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

Impact of Workplace Bullying on Nursing Care Quality: A Comprehensive Review

Workplace bullying, commonly known as mobbing, persists as a significant problem across various industries, including the healthcare sector. To establish effective interventions and protocols for enhancing the well-being of healthcare workers and patients, it is vital to fully grasp the link between workplace bullying and the quality of nursing care. The analysis highlights the complex link between workplace bullying and nursing care quality, stressing the urgency of addressing this issue due to its wide-reaching impact on individuals and healthcare organizations, ultimately affecting patient safety. Emphasizing the significance of addressing workplace bullying across different professional settings is crucial for protecting the mental health and well-being of employees. The research identifies various forms of aggression and emphasizes the need to understand how these behaviors affect patient outcomes. Further investigation is needed to clarify nurses' responses to workplace violence, particularly in specialized settings like mental health facilities. The studies underscore the numerous challenges nurses encounter when trying to report incidents of workplace bullying. This insight is vital for developing effective reporting mechanisms and targeted interventions to combat bullying behaviors in medical environments. Ultimately, establishing a safer working environment for nurses is paramount. This article aims to review the associations between workplace bullying and the quality of nursing care.

Influencing factors of inter-nursing lateral violence: A qualitative systematic review

BACKGROUND

Lateral violence is a global social problem that has attracted considerable attention in the field of public health. This has seriously affected the quality of care, the safety of patients' lives and the career development of nurses.

OBJECTIVE

To systematically evaluate the factors influencing of nursing lateral violence and provide evidence for preventing and reducing inter-nursing lateral violence.

METHODS

A systematic review of qualitative study was performed in accordance with the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) guidelines. We collected qualitative studies on the factors influencing of inter-nursing lateral violence by searching PubMed, EMbase, The Cochrane Library, Web of Science, CINAHL, Science Direct, WanFang Data, China National Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP) and Chinese Biomedical Literature Database (CBM). Data from inception to September 2023. Literature screening and data extraction were independently conducted by two reviewers. The Critical Appraisal Skills Program (CASP) scale was employed to assess the quality of the studies, including objectives, methodologies, designs, results and contributions.

RESULTS

A total of 25 studies involving 882 participants were included. The results of the thematic analysis indicated that inter-nursing lateral violence was influenced by hospital management, perpetrators, victims and sociodemographic factors.

CONCLUSION

Inter-nursing lateral violence was influenced by multidimensional factors. To reduce the occurrence of horizontal violence among nurses, hospitals need to explore the establishment and improvement of a horizontal violence resolution mechanism, and schools should pay attention to the joint support and education of nursing students, create a good working environment and harmonious nursing culture, and promote mutual respect among nurses.

RELEVANCE TO CLINICAL PRACTICE

This review emphasises the importance of the influencing factors of horizontal violence among nurses, analyses the importance of influencing factors from different perspectives, and proposes corresponding measures to reduce inter-nursing lateral violence.

NO PATIENT OR PUBLIC CONTRIBUTION

This study was mostly a literature review; neither patients nor pertinent staff were involved in either the design or conduct of the investigation.

A Descriptive Study Examining the Correlation of Emotional Intelligence and Leadership Styles to Conflict Management Styles of Nursing School Administrators

AIM

This study aimed to identify if a correlation exists among trait emotional intelligence (EI), leadership styles, and conflict management styles used by nurse education administrators.

BACKGROUND

Nursing is fraught with incivility, bullying, and increasing physical aggression. Conflict surrounds nurses at every level. EI and leadership styles in nursing have been addressed. Few studies were found that addressed conflict management by nurse education administrators.

METHOD

A quantitative nonexperimental correlational design using discriminant analysis was used in this study.

RESULTS

Trait EI factors of emotionality and sociability correlated with conflict management styles. Leadership styles and conflict management styles were situational; management styles of integrating and compromising were underused in conflict situations.

CONCLUSION

Nurse education administrators are in a position to become disruptive innovators in changing the nursing culture. The increased use of conflict management styles of integrating and compromising can help address incivility and bullying.

Verbal violence and missed nursing care: A phenomenological study

AIM

To define the missed care experiences of nurses exposed to verbal violence from patients.

BACKGROUND

Verbal violence takes the first place among the types of violence that nurses face in healthcare settings. This can cause negative emotional and physical responses in nurses and issues in patient and nurse interaction. As a result, it may lead to missed nursing care, defined as skipped, postponed or incomplete care during the patient's care.

METHODS

This is a phenomenological study. The study sample included 16 nurses working in inpatient clinics who reported experiencing verbal violence at least once in Turkey. The study was conducted between January and February 2022 with institutional permission and ethics committee approval (09/12/2021-2021/357). A semi-structured interview method was used to collect data. The information gathered from the interviews underwent thematic analysis using an inductive approach. The 'Consolidated Criteria for Reporting Qualitative Research (COREQ)' was used to report this qualitative study based on a comprehensive protocol.

RESULTS

The types of verbal violence most frequently faced by nurses were determined as swearing, insulting, shouting and threats. Study findings were classified into three main themes: (i) response to verbal violence, (ii) missed nursing care experiences and (iii) suggestions to cope with verbal violence. The most felt emotions in the face of verbal violence were feeling sad, unsafe and worthless. Nurses common behaviours, in response to verbal abuse were ignoring, getting used to, and wishing to get away. The examples of missed care included using non-therapeutic communication, postponing care or withdrawing from care.

CONCLUSION

Verbal violence caused negative emotional and behavioural responses in nurses, which, in turn, negatively affected the nurse-patient interaction. These findings mean that verbal violence may pave the way for missed nursing care.

IMPLICATIONS FOR NURSING POLICY

According to these findings, an uninterrupted nursing care process needs to focus on preventive measures against verbal violence and increase the administrative and legal support offered to nurses.

What are the key factors influencing newly graduated nurses' preference for choosing their workplace? A best-worst scaling approach

INTRODUCTION

The literature cites many factors that influence a nurse's decision when choosing their workplace. However, it is unclear which attributes matter the most to newly graduated nurses. The study aimed to identify the relative importance of workplace preference attributes among newly graduated nurses.

DESIGN

A cross-sectional study.

METHODS

We conducted an online survey and data were collected in June 2022. A total of 1111 newly graduated nurses in South Korea participated. The study employed best-worst scaling to quantify the relative importance of nine workplace preferences and also included questions about participants' willingness to pay for each workplace preferences. The relationships between the relative importance of the workplace attribute and the willingness to pay were determined using a quadrant analysis.

RESULTS

The order according to the relative importance of workplace preferences is as follows: salary, working conditions, organizational climate, welfare program, hospital location, hospital level, hospital reputation, professional development, and the chance of promotion. The most important factor, salary, was 16.67 times more important than the least important factor, the chance of promotion, in terms of choosing workplace. In addition, working conditions and organizational climate were recognized as high economic value indicators.

CONCLUSION

Newly graduated nurses nominated better salaries, working conditions, and organizational climate as having a more important role in choosing their workplace.

CLINICAL RELEVANCE

The findings of this study have important implications for institutions and administrators in recruiting and retaining newly graduated nurses.

Bullying among nursing professionals in Brazil: validity and reliability of the Negative Acts Questionnaire-Revised

Introduction

Bullying in the nursing work environment has negative consequences for both professionals and institutions. The early identification of this behavior can contribute to a positive organizational climate and better quality of life.

Objectives

This study analyzed the validity and reliability of the Negative Acts Questionnaire-Revised with nursing professionals.

Methods

A total of 350 nursing professionals were included in this methodological study. Multivariate confirmatory factor analysis was based on 4 domains, as in the Portuguese version of the Negative Acts Questionnaire-Revised. The instrument consists of 22 items that address negative acts committed in the work environment without directly mentioning bullying. Respondents indicate, on a Likert-type scale, how often they experience these acts in their work routine.

Results

The adjusted model of the Brazilian version of the Negative Acts Questionnaire-Revised resulted in an instrument with 20 items and 4 distinct domains that presented satisfactory validity and reliability for identifying bullying behavior among nursing professionals.

Conclusions

The Brazilian version of the Negative Acts Questionnaire-Revised is a valid instrument for identifying acts of bullying among nursing professionals and can be used in efforts to prevent such behavior in health services.

Workplace Bullying among Healthcare Professionals: A Quanti-Qualitative Survey in a Sample of Women Working in an Italian Healthcare Setting

The main objective of this study was to analyze, in a sample of female healthcare workers in Italy, the training needs to improve positive relationships in the healthcare organization. To better understand these needs, perceived workplace bullying and its consequences in terms of professional commitment and well-being were analyzed from a descriptive and quantitative perspective (or mixed-methods analysis). A questionnaire was completed online in a healthcare facility in northwestern Italy. The participants were 231 female employees. The quantitative data showed that, on average, the sampled population perceived a low burden of WPB. The majority of the sample expressed moderate engagement at work and moderate perception of psychological well-being. It is interesting to note that one element seemed to be overarching in the responses to the open-ended questions: communication, which emerged as a problematic element that affects the entire organization. The research data provide useful evidence for intervention in favor of an environment that helps to recognize the phenomenon and intervene in time, offering the possibility of accepting the discomfort and fatigue of healthcare workers and offering useful interventions to the individual and the team.

Effectiveness of transition programs on new graduate nurses' clinical competence, job satisfaction and perceptions of support: A mixed-methods study

AIM

To assess the effectiveness of two graduate nurse programs on new graduate nurses' overall competence at 3, 6, 9 and 12 months. Secondary aims were to assess new nurses' job satisfaction at 12 months and explore their experiences of support.

BACKGROUND

Most clinical settings have implemented transition programs to help new nurses to adapt to their new environments and expand their competences. To this day, very few studies have assessed the effectiveness of these programs.

DESIGN

Longitudinal mixed-methods study.

METHODS

The study was conducted at two teaching hospitals in Australia. New nurses were recruited during orientation. Data were collected at baseline (T0; n = 88), 3 (T1; n = 29), 6 (T2; n = 15), 9 (T3; n = 11) and 12 months (T4; n = 9). At each time point, the questionnaire included demographic and the Nurse Competence Scale. At T4, the questionnaire also included the Nurse Satisfaction Scale. Semi-structured interviews were conducted from T1 to T4. This study conforms to the STROBE guidelines.

RESULTS

Competence increased significantly at T1, with participants stating that they learned by "getting out" of student mode. At T2, despite no significant difference in competence, participants expressed they were more confident and in control, because they felt supported. Again, at T3, there was no significant increase in competence. Finally, at T4, competence increased significantly, with participants acknowledging that they still had a lot to learn.

CONCLUSION

This study supports that 12-month transition programs are necessary for NGNs to expand their competence. One major factor influencing NGNs during their first year was how well they felt supported and encouraged to seek help when they needed it.

RELEVANCE

There is a need to understand how new NGNs enrolled in transition programs expand their competences. Their professional development depends on a supportive environment where NGNs feel confident in asking questions or for help.

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.

A Qualitative Meta-Synthesis of Studies on Workplace Bullying among Nurses

This study aimed to further understand and compare the phenomenon of workplace bullying (WPB) among clinical nurses in various sociocultural contexts. The study sought to determine appropriate interventions, examining how said interventions should be delivered at individual, work-unit, and institutional levels. Qualitative meta-synthesis was chosen to achieve the study aims. Individual qualitative research findings were gathered, compared, and summarized using the thematic analysis suggested by Braun and Clark. Based on the predefined analytic points, the findings included the following themes: horizontal yet vertical violence, direct and indirect violence on victims, nurses feed on their own, accepting and condoning WPB embedded in ineffective work systems, and rippling over the entire organization. The results showed that the phenomenon of workplace bullying shares quite a few attributes across cultures in terms of the characteristics, types, perpetrators, subjects, and consequences. The findings suggest that interventions to change and improve organizational work culture must be developed and implemented.

Predictors of events of violence or aggression against nurses in the workplace: A scoping review

AIM

To identify predictors and consequences of violence or aggression events against nurses and nursing students in different work contexts.

BACKGROUND

Workplace violence against nurses and nursing students is a very common and widespread phenomenon. Actions to manage or prevent violent events could be implemented knowing the risk factors and consequences. However, there is a lack of systematic reviews that summarize knowledge on the predictors and consequences of workplace violence.

EVALUATION

A scoping review was conducted using electronic databases including APA PsycInfo, CINAHL, Cochrane, Ovid Medline, PubMed and Scopus.

KEY ISSUES

After full text analysis, 87 papers were included in the current scoping review. Risk factors of horizontal violence were grouped into 'personal' and 'Environmental and organizational', and for violence perpetrated by patients into 'personal', 'Environmental and organizational' and 'Characteristics of the perpetrators'.

CONCLUSIONS

The results of this scoping review uncover problems that often remain unaddressed, especially where these episodes are very frequent. Workplace violence prevention and management programmes are essential to counter it.

IMPLICATIONS FOR NURSING MANAGEMENT

The predictors and the consequents identified constitute the body of knowledge necessary for nurse managers to develop and implement policy and system actions to effectively manage or prevent violent events.

Conflicting Working Relationships Among Nurses: The Intersection of Should Nursing, Double Domination, and the Big Picture

Background

Research conducted on conflict between Registered Nurses (RNs) has established that it happens regularly within the hospital setting, that it adversely affects the health and well-being of RNs, impacts the effective functioning of the health care organization, and compromises quality patient care. In this article, the phrase conflicting working relationships (CWRs) is used to represent working relationships between RN peers that are non-collegial, uncaring, and non- supportive, and inclusive of the behaviours associated with incivility, horizontal violence, and bullying, among others.

Purpose

To examine how nursing, including nursing knowledge and practice, is socially organized within the hospital setting and how this organization is linked to CWRs between RN peers.

Methods

Interviews were conducted with 17 RNs, followed by text analysis and mapping guided by institutional ethnography (IE) as the research methodology.

Results

The intersections between should nursing, double domination, and the big picture threads shows work environments where RNs struggle to provide appropriate care and conflict has become institutionalized. The intersection between threads can be used as caution areas for RNs and individuals in leadership positions to reflect on nursing practice when conflict is being experienced.

Conclusions

The contextual variables surrounding professional nursing practice are very influential with respect to how RNs relate to each other. A new type of dialogue about the organization of nursing practice in the hospital setting is needed to support more relational practices between RNs.

Pathological narcissism, interpersonal cognitive distortions, and workplace bullying among nurses: A cross-sectional study

AIM

The aim of this work is to examine whether nurses' pathological narcissism and interpersonal cognitive distortions predict workplace bullying when controlling for organizational culture, work-related factors, and demographic variables.

BACKGROUND

To eradicate workplace bullying, a multifaceted holistic approach to identify potential predictors is needed. Nurses' narcissistic behaviours negatively affect collegial relationships and the organization. Furthermore, interpersonal cognitive distortions have been demonstrated to directly affect bullying and victimization.

METHODS

Responses from 236 nurses to an online survey were analysed. The Pathological Narcissism Inventory, Interpersonal Cognitive Distortions Scale, Positive Nursing Organizational Culture Measurement Tool, and The Negative Acts Questionnaire-Revised were used to measure the key variables.

RESULTS

A multiple regression analysis revealed that pathological narcissism (β = .33, p < .001) had the greatest effect on nurses' workplace bullying, followed by positive organizational culture (β = -.31, p < .001), interpersonal cognitive distortions (β = .17, p = .028), marital status (β = -.15, p = .020), and position (β = -.12, p = .047).

CONCLUSIONS

Although prejudice or stigma surrounding narcissistic personalities should be avoided, nurses should be aware of and manage such characteristics so that they do not become a factor in workplace bullying.

IMPLICATIONS FOR NURSING MANAGEMENT

There is a need to protect nurses from workplace bullying and create a positive organizational culture by recognizing narcissistic traits and preparing intervention strategies that support improvement.

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

BACKGROUND

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

METHODS

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

RESULTS

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

DISCUSSION

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

Strengthening a Culture to Address Bullying and Incivility in the Care Environment

The safety of our patients and our workforce is paramount to elevating the health and wellness of the global communities we serve. The health and well-being of our frontline staff directly influences the environment of care, and it is our job as healthcare leaders to address workplace bullying, incivility, and lateral and horizontal violence. From patient to provider violence, to peer-peer bullying, these acts of incivility erode at the core of the care environment and impact an organization's culture of safety, influence nursing engagement scores, negatively impact patient outcomes, and decrease overall retention. Magnet® organizations help to elevate the practice of nursing and ensure world-class interprofessional care. Therefore, the Commission on Magnet has included new language in the 2023 Magnet Application Manual in the Organizational Overview (OO7), which directly addresses the organization's structure and processes aimed at addressing workplace violence, bullying, and incivility.

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

PROBLEM

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

AIM

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

METHODS

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

FINDINGS

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

CONCLUSIONS

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

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.

The impact of horizontal violence on the individual nurse: A qualitative research study

AIM

Horizontal violence (HV) is a familiar term used in nursing. Certain populations of nurses are more susceptible to HV than others. Graduate nurses (nurses within their first 12 months of practice) are widely considered a vulnerable population in the profession and thus more at risk for HV. The purpose of this qualitative study was to explore how HV affects graduate nurses (GNs).

DESIGN

Inductive thematic analysis was used in the design of this study.

METHODS

Participants included eight Canadian GNs or Registered Nurses (RNs), all of whom had experience with HV in their first 12 months of practice. Data collection was done via one-on-one interviews.

RESULTS

Two main themes were revealed from the data collected - Toxic Nursing Culture and Fear. Several subthemes were also identified - cycle of violence, nurses eating their young, shame, drowning, isolation and vulnerability. The findings indicate that HV is prevalent in the first year of practice and is destructive to the mental health of the individual nurse. Horizontal violence poses a serious challenge for GNs entering nursing and is often touted as the reason new nurses leave the profession altogether.

CONCLUSION

This study highlighted the personal and professional challenges that are heightened for a GN when they experience HV in their first year of practice. These experiences emphasize the impact that HV can have on the mental health of nurses and their ability to deliver safe patient care.