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Exploring Workplace Bullying in Nursing PROFESSIONAL PRACTICE Exploring Workplace Bullying in Nursing Emerald Etienne, MSN, BSN, RNC-OB Bullying in the nursing workplace has been identified as a factor that affects place bullying negatively affects nurses and their work, bullying con- patient outcomes and increases occupational stress and staff turnover. The tinues to be a global problem (John- purpose of this project was to assess registered nurses’ perceived exposure son & Rea, 2009; McKenna, Smith, to workplace bullying. A convenience sample of a Pacific Northwest state Poole, & Coverdale, 2003; Sa & professional nurses’ association membership was solicited for this descriptive Fleming, 2008; Simons, 2008). Due study using the Negative Acts Questionnaire-Revised (NAQ-R). Forty-eight to the worldwide nursing shortage (American Association of Colleges percent of respondents admitted to being bullied in the workplace during the of Nursing, 2012), factors that con- previous 6 months, with respondents choosing “being ignored or excluded” as tribute to nurse turnover and attrition the most common negative experience in the workplace. The results of this must be eradicated (Simons, Stark, & study suggest that workplace bullying remains a problem for which reduction DeMarco, 2011). It is imperative that strategies must be devised as a means of retaining nurses and preventing workplace bullying be investigated to adverse outcomes. One strategy shown to be effective in curbing bullying is identify the scope of the problem and possible solutions. The Joint Com- assertiveness and aggression training for nurses. [Workplace Health Saf mission (2008) has identified work- 2014;62(1):6-11.] place bullying as a sentinel event that should be reported because it “un- ullying of nurses has been in the course of employment, which dermines a culture of safety” (p. 1). identified as affecting pa- could reasonably be regarded as un- Implicit in this statement is the need tient outcomes, occupational dermining the individual’s right to to educate nurses about strategies for B dignity at work. (p. 5) stress, and staff turnover. The Task creating a safe environment where Force on the Prevention of Work- nurses want to work. place Bullying (2001) has defined Simons (2008) wrote that bully- bullying as: ing is a problem that must be explored LITERATURE REVIEW for the retention of an adequate work- Workplace bullies are individu- Repeated inappropriate behavior, force; both Quine (1999) and Simons als in diverse roles, including manag- direct or indirect, whether verbal, (2008) found a correlation between ers, administrators, clinical instruc- physical or otherwise, conducted by bullying and nurses’ intention to leave tors, charge nurses, and staff nurses. one or more persons against another or others, at the place of work and/or the employing organization. Nurse-to-nurse hostility, also known Creating an environment where as lateral or horizontal bullying, re- nurses feel safe increases productiv- fers to aggression among peers or co- ABOUT THE AUTHOR ity (Felblinger, 2008). Randle (2011) workers on the same organizational Ms. Etienne is a Registered Nurse and Mas- ter of Nursing Education Graduate, University stated that “work should not hurt” (p. level (Johnson & Rea, 2009). of Alaska-Anchorage, Anchorage, Alaska. 391); therefore, a zero tolerance of In Johnson and Rea’s (2009) re- Submitted: August 5, 2013; Accepted: Octo- workplace bullying should be adopt- search on workplace bullying, 27.3% ber 8, 2013; Posted online: January 7, 2014 The author has disclosed no potential con- ed and interventions should be imple- of the 249 emergency room nurses flicts of interest, financial or otherwise. mented to change workplace cultures surveyed admitted to being bullied Correspondence: Emerald Etienne, MSN, BSN, RNC-OB, 3025 183rd Place SE, Bothell, of aggression and dissention. More- at work. Fifty percent of those who WA 98012. E-mail: [email protected] over, despite decades of research reported being bullied identified doi:10.3928/21650799-20131220-02 (Einarsen & Skogstad, 1996; Quine, managers or directors as the bullies; 1999, 2001) documenting that work- 25% named charge nurses as the bul- 6 Copyright © American Association of Occupational Health Nurses, Inc. PROFESSIONAL PRACTICE lies. Similarly, 21% of the 286 nurses ior (i.e., nurses who lack the power as the bullying frequency increased surveyed in a Turkish study admitted to respond effectively to managers so did the likelihood of nurses leav- exposure to workplace bullying and or hospital administrators turn their ing the organization. Rosenstein and reported that 39% of the bullying hostility toward each other). O’Daniel (2005) surveyed 1,509 behaviors were perpetrated by ad- In exploring nurses’ experiences health care workers about bullying ministrators (Yildirim, 2009). Berry, confronting workplace bullies, Gaff- and found that 17% of the workers Gillespie, Gates, and Schafer (2012) ney, DeMarco, Hofmeyer, Vessey, reported that disruptive workplace used an Internet-based descriptive and Budin (2012) noted that inad- behaviors adversely affected workers cross-sectional design to survey 197 equate nursing support in the work- and the organization. Moreover, one novice nurses from Ohio, Kentucky, place and a culture of silence pro- in four respondents acknowledged a and Indiana; 72.6% of those nurses tected perpetrators. Porto and Lauve link between disruptive behavior and reported experiencing at least one (2006) also alluded to a history of patient mortality. workplace bullying event in the pre- indifference to and tolerance of bul- In a descriptive study, Simons vious month. Sixty-three percent lying in health care workplaces. Ka- and Mawn (2010) examined bul- of those who experienced bullying trinli, Atabay, Gunay, and Cangarli lying in the workplace among 184 identified the perpetrators as more (2010) explored the perceptions of a newly licensed registered nurses in experienced nursing colleagues. group of 232 Turkish nurses regard- the United States. They identified Their findings were comparable to ing individual and organizational rea- four main themes, including structural those of Clarke, Kane, Rajacich, and sons for horizontal bullying. Among bullying (“perceived unfair and puni- Lafreniere (2012), who surveyed 674 the perceived reasons for bullying tive actions taken by supervisors,” p. baccalaureate nursing students and were negative performance apprais- 307), nurses eating their young (abu- found that the two main sources of als, decisions about organizational sive treatment of new nurses), being bullying in the clinical setting were structure (e.g., a perpetrator bullies out of the clique (feeling alienated clinical instructors (30.25%) and to secure a new position in the orga- due to ethnicity or educational level), staff nurses (25.49%). nization), and equipment allocation. and leaving the job (leaving the job or It has long been said that “nurses In other words, for career ad- profession due to bullying). Those re- eat their young” (Bartholomew, 2006), vancement or a better performance sults are similar to the findings of Fel- and if left unhindered these negative review, nurses may bully others to blinger (2008), who examined nurses’ acts can further escalate the nursing negatively affect others’ performance shame responses related to incivility shortage. Novice nurses are the face and enhance their own performance. and bullying in the workplace; those of the future; experiencing workplace Possible motivations for bullying in- responses included anger and a ten- bullying when entering the nursing cluded perpetrators’ need for power dency of nurses to blame themselves workforce sets a negative precedent. and their own psychological and per- for the behavior of others, resulting sonal life problems. in occupational stress that can ad- REASONS BULLYING OCCURS versely affect nurses and negatively AND PERSISTS IN THE EFFECTS OF BULLYING affect patient outcomes. Nurses who WORKPLACE Hutton and Gates (2008) sur- are stressed or “burned out” are not Einarsen, Hoel, and Notelaer veyed 184 direct care workers, 81% able to practice competently, increas- (2009) categorized bullying into per- of whom were registered nurses. ing the risk of clinical errors. Some sonal bullying, work-related bully- The study results suggested that the nurses experienced symptoms of post- ing, and physically intimidating acts. source of bullying had a greater im- traumatic disorders after being bullied Personal bullying is gossiping about pact than the frequency of bullying. at work (Felblinger, 2008). an individual and work-related bul- For example, although bullying from lying includes criticizing an individ- supervisors and patients was less fre- METHODS ual’s work. Physically intimidating quent than from physicians and other A descriptive survey design was acts may involve physical violence direct care workers, bullying from used to generate information regarding or the risk of violence. Both staff supervisors and patients had a greater the extent to which nurses in a Pacific shortages and occupational stress impact on productivity. Thus, it is vi- Northwest state perceived that they create an environment conducive to tal to identify the sources of bullying were experiencing workplace bullying. bullying (Simons & Mawn, 2010). in an effort to develop effective and Approximately 10,000 registered nurs- Some researchers have hypothesized appropriate interventions to curtail es from that state’s professional nurses’ that because nurses
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