Uncaring Nurses: Violence in Academia Melissa Renée Berquist Thesis submitted to the Faculty of Graduate and Postdoctoral Studies in partial fulfillment of the requirements for the Doctorate in Philosophy degree in Nursing School of Nursing Faculty of Health Sciences University of Ottawa © Melissa Renée Berquist, Ottawa, Canada, 2017 ii ABSTRACT Workplace violence is an area of increasing concern worldwide. Issues of violence are well documented in nursing. To address this, a better understanding of the culture of nursing academia is required. Problems of incivility are reported between students, between students and faculty, and between faculty and faculty. The purpose of this study is to increase understanding of faculty to faculty violence in nursing academia. Guided by a theoretical framework incorporating the perspectives of Mason and Foucault and specifically on the concepts of violence, power, knowledge, difference and resistance, this study focuses on aspects of the social and cultural work environment, and organizational policies and procedures influencing workplace violence between faculty members. Using principles from critical ethnography, the research was conducted within three schools of nursing at universities in eastern Canada. Data collection included 29 semi-structured interviews with nursing faculty, key informants (including representation from management, human resources, support staff and human rights office) and mute document review. Three major themes emerged: the academic apparatus, experiencing academia, and coping mechanisms. Nursing academic culture is divergent, exhibiting fierce competitiveness and elitism, intertwined with pockets of support and resilience. Faculty identified diverse personal and professional strategies employed to withstand the challenges. Need for change was expressed by some faculty and managers. These findings may inform the efforts of faculty and management seeking transformation to a less competitive and elitist culture. iii ACKNOWLEDGMENTS I would like to take this opportunity to thank the people who made this project possible. My thesis supervisors, Pr. Dave Holmes and Dr. Isabelle St-Pierre have provided me with encouragement, support and expert guidance. Their critical thinking skills in conjunction with their theoretical and methodological background have provided phenomenal support. Without them, I would not have completed this project. This project also would not have been possible without the cooperation and contributions of each participating university’s management, faculty, support staff and other study participants. I am very grateful for everyone’s participation, taking time out of your busy days to meet with me to share your thoughts and experiences. Your contribution is sincerely appreciated and acknowledged. I would also like to thank the members of my thesis committee, Dr. Amelie Perron and Dr. Josephine Etowa. Thank you to my friends, including my PhD classmates, and especially my friend Barb LeBlanc, for her support and encouragement. She gave me the confidence to undertake this project, and provided me with her knowledge and support throughout. Thank you to my children Melissa, Courtney and Justin. They have shown great consideration for me and my work. Their support and encouragement, and their belief in my abilities to complete this project helped when I had doubts. Thank you to my husband Scott. He supported me immeasurably throughout this process. His understanding and consideration of my work, and his belief in me helped to carry me and to never lose sight of my goals. iv TABLE OF CONTENTS ABSTRACT…………………………………………………………………….…… ii ACKNOWLEDGEMENTS………………………………………………………...... iii LIST OF FIGURES……………………………………………………………..….... ix CHAPTER 1 – PROBLEM STATEMENT………………………………………… 1 Research Objectives………………………………………………………………… 5 Research Questions………………………………………………………………...… 6 Epistemological Stance………………………………………………………………. 6 CHAPTER 2– LITERATURE REVIEW……………………………….….….…….. 11 Workplace Violence………………………………...………….................................. 11 Laws……………………………...…………………………….…………….. 12 Antecedents, Prevalence, Consequences…………………...…….………….. 14 Definitions…………………………………………………………………… 19 Power and Resistance……………………………………………...………… 20 Workplace Violence in Academia…………………………………………...……….. 21 Organizational Culture……………………………………………………..... 22 Gender…………………………………………………………………...…... 24 Power and Discipline………………………………………………………… 27 Types of Violence……………………………………………………………. 29 The Role of Policies………………………………………………………….. 32 Workplace Violence in Nursing……………………………………………………... 32 Types of Violence……………………………………………………………. 33 Bullying……………………………………………………………………… 35 Lateral, Horizontal and Intra-Staff Violence…….….……………………...... 37 Perpetrators of Workplace Violence……………………………………….... 38 Organizational Policies………………………………………………………. 39 Antecedents and Consequences……………………………………………… 40 Role of Managers…………………………………………………………….. 42 Education and Mentoring……………………………………………………. 44 Workplace Violence in Nursing Academia………………………………….............. 45 Incivility……………………………………………………………………… 45 Consequences………………………………………………………………... 47 v Recommendations…………………………………………………………… 48 Horizontal Violence Between Faculty……………………………………….. 48 Protective Factors……………………………………………………………. 52 Concluding Remarks………………………………………………………… 52 Summary of Literature Review…………………………………………………….... 53 Language……………………………………...……………………………... 54 Contributing Factors………………………………………...……………….. 54 Antecedents and Consequences………………….………………...………… 56 Managers…………………………………………………………………….. 56 Policies…...…………………………………………………………………... 56 Education…………...………………………………………………………... 57 Other Recommendations…………………………………………………….. 58 CHAPTER 3 – THEORETICAL FRAMEWORK………………………………….. 59 Theoretical Perspective: Power……………………………………………………… 59 Sovereign power…………………………………………………...………… 59 Disciplinary power…………………………………………………………... 60 Hierarchical observation………………………………….................. 62 Normalizing judgment……………………………………………….. 63 Examination……………………………………………….................. 64 Pastoral power………………………………………………………………. 66 Theoretical Perspective: Violence………………………………………………...…. 67 Theoretical Perspective: Knowledge………………………………………………… 72 Theoretical Perspective: Difference.……………………..………………………..… 73 Theoretical Perspective: Resistance…...…………………………………………….. 74 Relationship between Knowledge, Power, Violence, Difference and Resistance…… 76 Integration of the Five Theoretical Perspectives……………...……….……...……... 79 Summary of the Theoretical Framework…………………………………………….. 81 CHAPTER 4 – METHODOLOGICAL CONSIDERATIONS…………………….... 83 Research Design: Critical Ethnography……………………………………………... 83 vi Sensitive Research…………………………………………………………... 87 Settings………………………………………………………………………………. 88 Sampling……………………………………………………………………………... 91 Data Collection Strategies and Tools………………………………………………... 93 Interviews……………………………………………………………………. 94 Socio demographic questionnaire…………………………………………… 95 Mute evidence………………………………………………………………... 95 Data Collection………………………………………………………………………. 102 Data Analysis………………………………………………………………………… 103 Methodological Rigor…..………………………………………………………..…... 105 Credibility……………………………………………………………………. 105 Transferability……………………………………………………………….. 106 Dependability and Conformability…………………………………………... 106 Reflexivity…………………………………………………………………… 107 Ethical Considerations……………………………………………………………….. 108 Summary of Methodology…………………………………………………………… 109 CHAPTER 5 – RESULTS………………………………………..……………….…. 111 Interview Themes……………………………..……………………………………... 111 Theme One – Academic Apparatus……………………………………..………...... 111 Sub-Theme One – Macro……………………………………………………. 113 Internal influences…………………………………………………… 113 External influences…………………………………………………... 123 Formal structures………………………………………………...…... 126 Sub-Theme Two – Micro……………………………………………………. 132 Management…………………………………………………………. 133 Hiring practices………………………………………………………. 139 Respect and being valued..…………………………………………... 141 Theme Two: Experiencing Academia……………………………………………….. 144 Sub-Theme One – Uncaring Practices……………………………………….. 145 Overt………………………………………………………................. 145 Covert…………………………………………………....................... 159 vii Sub-Theme Two- Tensions………..………………………………………… 164 Philosophy/worldview……………………………………………….. 164 Priorities……………………………………………………………… 166 Perceptions…………………………………………………………… 168 Environment…………………………………………………………. 169 Sub-Theme Three – Relationship Among Actors……………………...…… 174 Positive…..…………………………………………………………... 174 Negative……………………………………………………………… 180 Sub-theme Four – Consequences of Violence………..……………………… 184 Normalization of behavior…………………………………………… 184 Perpetuation of culture………………………………………………. 187 Suffering and uncertainty……………………………………………. 190 Theme Three: Coping Mechanisms………………………………………………….. 193 Sub-Theme One – Personal………………………………………………….. 193 Extraordinary career.………………………………………………… 194 Self-esteem…………………………………………………………... 197 Is this worth it?...........……………………………………………….. 200 Being strategic……………………………...………………………... 202 Benevolence and respect…………………………………………….. 206 Promoting change……………………………………………………. 209 Sub-Theme Two – Professional……………………………………………. 211 Gunning for tenure…………………………..……………………….. 211 Pressure to perform………………………………………………….. 213 Promoting a healthy workplace……………………………………… 214 Summary of Results………………………………………………………………….. 217 CHAPTER 6 – DISCUSSION………………………………………………..……... 220 Fighting to the top and fighting to stay on top……………………………………….. 220 Academic Snobbery …………………………………………………………………. 229 Mean Girls……………...…….…………..……...………………………………….