View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by The University of North Carolina at Greensboro SAUER, PENNY A., Ph.D. Does Resilience Mediate the Effects of Bullying in Nurses? (2013) Directed by Dr. Susan Letvak. 158 pp. The overarching purpose of the research was to examine workplace bullying among nurses who work in North Carolina hospital. The research examines the influence of individual factors, individual characteristics and organization factors on physical health, mental health and intent to leave position in nurses who were bullied. In particular, this study explored the influence of resilience on physical health, mental health and intent to leave in nurses who have experienced bullying. In this sample, 64 of 160 (40%) of nurses experienced workplace bullying. Linear regression analysis indicated nurses who are bullied have a lower average scores in mental health measures (p<0.001), and are more likely to leave their unit (p<0.001). Multiple regression models revealed that nurses who experienced severe bullying and had high levels of resilience their intention to leave their unit was elevated as compared to others. The mediation results from the path analysis using Mplus reveled resilience was not a mediator of bullying on physical health, mental health or intent to leave. DOES RESILIENCE MEDIATE THE EFFECTS OF BULLYING IN NURSES? by Penny A. Sauer A Dissertation Submitted to the Faculty of the Graduate School at The University of North Carolina at Greensboro in Partial Fulfillment of the Requirements for the Degree Doctor of Philosophy Greensboro 2013 Approved by _________________________________ Committee Chair © 2013 Penny A. Sauer This work is dedicated to my husband Keith, our daughter Michelle, and nurses everywhere. ii APPROVAL PAGE This dissertation written by PENNY A. SAUER has been approved by the following committee of the Faculty of The Graduate School at The University of North Carolina at Greensboro. Committee Chair ___________________________________________ Susan Letvak Committee Members ___________________________________________ Patricia Crane ___________________________________________ Eric Ford ___________________________________________ Eileen Kohlenberg ____________________________ Date of Acceptance by Committee _________________________ Date of Final Oral Examination iii ACKNOWLEDGEMENTS Dr. Susan Letvak, chair of my dissertation committee, encouraged guided and supported this work for the past several years. Dr. Patricia Crane, Dr. Eric Ford and Dr. Eileen Kohlenberg encouraged this work every step of the way and willingly shared their wisdom and experiences. I am grateful for their advice, questions and guidance through this process. Thomas McCoy patiently worked with me on data analysis. His assistance was much appreciated. No one is able to complete a dissertation without a significant amount of support and goodwill. My friends and family encouraged and supported me throughout my dissertation journey. I have learned a great deal from my students and the many nurses who have shared their experiences about nurse bullying. I appreciate their encouragement and belief in research. iv TABLE OF CONTENTS Page LIST OF TABLES ............................................................................................................. vi LIST OF FIGURES .......................................................................................................... vii CHAPTER I. INTRODUCTION ...............................................................................................1 II. REVIEW OF THE LITERATURE ....................................................................26 III. METHODS .........................................................................................................44 IV. RESULTS ...........................................................................................................63 V. CONCLUSIONS...............................................................................................100 REFERENCES ................................................................................................................124 APPENDIX A. SURVEY ................................................................................................143 APPENDIX B. RECRUITMENT LETTER ....................................................................157 APPENDIX C. LIST OF ACRONYMS ..........................................................................158 v LIST OF TABLES Page Table 1. Demographic Statistics of Sample (N=182) ....................................................65 Table 2. Reliability Measurement for Instruments ........................................................66 Table 3. Frequency of Bullying Behaviors ....................................................................69 Table 4. Correlation between Variables .........................................................................73 Table 5. Simple Linear Regression for NAQR and SF12 PCS and Method for Missing Data ..............................................................................76 Table 6. Simple Linear Regression for NAQR and SF12 MCS and Method for Missing Data ..............................................................................78 Table 7. Simple Linear Regression for NAQR and Intent to Leave Unit and Method for Missing Data .......................................................................80 Table 8. Simple Linear Regression for NAQR and Intent to Leave Organization and Method for Missing Data .................................................82 Table 9. Summary Results from Multiple Linear Regression Analysis by Outcome and Method for Missing Data* ......................................................84 Table 10. Multiple Linear Regression of SF12 PCS ........................................................85 Table 11. Multiple Linear Regression of SF12 MCS ......................................................87 Table 12. Multiple Linear Regression of Intent to Leave Unit ........................................90 Table 13. Multiple Linear Regression of Intent to Leave Organization ..........................92 vi LIST OF FIGURES Page Figure 1. Conceptual Model based on NIOSH Model of Job Stress ...............................16 Figure 2. Hypothesized Mediation Relationship of Bullying, Resilience and Physical Health......................................................................................60 Figure 3. Scatterplot of SF12 PCS vs. NAQR with Linear and LOESS Fit Lines .......................................................................................................75 Figure 4. Scatterplot of SF12 MCS vs. NAQR with Linear and LOESS Fit Lines .......................................................................................................77 Figure 5. Scatterplot of Intent to Leave Unit vs. NAQR with Linear and LOESS Fit Lines ..........................................................................................79 Figure 6. Scatterplot of Intent to Leave Organization vs. NAQR with Linear and LOESS Fit Lines ................................................................81 Figure 7. Mediation Results for Bullying and Resilience from Modeling of SF12 PCS .................................................................................................94 Figure 8. Mediation Results for Bullying and Resilience from Modeling of SF12 MCS ...............................................................................................95 Figure 9. Mediation Results for Bullying and Resilience from Modeling of Intent to Leave Unit .................................................................................96 Figure 10. Mediation Results for Bullying and Resilience from Modeling of Intent to Leave Organization ...................................................................97 vii CHAPTER I INTRODUCTION Nursing is an honored and respected profession. Nursing professionals have consistently been recognized by the public as having the highest degree of honesty and ethics for the past decade (Gallup, 2012). What the public does not know is that nursing has a darker side: bullying among nurses. Nurse on nurse bullying has occurred in the nursing profession for many years. Over 25 years ago, Meissner (1986) wrote “Nurses, are we eating our young?” to highlight the hostility that exists between nurses in the workplace. Since 1986, researchers have confirmed that nurses are bullied and that bullying takes a toll on nurses and in turn, patients, and the quality of care. Bullying is detrimental to the work environment (Einarsen, Hoel, Zapf, & Cooper, 2011), the victims’ health (Namie, 2012) and patient outcomes (Longo, 2012). To date, a reliable and affective method to eliminate bullying in the workplace has not been found (Einarsen et al., 2011). Because prevention has not been successful, it is important to explore other ways victims can be protected from the devastating effects of bullying. Bullying is unacceptable among professionals, yet it still occurs with surprising regularity. Researchers have found that the consequences of bullying behaviors on patients, nurses, and the nursing profession are substantial (Longo, 2012). Nurses who are bullied have higher levels of stress (Magnavita & Heponiemi, 2011; Walrath, Dang, & Nyberg, 2010), depression (Yıldırım, 2009), and anxiety (Pai & Lee, 2011; Vessey, 1 Demarco, Gaffney, & Budin, 2009). Bullied nurses often plan on leaving their position or perhaps the profession