Workplace Incivility and Turnover Intention in Organizations: A Meta-Analytic Review

Experiences with Negative Behavior and Incivility: Perspectives of Unlicensed Assistive Personnel and Registered Nurses

Healthcare professionals experience negative behaviors such as incivility from various sources within the hospital environment. However, little is known regarding the experience of unlicensed assistive personnel with these behaviors. Using a cross-sectional survey design, the research team aimed to examine the presence, sources, and impact of negative behaviors among registered nurses and unlicensed assistive personnel within a US hospital. Descriptive and inferential statistics were used to analyze quantitative data, while thematic analysis was used to analyze the qualitative responses. A total of 309 participants completed the survey, and 135 participants responded to three qualitative questions. Most respondents identified inadequate staffing/resources to handle workload (87%) and job stress leading to loss of control over behavior as contributing factors to lateral/vertical aggression in the work environment (71%). Impacts of negative behavior on job performance were related to both personal well-being and the work environment. Demoralization was identified as a common consequence of negative behaviors for individuals and within the work environment. The results suggested that registered nurses, unlicensed assistive personnel, and nursing leadership may benefit from system-wide approaches addressing negative behaviors such as incivility within the clinical environment. Specifically, efforts and policies aimed at aiding clinicians in responding to negative behaviors could potentially improve the clinical environment.

A systematic review and meta-analysis of the effectiveness of social support on turnover intention in clinical nurses

Background

Nurse turnover has become a salient issue in healthcare system worldwide and seriously compromises patient outcomes. Social support is considered an effective contributor to alleviate nurse turnover intention (TI). However, the degree of correlation between social support and nurse TI remains elusive.

Aims

This study aims to evaluate the strength of the effectiveness of social support on TI among nurses as well as its potential moderators.

Design

This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

Methods

To obtained qualified studies, two researchers searched Embase, PubMed, Web of science, CINAHL, CNKI, WanFang, and Chinese Medical Journal Full Text Database from inception to January 6, 2024. Meta-analysis, publication bias, and sensitivity analysis were carried out on the included studies using CMA 3.0 software, and the moderating effect was verified through meta-analysis of variance (ANOVA).

Results

A total of 38 studies were obtained, involving 63,989 clinical nurses. The comprehensive effect size of the random effect model showed a significant medium negative correlation between social support and TI among nurses (p < 0.001). The sample size and TI measurement tools significantly moderated the correlation between social support and TI (p < 0.050). However, nurse department, gender, data collection time, and social support measurement tools did not moderate the correlation between the two variables.

Conclusion

Social support is negatively associated with TI in nurses. Nursing administrators and the medical community should fully recognize the importance of social support for nurses and take corresponding measures to enhance it, thereby reducing TI and ensuring the stability of the nursing team.

Emotional Exhaustion and Emotional Contagion: Navigating Turnover Intention of Healthcare Personnel

Purpose

This study aimed to examine the role of personal emotions and emotional contagion within organizations on the behavior and attitudes of healthcare personnel. This study is expected to provide a theoretical foundation for reducing resignation behaviors and improving healthcare quality.

Materials and Methods

This study adopted a quantitative research method with a cross-sectional survey through an online questionnaire. The bootstrap method with 5000 iterations was used to validate the role of variables within a 95% confidence interval. SPSS 26.0 and Model 5 in Process 3.4 for SPSS were used for the data analysis.

Results

This research involved 459 healthcare personnel, whose levels of role overload (3.821±0.925), emotional exhaustion (3.436±1.189), and turnover emotional contagion (3.110±1.099) were notably high. Role overload was positively related to turnover intention, with emotional exhaustion as a mediator. Notably, turnover emotional contagion exerted a positive moderating effect.

Conclusion

This study emphasizes the adverse effects of emotional exhaustion and turnover emotional contagion in the Chinese context, offering practical recommendations for medical organizational managers to navigate turnover intention among healthcare personnel. This study suggests paying attention to the emotional state of healthcare personnel and providing adequate support resources. Managers should routinely assess and track turnover emotional contagion within the organization, fostering a positive emotional atmosphere.

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.

What Went Right? A Mixed-Methods Study of Positive Feedback Data in a Hospital-Wide Mortality Review Survey

BACKGROUND

Toxic work culture contributes to healthcare worker burnout and attrition, but little is known about how healthcare organizations can systematically create and promote a culture of civility and collegiality.

OBJECTIVE

To analyze peer-to-peer positive feedback collected as part of a systematized mortality review survey to identify themes and recognition dynamics that can inform positive organizational culture change.

DESIGN

Convergent mixed-methods study design.

PARTICIPANTS

A total of 388 physicians, 212 registered nurses, 64 advanced practice providers, and 1 respiratory therapist at four non-profit hospitals (2 academic and 2 community).

INTERVENTION

Providing optional positive feedback in the mortality review survey.

MAIN MEASURES

Key themes and subthemes that emerged from positive feedback data, associations between key themes and positive feedback respondent characteristics, and recognition dynamics between positive feedback respondents and recipients.

KEY RESULTS

Approximately 20% of healthcare workers provided positive feedback. Three key themes emerged among responses with free text comments: (1) providing extraordinary patient and family-centered care; (2) demonstrating self-possession and mastery; and (3) exhibiting empathic peer support and effective team collaboration. Compared to other specialties, most positive feedback from medicine (70.2%), neurology (65.2%), hospice and palliative medicine (64.3%), and surgery (58.8%) focused on providing extraordinary patient and family-centered care (p = 0.02), whereas emergency medicine (59.1%) comments predominantly focused on demonstrating self-possession and mastery (p = 0.06). Registered nurses (40.2%) provided multidirectional positive feedback more often than other clinician types in the hospital hierarchy (p < 0.001).

CONCLUSIONS

Analysis of positive feedback from a mortality review survey provided meaningful insights into a health system's culture of teamwork and values related to civility and collegiality when providing end-of-life care. Systematic collection and sharing of positive feedback is feasible and has the potential to promote positive culture change and improve healthcare worker well-being.

Relationship Building between International Healthcare Volunteers and Local Healthcare Providers in Ethiopia: Real-Life Experiences in Low-Income Country

BACKGROUND

The number of international healthcare volunteers in low-income countries that need trained human resources has been increasing. However, migrating to a foreign country requires adapting to its environment and culture. The purpose of this study was to explore the international healthcare volunteers' experiences in Ethiopia in building relationships with local healthcare providers.

METHODS

Six participants were enrolled in the study, and data were collected through individual in-depth interviews conducted between September and October 2018. The collected data were analyzed using Colaizzi's phenomenological method.

RESULTS

Ten subthemes emerged from five themes: "facing new situations", "accepting myself as an outsider in Ethiopia", "impact on the wall of prejudice", "adapting to a new culture", and "positive outlook".

CONCLUSIONS

This study shows that international healthcare volunteers in Ethiopia experienced challenges in building relationships with local healthcare providers due to linguistic and cultural gaps. Nevertheless, they strived to accept the culture and play their part as helpers in providing healthcare services.

Organizational Change and Workplace Incivility: Mediated by Stress, Moderated by Emotional Exhaustion

Modern organizations continuously undergo change processes. The focus of the organizations remains on the macro level, but the micro level (i.e., employee's perspective) is neglected. Using the conservation of resource theory (COR), this study examines the association between organizational change and workplace incivility. This study also proposes mediating and moderating mechanisms of stress and emotional exhaustion. The data were collected from 262 respondents working in public sector organizations in Pakistan using a time-lagged technique. The results proved that change significantly impacts workplace incivility. Moreover, stress mediates their relationship and emotional exhaustion moderates it. Furthermore, emotional exhaustion also moderates the stress-incivility relationship. Public sector organizations must focus on well-planned, inclusive, and adequately managed change processes to achieve the desired outcome; otherwise, adverse behaviors, including incivility, manifest. To the best of the authors' knowledge, the organizational change and incivility relationship has not been explored in the past. Additionally, their relationship with stress and emotional exhaustion also requires empirical investigation. This study also adds to the literature on the conservation of resource theory.

Relationship between turnover intention and workplace personal relations among care workers employed by elder care facilities

BACKGROUND

This study focuses on care workers at elder care facilities to examine what factors (including workplace personal relations) influence turnover intention and to what extent. Based on this analysis, the study discusses the content of workplace personal relations problems in qualitative terms.

METHODS

The study targeted care workers at elder care facilities. There were 406 participants with no missing data who were analyzed. The survey period ranged from September to November 2021. Questions consisted of basic attributes, turnover intention, problems with workplace personal relations, content of personal relation problems, and psychological distress.

RESULTS

Female care workers were 2.25 times more likely than male care workers to have turnover intention. Care workers with workplace personal relation problems were 1.97 times more likely than those without these problems to have high turnover intention. Moreover, with regard to psychological distress, the ratio increased to 4.99 times. The following six categories were extracted from the text data on workplace personal relation problems: insufficient communication, bullying, sense of unfair workload, different attitudes to care work, difficulty in guidance for subordinates/new staff, and labelling.

CONCLUSIONS

Gender, workplace personal relation problems, and psychological distress have shown to affect care workers' turnover intentions. To prevent care worker turnover, future studies should focus on the development and impact of strategies to improve workplace personal relations specific to care workers, targeting the six factors identified in this study.

The impact of role conflict on turnover intention among faculty members: A moderated mediation model of emotional exhaustion and workplace relational conflict

This study examines the impact of emotional exhaustion on faculty role conflict as a source of stress that leads to turnover intention, which is considered to be an undesirable organizational behavior. Drawing on conservation of resources and job-demand theories, the study investigates the moderating effect of workplace relational conflict on the relationships between role conflict among faculty members and both emotional exhaustion and turnover intention. Cross-sectional survey data were collected from 321 faculty members employed in 58 Saudi universities and institutions of higher education. Structural equation modeling revealed that emotional exhaustion mediates the significant positive relationship between faculty members' role conflict and their turnover intention and that these mediating effects are enhanced by the moderating effect of workplace relational conflict on the significant positive relationship between emotional exhaustion and turnover intention. Unexpectedly, the moderating effect of workplace relational conflict on the relationship between role conflict and emotional exhaustion was not supported by the results. The study concludes by highlighting several theoretical and practical implications and providing suggestions for future research.

Exploring the effect of workplace incivility on job outcomes: testing the mediating effect of emotional exhaustion

Purpose

The main goal of this research study is to look at the mediating effect of emotional exhaustion in the association between workplace incivility and job outcomes (job stress, job satisfaction, and employee turnover intentions).

Design/methodology/approach

The authors gathered field data from individuals working in the higher education sector of Jammu and Kashmir to test the proposed study paradigm. A total of 550 respondents reported their perceptions of workplace incivility, emotional exhaustion, and job-related outcomes (job stress, job satisfaction, and employee turnover intention) at Time 1 in the Kashmir division and Time 2 in the Jammu division of Jammu and Kashmir via a two-wave data collection design.

Findings

The findings supported the hypothesized relationships, demonstrating that emotional exhaustion acts as a mediator between workplace incivility and employee job outcomes (job stress, employee job satisfaction, and employee intention to leave).

Practical implications

The findings of this research study will assist organizations and practitioners in comprehending the implications of workplace incivility and emotional exhaustion, as well as how they positively impact job-related outcomes (employee job stress, turnover intention), and negatively on job satisfaction.

Originality/value

This study adds to existing knowledge on COR theory by suggesting workplace incivility as a stressor and also testing emotional exhaustion as a defense mechanism for determining the effect of workplace incivility on employee job outcomes.

The moderating role of transformational leadership on the relationship between deviant workplace behaviors and employee turnover intentions in China

This study aimed to analyze the effect of deviant workplace behaviors, such as mistreatment, bullying, and incivility on employee turnover intention and identify the transformational leadership role as a moderator. The data was collected through a survey questionnaire with the help of a purposive sampling technique. A total of 318 respondents’ data was gathered from university academic and general staff in China. The results were analyzed through SPSS and structural equation modeling structural equation modeling (SEM) software. The findings indicate that deviant workplace behavior, i.e., mistreatment, bullying, and incivility, significantly affect employee turnover intention. Moreover, a result shows that transformational leadership has a significant moderating role on the relationship between turnover intention and workplace bullying and incivility but was insignificant between turnover intention and workplace mistreatment. Lastly, implications and limitations were also discussed in this article.

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.

A Parallel Mediation Analysis on the Effects of Pandemic Accentuated Occupational Stress on Hospitality Industry Staff Turnover Intentions in COVID-19 Context

The purpose of this research was to analyze how different effects of the COVID pandemic, expressed through pandemic accentuated occupational stress, perceived job insecurity, occupational safety and health perception and perceived organizational effectiveness, may impact turnover intentions of the personnel in the hospitality industry. Our research team designed an online questionnaire which was analyzed with network analysis to depict the relationship between factors, and, then, a confirmatory factor analysis was employed to confirm the distribution of the items to the envisaged five factors. Based on a sample of 324 randomized Romanian hospitality industry staff, the results of our cross-sectional study revealed that occupational safety and health perception, perceived organizational effectiveness and perceived job insecurity in the pandemic accentuated occupational stress to indirectly and significantly impact hospitality industry staff turnover intentions (TI). The results indicated that, while the total effect of PAOS on TI was significant, the direct effect was still significant, while all three mediators remained significant predictors. Overall, mediators partially mediated the relationship between PAOS and TI, indicating that employees with low scores on occupational safety and health perception (OSHP), and perceived organizational effectiveness (POE) and high scores on perceived job insecurity (PJI) were more likely to have higher levels of TI turnover intentions.

Association between Burnout, Job Dissatisfaction and Intention to Leave among Medical Researchers in a Research Organisation in Malaysia during the COVID-19 Pandemic

Employee turnover could affect the organisation's performance. Job dissatisfaction and burnout have been identified as factors influencing the intention to leave. Thus, this study aimed to determine the level of intent to leave, and predictors associated with intention to leave among medical researchers in Malaysia. A cross-sectional, stratified random sampling study was conducted among researchers in a research organisation under the Ministry of Health. Respondents answered an online questionnaire that included sociodemographic information, job dissatisfaction, burnout, and intention to leave. A total of 133 researchers participated. More than one-third (41.4%) of the researchers had a moderate and high level of intention to leave. Burnout and job dissatisfaction were identified as significant predictors. Burnout was noted to have a positive relationship with the intent to leave (β = 0.289, 95% CI (B): 0.287, 1.096). Meanwhile, job satisfaction was found to have a negative relationship with the intention to leave (β = -0.348, 95% CI (B): -0.768, -0.273). Burnout among researchers is quite worrisome as more than two-thirds of the researchers experienced moderate to high burnout. Reducing burnout and job dissatisfaction would increase work performance and produce high-quality research output, hence decreasing the turnover rate.

Nexus of Ethical Leadership, Career Satisfaction, Job Embeddedness, and Work Engagement in Hospitality Industry: A Sequential Mediation Assessment

The paper proposes a research model explaining the sequential mediation effect of job embeddedness (JE) and work engagement (WENG) between ethical leadership (EL) and career satisfaction (CS). The model also examines whether JE heightens WENG, a factor indirectly influenced by ethical practices ending in employee satisfaction. The study used a time-lagged data collection procedure and survey responses of 247 hotel workers in China. Data were analyzed through structural equation modeling. The results showed that EL directly and indirectly (through sequential mediation effect of JE and WENG) contributes to employee CS. The present empirical framework extends the hospitality industry literature by explaining the precise mechanism (i.e., JE and WENG) through which EL generates CS among hospitality workers in China. The paper offers theoretical and practical implications and future research directions.

You Really Affect Me: The Role of Social Influence in the Relationship between Procedural Justice and Turnover Intention

This research aims to test the impact of procedural justice on employees’ turnover intention via their intention to stay or give up their positions by putting social influence in the spotlight as a mediating variable. Although the topic dealing with the relationship linking organizational justice to turnover intention has taken some wrinkles, there has been no published research, to the best of researchers’ knowledge, that integrates social influence as a mediating variable between the aforementioned relationships. A questionnaire survey was administered to 558 employees working in a renowned banking institution located in the capital city of Tunis, Tunisia. Structural equation modeling (SEM) results using AMOS software, IBM, version 23, showed that social influence partially mediated the relationship between procedural justice and turnover intention. More specifically, procedural justice has a significant negative effect on turnover intention (β = −0.30, p < 0.01) and a significant positive effect on social influence (β = +0.54, p < 0.01), which will have a significant positive effect on turnover intention (β = +0.91, p < 0.01). The results confirm that procedural justice is necessary for any organization; however, it is not enough to eliminate the turnover intention, especially with the presence of social influence. Social influence alters the judgments of those caught in its nets. This intangible aspect and power is even more enigmatic and harmful, which can lead to a change in cognitive references and behaviors. Social influence heavily affects the spontaneity of individuals and they became subject to dominant forces, which has to be properly controlled by management.

The relationship between workplace incivility and turnover intention in nurses: A cross-sectional study

AIM

The aim of this study was to examine the relationship between workplace incivility and the turnover intention in nurses.

BACKGROUND

Studies assessing the association between nurses' turnover intention and workplace incivility are limited.

METHODS

The research was carried out on a total of 250 nurses working in three private hospitals in Antalya, Turkey. The data were collected using a Demographic Questionnaire, the Workplace Incivility Scale and the Turnover Intention Scale.

RESULTS

The mean workplace incivility scores of the nurses were determined to be 6.68±7.96. The mean turnover intention scores of the nurses were 6.38±3.44. A statistically significant positive relationship was found between workplace incivility scores and turnover intention scores (r = 0.632, p = 0.0001). The linear regression model showed that workplace incivility, working in the emergency or intensive care unit, and dissatisfaction with the current institution were independent factors of turnover intention.

CONCLUSIONS

The results of the study demonstrated a significant relationship between workplace incivility and turnover intention in nurses. Nurses who are less exposed to workplace incivility were seen to have a lower turnover intention.

IMPLICATIONS FOR NURSING MANAGEMENT

Simple measures that organizations may take to reduce workplace incivility may increase nurses' workplace satisfaction, reduce turnover intention, and enable them to work more efficiently. It would be useful for nursing managers to lead initiatives in institutions to reduce workplace incivility and improve the culture of civility.