Duquesne University Duquesne Scholarship Collection Electronic Theses and Dissertations Summer 8-11-2018 Workplace Bullying, Nurse Practice Environment, Patient Outcomes: A Descriptive Study Noreen Houck Follow this and additional works at: https://dsc.duq.edu/etd Part of the Nursing Administration Commons Recommended Citation Houck, N. (2018). Workplace Bullying, Nurse Practice Environment, Patient Outcomes: A Descriptive Study (Doctoral dissertation, Duquesne University). Retrieved from https://dsc.duq.edu/etd/1470 This One-year Embargo is brought to you for free and open access by Duquesne Scholarship Collection. It has been accepted for inclusion in Electronic Theses and Dissertations by an authorized administrator of Duquesne Scholarship Collection. For more information, please contact [email protected]. WORKPLACE BULLYING, NURSE PRACTICE ENVIRONMENT, PATIENT OUTCOMES: A DESCRIPTIVE STUDY A Dissertation Submitted to the School of Nursing Duquesne University In partial fulfillment of the requirements for the degree of Doctor of Philosophy By Noreen M. Houck August 2018 Copyright by Noreen M. Houck 2018 WORKPLACE BULLYING, NURSE PRACTICE ENVIRONMENT, PATIENT OUTCOMES: A DESCRIPTIVE STUDY By Noreen M. Houck Approved May 16, 2018 _______________________________ ________________________________ Alison M. Colbert, PhD, PHCNS-BC Peggy Chinn, RN, PhD, FAAN Associate Professor, Associate Dean Professor Emeriti for Academic Affairs University of Connecticut (Committee Chair) (External Committee Member) _______________________________ ________________________________ Melissa Kalarchian, PhD Rick Zoucha, PhD, APRN-BC, CTN-A, Associate Dean for Research FAAN (Committee Member) Professor/Chair of Advanced Role and PhD Program and Joseph A. Lauritis, C.S.Sp. Chair for Teaching and Technology School of Nursing _______________________________ ________________________________ Bonnie Dean, PhD, RN Mary Ellen Glasgow, PhD, RN, ANEF, Emeritus Professor FAAN (Committee Member) Dean and Professor School of Nursing iii ABSTRACT WORKPLACE BULLYING, NURSE PRACTICE ENVIRONMENT, PATIENT OUTCOMES: A DESCRIPTIVE STUDY By Noreen M. Houck August 2018 Dissertation supervised by Alison M. Colbert, PhD, PHCNS-BC, Associate Professor, Associate Dean for Academic Affairs. Better nursing practice environments are associated with improved patient safety, yet little is known about the nurse’s experiences of bullying or flourishing within the practice environment. This study described nurses’ experiences of workplace bullying and flourishing and identified associations with patient outcomes. The study used an exploratory cross-sectional survey design following Donabedian’s Quality Framework of structure-process-outcome and informed through critical feminist theory. The study took place at a large medical facility in the northeastern United States. A multi-instrument survey included four sections. The demographic section and the Practice Environment Scale of the Nurse Work Index (PES-NWI) were used to measure structure variables. The process variables were measured using the Negative Acts Questionnaire Revised for the United States (NAQR-US) to measure workplace bullying, iv and an investigator designed instrument to measure the workplace flourishing based on Chinn’s PEACE and Power model. The online survey results from 138 bedside nurses were correlated with outcome variables patient satisfaction from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys, and unit based patient safety rates. Patient falls, 30-day readmissions, medication errors, pressure injuries, overall patient satisfaction, and whether patients would recommend the hospital were averaged by patient unit and assigned to each nurse based on unit association. Following descriptive analysis, multiple regression models were conducted for each patient outcome. The respondents were 76% female, 52 % had a bachelor’s degree or higher and the average time as an RN was 15 years. Nurse perception of the practice environment was inversely associated with patient falls (r=-0.21, p<.01) and 30-day readmissions (r=-0.21, p<.01). Twenty percent of the respondents’ report incidents of bullying occur weekly or more. Bullying was significantly and negatively associated with the overall quality of the practice environment (r=-0.26, p <.01) and with patients’ Recommend the Hospital (r=- 0.26, p<0.01). Workplace bullying and flourishing association had very small and not significant associations with patient safety variables. Workplace flourishing had a moderate and significant positive association with the better practice environments (r=0.44, p<0.000) but had very small associations with all patient outcomes variables and with workplace bullying. This study contributes to a better understanding of the nurses practice environment by the associations found with bullying and flourishing. Implicit in the PES-NWI description of strong nursing practice environments is nursing control and autonomy of v practice. More work is needed to explore the concept of flourishing and what keeps nurses working in adverse environments. As the practice environment is linked to patient safety, an understanding of nurse’s work that includes the practice environments, work satisfaction, the absence of bullying and intentional work flourishing will contribute to better patient outcomes. Further research is needed to understand the complex nature of the nurses’ work environment and the impact on nurses and patients. vi DEDICATION This dissertation is dedicated to the many people who have supported and inspired me throughout this journey. First, my husband, Nathan, who has shown his love and encouragement in all areas of our life together; my daughter, Hadley, who grew up with a mom reading, writing, and hushing; she is my greatest joy and the nicest person I know, I am forever your biggest fan; to my mother who passed away during this process, she was both the mother and the nurse I seek to be; my colleagues who believed in me and my topic, especially Anne Watson Bongiorno, Sarah Charles, Faye Grund, Tarsha Jones, and my PhD classmates; and finally the many nurses and colleagues who work under adverse conditions but continue to support each other and strive for the best quality care for their patients. vii ACKNOWLEDGEMENT There are many individuals I must acknowledge who have championed me through this process. I felt their unselfish gift of time and advice. You are each an inspiration to me. I would like to acknowledge the guidance and support of my committee. Alison Colbert, my committee chairperson and program advisor, who offered me the support of a colleague and mentor, and a persistent belief in the project that carried me through with her confidence when mine lagged. Dr. Bonnie Dean, whose experience in hospital administration helped me frame my requests to clinical sites with an understanding of the importance of the study and the hospital resistance I would meet. Thank you for staying with me. Dr. Melissa Kalarchian, provided meticulous editing, proofing, and an unwavering enthusiasm. Dr. Peggy Chinn provided generous and never failing support, her support of nurse activism and feminism, including her PEACE and Power model and writings in nursing inspired this thesis. The Duquesne nursing program, its faculty and staff, must be acknowledged for the supportive and nurturing environment they provided in the accomplishment of my studies and this work. viii TABLE OF CONTENTS Page Abstract .............................................................................................................................. iv Dedication ......................................................................................................................... vii Acknowledgement ........................................................................................................... viii Lists of Tables .................................................................................................................... xi List of Figures .................................................................................................................. xiii List of Abbreviations ....................................................................................................... xiv CHAPTER 1 PROBLEM AND SIGNIFICANCE ............................................................. 1 Background ..................................................................................................................... 2 Purpose ............................................................................................................................ 8 Specific Aims and Research Hypothesis ........................................................................ 8 Definition of Terms......................................................................................................... 8 Patient Safety .............................................................................................................. 8 Patient satisfaction ...................................................................................................... 9 Workplace bullying ..................................................................................................... 9 Workplace Flourishing .............................................................................................. 10 Socio-demographic variables .................................................................................... 10 Assumptions and Limitations ..........................................................................................