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A Dissertation Entitled New Graduate Nurses Perception of the Workplace A Dissertation entitled New Graduate Nurses Perception of the Workplace: Have they Experienced Hostility? by Darla A. Vogelpohl Submitted to the Graduate Faculty as partial fulfillment of the requirements for The Doctor of Philosophy Degree in Foundations of Education: Educational Psychology ____________________________________ Mary Ellen Edwards, PhD., Committee Chair ____________________________________ Lisa Kovach, PhD., Committee Chair ____________________________________ Patricia Devlin, PhD., Committee Member ____________________________________ Susan Rice, PhD., Committee Member ___________________________________ Christopher Bork, PhD., Committee Member ___________________________________ Dr. Patricia R. Komuniecki, Dean College of Graduate Studies The University of Toledo May 2011 Copyright 2011, Darla A. Vogelpohl This document is copyrighted material. Under copyright law, no parts of this document may be reproduced without the expressed permission of the author. An Abstract of New Graduate Nurses Perception of the Workplace: Have They Experienced Hostility? by Darla A. Vogelpohl Submitted to the Graduate Faculty in partial fulfillment of the requirements for the Doctor of Philosophy in Foundations of Education: Educational Psychology The University of Toledo May 2011 Understanding the new graduate nurse’s recognition of hostility in the workplace may give insight into how to handle encounters with this workplace problem. Preventing new graduate nurses from leaving the nursing profession in the first three years after graduation is an important issue as there is a growing nursing shortage of qualified licensed RNs. Through nursing education, the new nurse graduate needs to be prepared to recognize and handle the negative behaviors that may exist in workplace bullying This study investigated the bullying experience of 135 newly graduated RNs, using the Negative Acts Questionnaire-Revised, developed by Norwegian researchers. The participants reported that 20.5% of them had been bullied in the workplace and 46.7% had observed bullying in the workplace. Sixty percent of the new nurse graduate participants reported the main person causing the problem in the workplace were peers, physicians, and the patient’s family. Bullying affected the job performance for 31.6% and 29.5% had considered leaving the nursing profession. Less than one-fourth of the participants reported that bullying was a covered topic in their nursing curriculum in school. Policies to deal with bullying in the workplace were supported by 96% of the participants. Internal and external behavioral reactions to bullying were analyzed. iii This study is dedicated to new graduate nurses that are beginning their career as a newly licensed registered nurse. Recognizing problems in the workplace and being able to manage and prevent them are important for achieving harmony in the workplace. Retaining nurses in the workforce with high professional standards is achieved through respect for one another. iv Acknowledgements There are many to acknowledge who helped me on this journey. My husband, Chris, was continually very supportive and believed that I could accomplish this degree. My children, Curt, Dana, and Karyn were also very encouraging during this endeavor. I appreciate my Committee Chairs, Dr. Mary Ellen Edwards and Dr. Lisa Kovach who provided guidance, support, and thorough reviews of this paper. Other Committee Members, Dr. Patricia Devlin and Dr. Susan Rice, provided much support and enthusiasm for completing the work of this degree. My Committee Member, Dr. Christopher Bork, provided expert direction in analyzing the statistical data. I also appreciate the faculty at The University of Toledo College of Nursing for their encouragement for finishing the dissertation. I truly appreciate the work of the Bergen Bullying Research Group for their research in the area of workplace bullying and for the use of their tool, the NAQ-R, for this dissertation. v Table of Contents Abstract iii Acknowledgements v Table of Contents vi List of Tables x List of Abbreviations xi I. Introduction 1 A. Background 4 B. Statement of the Problem 11 C. Purpose of the Study 13 D. Research Question and Hypothesis 15 E. Operational Definitions 17 a. Bullying 17 b. Workplace Bullying 18 c. Horizontal Hostility 18 d. Horizontal / Lateral Violence 19 e. Work – Related Bullying 19 f. Person – Related Bullying 19 g. Physically Intimidating Bullying 20 F. Delimitation 20 G. Limitiation 21 II. Review of Literature 22 A. Introduction 22 vi B. Historical Background 22 C. Workplace Bullying Defined 29 D. Consequences of Bullying 33 E. Horizontal / Lateral Violence and Nursing 37 F. Oppression Theory and Nursing 40 G. Causes of Oppression and the New Nurse Graduate 44 H. Bullying and the New Nurse Graduate 47 I. Prevention of Bullying Through Higher Education 49 J. Nursing and Bullying – Role Conflict 51 K. Health Organization Responsibility 53 L. Summary 55 III. Methodology 57 A. Introduction 57 B. Research Design 57 C. Sample Population 58 D. Research Questions and Statistical Hypothesis 59 E. Survey Instrument 63 F. Procedure 63 G. Data Analysis Procedure 70 H. Protection of Human Rights 71 I. Summary 72 IV. Data Analysis and Results 73 A. Demographic Description of Participants 73 vii B. Analysis of Research Questions and Hypothesis 76 C. NAQ – R Survey Questions and New Nurse Graduate Responses 76 a. Work – Related Bullying 76 b. Person – Related Bullying 81 c. Physically Intimidating Bullying 88 D. Have You Been Bullied at Work? 90 E. Internal and External Behavioral Reactions to Bullying 92 F. Bullying Affects on Job Performance 94 G. Who is the Bully in the Workplace? 96 H. Educational Efforts to Manage Bullying 97 I. Workplace Efforts to Educate Employees and Manage Bullying 99 J. Hypothesis Testing 102 K. Research Question One 103 L. Research Question Two A 107 M. Research Question Two B 109 N. Research Question Three 121 O. Research Question Four 125 P. Statistical Analysis Using Chi Square 128 Q. Summary of Data Analysis and Findings 132 V. Summary, Conclusion and Recommendations 140 A. Conflict Management Theory 141 B. Accepted Hypothesis and Rejected Hypothesis 143 a. Research Question One 143 viii b. Research Question Two A. 1. 145 c. Research Question Two A. 2. 145 d. Research Question Three A. 147 e. Research Question Four A. 148 f. Research Question Four B. 149 C. Discussion 149 D. Implications 151 E. Limitations 152 F. Recommendations for Future Studies 153 G. Implications and Limitations 153 References 161 Appendices A. Negative Acts Questionnaire - Revised 156 ix List of Tables Table 1. Factor loading and sub-factors of NAQ-R.......................................................66 Table 2. Frequency of race of nurse respondents...........................................................74 Table 3. Nurse practice settings of nurse respondents....................................................74 Table 4. Nursing role of nurse respondents....................................................................75 Table 5. Educational background of nurse respondents.................................................75 Table 6. Percentage of respondents who reported internal and external behavioral reactions to bullying..........................................................................................93 Table 7. Percentage of nurse frequencies of “who is the bully in the workplace?”.......................................................................................................97 Table 8. Einarsen and new graduate nurse results “work-related bullying”..........................................................................................................103 Table 9. Einarsen and new graduate nurse results “person-related bullying”..........................................................................................................105 Table 10. Einarsen and new graduate nurse results “physically-intimidating bullying”..........................................................................................................107 x List of Abbreviations ANA…..............American Nurses Association CP……..............Conditional Probability ED……..............Emergency Department ER……..............Emergency Room Ho: ....................Null Hypothesis HMO…….........Health Maintenance Organization IRB……..... ......Internal Review Board JCAHO….........Joint Commission on Accreditation of Healthcare Organizations LCC……..........Latent Class Cluster MD…...............Medical Doctor MSN…….........Master Science in Nursing N……...............Nurse NAQ…….........Negative Acts Questionnaire NAQ – R….......Negative Acts Questionnaire – Revised ONA…….........Ohio Nurses Association PWC HRI........PricewaterhouseCoopers’ Health Research Institute RN………........Registered Nurse RNC….............Royal College of Nursing SPSS……........Statistical Package for the Social Sciences UK…...............United Kingdom US…................United States xi Chapter One Introduction This chapter provides the background, statement of the problem, purpose of the study research questions and hypothesis, the definition of terms, and the limitations and delimitations of the study. This study expands understanding of the new graduate nurse’s incidence and perception of workplace bullying in the US. The study determines if the new graduate registered nurse (RN) feels educationally prepared to recognize and manage bullies in the workplace, and if they have left a nursing position or their career in nursing
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