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Workplace Bullying: Exploring the Prevalence, Impact, And Workplace Bullying: Exploring the Prevalence, Impact, and Consequences to Nurses A dissertation submitted to the Graduate School of the University of Cincinnati in partial fulfillment of the requirements for the degree of Doctor of Philosophy of the College of Nursing by Peggy Ann Berry 2015 Bachelor of Science in Nursing, University of Texas at Arlington, 1997 Master of Science in Nursing, University of Cincinnati, 2007 Dissertation Chair: Gordon L. Gillespie, Ph.D., PHCNS-BC, FAEN Abstract Introduction: Most novice nurses will experience workplace bullying (WPB) behaviors within 1-2 years of licensure. This exposure adversely affects work productivity. The purposes of this study were to (1) explore factors that resulted in the adoption of WPB behaviors; (2) determine the differences in perceived stress, anxiety state, and posttraumatic stress symptoms based on bullying exposure frequencies and select nurse characteristics; and (3) explore strategies to manage or stop WPB behaviors. Methods: A longitudinal quantitative dominant mixed methods design was used with nurse respondents (n=80) from three Midwestern states who participated in a prior study on WPB. In Manuscript 1, respondents completed a multicomponent survey. Descriptive statistics, nonparametric statistics, and path analysis were computed to explore trait anxiety, perception of bullying behaviors, self-labeling as a target, and adoption of bullying behaviors. In Manuscript 2, data from a purposeful sub-sample (n=37) of respondents who maintained employment after an observed or targeted WPB incident and continued bullying behaviors were analyzed using descriptive and Mann-Whitney U statistics. Next semi-structured interviews with 11 respondents were conducted. Interview transcripts were analyzed using content analysis. Results: In Manuscript 1, 11 respondents adopted bullying behaviors. There was no difference in the adoption of bullying based on WPB exposure (χ2 = 2.26, p = .38). For respondents (n=31) who had a positive history of being bullied prior to their nurse licensure, statistically significant findings were seen with age (Md = 33 vs. 26, U = 456.5, p = .04), state anxiety (Md = 40 vs. 34, U = 480.5, p = . 008), and posttraumatic stress symptoms (Md = 29 vs. 23, U = 506.5, p = . 017) compared to respondents (n=49) with no history of WPB behaviors prior to their nurse licensure. The final path model displayed a path from self-labeling as a target at Time 1 (2010), trust in iii management, and anxiety state to the adoption of WPB behaviors through a common variable of 2 self-labeling as a target of WPB behaviors at Time 2. This path achieved a minimum fit (X [36, N = 80] = 23.116, p = .952) with GFI = .95, RMSEA < .001, AGFI = .70, and NFI = .545. In Manuscript 2, significant differences were seen with perceived stress, anxiety, and posttraumatic symptoms for persons with frequent to daily WPB behavior exposure. A significant difference was seen between respondents 29 years and younger (n=23, Md = 21) and respondents 30 years and older (n=12, Md = 33) for posttraumatic stress symptoms (U = 86.5, p = .018). Narrative analyses demonstrated bullied novice nurses avoided perpetrators rather than ask for assistance. Nurse peers and leaders minimized WPB behaviors. Half the nurses interviewed were making plans to leave their current employment. Conclusions: As WPB behaviors become or remain embedded into the unit culture, the risk of more nurses adopting bullying behaviors will likely continue. Elimination of WPB behaviors is complicated and requires a cultural change for how some nurse leaders and their employees address aggression and violence in their workplaces. iv Copyright 2015 ii Dedication To my family, I love you all. David Berry, thank you, we stayed financially afloat. Kobe Jordan, thank you for giving up “grandma” time. Kristina Vineyard, Sean Vineyard, Ellen Wangler, Mary Beth Koenig, Arthur Koenig, thank you for the verbal support. To David Yamada, Gary and Ruth Namie, Cheryl Dellasega, Beth Boyton, and other advocates for psychologically safe workplaces, thank you for your thoughts, emails, opportunities, and mentions. We will all work together to demonstrate organizational profitability by making work physically and psychologically safe. Work should not hurt. I also am grateful for two unique situations that helped solidify my reason for studying WPB. I was a target, squashed in-between a hospital culture in the midst of change and direct reports who had lost a long time manager. I was unprepared to overcome the barriers of emotions, distrust, and anger from below and the emotions, distrust, and anger from above related to the organizational change. Change is a great motivator and learning to adapt to change makes the difference between thriving, surviving, or extinction. The second incident involved a student nurse. A charge nurse was verbally abusing her and I step in to stop it. In this encounter, I found my challenge and meaning. I made it a point to learn more about workplace bullying to understand the multiple whys of aggression and give some explanations and meanings to workplace aggression. With that, I will continue to collaborate with others to raise awareness and find better ways to improve and maintain healthy and safe workplace environments through research and evidence-based practices. v Acknowledgements I am grateful to my chair, Dr. Gordon Gillespie, for his patience, mentoring and discussions on human aggression and violence. Dr. Gillespie has coached and mentored me with much thought and time to keep me focused towards the end. He has guided me in the waltzing of design, implementation, and completion of this study. I hope to continue to write with him on future analyses of all the data collected with this research. I also am grateful to Dr. Bonnie Fisher and Dr. Denise Gormley for stepping up to be part of my committee. Bonnie has given me careful insight on my writing and statistical analysis. Bonnie’s immense writing and grant history has been an inspiration to me as well as her vast knowledge on violence. I hope to pattern my career to her prolific and critical abilities in writing. Dr. Gormley stepped in when others had to leave. Her administrative excellence as a nurse executive and the challenges she had to go through to obtain her Ph.D. are inspiring. Although they were unable to stay on committee, I want to thank Dr. Donna Gates and Dr. John Schaffer, both gifted in violence research, for their faith in me as a Ph.D. student and candidate. Without funding, none of this would have happened. I would like to acknowledge the National Institute for Occupational Safety and Health Pilot Research Training Program of the University of Cincinnati for their generous support with my preliminary study and the American Nurses Foundation for their generous support of my dissertation. Finally, I thank all the novice nurses who took time out of their day to fill out one more survey, answer my calls for interviews, and want to be the next protectors of newly hired novice nurses. You will make it happen. vi TABLE OF CONTENTS Abstract ......................................................................................................................................... iii Dedication ...................................................................................................................................... v Acknowledgements ...................................................................................................................... vi List Of Tables .............................................................................................................................. xv List Of Figures............................................................................................................................ xvi List Of Appendices .................................................................................................................... xvii List Of Abbreviations .............................................................................................................. xviii CHAPTER 1: PROBLEM, PURPOSE, AND SIGNIFICANCE.............................................. 1 Statement of the Problem ................................................................................................................ 3 Purpose of the Study ........................................................................................................... 5 Specific Aims ...................................................................................................................... 5 Aim 1: Determine The Proportion Of Nurses Adopting WPB Behaviors .......................... 6 Hypothesis 1................................................................................................ 6 Aim 2: Test A Hypothesized Model For The Adoption Of WPB Behaviors .................... 6 Hypothesis 2a .............................................................................................. 6 Hypothesis 2b.............................................................................................. 6 Hypothesis 2c .............................................................................................. 6 Aim 3: Describe The Consequences Of WPB Behavior Exposure .................................... 7 Hypothesis 3................................................................................................ 8 Aim 4: Explore Strategies To Manage Or Stop WPB Behaviors ....................................... 8 Definitions
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