A Report on the Extent of Bullying and Negative Workplace Behaviours Affecting Irish Nurses

Research Team: Dr. Juliet McMahon, Dr. Sarah MacCurtain, Dr. Michelle O’Sullivan Dr. Caroline Murphy, Dr.Tom Turner

Department of Personnel and Employment Relations, Kemmy Business School, University of Limerick

March 2013

1 2 Executive Summary

The University of Limerick in conjunction with the INMO has undertaken the largest-scale survey of nurses in Ireland on the issue of workplace bullying. Prior to the survey, little was known about the extent of bullying among nurses or about the specific outcomes of bullying.

A self-report postal survey was undertaken, to which 2929 nurses responded. Measures from the Negative Acts Questionnaire were used, which is an internationally accepted research instrument for measuring the frequency, intensity and prevalence of workplace bullying. The questionnaire also included measures on organisational climate, reflecting the importance of organisational factors. The findings indicate that a majority of nurses did not experience negative acts of bullying but a significant minority have. Most of the bullying was experienced in acute services and in larger organisations with 500-1000 employees. Of those who did experience bullying, much of it was not frequent (on average once a month or less) but almost 10 percent of respondents reported being bullied more frequently. Almost three quarters of bullying was reported to be perpetrated by management and a third by colleagues.

The vast majority of those bullied were negatively affected in some way, with the most frequently cited effects including the erosion of self-esteem and self-confidence and feeling anxious at work. In addition, approximately 80 percent of respondents indicated that they had observed bullying in the workplace, with 15 percent indicating that it was on average once a week or more. Victims and observers of bullying had a poorer opinion of their work climate than non-victims and non-observers.

1 TABLE OF CONTENTS

1 Introduction 5 1.1 Aims of Report 5 Causes, Types and Effects of Bullying 7 2 Defining Bullying 8 2.1 Causes and Effects of Bullying 9 2.1.1 Personality of victim and perpetrator 9 2.1.2 Workplace bullying and the effect of organisation culture 9 2.1.3 Workplace bullying the effect of job demands 10 2.2 Outcomes of Workplace bullying 11 2.3 Tackling Workplace Bullying 11 2.4 Workplace Bullying and the Healthcare Sector 12 Survey Methodology and Findings 13 3 Methodology 14 3.1 Participants 15 3.1.1 Gender Profile of Survey Respondents 15 3.1.2 Age Profile of Survey Respondents 15 3.2 Education Profile of Survey Respondents 15 3.3 Work Profile of Survey Respondents 15 3.4 Findings and Analysis 16 3.4.1 Negative Acts and Bullying in the workplace 18 3.5 The Individual within workplace bullying 21 3.5.1 Who is bullying in the workplace? 21 3.6 Outcomes of bullying in the workplace 22 3.6.1 How have employees bullied been affected by bullying? 22 3.7 Actions Taken by Victims 24 3.8 Observers of Bullying 24 3.8.1 Personal and workplace characteristics 25 3.8.2 Actions Taken by Observers 26 3.8.3 Using Formal Procedures 27 3.9 Supervisors Responses to Bullying 27 3.10 Outcomes of Complaints regarding Bullying 29 3.11 Influence of Organisational Climate 29 Conclusion 31 4 Conclusion 32 5 Bibliography 33 6 Appendix 39

2 LIST OF FIGURE

Figure 1: Percentage Bullied and Time Period 20

Figure 2: Reported Victims of Bullying by Age Group 20

Figure 3: Reported Victims of Bullying by Work Area 20

Figure 4: Reported Perpetrators of Bullying. 21

Figure 5: Number of Bullying Perpetrators and Frequency 22

Figure 6: Effects of Bullying on Personal Wellbeing 23

Figure 7: Effects of Bullying on Aspects of Work 23

Figure 8: Effects of Bullying on Absenteeism 24

Figure 9: Reported Outcomes of Bullying Complaints 29

Figure 10: Organisational Climate Measures 30:

3 LIST OF TABLES

Table 2.2 1: Age Profile of Respondents 15

Table 2.3 1: Respondents by Education Level 16

Table 2.4 1: Respondents Work Profile 16

Table 2.4 2: Respondents by Organisation Type 17

Table 2.4 3: Respondents by Employment Status 17

Table 2.4 4: Respondents by Occupation Grade 17

Table 2.4 5: Respondents by Length of Service 17

Table 2.5 1: Negative Acts in the Workplace: Monthly, Weekly or Daily 18

Table 2.5 2: Identification of Bullying as a Problem at Work 19

Table 2.8 1: Actions Taken by Reported Victims of Bullying 24

Table 2.9 1: Observed Bullying over previous six months 25

Table 2.9 2: Observation of Bullying by Age Group (%) 25

Table 2.9 3: Observation of bullying by Size of Organisation (%) 26

Table 2.9 4: Observation of bullying by Area of Work (%) 26

Table 2.9 5: Actions taken having observed Bullying 26

Table 2.9 6: Reasons stated for feeling comfortable in taking formal action 27

Table 2.9 7: Reasons stated for feeling uncomfortable in taking formal action 27

Table 2.10 1: Supervisors opinions resolution of bullying complaints 28

Table 2.10 2: Factors which had a positive influence on dealing with bullying complaints 28

Table 2.10 3: Factors which had a negative influence on dealing with bullying complaints (%) 29

Table 2.12 1: Organisational Climate Measures 30

4 1 Introduction

A plethora of research exists to suggest that bullying is a serious problem in the health sector internationally. Studies reveal that bullying is widespread at all levels and professions including amongst junior doctors, social care workers, supervisors and managers and across all facets whether it be hospitals, smaller clinical practices or social care settings (Cheema et al. 2005; Quine, 2002; Salin, 2005). Nurses in particular have been identified as a group where bullying has such a profound effect that it has been identified as a direct factor in nurses’ intention to leave their job or the profession entirely (Hogh et al. 2011; McKenna et al. 2003; Dasiski, 2004; McMillan, 1995; Yildirim and Yildirim, 2007; Duffy 1995; Quine, 1999; Farrell, 2001; Lewis 2001). Bullying therefore is viewed as having serious consequences for both the individual’s personal wellbeing and career (Johnson 2009; Einarsen and Mikkelsen, 2003; Zapf and Einarsen, 2001). Bullying can have potentially serious consequences beyond the individual extending to service provision and patient care and to the efficiency and performance of the organisation (Farrell et al. 2006; Quine, 2001; Simons, 2008). While there is significant research on bullying in healthcare settings in other countries, little research has been conducted on the issue in Ireland.

1.1 Aims of Report The overall objective of this report is to capture the experiences of INMO members with regard to bullying in the workplace. The specific research aims are: 1. To review the extant literature on the nature, type and causes of bullying. 2. To examine international studies on the consequences of bullying for individuals and the organisation. 3. To review the role organisational factors play in triggering and sustaining bullying behaviours. 4. To survey INMO members with a view to ascertaining: • The frequency and type of negative acts experienced by nurses • The frequency with which nurses are victims or observers of bullying • The effects of bullying behaviour on victims, observers and the organisation • The extent and type of action taken by victims and observers of bullying • The relationship between being bullied and the work climate

The structure of this report is as follows. Section one reviews the key findings of studies on bullying and particularly bullying in nursing internationally. Section two details the methodology used in the UL/INMO survey and reports the results of it. Section three summarises the key conclusions that are drawn from the findings

5 6 CAUSES, TYPES AND EFFECTS OF BULLYING

7 2 Defining Bullying

The first systematic description of the phenomenon of bullying is attributed to Heinemann (1972) and referred to bullying behaviours at school. Over time, the field grew to include issues surrounding bullying at work. Workplace bullying in recent years has received significant academic and practitioner attention (Adams, 1992; Leyman, 1996; Bowling and Beehr, 2006; Nielsen et al. 2008, Hutchinson and Hurley, 2012). Within the field of nursing, the term BHHV refers to bullying, harassment and horizontal violence at work. Bullying has been defined as a subtype of aggressive behaviour, in which an individual or a group of individuals repeatedly attacks, humiliates, and/or excludes a relatively powerless person (Salmavalli, 2009). Specifically from a workplace perspective, Einarsen et al. (2003:15) argue that bullying can be defined as “harassing, offending, socially excluding someone or negatively affecting someone’s work tasks”. Furthermore, there is general consensus among authors that in order for the label bullying to be applied to a particular activity, interaction or process, it has to occur repeatedly and regularly (Ortega et al. 2009, Tuckey et al. 2009, Einarsen et al. 2003:15). Bullying therefore is accepted to be a gradually evolving process, often triggered by a work- related conflict (Leymann, 1996). Bullying behaviour may not always manifest itself as openly aggressive acts but rather they may be subtle and covert in nature. Therefore, the victim’s perception of the event can differ from that of the perpetrator significantly.

Despite the fact that the term ‘bullying’ can be subjective, there appears to be international consensus on certain dimensions of bullying. These are • that the behaviour must be continuous and frequent • that the behaviour has negative outcomes for the victim • that there is an imbalance of power between the parties • the impact on the victim is the key defining factor not the intent of the perpetrator. This last condition poses difficulties as conflict can often arise between an individual’s perception that behaviour towards them constitutes bullying whereas the alleged perpetrator(s) may argue that no harm was intended. This issue has also been raised in relevant case law. For the purposes of this report and the questionnaire, bullying is defined using the Labour Relations Commission (LRC) Code of Practice definition which has been adopted by the HSE. Thus bullying is defined as: Workplace Bullying is repeated inappropriate behaviour, direct or indirect, whether verbal, physical or otherwise, conducted by one or more persons against another or others, at the place of work and/or in the course of employment, which could reasonably be regarded as undermining the individual’s right to dignity at work. An isolated incident of the behaviour described in this definition may be an affront to dignity at work but, as a once off incident, is not considered to be bullying.

Furthermore the HSE Code of Practice on Bullying indicates similarity with much of the findings of research in the area by stating: A key characteristic of bullying is that it usually takes place over a period of time. It is regular and persistent inappropriate behaviour which is specifically targeted at one employee or a group of employees. It may be perpetrated by someone in a position of authority, by employees against a manager or by employees in the same grade as the recipient.

Bullying therefore is not confined to the manager/employee relationship but can exist horizontally (between peer groups) or vertically (upwards or downwards in the organisation). In published research, cited examples of workplace bullying tend to fall into two categories (i) more explicit forms of bullying such as: being subjected to physically aggressive

8 behaviour, teasing, threatening, verbal abuse and being humiliated in front of others. (ii) more subtle forms of bullying such as being subjected to unreasonable work demands, being excluded or isolated, being undermined, spreading of rumours or innuendo about a person or persons, or having necessary work information withheld.

Direct bullying involves interaction between the bully and the person being bullied and can take the form of verbal harassment, persistent criticism, humiliation, and intentional demeaning of an individual (Gardner and Johnson, 2001; Quine, 1999; Rayner and Hoel, 1997). Indirect bullying involves interaction between the bully and others that then indirectly impacts the person being bullied. Such bullying can include exclusion and isolation, spreading gossip, lies and making false accusations (Einarsen, 2000; Quine, 1999; Vartia, 2001; Rayner and Hoel, 1997). 2.1 Causes and Effects of Bullying

2.1.1 Personality of victim and perpetrator Initial early research into workplace bullying focused on the personalities of both the victim and the perpetrators of bullying. The victims of bullying have been presented as having common personality traits that make them more susceptible to workplace bullying. Einarsen et al. (1994) argue that the personality of the victim may provoke aggression in others. Similarly, Felson (1992) indicates that those with ‘annoying’ personalities tend to provoke more aggressive type behaviour that could lead to bullying. It was argued that individuals with low self-esteem, those viewed as anxious in social settings, those who are conscientious in nature or are seen as overachievers were more susceptible to bullying type behaviour (Brodsky, 1976; Einarsen et al. 1994). The perpetrators of bullying, according to Bjorkqvist et al. (1994), were concerned about status and job positions, were envious of others, and were uncertain of themselves while victims of bullying have also identified the ‘difficult’ personality of the bully as a reason for bullying behaviour (Seigne, 1998). Victims of bullying suggested that envy triggered bullying behaviour though Einarsen et al. (1994) caution that this association could be a self-preserving attribution on the part of victims. Some commentators have criticised the focus on ‘personality’. Leymann (1996) claims that any differences in personality between victims and non-victims of bullying can be attributed to the act of bullying itself. Lewis (2006:55) also dismisses what he terms the “defective personality explanation” and he highlights that many victims are also perpetrators of bullying and contends that personality is mainly workplace mediated. Much of the more recent research on bullying has moved away from ‘personality’ and has focused instead on organisational factors. 2.1.2 Workplace bullying and the effect of organisation culture Early Research on the reasons for workplace bullying centred on the personality of the victim and the personality of the bully. However, more recent research has moved away from this focus and has found evidence that workplace bullying is rooted in an organisation’s characteristics, leadership and systems. There is some evidence that certain organisational cultures (e.g. power cultures based on rank and position) can lead to the normalising of bullying behaviours (Archer, 1999). Recent studies have found that aspects of ‘destructive’ leadership (Skogstad et al. 2007; Salin, 2008) contribute to the prevalence of bullying in organisations whereby managers effectively condone bullying through laissez faire approaches of non intervention. Indeed much research indicates that the highest incidences of workplace bullying are found where senior management are perceived as tolerating/ignoring such behaviour and allowing such a culture to develop (Lewis, 2006; Brennan, 2001; Mayhew and

9 Chappell, 2003). In other words organisations in a sense ‘reward’ bullying in that perpetrators remain in positions of relative power, or advance within the organisation whilst victims often leave or are isolated for challenging bullying.. In line with social learning theories (Mawtiz et al. 2012), it would be expected that if there is such a tacit and visible ‘reward’ for bullying then this will become a learned behaviour and incidences of bullying would be expected to increase within an organisation. Informal organisational alliances within workplaces also provide the mechanism through which bullying becomes a learned organisational behaviour and the literature draws links between such alliances and the tolerance and reward of bullying (Hutchinson, 2008). Thus organisations develop ‘cultures’ whereby bullying is part of the fabric of the organisation. Organisations that have rigid hierarchical structures and top-down management structures are dependent on employees being obedient, loyal to the organisation as well as having managers who make most of the decisions within the organisation. This results in power within an organisation in the hands of a small few. These types of organisational structures create a separation between employees and management promoting those that are effective rather than those with leadership qualities and firmly establishes a culture of fear (Glendinning, 2001). A rigid hierarchy generates employee versus management type culture that increases the risk of bullying occurring (Randle, 2007). Healthcare organisations are normally permutated with this management type structure (Randle, 2006). Another consequence of these organisational structures is that bullying is seen as normal behaviour or acceptable resulting in incidences of bullying being rarely reported formally to management as victims fear isolation or fear the seniority and power of the perpetrators (Hennessey and Spurgeon, 2000; Mayhew and Chappell, 2001). Legitimate power within an organisation is given to individuals by the organisation. These individuals, such as managers or supervisors, use this power to influence the behaviour of others and can take punitive action against employees who breach rules or power. Researchers of workplace bullying especially within the nursing profession have illustrated that this granted legitimate power can sometimes be misused. Hutchinson (2006) uses Clegg’s model of ‘circuits of power’ to illustrate how power can be misused to strategically maintain order, reinforce rules and maintain the status quo within organisations. An environment where management are under pressure to deliver change in order to compete effectively can result in the misuse of legitimate power resulting in a tolerance of bullying within an organisation (Hutchinson et al. 2008).

2.1.3 Workplace bullying the effect of job demands Cultural and organisational factors which affect bullying can be exacerbated by external pressures for example due to increasing pressure to improve efficiency and cost effectiveness whilst at the same time improving quality of service. There are inherent tensions in these aims and indeed changes in working conditions and work pressures in organisations can act as precipitating triggers for bullying. These can include high levels of stress, role ambiguity (Notelaers et al. 2009), job cuts (De Cuyper et al. 2009), precarious employment, reorganisation, top-down targets, organisational change and work intensification. For instance in a situation where people are competing for tenure or vary scarce promotional opportunities there may be an incentive to engage in negative behaviour towards other employees. Salin (2003) for instance found evidence of possible increased engagement in bullying as a micropolitical strategy for eliminating unwanted persons or improving ones’ own position through such behaviour as deliberate withholding of information. An emerging and very relevant area of study with respect to bullying in this regard is to be found in research which examines bullying through the lens of job demands and related job strain. (Tuckey et al. 2009; Baillen et al. 2010). Here research is indicating that where job demands increase to the point

10 where strain is evident, then there is evidence of a higher propensity among workforces to engage in bullying or to be more at risk of being bullied. A recent analysis of data across a large sample of nurses and medics in the NHS (MacCurtain and MacMahon, 2012) indicated that this is indeed the case.

2.2 Outcomes of Workplace bullying The direct impact of bullying on individual well being and on the organisation is extensively reported Mac Mahon et al. (2010). The following are examples: For the victim, research confirms an association between bullying and a range of psychosocial and physiological symptoms such as sleeping problems, anxiety and irritability (Rodriguez-Munoz et al. 2010; Parent-Thirion et al. 2007). Healthcare staff subjected to bullying have reported burn out, psychological and somatic complaints, dissatisfaction, anxiety, depression, job dissatisfaction, job stress, perceptions of injustice, low trust, propensity to leave, suicidal behaviour, sleeplessness, self-hatred, stress, lowered confidence and self-esteem, anger, powerlessness, drug and alcohol abuse and an increase in absence or sickness (Randle, 2003; O’Connell et al. 2007; Kivimäki et al. 2000). In addition, victims can become bullies themselves (Randle, 2003).

From the organisations’ perspective, bullying has been associated with absenteeism, turnover, replacement costs, deterioration in productivity and efficacy of performance, patient care, possible compensation and litigation and loss of public goodwill and reputation (Hoel et al. 2003; Kauppinen et al. 2001; Kivimäki et al. 2000; Parent- Thirion et al. 2007; Zapf and Gross, 2001). Bullying can go beyond individual consequences and outcomes and affect the collective perception of the organisation - even among those employees who have not experienced bullying themselves. Thus bullying can have a serious impact on bystanders or observers of negative actions and can have major further implications for management of healthcare organisations in terms of collective staff morale, retention/turnover trust and ultimately of patient/service user care. 2.3 Tackling Workplace Bullying Research would seem to indicate that many organisations struggle with the issue of bullying and their response is often to remove the victim from the workplace rather than the perpetrator(s) (Leymann, 1996). Salin (2008) highlights that very often there seems to be no visible disincentive cost to perpetrators to discourage them from bullying i.e. the risk of being discovered and reprimanded. Thus negative cultures which are perceived to support bullying behaviour are perpetuated through lack of action by management The ‘accepted’ method for dealing with workplace bullying has traditionally been through the use of policies and procedures with the onus being on victims to make formal complaints and instigate a formal process. This approach has come under criticism in recent times (Hoel and Einarsen, 2009). Some criticisms that emerge are: that the approach is very reactive and takes little account of the ongoing wellbeing of the complainant, that the effect of utilising lengthy procedures involving various members of a reporting hierarchy who are often unwilling to engage in the issue results in a long drawn out process, that use of procedures in a sense forces the individual to act alone and takes the issue out of a collective sphere where a complainant might have more power, that the existing approaches encourage a litigious approach and response, that often the complainant will effectively have to resign and take a legal case against a company. Furthermore research has shown that very often complainants are unwilling to make a complaint (Mayhew and Chapell, 2001; Birman, 1999; Kelly, 2006; Field, 2003) due a fear of no longer ‘fitting in’ or a fear that the consequences for them

11 of such action will be an increase rather than a decrease in bullying (Vessey et al. 2009) especially in cultures that tolerate bullying or where the perpetrator is in a position of power within the organisation as discussed in previous paragraphs. In recent research high levels of support at work have been postulated as a much more proactive and effective method of reducing the likelihood of workers being subjected to bullying and to protecting individuals from some of the harmful effects of bullying (Tuckey et al. 2009; Vessey et al. 2009).

2.4 Workplace Bullying and the Healthcare Sector Healthcare organizations have been characterized as being/becoming transactional in nature, where a focus on productivity and a withdrawal of resources due to cost issues can engender tolerance and reward of bullying (Hutchinson et al. 2008). There are significant pressures on the nursing profession with a worldwide shortage of healthcare workers (Buchan, 2002) and workplace bullying within nursing can exacerbate this problem. Hoel and Salin (2003) highlight that bullying is more likely to occur when an organisation is being restructured or downsized and healthcare organisations are particularly prone to these types of pressures. In 2007, O’Connell et al. (2007) reported that that 7.9 percent of those at work in Ireland had reported experiencing bullying in the previous six months. The reported incidence of bullying was higher for the public sector (10.5%) than the private sector (6.9%). Health and Social Work had one of the highest reported rates of bullying at 12.4 percent (O’Connell et al., 2007). O’Connell’s study focused on victims of bullying while the UL/INMO survey also captures observers of bullying. In the United Kingdom a study in the health sector found that 44 percent of community nurses reported experiencing workplace bullying while 50% reported observations of workplace bullying (Quine, 2001). While incidents of workplace bullying can be found in many organisations it seems that the healthcare sector in general is particularly prone to higher levels of workplace bullying than in other sector. While the outcomes for workplace bullying at an individual and organisational level were discussed in section 2.5 of this report, the healthcare sector and the nursing profession have some characteristics that require further discussion.

12 SURVEY METHODOLOGY AND FINDINGS

13 3 Methodology

This section details the chosen methods of research, the steps taken in the collection of data, how data was stored and sorted for analysis, and any ethical considerations taken by the authors. The aim of this report is to highlight the extent to which bullying in the workplace occurs within the nursing profession in Ireland. In order to achieve these aims the following questions guided the research design: • Do respondents see workplace bullying as a problem in the workplace? • Have respondents been bullied or observed bullying in the previous 6 months? • Were respondents subjected to negative acts in the workplace? • Was the bullying carried out by one or more people? • Who were the reported perpetrators of the bullying? • What were the effects of bullying on the victims health and work effectiveness? • What, if any, actions were taken by the victims and observers to address the bullying? • What are the experiences of nurses in supervisory positions in dealing with bullying? • What are nurses’ views of their work climate?

The choice of questionnaire in this study was influenced by previous empirical studies that utilised the Negative Acts Questionnaire (NAQ) developed by Einarsen (1994). Permission was granted to the investigators to use this instrument; in addition we employed measures from previously validated surveys to test issues regarding organisational climate. The NAQ is an internally accepted research instrument for measuring the frequency, intensity and prevalence of workplace bullying. The NAQ items are posed in behavioral terms and include no direct reference to terms such as bullying of BHHV (bullying, harassment and horizontal violence). Respondents are therefore able to complete the initial section of the NAQ without having to label themselves victims of bullying. However, later questions do require the respondent to indicate whether or not they consider themselves to be victims of bullying at work. The scale has satisfactory reliability and constructs validity. A core strength of the NAQ is the range of areas represented within the questionnaire including job satisfaction, bullying acts, the causes of bullying its effects and actions taken to combat the problem. A printed copy of the questionnaire was included in a monthly newsletter to a cohort of the union’s membership with a prepaid addressed envelope for ease of return directly to the research team at the University of Limerick. The questionnaire was posted to 27,000 INMO members (excluding midwives) and 2929 responses were received, representing a response rate of 10.8 percent.

The NAQ used in the research was redesigned to fit the Irish healthcare and nursing profession context. A number of demographic questions were added to Einarsen’s NAQ and these were specific to the population surveyed. This paper is based on a selection of the variables from the original study where the broad aim was to explore the antecedents, effects and interventions related to bullying. Given that the research was of a sensitive nature, strict ethical guidelines were followed as advised by the University of Limerick’s Ethics Committee. The survey questionnaire was anonymous and confidential in nature. Throughout the duration of the project completed questionnaires were kept in a secure location and data transferred from questionnaires to software packages were kept on an IT system that was password protected with single user access.

The data contained within these questionnaires was analysed using SPSS software that is designed to provide predictive analytical solutions for raw data and allows the user to discover patterns and associations. Every question asked within the questionnaire was assigned a code

14 within SPSS and further assigned whether it was a nominal, ordinal, or scale category. To create a profile summary of survey respondents a frequency analysis was completed in terms of age, gender, nationality, education, and work profile. In order to determine the extent of workplace bullying, a frequency analysis was performed on whether respondents thought bullying was a problem in the workplace and whether respondents had been bullied in the last 6 months. In determining the causes of bullying, a cross tabulation was performed on each negative act and whether a respondent was bullied or not. To determine who was involved in bullying, cross tabulations were carried out on who those who were bullied against the numbers doing the bullying and who was doing the bullying, as reported by the respondents. To determine the outcomes of bullying, cross tabulations were carried out on those who were bullied against the effects of bullying, the actions taken as a result of bullying, and the outcomes of formal reports of bullying.

3.1 Participants 3.1.1 Gender Profile of Survey Respondents Nursing as a profession has traditionally been female-dominated with most modern societies demonstrating an average gender breakdown of 90 percent female and 10 percent male. In Ireland the breakdown is that male nurses make up only 7.6 percent of the total nursing population (Irish Nursing Board, 2006). The total number of females that responded to the questionnaire was 2825 representing 96.6 percent of the total number of respondents with the balance of 100 respondents being male respondents (3.4%). It is worth noting that the majority of male nurses in Ireland are psychiatric nurses and these are unlikely to have been captured in the sample. 3.1.2 Age Profile of Survey Respondents

Table 2.2 1 Age Profile of Respondents Age Group Percent Number 18-25 2.8 83 26-30 6.9 202 31-35 15.4 449 36-40 16.7 489 41-45 27.2 795 46-50 7.7 226 51-55 12.9 376 56-60 7.8 227 61-64 2.4 71 65+ 0.2 6 Missing 0.2 5

The age profile of the sample size that responded to this survey represents a cross section of ages ranging from 18 through to 65+ years of age. Those aged from 31 to 45 make up 59.3 percent of the survey respondents which represents a significant proportion of the overall skills in nursing in Ireland. Those aged between 18 and 30 make up 12.5 percent of the survey respondents.

15 3.2 Education Profile of Survey Respondents Nursing as a career requires continuous lifelong learning and this is also recognised in the increased numbers of opportunities for nurses to avail of post graduate training. Respondents to this questionnaire indicated that 17.7 percent had a certificate qualification with 21.3 percent indicating that they had a diploma qualification as their highest level of education. Over half of respondents had a degree or higher highlighting the changes that have been made since 1994 in nurse education, one can expect this figure to increase overtime.

Table 2.3 1: Respondents by Education Level Level Percent Number Level Percent Number Certificate 17.7 513 Diploma 21.3 618 Degree 25.4 739 Post-Graduate 29.1 844 Other 6.5 189 Missing 0.9 25

3.3 Work Profile of Survey Respondents Respondents to the questionnaire were asked to indicate their area of work and the organisation type. Almost half of respondents worked in acute services and the lowest number of respondents (0.4%) worked within the mental health area (table 2.4.1). The majority of respondents worked in the public sector (68.2%) with the remainder generally evenly split between the public voluntary sector and the private sector (table 2.4.2). The fact that the HSE is the overwhelming employer of nurses in Ireland reflects the very high number of respondents that indicated that they worked in the public sector. In terms of employment status, the vast majority of respondents were permanent (table 2.4.3). With regard to occupational grade, over half of respondents were staff nurses, a quarter were CNMs and almost 5 percent were Assistant Directors/Directors of Nursing (table 2.4.4). Three quarters of respondents had less than ten years’ service (table 2.4.5).

Table 2.4 1: Respondents Work Profile Area Percent Number Acute 49.0 1428 Continuing Care 12.4 360 Community Care 14.3 416 Intellectual Disability 8.3 241 Mental Health .4 12457 Other 15.7 15 Missing .5

16 Table 2.4 2: Respondents by Organisation Type Area Percent Number Public Hospital 68.2 1996 Public Voluntary Sector 16.6 487 Private Healthcare Org 14.1 413 16 Other 1.0 29 Missing .1 3

Table 2.4 3: Respondents by Employment Status Status Percent Number Permanent 82.9 2421 Temporary 6.4 188 Agency 0.8 23 Other 9.3 271 Missing .3 8

Table 2.4 4: Respondents by Occupation Grade Grade Percent Number Staff Nurse 57.9 1687 CNM 1 7.4 216 CNM 2 15.9 464 CNM 3 1.6 48 AD Nursing 3.4 99 D Nursing 1.4 41 Other 12.3 359 Missing .5 15

Table 2.4 5: Respondents by Length of Service Years Percent Less than 2 14.3 2-5 27.8 5-10 32.9 10-15 11.4 15-20 6.8 20-25 3.7 25-30 1.8 30+ 1.3

17 3.4 Findings and Analysis

3.4.1 Negative Acts and Bullying in the workplace Before asking respondents whether they had experienced bullying or not, we asked them to indicate whether or not and how frequently they had experienced negative acts at work in the previous six months at work. Respondents were provided with a list of thirty acts and were asked to indicate whether they had experienced these never, now and then, monthly, weekly or daily. The majority of nurses reported never experiencing such acts. However, a substantial minority of people has experienced the following behaviours at least monthly Table 2.5.1 below shows those acts that were experienced on a monthly, daily or weekly basis. It indicates that a fifth of respondents had experienced ‘being exposed to an unmanageable workload’, and this was followed in level of frequency by ‘being ordered to do work below your level of competence’, ‘having opinions ignored, ‘someone withholding information’, ‘having responsibility removed’ and ‘being excluded’. Very small percentages of respondents experienced more overt and extreme negative acts such as threats of violence or insulting emails or phone calls.

Table 2.5 1: Negative Acts in the Workplace: Monthly, Weekly or Daily

Negative Acts in the Workplace Never Now & Then Monthly Weekly Daily Having your opinions and views ignored 45.2 39.3 6.7 4.6 4.3 Being humiliated in connection with your work 60 30.1 3.9 3.9 2 Being exposed to an unmanageable workload 49.4 30 6.6 5.7 8.3 Being excluded 55.7 31.7 4.5 4.1 4 Someone withholding information that affects your performance 53.8 33.4 4.7 5.2 2.9 Facing a hostile reaction when you approach 66.4 24.1 4.2 3.2 2.1 Being ordered to do work below your level of competence 55.8 26.9 4.4 6.6 6.2 Being ridiculed in connection with your work 69.5 22.3 3.7 3 1.5 Being the target of spontaneous anger 63.3 28.3 4.5 2.6 1.3 Responsibility removed or replaced with trivial or unpleasant acts 64.9 22.4 4.5 4.8 3.4 Attempts to find fault in your work 72.4 19.6 3.1 2.6 2.3 Being shouted at 68.7 23.7 4.1 2.4 1.1 Spreading of gossip or rumours about you 72.6 19.9 2.7 2.7 2.1 Pressure not to claim something which by right you are entitled 70.8 20.8 4.1 2 2.3 Repeated reminders of your errors or your mistakes 75.3 18.5 3.2 1.8 1.2 Excessive monitoring of your work 74.1 16.6 3.4 2.7 3.2 Persistent criticism of your work and effort 77.1 16.1 2.9 2.2 1.7 Being given tasks with unreasonable or impossible deadlines 68.5 22.6 3.7 2.9 2.4 Having insulting or offensive remarks made about your person 78.7 15.2 2.6 2.1 1.4 Intimidating behaviour 79.8 14.7 2.6 1.7 1.2 Being moved or transferred against your will 76.2 16.5 3.2 1.8 2.2 Having allegations made against you 81.1 15.1 2 1.2 0.7 Threats of making your life difficult 84.3 11.4 1.7 1.2 1.5 18 Negative Acts in the Workplace Never Now & Then Monthly Weekly Daily Systematically being required to carry out tasks outside your job description 82 11.9 2.2 2.1 1.9 Being the subject of excessive teasing or sarcasm 87.7 9.2 1.3 0.9 1 Hints or signals from others that you should quit your job 88.1 8.6 1.6 0.8 0.9 Insulting messages, telephone calls, or emails 90.9 6.7 1.1 0.8 0.6 Practical jokes carried out by people you don’t get on with 93.9 4.7 0.7 0.4 0.5 Offensive remarks/behaviours with reference to race or ethnicity 94.3 3.3 1.1 0.6 0.8 Threats of violence 91.4 6 1.3 0.9 0.4

In determining the levels of bullying amongst the workforce, the questionnaire provided the following definition of bullying followed by direct questions based around this definition. ‘A situation where one or several individuals persistently over a period of time perceive themselves to be on the receiving end of negative actions from one or several persons, in a situation where the target of bullying has difficulty in defending him or herself against these actions. We will not refer to a one-off incident as bullying’. Provided with the definition of bullying, respondents were provided with the statement ‘I feel bullying is a problem in my workplace’ and were asked to rate their level of agreement with this statement. Table 2.5.2 shows that similar proportions of respondents agreed (41.1%) or disagreed (41.6%) that bullying was a problem at work while 16.6 percent neither agreed nor disagreed with the statement. This question provides a more revealing picture of bullying than just asking if someone experienced bullying.

Table 2.5.2: Identification of Bullying as a Problem in the Workplace

Level Percent Number Strongly agree 13.3 379 Agree 27.8 794 Neutral 16.6 739 Disagree 26.1 764 Strongly Disagree 15.5 443

Respondents were then asked to indicate, referring to the definition of bullying provided, whether they had been bullied in the previous 6 months and to indicate the level of bullying that they encountered. This rate of bullying is higher than that reported by O’Connell et al. (2007) for the general population (7.9%) and for the health and social work sector (12.4%). However the results are similar to Quine’s (2001) study, which noted that 44% of community nurses in the United Kingdom experienced workplace bullying and also supports Zapf et al.’s (2003) contention that the healthcare sector internationally is particularly prone to higher levels of workplace bullying than in other sectors.

In terms of personal characteristics, the majority of reported victims of bullying were in the 31-50 age group but it should be remembered that the this age groups also accounted for two thirds of respondents to the study. In regard to work area, over half of reported victims worked in acute services and the remainder were generally evenly distributed between intellectual disability, community care and continuing care (Figure 1).

19 Figure 1: Percentage Bullied and Time Period

61.5 60

40

20 18.7 10.7 5.8 1.6 1.7 0

Never Weekly Very rarely Now and then Almost daily Yes, several times

Figure 2: Reported Victims of Bullying by Age Group

40

20

0 18 - 30 31 - 40 41 - 50 51 - 60 60+

Figure 3: Reported Victims of Bullying by Work Area

60 50.7

40

20 16.3 12.2 11.3 9.4

0

Acute Other Community Intellectual Continuing care disability

20 3.5 The Individual within workplace bullying 3.5.1 Who is bullying in the workplace? Having determined the extent of bullying in the workplace, this section discusses the perpetrators as identified by reported victims. Respondents were allowed to select one or more groups responsible for the bullying towards them. Management was identified most frequently as the source of bullying, either by supervisors or senior managers (Figure 4). These findings are similar to international studies where managers are usually identified as the group most responsible for bullying (Saunders et al. 2007; Hoel et al. 2001). This does differ somewhat with the O’Connell et al. (2007) report on workplace bullying in Ireland which put colleagues of those bullied as being the highest category group responsible for bullying. Significant minorities identified colleagues and subordinates as sources of bullying. The literature on bullying in healthcare indicates that clients/patients and their families can be sources of bullying and these groups were identified by 8.9 percent and 9.5 percent of respondents respectively. The least frequently cited source of bullying was students.

Figure 4: Reported Perpetrators of Bullying.

43.9 40 38.2

30.3

20 13.5 9.5 8.9 6.8 0.5 0

Other Clients Students Families Colleagues Supervisor Subordinates Senior manager

Presented in Figure 5 is the results of a cross tabulation carried out of respondents who indicated that they were bullied in the last 6 months against whether there were one or more perpetrators of the bullying. More than half of those who indicated that they were bullied indicated that the bullying was carried out by one person and almost half indicated that it was carried out by more than one person. These results here are not inconsistent with the most recent report on workplace bullying in Ireland by the O’Connell et al. (2007) which stated that almost 60 percent of respondents were reportedly bullied by a single individual while the remainder indicated it was by more than one person. A significant finding illustrated in Figure 5 is that respondents reported being bullied more frequently by multiple people than by one person. In particular, respondents reported that they were bullied by multiple people almost twice as much on a daily basis than by an individual.

21 Figure 5: Number of Bullying Perpetrators and Frequency

60

40

20

0

y Weekly Very rarel Almost daily Now and then Yes, several times

One person More than one person

3.6 Outcomes of bullying in the workplace This section of the report discusses how those that have been bullied in the last 6 months have been affected personally by workplace bullying, what steps they took when the bullying occurred, and the outcomes that occurred when a formal complaint of workplace bullying was made. 3.6.1 How have employees bullied been affected by bullying? Respondents to the questionnaire were asked to indicate how they were affected by workplace bullying and the results are presented here in the form of a cross tabulation with those that indicated they were bullied within the last 6 months. It is clear from the results those who reported being bullied were affected in some way (84%). The most significantly effected areas were in relation to self-esteem and self-confidence (Figure 6). Similarly, almost 40 percent stated that they dreaded going to work and had problems sleeping. With regard to the effects of bullying on an individual’s work, the areas most effected were feelings of anxiety at work, feeling less effective at work, negative relations with colleagues and ‘taking it out’ on colleagues (Figure 7). A smaller percentage (12%) stated that their relationship with patients/service users had been negatively affected. As Figure 8 shows, victims reported that bullying resulted in them taking certified (14.5%) and uncertified sick leave (11.5%) which is broadly in line with O’Connell et al.’s (2007) findings on the levels of sick leave taken as a result of workplace bullying. Almost half of respondents (48.6%) stated that they felt a sense of powerlessness as a result of the bullying and 21.5 percent indicated that they would be actively seeking work elsewhere.

22 These findings emphasise the importance of addressing workplace bullying not only for the individual’s health and wellbeing but also for the organisation and the service user. The results suggest that many reported victims feel a sense of futility in addressing bullying and this is despite legislation and the introduction of workplace policies and procedures. The sense of powerlessness may be exacerbated by the earlier finding that almost half of perpetrators involve more than one person.

Figure 6: Effects of Bullying on Personal Wellbeing

60 52.1

43.8 38.5 40 36 24.8

21.5 20

0

Not sleeping Seeking other work Family life affected Self esteem eroded Dread coming to work Self confidence eroded

Figure 7: Effects of Bullying on Aspects of Work

60

51.2

40 37.9 36.6 31.1

23.6 20 12.2

0

Anxious Less effective

Difficulty concentrating Negative effectTake onit out on colleagues Negative relations / colleagues relationship with service users

23 Figure 7: Effects of Bullying on Aspects of Work

Figure 8: Effects of Bullying on Absenteeism

20 14.5 11.5 10

0

Taken certified leave Taken uncertified leave

3.7 Actions Taken by Victims Those who reported being bullied were asked if, and what type, of action they took to address the bullying behaviour. On a positive note, few respondents cited ‘not reporting or not discussing the bullying’ while most others indicated that they took some form of action (Table 2.8.1). The most popular action taken was for victims to discuss the bullying with either colleagues or their manager. The next most frequent actions cited were for victims to confront the perpetrator and to report the bullying formally to their supervisor.

Table 2.8 1: Actions Taken by Reported Victims of Bullying

Action Number % Confronted perpetrator 391 21.6 Formally reported to supervisor 221 12.2 Reported to union 117 6.5 Plan to leave organisation 135 7.4 Discussed with colleagues 475 26.2 Discussed informally with manager 326 18 Did not report or discuss 93 5.1 Other 56 3.1

3.8 Observers of Bullying One issue highlighted by the existing literature on bullying is the issue of bystanders (Ritta- Parizival and Salin, 2010), i.e. that the negative effects of bullying are not confined to the individual victim but observation of others being bullied can have negative effects on those who observe it in the workplace. With this in mind, the questionnaire sought to ascertain the extent to which nurses have observed bullying and whether or not they took action to address it. Respondents were asked to state the frequency with which they had observed bullying in the previous six months. The vast majority of respondents said they reported observing bullying to some extent (table 2.9.1). Over a third indicated that they had observed bullying rarely (once or twice over the previous six months) while another third reported observing bullying more frequently on a monthly, weekly or daily basis (table 2.9.1). The next step was to examine the relationship that existed between observation of bullying and recognition of bullying as a problem in the workplace. Somewhat surprisingly, 47.9 percent of those who had observed bullying did not view this conduct as a problem while the remainder did believe bullying was a problem in their workplace. A small group of individuals (10.9%, n=91) viewed bullying as a problem despite having never observed any form of bullying

24 themselves. Their opinion of bullying as a problem may therefore have been formed based on other factors outside of direct observation, for example through discussion with peers who had either experienced or observed bullying themselves.

Table 2.9 1: Observed Bullying over previous six months

Observed Frequency % Never 29.2 Yes but rarely 37.7 Now and then 18.6 Often/very often 14.4 Total 100

3.8.1 Personal and workplace characteristics We further examined the effect of control variables such as age and gender on observations of bullying. The analysis reveals a negative relationship existed between age and observations of bullying (table 2.9.2). The younger cohorts surveyed (18-30 and 31-40 year olds) reported higher levels of observing bullying than older age groups. They also reported observing bullying on a more frequent basis (on average once a week or more) than other age groups. In terms of gender, male nurses (75%) had a slightly higher rate of observing bullying than female nurses (70%).

Table 2.9 2: Observation of Bullying by Age Group (%)

Observed Frequency 18-30 31-40 41-50 51-60 61+ Never 24.5 25.9 30.4 34.6 30.4 Yes but rarely 38.2 37.9 39.6 34.6 31.9 Now and then 20.3 20.6 15.4 18.2 30.4 Often 17.3 15.6 14.6 12.5 7.2 Total 100 100 100 100 100

A correlation was also found to exist between organisational size and observations of bullying. Respondents were least likely to have observed bullying in small organisations with under 25 employees, while the highest percentage of observations was found in organisations with 500-1000 employees (Table 2.9.3). With regard to area of work, 64.5 percent of respondents working in private hospitals reported observations of bulling while the figure was slightly higher in public and voluntary organisations at 71.8 percent. Those working in community care settings recorded lower observations of bullying (59%) than those working in acute care, intellectual disability and continuing care (all over 70%). It is noteworthy that community care had the lowest number of respondents who viewed bullying as a problem at work (28%) while 45 percent of respondents working in acute care reported feeling that bullying was a problem. No significant differences were found in observations of bullying with regard to the job level or grade of the respondents.

25 Table 2.9.3: Observation of bullying by Size of Organisation (%)

Observed Frequency Under 25 26-100 101-500 501-1000 1000+ Never 40.6 27.7 30.2 21.7 29.1 Yes but rarely 33.2 37.3 40.4 39.2 36.3 Now and then 13.8 18.8 17 20.8 19.9 Often/very often 12.4 16.2 12.3 18.2 14.8 Total 100 100 100 100 100

Table 2.9.4: Observation of bullying by Area of Work (%)

Observed Frequency Acute Continuing Community Intellectual Other care disability Never 24.8 30.4 41 24.8 33.2 Yes but rarely 38.5 37.1 35.3 35.5 39.4 Now and then 20.5 16.8 14.75 22.6 15.4 Often/very often 16.1 15.7 9 17.1 12 Total 100 100 100 100 100

3.8.2 Actions Taken by Observers Another important issue that arises is what action if any do individuals take having observed bullying. The question posed to participants was: if you have observed bullying have you taken any of the following actions? By far, observers were more likely to engage in informal action by discussing the issue with colleagues or manager than to invoke formal procedures and report it to a supervisor (table 2.9.5). The results showed that a significant percentage of individuals who, upon observing bullying, took it upon themselves to confront the perpetrator directly (12.7%).

Table 2.9.5: Actions taken having observed Bullying

Action Number Percentage Confronted Bully Directly 308 12.7 Formally Reported to Supervisor 233 9.6 Formally Reported to union representative 49 2 Discussed with Colleagues 1015 41.9 Discussed informally with manager 538 22.2 Took no action 210 8.7

For further analysis, we recoded these action items into four categories: took no action, confronted the bully directly, engaged formal procedures and informal discussion. Of particular interest here are the observers who confronted the perpetrator directly. As table 2.9.5 shows, of the 308 instances in which observers confronted the perpetrator directly, in only 12.7 percent were formal procedures also invoked.

26 3.8.3 Using Formal Procedures The existence of a formal policy with regard to bullying/dignity and respect is now commonplace in many workplaces. However, these procedures will prove ineffective where staff feel uncomfortable engaging with the process. With this in mind the participants were posed the question, would you feel comfortable reporting or taking formal action relating to bullying in your organisation? The entire population surveyed was included in the analysis of this question. A slightly higher proportion of respondents (54.6%) stated that they would not feel comfortable taking formal action. Despite the fact that just under half of people said they would feel comfortable taking formal action, we noted earlier that much lower percentages of victims (12.2% formally reported to supervisor) and observers (9.6%) had actually done so. Table 2.9.6 below outlines the reasons which respondents gave as to why they would feel comfortable taking reporting bullying in their workplace. The most significant factor in making individuals feel comfortable was support – either from colleagues or managers while a significant minority noted the importance of complaints be dealt with adequately by management. Table 2.9.7 below outlines the reasons why individuals would not feel comfortable taking formal action against bullying. The greatest deterrents from taking formal action were the negative effect on their career, fear of isolation and fear that the perpetrator would be too powerful. Both victims and observers may feel that taking formal action could leave them labelled as trouble makers, as both groups noted the effect on their career as the greatest deterrent.

3.9 Supervisors Responses to Bullying

Table 2.9.6: Reasons stated for feeling comfortable in taking formal action

Reason Number Percentage Strong support from line manager 760 36.3 Strong support from colleagues 807 38.6 Formal complaints are acted upon effectively by line managers 441 21.1 Formal complaints are acted upon effectively by senior management 332 15.9 Investigations into bullying are dealt with in a timely manner 336 16.1

Table 2.9.7: Reasons stated for feeling uncomfortable in taking formal action

Reason Number Percentage Formal complaints are ignored 300 13.1 Formal complaints are actively discouraged 230 10 I would feel isolated 667 29.1 Negative effect on career 911 39.7 Perpetrator is too powerful 815 35.5

A section of the survey included questions for nurses working in a supervisory capacity to examine how they deal with complaints of bullying. In total 139 respondents completed the section on dealing with complaints of bullying in the questionnaire. Victims and bullying procedures generally lay the bulk of the responsibility for resolving bullying issues on supervisors and senior management. Our findings revealed that over half of supervisors found

27 it difficult to deal with bullying claims while 43.8 percent of supervisors surveyed in our study felt that bullying issues were impossible to resolve satisfactorily (table 2.10.1).

Table 2.10. 1: Supervisors opinions resolution of bullying complaints To investigate the supports and challenges experienced by supervisors in dealing with bullying claims, they were asked to state their level of agreement with a range of statements. Firstly,

Reason Strongly agree Agree Disagree Strongly Disagree I find it difficult to deal with claims of bullying 11.8 42.6 36.8 8.8 Bullying Issues are impossible to resolve satisfactorily 12.9 30.2 48.9 7.9

we presented statements related to factors which could have a positive effect on their ability to manage bullying complaints such as adequate training, support from colleagues and senior management. Secondly, supervisors were asked to state their level of agreement with statements related to issues which led to difficulty in dealing with bullying complaints such as victims’ refusal to engage with the formal procedures and the level of power which the perpetrator held. In general, the majority of respondents felt they had adequate training and felt supported by senior management and colleagues when dealing with complaints. However, 40 percent remained unhappy about the level of training which they had received.

Table 2.10. 2: Factors which had a positive influence on dealing with bullying complaints (%)

Reason Strongly agree Agree Disagree Strongly Disagree I feel I have adequate training to deal with the issue 6.6 53.3 31.4 8.8 I feel supported by senior management when I have to deal with these issues 11.8 55.9 21.3 11.0 I feel supported by colleagues when I have to deal with these issues 10.9 62.8 21.2 5.1

There was a high level of agreement by the respondents to each statement presented but the vast majority of them indicated that people expected them to resolve bullying issues without wanting to make a formal complaint (84%) (table 2.10.3). Almost 70 percent of supervisors felt that it was very difficult to establish all the facts of the case with regard to bullying allegations. We can’t be sure of the exact reasons for this but we surmise that this may be related to the fact that bullying behaviour can be covert, that it may not be witnessed by people other than the victim or that others may not be willing to speak about the bullying and therefore the investigation becomes a case of ‘he said, she said’. Finally, and perhaps most significantly, over 66 percent of supervisors felt that in some cases the alleged perpetrator was in such a position (be that in a formal role or socially) which they viewed as too powerful to tackle on the issue of bullying.

28 Table 2.10 3: Factors which had a negative influence on dealing with bullying complaints (%)

Reason Strongly Agree Agree Disagree Strongly Disagree Generally people expect me to resolve it but they don’t want to make a formal complaint 39.9 44.2 14.5 1.4 It is difficult to gather facts on relation to bulling allegations 15.9 62.3 18.8 2.9 Sometimes the alleged perpetrator is too powerful to take on 23.3 43.6 24.1 9.0

3.10 Outcomes of Complaints regarding Bullying Previous research has shown that bullying cases are often resolved through transferring the victim to a different setting in the organisation, through the victim’s eventual exit from the organisation or in some cases through mediation involving third parties or legal cases. In this survey, we asked about the general outcomes of bullying complaints, in nurses’ experience. Similar to the other studies, the findings revealed that most of the outcomes involved inaction, moving the victim or the victim leaving the organisation (Figure 9.)

Figure 9: Reported Outcomes of Bullying Complaints

40 36.6

28.5

20 18.6 17.5

0

The victim was Nothing happened moved to another job The complainant left the organisation Disciplinary action was taken against the perpetator 3.11 Influence of Organisational Climate We noted earlier that it is important to examine an organisation’s climate to understand why bullying may be more prevalent in some organisations than others. Organisational climate relates to the prevailing atmosphere in the workplace and specifically encompasses employees’ feelings with regard to the level of morale, commitment and goodwill that exists among members of the organisation (Mullins, 2011). From the questions included in section three of the survey a selection of seven items was chosen to measure nurses perception of organisational climate. Nurses were asked to state their level of agreement with each statement, which items are listed in table 2.12.1. Using SPSS statistical analysis software the reliability of our measure of organisational climate was found to be strong.

29

Table 2.12 1: Organisational Climate Measures

Measure The organisation tries to look after its employees The organisation pays little attention to the interests of its employees Morale is generally good in this workplace This organisation tries to be fair in its action towards employees I would recommend this organisation as a good place to work

We would expect that victims and observers of bullying would hold more negative perceptions of the organisational climate than non-victims and non-observers. In order to determine if nurses’ perceptions of organisational climate were affected by experience of bullying, we compared the perceptions of those who responded that they had been victims of bullying with the perceptions of those who indicated they had not. Our result found that the mean satisfaction score with aspects of organisational climate of victims was 2.734 while the satisfaction of non-victims was 2.106. Bearing in mind that a higher score reveals greater dissatisfaction (because respondents level of agreement was on a scale from 1=strongly agree to 4= strongly disagree), our evidence suggests that victims of bullying also perceive a poorer organisational climate to exist in their respective workplaces.

Furthermore, we examined whether observing bullying over the previous six months would affect perceptions of organisational climate. In order to determine this we compared the perceptions of organisational climate among those had observed bullying with those who had not observed bullying. Again, our findings revealed that observers of bullying were less satisfied with organisational climate than those who had not observed any bullying (mean of non-observers 2.137, observers, 2.584).

Figure 10: Organisational Climate Measures

40

20

0

Victims Observers Non-victims Non-observers

30 CONCLUSION

31 4 CONCLUSION While there have been numerous studies on bullying in healthcare in other countries, there was limited information on the extent and nature of bullying amongst nurses in Ireland. According to the findings from this survey, a significant minority of respondents believe bullying to be a problem at work and have experienced bullying in the previous six months while 80 percent of respondents indicated that they had observed bullying. While much of the experience and observation of bullying occurred on average once a month or less, nine percent experienced bullying and 14 percent observed bullying more frequently. Respondents reported that the most common source of bullying was management. In line with international literature, reported victims of bullying indicated that their mental health was negatively affected and that their relations with colleagues suffered. The good news is that few victims did nothing at all about the bullying. While many discussed the bullying, 33.8 percent confronted the bully and/or reported it formally to their supervisor. However over 50 percent of respondents indicated that they would not feel comfortable taking formal action which is worrying. For those who reported that they would not be comfortable reporting bullying, the most cited reasons were the consequences for career, fear of isolation and the power of the perpetrator. Contributing to the problem of a lack of reporting may be the fact that half the alleged perpetrators involve more than one person, who reportedly bullying more frequently than a single person. Unwillingness to engage in formal reporting also puts supervisors in a difficult position in trying to process informal reports to them by victims or observers. Furthermore an analysis of outcomes of formal reporting indicates that where complaints were processed the most common outcomes were that the complainant was moved, left the job or that nothing was done. There was a much lower incidence of disciplinary action against the perpetrator. These outcomes are visible not just to those who have been bullied but also those who observe or might be future targets of workplace bullying. Such outcomes may perpetuate the unwillingness of victims to initiate formal action where they perceive the outcomes as possible not ‘victim oriented’ The low percentage of perpetrator discipline may be reflective of the challenges highlighted by managers, three quarters of whom said that it was difficult to gather facts in a bullying case and two thirds of whom expressed concern of the power of the perpetrator.

The survey findings emphasise the importance of support in the workplace for victims of bullying. Given that a fifth of observers had already either confronted the perpetrator or reported the bullying suggests that bystanders may be a critical source of support for victims.

As noted in the first section, research on organisation climate indicates that workplace bullying can be both a symptom of an existing poor work climate and a contributory factor to the development of a poor work climate and even more so when employees are under pressure from organisational change. As was predicated, victims and observers of bullying had a poorer opinion of their work climate than non-victims and non-observers. In addition to the specific organisational climate measures we used, other questions provide insight into the significance of organisational factors. As mentioned, victims and nurse managers noted the importance to them of workplace support and both groups alluded to the power of the perpetrator, reminiscent of the ‘misuse of power’ theories noted by bullying researchers.

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38 Appendix

39 Cross-Tabulation : Being Bullied and Negative Actions in the Workplace

Negative Acts in the Workplace Now & Then Monthly Weekly Daily Overall Having your opinions and views ignored 47.33% 15.10% 9.02% 9.76% 81.22% Being humiliated in connection with your work 47.42% 8.12% 10.15% 4.43% 70.11% Being exposed to an unmanageable workload 35.48% 9.93% 10.85% 13.60% 69.85% Being excluded 40.97% 9.12% 10.06% 8.75% 68.90% Someone withholding information that affects your performance 41.20% 7.68% 11.05% 6.37% 66.29% Facing a hostile reaction when you approach 42.09% 9.12% 8.01% 4.28% 63.50% Being ordered to do work below your level of competence 31.46% 5.99% 12.73% 12.17% 62.36% Being ridiculed in connection with your work 40.67% 7.09% 6.34% 3.73% 57.84% Being the target of spontaneous anger 40.37% 8.33% 4.44% 3.15% 56.30% Responsibility removed or replaced with trivial or unpleasant acts 31.52% 8.44% 9.38% 5.82% 55.16% Attempts to find fault in your work 36.13% 6.89% 6.15% 4.66% 53.82% Being shouted at 37.17% 8.36% 3.72% 3.35% 52.60% Spreading of gossip or rumours about you 35.07% 6.94% 5.59% 4.24% 51.83% Pressure not to claim something which by right you are entitled 30.37% 9.81% 4.63% 5.19% 50.00% Repeated reminders of your errors or your mistakes 34.39% 7.81% 4.28% 2.97% 49.44% Excessive monitoring of your work 27.37% 6.89% 5.77% 7.26% 47.30% Persistent criticism of your work and effort 29.85% 7.46% 5.78% 4.10% 47.20% Being given tasks with unreasonable or impossible deadlines 29.21% 5.36% 4.99% 5.73% 45.29% Having insulting or offensive remarks made about your person 27.90% 6.93% 5.99% 2.43% 43.26% Intimidating behaviour 24.58% 6.89% 3.54% 2.98% 37.99% Being moved or transferred against your will 21.34% 6.12% 5.01% 4.27% 36.73% Having allegations made against you 25.51% 5.59% 3.35% 0.93% 35.38% Threats of making your life difficult 20.04% 4.08% 3.34% 2.97% 30.43% Systematically being required to carry out tasks outside your job description 17.35% 3.73% 3.36% 3.17% 27.61% Being the subject of excessive teasing or sarcasm 20.67% 2.42% 1.49% 0.93% 25.51% Hints or signals from others that you should quit your job 16.91% 3.53% 2.04% 2.60% 25.09% Insulting messages, telephone calls, or emails 10.49% 2.43% 1.31% 0.75% 14.98% Practical jokes carried out by people you don’t get on with 10.30% 1.50% 0.56% 0.94% 13.30% Offensive remarks/behaviours with reference to race or ethnicity 6.70% 3.91% 1.49% 0.93% 13.04% Threats of violence 8.77% 2.05% 1.49% 0.56% 12.87%

40 Cross-Tabulation : Not Bullied and Negative Actions in the Workplace

Negative Acts in the Workplace Now & Then Monthly Weekly Daily Overall Having your opinions and views ignored 34.3% 2.8% 0.7% 1.0% 38.70% Being humiliated in connection with your work 19.2% 1.3% 0.6% 0.4% 21.49% Being exposed to an unmanageable workload 26.3% 4.7% 2.5% 3.7% 37.29% Being excluded 25.1% 1.6% 0.8% 0.7% 28.09% Someone withholding information that affects your performance 26.9% 2.7% 1.6% 0.6% 31.76% Facing a hostile reaction when you approach 13.6% 0.7% 0.7% 0.3% 15.29% Being ordered to do work below your level of competence 23.0% 2.9% 3.7% 2.9% 32.54% Being ridiculed in connection with your work 11.2% 0.9% 0.6% 0.3% 13.00% Being the target of spontaneous anger 19.4% 1.8% 1.7% 0.4% 23.29% Responsibility removed or replaced with trivial or unpleasant acts 18.0% 1.6% 2.1% 1.5% 23.12% Attempts to find fault in your work 9.6% 0.7% 0.1% 0.8% 11.14% Being shouted at 16.1% 2.1% 0.8% 0.1% 19.12% Spreading of gossip or rumours about you 11.5% 0.9% 0.8% 0.4% 13.61% Pressure not to claim something which by right you are entitled 14.6% 1.7% 0.3% 0.7% 17.27% Repeated reminders of your errors or your mistakes 8.7% 0.6% 0.3% 0.2% 9.81% Excessive monitoring of your work 10.2% 0.8% 0.9% 0.6% 12.40% Persistent criticism of your work and effort 6.4% 0.4% 0.3% 0.2% 7.37% Being given tasks with unreasonable or impossible deadlines 16.4% 2.1% 0.8% 1.2% 20.55% Having insulting or offensive remarks made about your person 8.7% 0.9% 0.0% 0.2% 9.83% Intimidating behaviour 7.6% 0.6% 0.8% 0.3% 9.27% Being moved or transferred against your will 15.3% 1.0% 0.1% 0.7% 17.09% Having allegations made against you 6.2% 0.3% 0.1% 0.2% 6.83% Threats of making your life difficult 4.3% 0.7% 0.3% 0.3% 5.60% Systematically being required to carry out tasks outside your job description 6.9% 1.1% 1.0% 0.8% 9.81% Being the subject of excessive teasing or sarcasm 1.7% 0.3% 0.0% 0.4% 2.46% Hints or signals from others that you should quit your job 2.9% 0.1% 0.1% 0.2% 3.34% Insulting messages, telephone calls, or emails 3.5% 0.3% 0.2% 0.3% 4.36% Practical jokes carried out by people you don’t get on with 2.1% 0.0% 0.1% 0.2% 2.45% Offensive remarks/behaviours with reference to race or ethnicity 1.1% 0.4% 0.0% 0.3% 1.89% Threats of violence 5.2% 0.6% 0.8% 0.3% 6.91%

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