Workplace incivility, lateral violence and bullying among nurses. A review about their prevalence and related factors

Exploring the dark side of informal mentoring: Experiences of nurses and midwives working in hospital settings in Uganda

Mentoring literature explores the dark side of mentoring as factors such as gender and race and how they affect the overall mentoring experience. The sociocultural context of the nursing and midwifery professions presents unique characteristics warranting a qualitative exploration of negative mentoring experiences. We aimed to characterise the dark side of mentoring based on informal mentoring relationships occurring among nurses and midwives working in hospitals. Utilising semistructured interviews in a qualitative descriptive design and reflexive thematic analysis, we examined the perceptions of 35 nurses and midwives from three public hospitals located in the Western, Northern and North-western regions of Uganda. Findings emerged in four overarching themes mentoring process deficits, mentoring relational problems, organisational challenges in mentoring and implications of negative mentoring experiences. Our study findings underscore that, while mentoring is frequently beneficial, it can also be interspersed with negative experiences arising from relational dynamics, particular mentoring processes and the overarching hospital environment. Notably, nurses and midwives actively transformed these challenges into opportunities for growth and self-improvement, while introspectively examining their roles in contributing to these negative experiences. Such a proactive approach highlights their resilience and steadfast commitment to professional development, even in the face of adversity.

Assessing Workplace Violence: Methodological Considerations

The risk of violence is present in all workplaces. It must be accurately assessed to establish prevention and protection measures tailored to the features of each situation. The risk management process requires compliance in a sequential order: 1) risk identification, 2) quantitative risk assessment, and 3) impact assessment. Gathering workers' experiences using lists, focus groups, or participatory ergonomics groups is necessary to identify the phenomenon. For risk assessment, spontaneous reporting of events is often insufficient. It may be complemented with two methods: systematic recording of violent events that occurred in the past year during periodic medical examinations of workers and targeted surveys. The epidemiological analysis of data from individual interviews and surveys provides the phenomenon's prevalence, incidence, and evolution. Moreover, reporting the harm suffered by victims of violence allows constructing impact matrices to allocate resources where they are most needed.

Prevalence and Impact of Workplace Bullying among Pharmacy Practice Faculty in the United States

Objective: To identify the prevalence and impact of workplace bullying among pharmacy practice faculty in the United States. Methods: Members of the Pharmacy Practice section of the American Association of Colleges of Pharmacy were invited to complete an online survey about the frequency with which they experienced negative workplace behaviors in the communication, humiliation, manipulation, discrimination, and violence domains as well as workplace bullying in the previous 12 months. Independent t-tests and chi-squared tests were used to investigate associations between workplace bullying and pharmacy practice faculty demographic and employment characteristics. Results: Participants (n=256) reported a median of 6 negative behaviors in the workplace, most often in the communication and humiliation domains. A total of 50 (19.5%) reported experiencing workplace bullying. The most common impacts of workplace bullying included increasing their stress level (n=44/49, 89.8%), negative effects on their emotional health (n=42/49, 85.7%), and job dissatisfaction (n=40/49, 81.6%). Female participants more frequently reported workplace bullying (n=43/196, 21.9%) compared to male participants (n=4/56, 7.1%; p=0.012). Individuals who identified as white were less likely to report workplace bullying (n=40/233, 17.2%) compared to individuals of all other races (n=8/19, 42.1%; p=0.008). Conclusion: Most pharmacy practice faculty reported experiencing some degree of negative workplace behaviors during the past 12 months. Additional strategies are needed to create inclusive work environments with transparent, actionable policies when workplace bullying occurs.

Socializing into a Profession with High Early Turnover: Nursing Students' Expectations for Leader-Member Relationships

The nursing profession is wrought with high levels of turnover, particularly among new nurses. One reason for this turnover may be explained by a disparity between what new nurses expect in terms of communication from leaders and coworkers and what they realistically receive. This study uses a mixed-methods experimental design to explore young adult nursing students' preferences for manager communication behaviors, how different managerial archetypes influence nursing students' perceptions of their leader, and how personal factors may influence nursing students' preferences for various managerial styles. Findings suggest that new nurses prefer more mentor- and teacher-type managers and that managerial archetypes influence young adult nursing students' perceptions of leader credibility, effectiveness, leader-member exchange, and employee commitment. Furthermore, personal factors such as self-worth and desire for relational communication behaviors influence preferred manager type. Participants' qualitative responses reveal several task and behavioral wants and needs of new nurses. Findings from this study can informatively help to bridge the gap between expectations and reality in the nursing profession, thus addressing a potential reason for consistent turnover.

The Relationship between Bullying and Emotional State among Undergraduate Nursing Students: A Cross-Sectional Correlation Study

Introduction

Bullying behavior by nursing students is a serious problem that has contributed to the drop in numbers in the nursing profession.

Aim

The study investigated the relationship between bullying and the emotional state of undergraduate nursing students.

Methods

The study used a cross-sectional correlation design with a sample of 286 undergraduate nursing students from multiple nursing colleges located in the western region of Saudi Arabia. The 21-item depression, anxiety, and stress scale (DASS-21) was used to measure the study outcomes. A revised version of the Bullying Assessment Questionnaire was used to assess bullying experiences. Statistical analyses, including a t-test, Pearson correlation coefficient, and a one-way between-subjects ANOVA, determined the significance of the relationship between study variables.

Results

There was a high prevalence of depression, anxiety, and stress symptoms among Saudi nursing students. Most of the respondents reported mild to extremely severe symptoms of depression (58.7%), anxiety (58%), and stress (44.8%). Around 90.1% of the nursing students reported exposure to a form of bullying over the previous 12 months. The most common items reported as part of this behavior included continually being assigned tasks beyond their capacity. Family members were the most frequently reported source of bullying (29.8%), followed by nursing faculties (20.9%). Bullying behavior was positively correlated with students' scores for depression, r (284) = 0.49, n = 286, p < 0.01; anxiety, r (284) = 0.54, p < 0.01; and stress, r (284) = 0.56, p < 0.01.

Conclusion

The study's findings raise concerns and highlight the importance of decreasing the risk of depression, anxiety, and stress among undergraduate nursing students. Nurse educators must ensure that students receive psychological support to decrease these psychological outcomes. Regularly monitoring bullying behavior is essential to maintain students' psychological stability, which could eventually reduce professional dropout rates.

Enhancing Respiratory Therapists' Well-Being: Battling Burnout in Respiratory Care

Burnout is a major problem in health care and is associated with adverse sequelae for patients, health care workers, and organizations. Burnout among respiratory therapists (RTs) is as high as 79% and is associated with poor or ineffective leadership, inadequate staffing, high work load, non-leadership position, and work environment. An understanding of burnout is necessary for both staff and leadership to ensure RT well-being. This narrative review will discuss the psychology of burnout, prevalence, drivers, mitigation strategies, and future directions for research.

Prevalence of psychological symptoms and associated risk factors among nurses in 30 provinces during the COVID-19 pandemic in China

BACKGROUND

With the outbreak of the coronavirus disease 2019 (COVID-19), nurses have won well-deserved recognition for their indispensable roles in providing humane and professional healthcare for patients. However, by the nature of their role working at the forefront of patient care, nurses are prone to experiencing mental health consequences. Therefore, we pay attention to measuring the magnitude of psychological symptoms and identifying associated factors among nurses in China.

METHODS

We launched a nationwide, cross-sectional survey of nurses who worked in secondary or tertiary hospitals and public or private hospitals from 30 provinces in China. The prevalence and severity of symptoms of burnout, depression, and anxiety were investigated, respectively. Multivariable logistic regression analyses were performed to identify factors associated with each psychological symptom.

FINDINGS

A total of 138 279 respondents who worked in 243 hospitals completed this survey. A substantial proportion of nurses reported symptoms of burnout (34%), depression (55·5%), and anxiety (41·8%). In line with the disproportionality of economic development, we noted that the middle or western region was an independent risk factor for depression and anxiety. Compared with those working in the secondary hospital, nurses who worked in tertiary hospitals were associated with a higher likelihood of burnout and depression.

INTERPRETATION

Nurses are experiencing emotional, physical, and mental exhaustion during the COVID-19 epidemic. Governments and health policymakers need to draw attention to reinforcing prevention and ameliorating countermeasures to safeguard nurses' health.

FUNDING

The strategic consulting project of the Chinese Academy of Engineering [2021-32-5]. Advanced Institute of Infomation Technology, Peking University, Zhejiang Province [2020-Z-17].

Psychological workplace violence and its influence on professional commitment among nursing interns in China: A multicenter cross-sectional study

Background

Psychological workplace violence (WPV) is the primary form of workplace violence suffered by nursing interns. Psychological WPV not only damages the physical and mental health of nursing interns, but also has a negative impact on their work quality and career choice.

Aim

To investigate the characteristics and types of psychological WPV suffered by nursing interns in China, analyze the influencing factors of psychological WPV among nursing interns, and explore the influence of psychological WPV on the professional commitment of nursing interns.

Methods

The subjects were 1,095 nursing interns from 14 medical colleges in Shandong Province. The data were collected electronically using the psychological WPV against nursing interns questionnaire and the professional commitment scale of nursing. The frequency and component ratio were used to describe the incidence and characteristics of psychological WPV. Binary logistic regression was used to analyze the influencing factors of psychological WPV, and linear regression investigated the influence of psychological WPV on the professional commitment of nursing interns.

Results

In the study, 45.0% (n = 493) of nursing interns suffered at least one incidence of psychological WPV during clinical practice, mainly discrimination and verbal abuse. Patients and their relatives were the main perpetrators of psychological WPV. Discrimination and lack of trust were the two main reasons behind psychological WPV. Furthermore, 75.9% of psychological WPV incidents were not effectively reported. Logistic regression showed that clinical internship duration, place of family residence, and hospital level were the influencing factors of psychological WPV among nursing interns. Linear regression results showed that psychological WPV had a negative effect on nursing interns' professional commitment.

Conclusion

Psychological WPV against nursing interns is highly prevalent in China, negatively impacting their professional commitment. It is suggested that colleges should introduce courses for nursing interns to understand and cope with psychological WPV before entering clinical practice, and hospitals should establish a mechanism to prevent, cope with, report, and deal with psychological WPV to effectively reduce the incidence of psychological WPV against nursing interns, improve their ability to cope with psychological WPV, and enhance their professional commitment.

Association between horizontal violence and turnover intention in nurses: A systematic review and meta-analysis

Background

Horizontal violence is common in nurses. Most published studies have focused on horizontal violence and higher turnover rates in nurses; however, it lacks systematic reviews and meta-analyses. The purpose of this review is to quantitatively assess the correlation between horizontal violence and turnover intention in nurses.

Methods

Systematic review and meta-analysis were performed in accordance with PRISMA guidelines. The relationship between horizontal violence and turnover intention in nurses was obtained by systematically searching related literature in four English databases (Cochrane, PubMed, Embase, and CINAHL) and three Chinese databases (SinoMed, CNKI, and Wanfang) (up to 6 March 2022). The relationship between horizontal violence and turnover intention was evaluated using Fisher's z-value, which was then converted to r. STATA 16.0 was used to perform statistical analysis. The random-effects model was performed to synthesize data.

Results

A total of 14 studies with 6,472 nurses were included. A low-positive correlation of horizontal violence with turnover intention was found (pooled r=0.32 [0.29-0.34]). Subgroup analysis showed that sample size and quality were not the source of heterogeneity. Measurement tool was the source of heterogeneity. Although geographic region might not be the source of heterogeneity, further subgroup analysis of the country reveals heterogeneity. The funnel plot and Egger's test showed no publication bias.

Conclusion

Horizontal violence had a low positive correlation with turnover intention in nurses. Nurses who experienced horizontal violence were more likely to leave or change careers than those who did not experience horizontal violence. This finding helps to draw attention to horizontal violence by nursing managers and implement effective interventions for nurses, so as to reduce nurses' turnover.

Conflict at Work Impairs Physiological Recovery during Sleep: A Daily Diary Study

Sleep plays an essential role in maintaining employees' health and well-being. However, stressors, such as conflict at work, may interfere with employees' sleep. Drawing on previous literature on the relationship between conflict at work and sleep outcomes, we proposed a negative relationship between daily conflict at work and physiological changes during early sleep, particularly nocturnal heart rate variability (HRV). Furthermore, building on the perseverative cognition hypothesis, we proposed that daily work-related rumination mediates the relationship between conflict at work and nocturnal HRV. Ninety-three healthcare employees participated in a daily diary study for five workdays, resulting in 419 observations. Multilevel analysis revealed a significant relationship between daily conflict at work and nocturnal HRV, specifically high-frequency (HF) power. Daily conflict at work was found to predict rumination; however, rumination did not significantly predict nocturnal HRV. Our results suggest that daily conflict at work increases rumination during the off-job time and may directly alter nocturnal HRV, specifically parasympathetic function in early sleep.

Nurse-to-nurse horizontal violence in Chinese hospitals and the protective role of head nurse's caring and nurses' group behaviour on it: A cross-sectional study

AIMS

This study aimed to analyse the prevalence of nurse-to-nurse horizontal violence in Chinese hospitals and examine the effects of head nurse's caring and nurse's group behaviour on horizontal violence.

BACKGROUND

Horizontal violence is a serious global problem affecting the nursing profession, but little is known of the issue in Chinese hospitals. Increasing evidence has showed that leadership and group factors are important in facilitating horizontal violence. Whether the head nurse's caring and group behaviour perceived by nurses has protective effects against horizontal violence remains unclear.

METHODS

A cross-sectional online-based questionnaire study was performed in seven general hospitals in Hubei Province, China. Data related to the demographic information, horizontal violence, head nurse's caring and group behaviour were collected. Descriptive analyses, chi-squared tests and logistic regression were used for data analysis.

RESULTS

In total, 1942 valid questionnaires were collected, with a 92.70% effective response rate (1942/2095). Of those, 59.1% (1148/1942) of respondents had experienced horizontal violence at least once in the previous 6 months. Covert negative behaviours were more frequently reported. Compared with the low level, moderate and high levels of the head nurse's caring showed a lower risk of horizontal violence (odds ratio [OR] = 0.400, p < .001; OR = 0.128, p < .001); moderate and high levels of group behaviour also showed a reduced risk (OR = 0.601, p < .001; OR = 0.221, p < .001).

CONCLUSION

Horizontal violence is common among Chinese nurses. The head nurse's caring and maintaining a good climate of nurses' group behaviours could serve as protective factors for preventing horizontal violence.

IMPLICATIONS FOR NURSING MANAGEMENT

This study helps nursing managers identify which specific negative behaviours occur frequently and require special attention. It suggests that nursing managers attach importance to improving their caring ability towards nurses and to creating an amicable climate of group behaviour to buffer against horizontal violence.

Psychological stress responses of medical staff after workplace violence: a longitudinal study

OBJECTIVE

To explore the occurrence and dynamic trends of psychological stress responses of medical staff experiencing workplace violence at different time points.

METHODS

A longitudinal study of 23 medical workers who experienced workplace violence was conducted. The perceived stress scale (PSS-4), posttraumatic stress disorder checklist for DSM-5 (PCL-5), and hospital anxiety and depression scale (HADS) were used to measure the medical workers' psychological perception of pressure, posttraumatic stress symptoms, anxiety, and depression at the time of exposure to violence, at 1 month, 2 months, and 4 months after exposure in the workplace, respectively. Repeated measures analysis of variance was applied to analyze psychological stress response and temporal effect. Factors influencing psychological stress responses were analyzed.

RESULTS

The scores of PSS-4, PCL-5, HADS-anxiety, and HADS-depression of medical staff exposed to violence began to increase at the time of exposure, peaked 1 month after exposure, and gradually decreased 2 months and 4 months after exposure (all P<0.05). The main influencing factors were being nurses, physical violence, working years ≤5, and being female.

CONCLUSION

Effective interventions for medical staff should be made up to 1 month after exposure to workplace violence when the psychological stress responses are the highest.

Job demands, job resources, and health outcomes among nursing professionals in private and public healthcare sectors in Sweden - a prospective study

BACKGROUND

Nursing professionals exhibit high prevalence of stress-related health problems. Job demands and job resources are parallel drivers of health and well-being among employees. Better job resources associate with better job satisfaction, job motivation and engagement even when job demands are high. To date, there is limited research which explores the association between job demands, job resources and health outcomes among nursing professionals in the Swedish context. The aim of this study was therefore to investigate Swedish nursing professionals' job demands and job resources in relation to health outcomes, with comparisons between the private and public healthcare sectors. The specific research questions were as follows: (1) Are there differences between private and public healthcare regarding job demands, job resources, and health outcomes? and (2) Are there prospective associations between job demands and job resources in relation to health outcomes?

METHODS

Data were drawn from the Swedish Longitudinal Occupational Survey of Health (SLOSH) 2016 and 2018, including 520 nurses and 544 assistant nurses working in the private and public healthcare sectors from 2016 (baseline). Data were analyzed using binary logistic regression.

RESULTS

Nursing professionals reported higher threats, lower bullying, lower control, lower social support, and lower cohesion in the public healthcare units compared to the private healthcare units. The prospective analyses showed that job resources in terms of social support and rewards were associated with higher self-rated health and lower burnout. Cohesion was associated with higher self-rated health. Job demands in terms of psychological demands and job efforts were associated with lower self-rated health, higher burnout, and higher sickness absence, while emotional demands were associated with higher burnout.

CONCLUSIONS

Nursing professionals' job resources are deficient in public healthcare units. Job resources are associated with positive health outcomes, whereas job demands are associated with negative health outcomes, among nursing professionals. Strengthening job resources among nursing professionals in the private and public healthcare sectors can promote and sustain their work-related health.

Registered Nurses' Experiences With Incivility During the Early Phase of COVID-19 Pandemic: Results of a Multi-State Survey

BACKGROUND

Incivility among workers in the health sector is recognized as an occupational hazard. The COVID-19 outbreak brought sudden and profound changes to many health care settings, many of which have been identified as antecedents to workplace incivility. The purpose of this retrospective study was to explore the experiences of registered nurses with workplace incivility, cyber-incivility, and incivility outside of work during the early phase of the COVID-19 pandemic.

METHODS

This mixed-methods study used convenience sampling. Data were collected from June to September 2020 via an online survey, which consisted of both closed- and open-ended questions. Participants were recruited from national nursing organizations and unions. Data were analyzed using descriptive statistics and thematic analysis for open-ended responses.

FINDINGS

A total of 526 nurses' responses were included in the analysis. More than one third experienced greater incivility at work during the COVID-19 outbreak than before the pandemic (37.4%), and almost half (45.7%) said they witnessed more incivility than before the pandemic. Cyber-incivility and incivility outside of work were also issues. Qualitative results indicated that respondents felt they were on edge during this period. Other themes included leadership failure, fractured co-worker relationships, heightened incivility from patients and families, and hostility and ostracism from the general public.

CONCLUSION/APPLICATION TO PRACTICE

Occupational health nurses, nursing leaders, and staff nurses need to work to restore relations that were fractured by incivility during the pandemic. In the future, improved preparedness, including establishing clear channels of communication, may lessen incivility by decreasing role stress and organizational chaos.

Gender Differences in the Relationship Between Workplace Civility and Burnout Among VA Primary Care Providers

BACKGROUND

Civility, or politeness, is an important part of the healthcare workplace, and its absence can lead to healthcare provider and staff burnout. Lack of civility is well-documented among mostly female nurses, but is not well-described among the gender-mixed primary care provider (PCP) workforce. Understanding civility and its relationship to burnout among male and female PCPs could help lead to tailored interventions to improve civility and reduce burnout in primary care.

OBJECTIVE

To analyze gender differences in civility, burnout, and the relationship between civility and burnout among male and female PCPs.

DESIGN

Multi-level logistic regression analysis of a cross-sectional national survey.

PARTICIPANTS

A total of 3216 PCP respondents (1946 women and 1270 men) in 135 medical centers from a 2019 national Veterans Health Administration (VA) survey.

MAIN MEASURES

Outcomes: burnout; predictors: workplace civility and gender; controls: race, ethnicity, VA tenure, and supervisory status.

KEY RESULTS

Workplace civility was rated higher (p<0.001) among male (mean = 4.07, standard deviation [SD] = 0.36, range 1-5) compared to female (mean = 3.88, SD = 0.33) PCPs. Almost half of the sample reported burnout (47.6%), but this difference was not significant (p = 0.73) between the genders. Higher workplace civility was significantly related to lower burnout among female PCPs (odds ratio [OR] = 0.46, 95% confidence interval [CI] = 0.31 to 0.69), but not among male PCPs (OR = 0.71, 95% CI = 0.42 to 1.22). Interactions between civility and other demographic variables (race, ethnicity, VA tenure, or supervisory status) were not significantly related to burnout.

CONCLUSION

Female PCPs report lower workplace civility than male PCPs. An inverse relationship between civility and burnout is present for women but not men. More research is needed on this phenomenon. Interventions tailored to gender- and primary care-specific needs should be employed to increase civility and reduce burnout among PCPs.

Self-Sacrifice in a Distressful and Threatening Environment: The Consequences of the COVID-19 Crisis in Intensifying Workplace Violence

BACKGROUND

The stress and mental pressure resulting from the challenges posed by the COVID-19 crisis exacerbated occupational stressors such as workplace violence against nurses even though nurses were endangering their lives to provide high-quality care and reduce patients' suffering. Therefore, the present study aimed to explain Iranian nurses' experiences of workplace violence during the COVID-19 crisis.

MATERIALS AND METHODS

This study was conducted using a qualitative approach. Twenty-five semi-structured interviews were conducted with nurses who had experienced workplace violence at COVID-19 referral centers in Kerman during the COVID-19 crisis. Conventional content analysis was used to analyze the data, and the research was reported via the COREQ checklist.

RESULTS

Analysis of the findings led to one main category, "nurses' self-sacrifice in a distressful and threatening environment," and four subcategories, which included "omitting entertainment and fun activities," "having challenging duties in unsafe conditions," "receiving insufficient support," and "nurses' toleration of disrespect."

CONCLUSION

Crises can exacerbate workplace violence toward nurses. Thus, it is necessary to design educational programs and prevention strategies to manage the destructive psychological and occupational impact of the crises on nurses. Nurses should receive training in crisis management to cope with the intensified aggressive behavior of managers, colleagues, patients, and patient companions during the crisis. Policy-makers must be prepared to deal with crises, and they should take measures to improve nurses' mental health and quality of care.

Factor Analysis of Iranian Version of Nursing Students' Incivility Questionnaire

Background:

Uncivil student behavior is one of the challenging issues in the nursing schools that disrupts the learning process and teacher-student interactions. Planning to control student's incivility requires knowing the condition using valid tools. The purpose of this study was to investigate the validity and reliability of the incivility occurrence's questionnaire among Iranian students.

Materials and Methods:

This methodological study was conducted on 358 nursing students and 122 nursing faculty members. The samples were selected from the nursing students of second to fourth year from September to October 2019. McDonald's omega, Cronbach's alpha coefficients and composite reliability were calculated. Exploratory and confirmatory factor analysis were used to investigate the construct validity of tool.

Results:

Content validity index was 0.94 for the whole instrument. In factor analysis, three factors of irresponsible, violent, and unsound behaviors were identified. These factors explained more than 50.52% of the variance. Model fit indices Parsimonious Normed Fit Index) = 0.74, Root Mean Square Error of Approximation = 0.05, Parsimonious Comparative Fit Index = 0.78, Goodness-of-Fit Index = 0.92, Comparative Fit Index ( CFI) = 0.92, Adjusted Goodness-of-Fit Index) = 0.89, CIMN=2.58) indicated the proportion of factors. Internal consistency was 0.77 to 0.89.

Conclusions:

This questionnaire is a three-dimensional tool with appropriate validity and reliability that can be used to evaluate occurrence rate of nursing student incivility in Iran.

A Systematic Review of Negative Work Behavior: Toward an Integrated Definition

The objective of this systematic review was to identify the overlapping and unique aspects of the operationalizations of negative work behaviors (NWBs) to specify a new integrative definition of NWB. More specifically, we examined (1) how many operationalizations and conceptualizations of NWB can be identified, (2) whether these operationalizations can be categorized into facets, i. e., the nature of NWB, harm, actor types, and roles, with subcategories, (3) what the meaningful overlap in these operationalizations was, (4) whether the operationalizations tapped unique and meaningful elements, i.e., positive labels and dynamic processes, and (5) how the overlapping and unique elements of the operationalizations could be integrated into a new theory-based research model for NWB for future research. In the literature search based on the Prisma framework, Pubmed, PsycINFO, and Google Scholar, we identified k = 489 studies that met the inclusion criteria of our review. The results of these studies revealed 16 frequently studied NWB labels, e.g., bullying and aggression. Many of these could be categorized in the same way, namely, in terms of the type of behavior, type of harm, and type of actor involved in the NWB. In our new definition of NWB, we integrated the content of the overlapping and meaningful unique elements of the 16 labels.

Tough Love Lessons: Lateral Violence among Hospital Nurses

Background: Workplace violence is a growing social problem among many professions, but it particularly affects the health sector. Studies have mainly focused on evaluating user violence toward health professionals, with less attention being paid to other sources of conflict, such as co-workers themselves. There are different manifestations of this violence in what has been called a context of tolerated or normalized violence among co-workers. However, its effects are far from being tolerable, as they have an impact on general health and job satisfaction and contribute to burnout among professionals. Based on this idea, and following the line of the previous literature, nursing staff are a population at high risk of exposure to workplace violence. For this reason, the present study aims to evaluate exposure to lateral violence or violence among co-workers in nursing staff in public health services and the relationship of this exposure with some of the most studied consequences. (2) Methods: A cross-sectional associative study was carried out in which scales of workplace violence (HABS-CS), burnout (MBI-GS), job satisfaction (OJS), and general health (GHQ-28) were applied to a sample of 950 nursing staff from 13 public hospitals located in the southeast of Spain. (3) Results: The results show that nursing staff have a high exposure to violence from their co-workers, which is more common in male nurses. Greater exposure is observed in professionals with between 6 and 10 years of experience in the profession, and it is not characteristic of our sample to receive greater violence when they have less experience or are younger. A positive correlation is observed with high levels of burnout and a negative correlation with general health and job satisfaction. (4) Conclusions: The results of this work contribute to increasing the scientific evidence of the consequences of a type of workplace violence frequent among nursing staff and to which less attention has been paid in relative terms to other types of prevalent violence. Organizations should be aware of the importance of this type of workplace violence, its frequency and impact, and implement appropriate prevention policies that include the promotion of a culture that does not reward violence or minimize reporting. A change of mentality in the academic environment is also recommended in order to promote a more adequate training of nursing staff in this field.

Beyond workplace violence: Direct and vicarious trauma among psychiatric hospital workers. A qualitative study

AIM

We aimed to explore psychiatric nurses' and other psychiatric workers' understanding of trauma in the context of their relationships with the people they care for and the effects on their mental health.

BACKGROUND

Workplace violence in psychiatric hospitals can lead to mental health problems, including posttraumatic stress disorder. Professional relationships with the people they care for may complicate psychiatric workers' experiences of trauma.

METHODS

We qualitatively analysed responses of 30 psychiatric workers who answered relevant open-ended questions in a survey of workplace violence and posttraumatic stress disorder symptoms.

RESULTS

We found that respondents were profoundly affected by violence and vicarious trauma through the current and previous suffering of people in their care. The effects of vicarious exposure and other potentially psychologically traumatic events were often made worse by lack of organizational support.

CONCLUSION

Not only direct exposure to violent events but also indirect exposure, vicarious traumatic stress and perceived lack of organizational support affect staff's well-being.

IMPLICATIONS FOR NURSING MANAGEMENT

Management should ensure that mental health supports are not limited to workers directly affected by workplace violence but should extend to those who witnessed the event and to those regularly exposed to vicarious trauma.

"You Need to Get Over the Difficulties and Stand Up Again"-A Qualitative Inquiry into Young Nurses' Coping with Lateral Violence from the Feminist Perspective

Previous studies have reported lateral violence (LV) styles among nurses and the adverse impacts of LV on nurses and nursing. Young nurses, including nursing students and novice nurses, are often victims of LV. A large qualitative research study that contained three sub-studies exploring professional identity development in different professional stages was conducted by a research team in Macau, Special Administrative Region of China. Semi-structured interviews with nursing students and clinical nurses were carried out; among the 58 participants in the three sub-studies, 20 described some forms of LV and their ways of dealing with them. Framed by the feminist perspective, the researchers explored young nurses’ coping strategies in dealing with LV perpetrated by senior colleagues. Two themes were developed reflecting the coping strategies for LV: “making extra efforts” and “soothing emotional distress”. Three sub-themes were under the theme of “making extra efforts”: “catching up knowledge”, “making the most use of learning resources”, “adjusting communication manner”; another batch of sub-themes was under the theme of “soothing emotional distress”: “seeking support from schoolmates”, “living with family but crying alone”, and “adjusting lifestyle”. The study implied that young nurses exerted their agency in coping with LV in clinical practices. Nursing managers and educators should support young nurses’ efforts in overcoming power-based LV and incivility.

The role of colleague incivility in linking work-related stressors and job burnout. A cross-sectional study in a sample of faculty administrative employees

Background:

Colleague incivility is one of the subtlest forms of workplace aggression, referring to any low-intensity deviant behavior in violation of the norms of mutual respect with ambiguous intent to harm the target. Although a large corpus of literature has identified the negative consequences of colleague incivility for workers and their organizations, there is a paucity of studies aimed at examining the role played by job characteristics in triggering this form of aggression. The present study, referring to the work environment assumption of Einarsen (2000), proposes that workplace aggression is primarily affected by factors related to deficiencies in the psychosocial work environment. In this view, the present study aimed to test whether the relationships between stressors in the psychosocial work environment (i.e., workload, role conflict, and unfair reward) and burnout (i.e., exhaustion and cynicism) are mediated by colleague incivility.

Methods:

The study design was cross-sectional and non-randomized. In total, 659 administrative officers employed in a large-sized Italian university completed a self-report questionnaire. Regression and mediation analyses (using the SPSS PROCESS macro) were performed to test the study hypotheses.

Findings:

After adjusting for control variables (i.e., superior incivility, age, gender, interactions with teaching staff, and interactions with students), the analyses indicated that colleague incivility mediated the associations of role conflict and unfair reward with the two dimensions of burnout. In contrast, the mediating role of colleague incivility in the associations of workload with exhaustion and cynicism was not supported.

Discussion:

The present study shed light on the key role of colleague incivility in the linkage of variables describing job characteristics and job burnout. From a practical point of view, the present study suggests that in order to prevent colleague incivility, interventions such as job (re)design should be implemented.

Experience of Workplace Incivility and Its Impact on Stress and Turnover Intention among the Nurses Working at a Hospital: Cross-Sectional Survey Approach

Background:

Incivility in the workplace drowns the mental health of the nurses and hampers the daily routine. The majority of the nurses working at hospitals were experiencing incivility. It affects the physical and psychological health of the nurses. Experience of workplace incivility and its impact on stress and turnover among nurses was discussed in this study.

Materials and Methods:

Cross-sectional survey approach was used to select 50 nurses by simple random sampling technique. Standard scales for incivility, stress, and pre-tested scale for the turnover intention was used to collect the data.

Result:

Nurses experience incivility in their workplace almost from all the sources. The majority (64%) of the staff nurses had a moderate level of stress and 30% had average intention to leave the present job. There was a positive relationship found between the experience of incivility and stress (r = 0.43, p < 0.002), stress, and turnover intention (r = 0.40, p < 0.004).

Conclusions:

Experience of incivility provokes stress among the nurses, and this may influence turnover intention.

Association Between Workplace Bullying Occurrence and Trauma Symptoms Among Healthcare Professionals in Cyprus

Workplace bullying/mobbing is an extreme work-related stressor, but also a severe hazard for physical, mental and psychological health in healthcare employees, including nurses. A range of trauma-related symptoms has been linked with bullying victimization. The aim of the study was the investigation of workplace bullying/mobbing-related trauma symptoms in Greek-Cypriot nurses working in emergency and critical care settings, as well as of potential correlations with demographic and occupational variables. A descriptive, cross-sectional correlational study was performed in a convenience sample of 113 nurses. A modified version of the Part B.CII of The Workplace Violence in the Health Sector-Country Case Studies Research Instrument (WVHS-CCSRI Part C.II-M) and the modified Secondary Traumatic Stress Scale (STSS-M) were used for the assessment of bullying/mobbing frequency and workplace bullying/mobbing-related trauma symptoms, respectively. A total of 46.9% of the sample reported experiences of both bullying/mobbing victimization and witnessing of bullying/mobbing to others (VWB subgroup), 21.2% reported solely bullying/mobbing victimization (SVB subgroup) and 10.6% reported witnessing of bullying/mobbing to others (SWB subgroup). A total of 22.3% did not experience or witness any bullying/mobbing at the workplace. Trauma symptoms intensity (STSS-M total score) was more severe in the participants a) with a high frequency of workplace bullying/mobbing experiences compared to those with a moderate frequency of such experiences (p = 0.018), b) of the VWB subgroup compared to those of the SWB subgroup (p = 0.019), c) employed in Emergency Departments compared to those employed in ICUs (p = 0.03), d) who had considered resigning due to bullying/mobbing experiences compared to those who had never considered resigning (p = 0.008), e) who had been punished for reporting a bullying/mobbing incident compared to those who had not (p = 0.001), and f) who considered the incident unimportant to be reported compared to those who avoided reporting due to other causes (p = 0.048). This data highlights the need to establish effective and safe procedures for bullying/mobbing reporting, aiming to support bulling/mobbing victims and witnesses, and further to protect their legal rights. Both victims and witnesses of workplace bullying/mobbing need to be assessed by mental health professionals for PTSD symptoms in order to have access to effective treatment.

Predictors and triggers of incivility within healthcare teams: a systematic review of the literature

OBJECTIVES

To explore predictors and triggers of incivility in medical teams, defined as behaviours that violate norms of respect but whose intent to harm is ambiguous.

DESIGN

Systematic literature review of quantitative and qualitative empirical studies.

DATA SOURCES

Database searches according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline in Medline, CINHAL, PsychInfo, Web of Science and Embase up to January 2020.

ELIGIBILITY CRITERIA

Original empirical quantitative and qualitative studies focusing on predictors and triggers of incivilities in hospital healthcare teams, excluding psychiatric care.

DATA EXTRACTION AND SYNTHESIS

Of the 1397 publications screened, 53 were included (44 quantitative and 9 qualitative studies); publication date ranged from 2002 to January 2020.

RESULTS

Based on the Medical Education Research Study Quality Instrument (MERSQI) scores, the quality of the quantitative studies were relatively low overall (mean MERSQI score of 9.93), but quality of studies increased with publication year (r=0.52; p<0.001). Initiators of incivility were consistently described as having a difficult personality, yet few studies investigated their other characteristics and motivations. Results were mostly inconsistent regarding individual characteristics of targets of incivilities (eg, age, gender, ethnicity), but less experienced healthcare professionals were more exposed to incivility. In most studies, participants reported experiencing incivilities mainly within their own professional discipline (eg, nurse to nurse) rather than across disciplines (eg, physician to nurse). Evidence of specific medical specialties particularly affected by incivility was poor, with surgery as one of the most cited uncivil specialties. Finally, situational and cultural predictors of higher incivility levels included high workload, communication or coordination issues, patient safety concerns, lack of support and poor leadership.

CONCLUSIONS

Although a wide range of predictors and triggers of incivilities are reported in the literature, identifying characteristics of initiators and the targets of incivilities yielded inconsistent results. The use of diverse and high-quality methods is needed to explore the dynamic nature of situational and cultural triggers of incivility.

ANAMT Technical Guideline (DT 07): epidemiological mapping and preventive interventions against workplace violence

Workplace violence has potentially high prevalence, in addition to positive correlation with risk of physical and mental disorders, absenteeism, high turnover rates, impaired productivity and poorer organizational climate. Workplace violence is embedded in the work routine, while its manifestations are heterogeneous and vary according to the local culture, work activities and organization. The scientific evidence for the efficacy of interventions to reduce the prevalence of violent incidents is insufficient to ground general recommendations applicable to any occupational activity. Consensus among organizational actors about notions, relevance, prevalence and risk factors associated with workplace violence, based on epidemiological mappings, is necessary, given the subjective and cultural nature of this problem, and also to enable organizational actors to jointly design pilot solutions. This approach is based on methods used in experimental studies and seeks to promote greater adherence to changes.