviated.

METHODS

This study adopted a cross-sectional design and a survey method. Proportionate random sampling was used to ensure sample representativeness. This study surveyed 430 registered nurses in a medical center in Taiwan between December 2021 and January 2022. We used Turnover Scale and Self-Efficacy Scale, and developed Having a Place Scale.

RESULTS

Psychological ownership comprises three dimensions: self-efficacy, nurse identity, and "having a place" in the nursing profession. This research is the first to examine how these three dimensions of psychological ownership of the nursing profession are related to the intention to leave a hospital or the nursing profession. Self-efficacy and "having a place" are negatively related to nurses' intention to leave a hospital (r=-.23 and -.31, p<.001). Nurse identity is negatively related to nurses' intention to leave the nursing profession (r=-.38, p<.001). Intention to leave a hospital is positively related to nurses' intention to leave the profession (r=.76, p<.001).

CONCLUSION

The findings provide novel insights for retaining nurses. Nurse managers could use strategies such as including nurses in making workplace decisions and encouraging them to personalize their workspace. Implications for Nursing Management Nurse managers can enhance nurses' self-efficacy and sense of "having a place" to retain nurses in hospitals, while enhance nurse identity to retain nurses in the profession.

Predictors of moral harassment in nursing work in critical care units

OBJECTIVES

to analyze the predictors of moral harassment in nursing work in critical care units.

METHODS

a cross-sectional study conducted in a public hospital in Fortaleza, Ceará, with 167 nursing professionals in 2016. Sociodemographic/occupational questionnaire and Negative Acts Questionnaire Revised were applied. The analysis included descriptive statistics, measures of central tendency and dispersion, as well as Mann-Whitney, Kruskal-Wallis and Conover Inman U-tests for multiple comparisons.

RESULTS

there was a 33% prevalence of self-perception of moral harassment, highlighting personal/professional disqualification and work-related harassment. The predictors of moral harassment included age, time working in the job and time in the unit, employment relationship and sector.

CONCLUSIONS

young professionals (< 30 years), cooperative, crowded in intensive care or emergency units, with less time working in the job (< 5 years) or greater time in the unit (above 10 years) are the biggest victims of moral harassment in the work of nursing in critical environments.

Workplace Aggression: Exploring Experiences of Occupational Therapy Practitioners in Healthcare Settings

Workplace aggression (WPA) among healthcare workers is a pervasive and serious problem in the healthcare industry, yet there is a poor understanding of WPA in the profession of occupational therapy (OT). The authors employed a mixed method design using a Likert scale survey and focus groups from two different settings and locations to explore WPA experiences of OT practitioners working in healthcare settings. Participants for the focus groups totaled 14 and 109 surveys were returned. The findings revealed that 100% of the focus group participants and 67% of the survey respondents report exposure to specific types of WPA. Key underlying causes relate to the challenges occupational therapy practitioner's face in advocating their professional role and values in a predominant biomedical setting. These findings are important not only to increase awareness among practitioners, leaders, and educators but to further examine how occupational therapy's unique role in healthcare can be fully recognized.

An educational intervention to promote civility in nursing: a pilot study

Objectives Nursing students are ill equipped to handle uncivil situations in the workplace. The purpose of this project was to determine if providing students with education about identifying and addressing incivility would alter how students perceived their ability to recognize and address uncivil situations when encountered. Methods This pre-post-test comparative pilot study used the Generalized Self Efficacy Scale along with The Confidence Scale to measure student self-efficacy and confidence before and after the receipt of educational interventions on recognizing and addressing uncivil behaviors. Results The statistical analysis reveals an increase in both self-efficacy and confidence scores in recognizing and addressing uncivil behaviors following the educational interventions (p=0.000, p<0.001, respectively). Conclusions Educating pre-licensure nursing students about incivility increases self-efficacy and confidence levels in pre-licensure nursing students to recognize and address uncivil behaviors when encountered.

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

BACKGROUND

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

AIM

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

SETTING

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Bullying in Nursing: Is it in the Eye of the Beholder?

The nursing profession is presented with numerous definitions of workplace bullying. This study provides an in-depth analysis of the concept of bullying in the nursing profession in Australia through a scoping review of definitions presented in literature published up until 2018. The research questions used to guide the search were as follows: How has the definition of bullying in nursing in Australia been conceptualized in the literature? How do these definitions of bullying differ? How has the definition of bullying, as used in the literature, evolved over time? The review was informed by the approach of Arksey and O'Malley, containing explicit definitions of bullying in nursing literature. The findings reveal that the literature does not reflect a shared and integrated vision of the exact nature of bullying in the nursing profession. The conceptualization of bullying in the nursing profession has become more dynamic over time. The myriad ways in which bullying in nursing is defined in Australia has important implications for research, practice, education, and policy.

On the line: Confronting isolation and bullying in the workplace

This article defines the terms associated with bullying, identifies two types of bullying behaviors, and discusses anti-bullying strategies based on education and professional behaviors to eliminate incivility in nursing departments.

The relationship between perceived competence and perceived workplace bullying among registered nurses: A cross sectional survey

BACKGROUND

Workplace bullying is one of the most prevalent work-related psychological and physical issues in health care facilities. Workplace bullying has detrimental effects not only on the bullied person/persons but also on health care facilities and care quality and patient safety.

AIMS

To examine the prevalence of workplace bullying and the relationship between workplace bullying and perceived competence among Jordanian registered nurses working in private hospitals DESIGN: A cross-sectional survey study.

SETTING

Data were collected from registered nurses working in seven private hospitals in the Capital of Amman.

PARTICIPANTS

Participants were 269 registered nurses who had a minimum of a bachelor degree, passed the hospital's competency nursing examinations, able to read and understand English, and were able and willing to complete the survey.

METHODS

The Negative Act Questionnaire-Revised, and Nurse Professional Competence scale were used for data collection. Multiple linear regression analysis was conducted to assess predictors of greater reporting of perceived workplace bullying.

FINDINGS

Almost 43% of the participants perceived themselves to be victims of severe workplace bullying while more than 31% perceived themselves to be victims of occasional workplace bullying. Person-related bullying was the most frequently reported type of workplace bullying followed by work-related bullying. Age, gender, and sum score on Nurse Professional Competence scale explained significant amount of variance in perceived workplace bullying.

CONCLUSION

The majority of Jordanian nurses working in private hospitals perceive themselves as victims of either occasional or severe workplace bullying. Amongst all related variables, perceived competence is the most significant predictor of perceived workplace bullying.

Systems thinking and incivility in nursing practice: An integrative review

BACKGROUND AND PURPOSE

There is a critical need for nurses and interprofessional healthcare providers to implement systems thinking (ST) across international borders, addressing incivility and its perilous effects on patient quality and safety. An estimated one million patients die in hospitals worldwide due to avoidable patient-related errors. Establishing safe and civil workplaces using ST is paramount to promoting clear, level-headed thinking from which patient-centered nursing actions can impact health systems. The purpose of the paper is to answer the research question, What ST evidence fosters the effect of workplace civility in practice settings?

METHODS

Whittemore and Knafl's integrative review method guided this study. The quality of articles was determined using Chu et al.'s Mixed Methods Assessment Tool.

RESULTS

Thirty-eight studies were reviewed. Themes emerged describing antecedents and consequences of incivility as embedded within complex systems, suggesting improvements for civility and systems/ST in nursing practice.

IMPLICATIONS FOR PRACTICE

This integrative review provides information about worldwide incivility in nursing practice from a systems perspective. Several models are offered as a means of promoting civility in nursing practice to improve patient quality and safety. Further study is needed regarding incivility and resultant effects on patient quality and safety.