BULLYING IN THE WORKPLACE: A STUDY OF AUSTRALIAN NURSES Marie Louise Hutchinson A thesis submitted in fulfilment of the requirements for the Degree of Doctor of Philosophy College of Business University of Western Sydney 2007 Acknowledgements I would like to extend my sincere thanks and appreciation to the following individuals who contributed their time, support and guidance to enable this study to be completed: To Associate-Professor Margaret H. Vickers, Professor Lesley Wilkes and Professor Debra Jackson, I am indebted for their untiring enthusiasm, support, and guidance over the years of my candidature. To Dr. Donna Gillies and Professor Rhonda G. Craven for their valuable assistance, and Anna McManus for her ongoing support. To the industry partners and participants who made this study possible. Finally, I extend a special thank-you to friends, nursing colleagues and my family, particularly my husband and children who supported me in the completion of this thesis. Table of Contents List of Tables ix List of Figures xi Style Notation for Interview Transcripts xii ABSTRACT xiii Chapter 1 INVESTIGATING BULLYING IN THE NURSING WORKFORCE: SETTING THE SCENE ABSTRACT 1 1.1 Introduction 2 1.1.1 The concept of workplace bullying 2 1.1.2 Bullying in the nursing context 4 1.2 Workplace bullying: The need for further research 6 1.3 The study 8 1.3.1 Aims and scope of the study 8 1.3.2 Positioning the researcher in the study 8 1.3.3 Outline of the study 10 1.3.4 Definition of terms 11 1.4 Thesis structure 12 1.5 Conclusion 15 Chapter 2 THE LITERATURE ON WORKPLACE BULLYING ABSTRACT 16 2.1 Introduction 17 2.2 Conceptualisations of workplace bullying 18 2.2.1 Defining workplace bullying 18 2.2.2. The behaviours involved 19 2.2.3 Differentiating workplace bullying 20 2.3 Contributory factors 23 2.3.1 Escalated interpersonal conflict 23 2.3.2 Personality characteristics of the target or perpetrator 25 2.3.3 Features of the work environment 26 2.3.4 Measurement instruments 28 i 2.4 Workplace bullying: Incidence rates and consequences 31 2.4.1 Incidence rates 31 2.4.2 Consequences of workplace bullying 33 2.5 Responding to workplace bullying 36 2.5.1 Organisational and regulatory responses 36 2.6 Workplace bullying in the nursing context 39 2.6.1 Characteristics of the nursing environment 39 2.6.2 Characteristics of the nursing work environment 43 2.6.3 The conceptualisation of bullying in nursing 45 2.6.4 The incidence and consequences of bullying in nursing 46 2.6.5 Responses to bullying in the nursing workplace 49 2.7 Summary of the literature 49 2.7.1 Identified gaps and limitations 51 2.7.2 Relevance for proposed study 54 2.7.2 The research questions 55 2.8 Conclusion 55 Chapter 3 RESEARCH DESIGN ABSTRACT 56 3.1 Introduction 57 3.2 Mixing methods for a more complete understanding 58 3.2.1 Reasoning and theoretical underpinnings 60 3.2.2 Paradigm stances in mixing methods 62 3.2.3 Adopting a pragmatic approach 64 3.3 The sequential staged design 65 3.3.1 Introducing each stage 68 3.3.1.1 Stage one 68 3.3.1.2 Stage two 68 3.3.1.3 Stage three 69 3.4 Conclusion 69 Chapter 4 STAGE 1(A): QUALITATIVE METHODOLOGY ABSTRACT 71 4.1 Introduction 72 ii 4.2 Naturalistic inquiry 73 4.2.1 Voice, transparency and reflexivity 76 4.3 Procedures 77 4.3.1 The setting 77 4.3.2 Gaining access 78 4.3.3 Recruitment of participants 78 4.3.4 Inclusion criteria 79 4.3.5 Participant characteristics 79 4.3.6 Ethical considerations 80 4.3.7 Conduct of the interviews 81 4.3.7.1 Developing rapport and sensitivity 84 4.3.7.2 Recording and transcribing 86 4.4 Data analysis 87 4.4.1 Verification strategies 87 4.4.2 Analysis procedures 90 4.4.2.1 Implementing the coding process 90 4.4.2.2 Analysing patterns and relationships 92 4.4.2.3 Defining major categories 93 4.5 Presentation of findings 94 4.6 Conclusion 96 Chapter 5 STAGE 1(B): NURSES EXPERIENCES OF BULLYING ABSTRACT 97 5.1 Introduction 98 5.2 Informal networks of predatory alliances 98 5.2.1 The structure and nature of predatory alliances 100 5.2.2 Bullying minimised, ignored, and denied 102 5.2.3 Promotion and protection 105 5.2.4 Bullying masked as legitimate authority 108 5.3 Normalisation of bullying behaviours in work teams 111 5.3.1 Indoctrination into the rules of work 112 5.3.2 Reinforcers of indoctrination: “Too weak” to be a “good nurse” 116 iii 5.4 A taxonomy of bullying behaviours 119 5.4.1 Personal attack 120 5.4.1.1 Isolation and exclusion 121 5.4.1.2 Intimidation and threats 123 5.4.1.3 Belittling and humiliating 124 5.4.2 Erosion of professional competence and reputation 125 5.4.2.1 Damaging professional identity 126 5.4.2.2 Limiting career opportunities 129 5.4.3. Attack through work roles and tasks 130 5.4.3.1 Obstructing work or making work life difficult 131 5.4.3.2 Denial of due process and natural justice 132 5.4.3.3 Economic sanctions 134 5.5 The consequences of workplace bullying 134 5.5.1 Reduced emotional wellbeing 135 5.5.2 Reduced physical wellbeing 138 5.5.3 Avoidance and withdrawal at work 140 5.5.4 Interruption to work and career 141 5.6 Summary of findings 143 5.7 Conclusion 145 Chapter 6 STAGE 2: DEVELOPMENT OF SURVEY INSTRUMENT ABSTRACT 146 6.1 Introduction 147 6.1.1 Aims 148 6.2 Initial instrument development 148 6.2.1 Determining instrument structure and content 149 6.2.1.1 Instrument structure 149 6.2.1.2 Instrument content 150 6.2.2 Establishing content validity 152 6.3 The pilot test: 155 6.3.1 Recruiting respondents and establishing procedures 155 6.3.1.1 The setting 155 6.3.1.2 The sample 155 6.3.1.3 Ethical considerations 155 iv 6.3.1.4 Respondents 156 6.3.1.5 Coding the data and analytical software 158 6.3.1.6 Missing data 158 6.3.1.7 Data analysis procedures 159 6.4 Instrument validation and modification 161 6.4.1 Determining instrument reliability 161 6.4.2 Identifying the factor structure of the instrument 164 6.4.2.1 Deciding the number of factors to extract 165 6.4.2.2 Rotation of factors and reliability of remaining items 166 6.4.2.3 Exploratory factor analysis: Part A (section 1 and 2 of survey) 166 6.4.2.4 Exploratory factor analysis: Part B (section 3 of survey) 169 6.5 Finalising the national survey instrument 172 6.5.1 Establishing reliability of revised instrument 172 6.5.2 Specifying the revised structure and content 173 6.6 Summary 174 6.7 Conclusion 174 Chapter 7 STAGE 3: NATIONAL SURVEY OF NURSES ABSTRACT 175 7.1 Introduction 176 7.1.2 Aims 177 7.2 The national survey 177 7.2.1 The sample 177 7.2.1.1 Adequacy of sample size 178 7.3 Data collection and analysis 179 7.3.1 Coding and preparation of the data 179 7.3.2 Data screening 179 7.3.3 Statistical analysis 180 7.4 Results 182 7.4.1 Part A - descriptive statistical analysis 182 7.4.1.1 Characteristics of respondents 182 v 7.4.1.2 Incidence of bullying 184 7.4.1.3 Patterns of bullying 187 7.4.1.4 Characteristics of bullies 190 7.4.1.5 Reporting workplace bullying 191 7.4.1.6 The consequences of bullying 193 7.4.2 Part B - confirmatory factor analysis 197 7.4.2.1 Hypothesis 197 7.4.2.2 Specifying the measurement model 198 7.4.2.3 Testing the measurement model 199 7.4.3 Part C - analysis of the structural model 202 7.4.3.1 Seven-factor model 203 7.4.3.2 Six-factor model 208 7.4.3.3 The extended consequences model 210 7.4.3.4 Summary 214 7.5 Chapter summary 214 7.6 Conclusion 217 Chapter 8 DISCUSSION ABSTRACT 218 8.1 Introduction 219 8.2 Main findings and contributions 219 8.2.1 Stage one 220 8.2.1.1 Informal networks of predatory alliances 221 8.2.1.2 Normalisation of bullying behaviours in work teams 227 8.2.1.3 A taxonomy of bullying behaviours 233 8.2.1.4 The consequences of workplace bullying 234 8.2.1.5 Synthesis of stage one findings 237 8.2.2 Stage two 245 8.2.2.1 The identification of seven latent factors underpinning workplace bullying 245 8.2.2.2 The development of scales measuring the seven latent factors 251 8.2.3 Stage three 252 8.2.3.1 Detail on the nature, extent and consequences of bullying 252 vi 8.2.3.2 Validation of a multidimensional workplace bullying scale 254 8.2.3.3 Confirmation of a seven factor model of workplace bullying 255 8.3 A model of bullying in the nursing workplace 257 8.4 Conclusion 262 Chapter 9 CONCLUSION AND RECOMMENDATIONS ABSTRACT 264 9.1 Introduction 265 9.2 Implications arising from the research 267 9.2.1 Explanatory models of workplace bullying 267 9.2.2 Nurse education 269 9.2.3 Management and human resource professionals 270 9.2.4 Further research 273 9.3 The current study - strengths and limitations 275 9.4 Conclusion 277 List of References 279 Appendices Appendix 1 List of peer reviewed publications from the study 313 Appendix 4.1 Information form on protocols for informed consent and confidentiality 315 Appendix 4.2 Consent to participate in interviews 316 Appendix 4.3 Prompts and triggers for the interviews 317 Appendix 4.4 Biographical details of research participants 318 Appendix 4.5 Hierarchy of bullies: Code note excerpt 320 Appendix 4.6 Sociograms depicting the networks of predatory alliances 321 Appendix 6.1 Pilot survey instrument 322 Appendix 6.2 Section 1: Individual item means and standard deviations 326 Appendix 6.3 Part A: Factor analysis outputs 330 Appendix 6.4 Part B: Factor analysis outputs 333 vii Appendix 6.5 The national survey instrument 334 Appendix 6.6 Unsatisfactory items removed 338 Appendix 7.1 Collinearity diagnostics output 339 Appendix 7.2 Factor based sub-scale reliability statistics 340 Appendix 7.3 AMOS output seven factor model 343 Appendix 7.4 AMOS output extended consequences model 346 viii List of Tables Table 3.1 Sequential presentation of research methodology 58 Table 3.2 Paradigm stances in mixing methods 63 Table 3.3 Summary of the research stages 66 Table 4.1 Participant characteristics 81 Table 4.2 Summarised results of content analysis 95 Table 5.1 Qualitative analysis: Major categories 98 Table 5.2 Personal attack: Sub-categories and components 121 Table 5.3 Erosion of professional competence and reputation: Sub-categories and components 126 Table 5.4 Attack through work roles and tasks: Sub-categories and components.