Confronting Subtle Workplace Mistreatment: The Importance of Leaders as Allies

Workplace Bullying Experiences of Nurses From Diverse Sexual Orientation and Gender Identity Groups

AIM

To examine nurse workplace bullying relative to diverse sexual orientation and gender identity groups.

DESIGN

Observational cross-sectional study.

METHODS

Using an annual organisational satisfaction survey from 2022, we identified free-text comments provided by nurses (N = 25,337). We identified and themed comments for specific bullying content among unique respondents (n = 1432). We also examined close-ended questions that captured organisational constructs, such as job satisfaction and burnout. We looked at differences by comparing diverse sexual orientation and gender identity groups to the majority using both qualitative and quantitative data.

RESULTS

For the free-text comments, themed categories reflected the type of bullying, the perpetrator and perceived impact. Disrespect was the most frequent theme with supervisors being the primary perpetrator. The reported bullying themes and workplace perceptions differed between nurses in the diverse gender identity and sexual orientation group compared to other groups. Nurses who reported bullying also reported higher turnover intent, burnout, lower workplace civility, more dissatisfaction and lower self-authenticity.

CONCLUSION

Diverse sexual orientation and gender identity groups are understudied in the nurse bullying research, likely because of sensitivities around identification. Our design enabled anonymous assessment of these groups. We suggest practices to help alleviate and mitigate the prevalence of bullying in nursing.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

IMPACT

We examined differences in perceptions of nurse bullying between diverse sexual orientation and gender identity groups compared to majority groups. Group differences were found both for thematic qualitative content and workplace experience ratings with members of minority groups reporting less favourable workplace experiences. Nurse leaders and staff can benefit from learning about best practices to eliminate bullying among this population.

REPORTING METHOD

STROBE guidelines for cross-sectional observational studies.

Supporting diverse health leadership requires active listening, observing, learning and bystanding

Purpose

Fostering diversity in health leadership is imperative as that not only enhances the quality of health care itself, but improves an organization's effectiveness and responsiveness to address the needs of a diverse population. Inequitable structures entrenched in health care such as sexism, racism and settler colonialism undermine efforts made by women from diverse backgrounds to obtain leadership roles. This paper identifies leading practices which support diverse health leadership.

Design/methodology/approach

A multi-methodological approach involving a targeted published and gray literature search undertaken through both traditional means and a systematic social media search, focused particularly on Twitter. A literature and social media extraction tool was developed to review and curate more than 800 resources. Items chosen included those which best highlighted the barriers faced by diverse women and those sharing tools of how allies can best support the diverse women.

Findings

Four core promising practices that help to disrupt the status-quo of health leadership include (1) active listening to hear and amplify voices that have been marginalized, (2) active learning to respond to translation exhaustion, (3) active observing and noticing microaggressions and their consequences and (4) active bystanding and intervention.

Social implications

When implemented, these practices can help to dismantle racism, sexism, ableism and otherwise challenge the status-quo in health leadership.

Originality/value

This paper provides an original and value-added review of the published literature and social media analysis of heretofore disparate practices of allyship, all while amplifying the voices of health leaders from marginalized communities.

Prevalence of Discrimination, Abuse, and Harassment in Emergency Medicine Residency Training in the US

IMPORTANCE

The prevalence of workplace mistreatment and its association with the well-being of emergency medicine (EM) residents is unclear. More information about the sources of mistreatment might encourage residency leadership to develop and implement more effective strategies to improve professional well-being not only during residency but also throughout the physician's career.

OBJECTIVE

To examine the prevalence, types, and sources of perceived workplace mistreatment during training among EM residents in the US and the association between mistreatment and suicidal ideation.

DESIGN, SETTING, AND PARTICIPANTS

In this survey study conducted from February 25 to 29, 2020, all residents enrolled in EM residencies accredited by the Accreditation Council for Graduate Medical Education (ACGME) who participated in the 2020 American Board of Emergency Medicine computer-based In-training Examination were invited to participate. A multiple-choice, 35-item survey was administered after the examination asking residents to self-report the frequency, sources, and types of mistreatment experienced during residency training and whether they had suicidal thoughts.

MAIN OUTCOMES AND MEASURES

The types and frequency of workplace mistreatment and the sources of the mistreatment were identified, and rates of self-reported suicidality were obtained. Multivariable logistic regression models were used to examine resident and program characteristics associated with suicidal thoughts.

RESULTS

Of 8162 eligible EM residents, 7680 (94.1%) responded to at least 1 question on the survey; 6503 (79.7%) completed the survey in its entirety. A total of 243 ACGME-accredited residency programs participated, and 1 did not. The study cohort included 4768 male residents (62.1%), 2698 female residents (35.1%), 4919 non-Hispanic White residents (64.0%), 2620 residents from other racial/ethnic groups (Alaska Native, American Indian, Asian or Pacific Islander, African American, Mexican American, Native Hawaiian, Puerto Rican, other Hispanic, or mixed or other race) (34.1%), 483 residents who identified as lesbian, gay, bisexual, transgender, queer, or other (LGBTQ+) (6.3%), and 5951 residents who were married or in a relationship (77.5%). Of the total participants, 3463 (45.1%) reported exposure to some type of workplace mistreatment (eg, discrimination, abuse, or harassment) during the most recent academic year. A frequent source of mistreatment was identified as patients and/or patients' families; 1234 respondents (58.7%) reported gender discrimination, 867 (67.5%) racial discrimination, 282 (85.2%) physical abuse, and 723 (69.1%) sexual harassment from patients and/or family members. Suicidal thoughts occurring during the past year were reported by 178 residents (2.5%), with similar prevalence by gender (108 men [2.4%]; 59 women [2.4%]) and race/ethnicity (113 non-Hispanic White residents [2.4%]; 65 residents from other racial/ethnic groups [2.7%]).

CONCLUSIONS AND RELEVANCE

In this survey study, EM residents reported that workplace mistreatment occurred frequently. The findings suggest common sources of mistreatment for which educational interventions may be developed to help ensure resident wellness and career satisfaction.

Inadequate treatment in internships: a comparison between medical and other students

Aims: Inadequate treatment is one of the factors interfering with a successful social and working life. Among students, it can impair their health and learning progress. In the field of medicine the problem of inadequate treatment seems widespread. This study examines wether inadequate treatment in internships differs between medicine and other academic disciplines. Method: Using a questionnaire, the frequency, forms and severity of inadequate treatment among students were compared between the disciplines of medicine, civil engineering and teaching. Results: 69,3% of medical students reported inadequate treatment during their internships, about twice as many as students of other disciplines. The ratios of verbal, non-verbal and organisational inadequate treatment were similar between the different academic disciplines. However, medical students executed tasks without receiving sufficient safety precautions or training significantly more often (sevenfold) than students of other disciplines. In total however, the experienced incidents of inadequate treatment were seen as similarly severe across the different academic fields. Conclusion: Inadequate treatment of students during internships is a larger problem in medicine than in civil engineering or teaching, particularly concerning the performance of unsafe tasks. With regard to the health of students and patients, inadequate treatment in the medical education should be tackled. Previous studies suggest that this goal can be achieved only through longtime extensive measures on the level of students, lecturers, faculty and teaching hospitals.

'calling-out' vs. 'calling-in' prejudice: Confrontation style affects inferred motive and expected outcomes

Laypersons differentiate between two confrontations styles, varying in communication style, perceived motive, and typical context: call-outs (typically public, non-accommodating language, and self-promoting confronter) and call-ins (typically private, accommodating language, and education-focused confronter). Popular press espouses a general preference for call-ins relative to call-outs, but no empirical work has addressed perceptions of these confrontation styles. To investigate the presumed efficacy of these styles, we modelled communicative differences with Communication Accommodation Theory (CAT), which explores the strategies individuals use to modulate communicative differences with interaction partners. The present studies examined third-party perceptions of confronter motive and likely outcomes between call-in and call-out styles (Study 1) and between typical private and atypical public styles (Study 2) about an anti-Black comment. We examined responses of participants who imagined themselves taking part in public vs. private call-in and call-out confrontations (Study 3). Results showed that these styles are seen as similarly effective in terms of target compliance and internalization, but as operating through different mechanisms. Specifically, call-in styles facilitated positive inferences of motive, which fostered expectations of positive confrontation outcomes. Additionally, the effects of communication style superseded the impact of context. Results have implications for strategies allies can use to facilitate effective, educational confrontations of prejudice.

Modern Discrimination in Organizations

This review describes the history, current state, and future of modern discrimination in organizations. First, we review development of discrimination from the early 1900s to the present day, specifically discussing various stigmatized identities, including gender, race, sexual orientation, religion, disability, weight, and age. Next, we describe both individual-level (e.g., identity management, allyship) and organization-level (e.g., training, norm setting) strategies for reducing and reacting to discrimination. Finally, we describe future research directions in the relationship between subtle and overt discrimination, intersectionality, the impact of social media, and cross-cultural considerations—areas that we suggest would help us gain a more comprehensive understanding of modern discrimination.

Investigating Ostracism and Racial Microaggressions Toward Afro-Brazilians

We examined two forms of social exclusion toward Afro-Brazilians commonly found in the United States, ostracism and racial microaggressions. We utilized a mixed-method (quantitative-experimental and qualitative) approach to investigate ostracism and a qualitative focus group approach to study racial microaggressions. In Study 1 ( n = 29), we experimentally investigated ostracism through a recall paradigm in which participants wrote about being either included or ostracized. An independent t test showed that participants in the ostracized condition reported significantly worse psychological outcomes than those in the included condition ( p < .001). We coded participants’ written responses by whether they included attributions of racial bias by experimental condition. A Pearson chi-square analysis ( p = .017) revealed that racial bias was mentioned in 75% of the cases in the ostracized condition. Studies 2a and 2b ( ns = 6 and 8, respectively) consisted of two focus groups in different regions of Brazil that asked participants about their experiences with racial microaggressions. We found similarities to previous microaggression categories identified in the United States, extending our understanding of how microaggressions evoke feelings of social exclusion, which also occur when someone is ostracized.

Surface Acting, Emotional Exhaustion, and Employee Sabotage to Customers: Moderating Roles of Quality of Social Exchanges

Using the conservation of resources theory and social exchange theory as our conceptual frameworks, the current study examined how employee surface acting relates to their sabotage to customers through the mediating role of emotional exhaustion and explored the moderating roles of coworker exchange (CWX) and leader-member exchange (LMX). We collected two-wave time-lagged data from 540 clinical nurses and found that emotional exhaustion mediated the positive relationship between surface acting and employee sabotage to customers. In addition, we found that CWX buffered the positive effect of surface acting on emotional exhaustion, while LMX buffered the positive effect of emotional exhaustion on employee sabotage to customers, such that the effects were weaker when CWX and LMX were higher, respectively. These findings shed light on the effect of surface acting on employee harmful behaviors, the potential underlying mechanism, and boundary conditions to mitigate the negative consequences of surface acting.