Open Access Research BMJ Open: first published as 10.1136/bmjopen-2017-020461 on 5 April 2018. Downloaded from Impact of workplace incivility against new nurses on job burn-out: a cross- sectional study in China Yu Shi,1 Hui Guo,2 Shue Zhang,3 Fengzhe Xie,1 Jinghui Wang,1 Zhinan Sun,4 Xinpeng Dong,5 Tao Sun,1 Lihua Fan1 Abstract This study had three objectives: (1) to investigate the impact of workplace incivility on job burn- Strengths and limitations of this study out of new nursing staff, (2) to verify the partial mediating This is the first study investigating the relationship of role of anxiety in the relationship between workplace ► workplace incivility with anxiety, resilience and job incivility and job burn-out, (3) to examine the resilience burn-out of new nurses. moderating the relations between workplace incivility and The finding that anxiety partially mediated the rela- job burn-out. ► tionship between workplace incivility and job burn- To cite: Shi Y, Guo H, Zhang S, Design A cross-sectional online survey was conducted in out is first reported among new nurses. et al. Impact of workplace May 2016 in China. This research has innovatively examined the resil- incivility against new nurses on Setting The survey was conducted in 54 cities across 29 ► ience moderating the relations between workplace job burn-out: a cross-sectional provinces of China. incivility and job burn-out. study in China. BMJ Open Participants A total of 903 participants were invited. 2018;8:e020461. doi:10.1136/ The method to self-reports of new nurses by an Ultimately, 696 new nurses (<3 service years) completed ► bmjopen-2017-020461 online survey may have led to response bias, valid questionnaires. The effective response rate was and causation cannot be established due to the ► Prepublication history for 77.1%. Entry criteria: voluntary participation, having less cross-sectional study design. this paper is available online. than three service years and being a registered nurse. The regional data source ratio would be unbalanced. To view these files, please visit Exclusion criteria: being an irregular nurse, having more ► the journal online (http:// dx. doi. than three service years and refusing to participate in this org/ 10. 1136/ bmjopen- 2017- work. 020461). Outcome measures An anonymous questionnaire was After nearly 30 years of exploration practice, YS, HG and SZ contributed distributed among new nurses. The relationships and Andersson and Pearson formally defined http://bmjopen.bmj.com/ equally. mechanism among the variables were explored using workplace incivility in 1999 as follows: ‘Work- descriptive statistical analysis, Pearson’s correlation place incivility is low-intensity deviant behavior Received 7 November 2017 coefficient and multiple linear regression analysis. with ambiguous intent to harm the target, Revised 6 February 2018 Results The findings showed that workplace incivility was Accepted 20 February 2018 in violation of workplace norms for mutual positively correlated with anxiety (r=0.371, p<0.01) and respect. Uncivil behaviors are characteristi- job burn-out (r=0.238, p<0.01) of new nurses. The positive cally rude and discourteous, displaying a lack relation between anxiety ( 0.364, p<0.01) and job burn- β= of regard for others.3 In 2002, a new concept out (β=0.240, p<0.01) was also significant. Moreover, anxiety partially mediated (z=7.807, p<0.01) and of workplace incivility was put forward by on September 23, 2021 by guest. Protected copyright. resilience moderated (β=−0.564, p<0.01) the association Western researchers. Lauer considered that between workplace incivility and job burn-out. uncivil behaviour harmed employees’ self-es- Conclusion Experience of workplace incivility by new teem in the organisation, causing harm to 4 nurses would likely generate anxiety in the victims. employees by disrespectful behaviour, but it Further, the increased anxiety state could elevate their is completely distinct from physical aggression level of job burn-out. New nurses with high levels of and violence. Workplace incivility has charac- resilience could buffer the negative influence of workplace teristics similar to the subtle spiral infiltration incivility by using a positive coping style. model. It would be accumulated at a low level for a long time, and the final outcome rises to a high level of harm to employees. The harm INTRODUCTION is sustained over a long period, and, there- For numbered affiliations see Background/literature review fore, the physical and mental damage to the 5 end of article. Workplace incivility was regarded as a nega- victim is difficult to recover in the short term. tive behaviour by organisation members According to previous reports, the influence Correspondence to which was clearly proposed by Katz in 1964.1 of workplace incivility on mental health of Professor Tao Sun; hydsuntao@ 126. com and However, this kind of behaviour and its nega- employees mainly included anxiety, cognitive Professor Lihua Fan; tive consequences did not attract attention dissonance, excessive worry, stress and mental lihuafan@ 126. com from management researcher at that time.2 depression and so on.6 The impact on physical Shi Y, et al. BMJ Open 2018;8:e020461. doi:10.1136/bmjopen-2017-020461 1 Open Access BMJ Open: first published as 10.1136/bmjopen-2017-020461 on 5 April 2018. Downloaded from health includes migraine headaches, stomach ulcers, high disappearance of sense of organisation belonging,21 blood pressure and so on.6 Typically, uncivil behaviours decline of nursing group cohesion,22 poor nursing work are unobserved and add up over time. Moreover, if a efficiency and lower job performance. It may even lead to hospital organisation cannot respond properly, these the loss of nursing talents.23 The reasons for job burn-out uncivil behaviours may lead to adverse organisational and have been analysed and mainly include excess workload,24 individual effects.3 Over time, the organisational conflict lack of support and resources,25 impeded information caused by uncivil behaviour would emerge,7 and serious and reduced sense of control,24 organisational injus- consequences will gradually appear in large numbers in tice,26 interpersonal roles conflict,27 and interpersonal 8 the group, such as the absenteeism, less organisational emotional stress at work.28 In addition, some researchers 9 10 citizenship behaviour, productivity slowdown, lower have conducted many studies to explore the relationship 11 12 job satisfaction, lower organisational loyalty and even between incivility and job burn-out in the nursing work- 13 heightened turnover intentions. place.20 However, previous studies exhibited a complete In recent years, residents’ expectations regarding lack of concern for new nurses. Further, during recent 14 medical service continue to rise. Due to the large popu- years, although researchers have successfully explained lation in China, an appropriate number of nurses is the role mechanism of job burn-out under the resource needed to deliver healthcare services to meet the health perspective, there are no researchers illustrating the 15 needs. Therefore, the sustainable recruitment of nurses mechanism of the relationship between workplace inci- and acceleration of their career development is crucial vility and job burn-out. for the nursing field. Improving the skills of nursing Additionally, the awareness of workplace incivility has staff relies on healthy career development, which is a been greatly enhanced recently, especially of the effects key task for China’s healthcare service system. Further, of uncivilised workplace behaviour on the psychological the Chinese health system faces problems such as weak health of employees.29 A new study also sheds light on medical service capacity in primary hospitals, health the workplace incivility experienced by Australian adult human resources of insufficient quality, rising healthcare 16 workers. The finding indicates that workplace incivility costs, fragmented medical services and so on. Novice is positively linked with anxiety.30 Anxiety is seen as an nurses (working service less than 3 years) as the new force adaptive motivational behaviour that helps individuals of the nursing team is the basis for the prosperity and cope with threatening situations.31 From the evidence of development of the nursing team. These new nurses have another study, anxiety refers to an unpleasant emotional the characteristics of young age, lack of work experience state that mainly includes such feelings as apprehension, and weak psychological coping ability. Yet, there is a high tension and worry.32 Anxiety is considered to be caused degree of job stress of new graduates in the Chinese by stimuli from the external environment. When people healthcare climate. Therefore, new nurses often lack the 32 http://bmjopen.bmj.com/ experience workplace incivility, they may feel anxious. skills to cope with problems in the new working condi- For example, their work performances are not being tions. The active adaptation, good job involvement, and respected, or they receive other people’s unreasonable physical and mental health of the new nurses are regarded malicious evaluations. Anxious employees are more apt to as motivating forces to encourage them and are greatly experience emotional exhaustion, body fatigue, reduced beneficial to their career success in the long term. An work involvement and lower job satisfaction with the active, enthusiastic and positive attitude towards nursing continuous depletion of psychological resources. In other work at the beginning of one’s career is necessary for 17 words, anxiety could increase the risk of employees’ job new nurses. However, new nurses early in their career on September 23, 2021 by guest. Protected copyright. burn-out. Resilience is the ability to bounce back or cope are likely to encounter variously offensive behaviours, successfully despite adverse circumstances.33 It is used which violate the principle of equality and respect among to describe when a person recovers easily and quickly organisation members and are highly hurtful with low intensity.5 These adverse behaviours under long-term from setbacks that occur during his or her life.