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Workplace Violence, Organizational Culture, and Registered Nurses' Incident Reporting Patterns in Acute Hospitals in Califor The University of San Francisco USF Scholarship: a digital repository @ Gleeson Library | Geschke Center Doctoral Dissertations Theses, Dissertations, Capstones and Projects 2016 Workplace Violence, Organizational Culture, and Registered Nurses' Incident Reporting Patterns in Acute Hospitals in California Feodora Jacobsen University of San Francisco, [email protected] Follow this and additional works at: https://repository.usfca.edu/diss Part of the Nursing Commons, Occupational Health and Industrial Hygiene Commons, and the Organizational Behavior and Theory Commons Recommended Citation Jacobsen, Feodora, "Workplace Violence, Organizational Culture, and Registered Nurses' Incident Reporting Patterns in Acute Hospitals in California" (2016). Doctoral Dissertations. 328. https://repository.usfca.edu/diss/328 This Dissertation is brought to you for free and open access by the Theses, Dissertations, Capstones and Projects at USF Scholarship: a digital repository @ Gleeson Library | Geschke Center. It has been accepted for inclusion in Doctoral Dissertations by an authorized administrator of USF Scholarship: a digital repository @ Gleeson Library | Geschke Center. For more information, please contact [email protected]. The University of San Francisco WORKPLACE VIOLENCE, ORGANIZATIONAL CULTURE, AND REGISTERED NURSES’ INCIDENT REPORTING PATTERNS IN ACUTE HOSPITALS IN CALIFORNIA A Dissertation Presented to Organization and Leadership Program The Faculty of the School of Education In Partial Fulfillment of the Requirements for the Degree Doctor of Education by M. L. Feodora Jacobsen San Francisco May 2016 ABSTRACT The purpose of this study was to increase understanding of the reporting patterns of WPV Type II in acute hospital settings. Although some patients are abusive toward nurses, that the abuse is underreported to hospital administrators. Qualitative studies identified common themes for underreporting including fear of being blamed, abuse considered part of the job, and not having sufficient time to fill out a formal report. This study is the first quantitative study to explore the changes in mean scores of organizational-culture factors under two mutually exclusive conditions: registered nurses (RNs) who do not report hospital incidents and RNs who do report them. Findings include several statistically significant mean score differences in the two groups of nurses on organizational justice and safety-culture scales. This is also the first study to determine if WPV Type II is underreported to a higher degree than other types of hospital incidents such as needle stick injuries, patient falls, and medication errors. The two highest rates for underreporting were verbal abuse at 65% and mild physical abuse at 51%. Higher rates were statistically significant. The percentage of RNs who experienced verbal abuse was 83% and mild physical abuse 54%. For every 100 nurses, 54 experienced and did not report verbal abuse and 28 experienced and did not report mild physical abuse. Examples of verbal abuse include patients or their families making graphic detailed threats to kill RNs. ii This dissertation, written under the direction of the candidate’s dissertation committee and approved by the members of the dissertation committee, has been presented to and accepted by the Faculty of the School of Education in partial fulfillment of the requirements for the degree of Doctor of Education. The content and research methodologies presented in this work represent the work of the candidate alone. Feodora Jacobsen May 11, 2016 Date Dissertation Committee Dr. Patricia Mitchell, Chairperson May 11, 2016 Dr. Darrick Smith, Second Reader May 11, 2016 Dr. Betty Taylor, Third Reader May 11, 2016 iii DEDICATION Thank you to my best friend, George A. Irving, who supported me in all ways imaginable and who spent his spare time shaping our slice of heaven that we now have time to enjoy. Thank you to Dr. Patricia Mitchell. You are a true leader who embraces diversity and helps each individual under your tutelage to fully develop his or her unique contribution to the world. This thesis is written to benefit nurses everywhere. You are courageous unsung heroes. iv ACKNOWLEDGMENTS A heart felt thank you to the members of my dissertation committee: Dr. Patricia Mitchell, Chairperson; Dr. Darrick Smith, Second Reader; Dr. Betty Taylor, Third Reader. Your guidance was invaluable. In addition, an acknowledgement for Thanh Ly. If students, professors and academic writings are bits of paper then you are the glue that holds us all together. v TABLE OF CONTENTS ABSTRACT ........................................................................................................................ ii DEDICATION ................................................................................................................... iv ACKNOWLEDGMENTS ...................................................................................................v LIST OF TABLES ............................................................................................................. ix LIST OF FIGURES .............................................................................................................x CHAPTER I: INTRODUCTION .........................................................................................1 Statement of the Problem .........................................................................................1 Background and Need ..............................................................................................1 Purpose of the Study ................................................................................................3 Conceptual Framework ............................................................................................4 Research Questions ..................................................................................................6 Delimitations ............................................................................................................6 Limitations ...............................................................................................................6 Educational Significance .........................................................................................8 Definitions................................................................................................................9 Summary ................................................................................................................11 CHAPTER II: LITERATURE REVIEW ..........................................................................13 Introduction ............................................................................................................13 Workplace Violence ...............................................................................................15 Workplace Violence Typology ..................................................................15 Prevalence Workplace Violence Type II and Prevalence in High Risk Areas ..........................................................................................................15 Organizational Culture ...........................................................................................20 Workplace Violence Type IV ....................................................................21 Suboptimal Organizational Culture ...........................................................22 Suboptimal Organizational-Culture Factors ..............................................23 Regulations & Laws ...................................................................................26 Underreporting .......................................................................................................29 Estimates for Underreporting .....................................................................30 Barriers to Reporting ..................................................................................31 Lack of Urgency ....................................................................................................42 Workplace Violence Impact ......................................................................43 Postevent Care ...........................................................................................49 Change Theory ...........................................................................................51 CHAPTER III: METHODOLOGY ...................................................................................56 Purpose ...................................................................................................................56 Research Design .....................................................................................................56 Setting ....................................................................................................................57 vi Population ..............................................................................................................58 Justification of the Survey Method ........................................................................59 Pilot Study ..............................................................................................................60 Survey Instrument Questions .................................................................................61 Maslach Burnout Inventory (MBI; Maslach & Jackson, 1981) .................61 Safety Attitude Questionnaire (SAQ; Sexton et al., 2006) ........................62 Instrumentation ......................................................................................................64
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