Workplace Bullying

By: Ashley, Brita, Dani, Sarah, Kortni

EBP Question

Among novice nurses, how does

workplace bullying effect quality of care?

We define quality of care as patient safety, productivity of the nurse, and the well-

being of patients and nurses

PICO P- novice nurses, 0-3 years of

experience I- workplace bullying C- n/a O- quality of care Question type: Prognosis

o Long term effects of workplace bullying

Search terms Workplace bullying Novice nurse Quality of care Patient safety Productivity Working culture Nursing outcomes

Evidence Search

Proquest Science Direct

Study 1

Bullying among Nurses Type of study: Qualitative

o surveys sent out through the mail to nurses in the area

Population: Nurses licensed in Massachusetts from 2001-2003

Sample size: 511 (1000 surveys sent out, 511 returned)

Purpose To determine if

bullying had any effect on nurses leaving their jobs

Found out more about the types of bullying going on among nurses

Results 511 surveys were returned, 184 with extra

comments about being bullied or seeing bullying happen.

4 themes describing bullyingo “Structural bullying”o “Nurses eating their young”o “Feeling out of the clique”o “Leaving the job”

Conclusion “Bullying has been part of

workplace culture since the beginning of professional nursing and has been tacitly accepted by nurses for too long. Nurses are only just beginning to understand the root of this unfortunate phenomenon”

Important 4 themes More research needed

Study 2

Type of StudyWORKPLACE BULLYING IN NURSING: A PROBLEM THAT CAN’T BE IGNORED

Systematic Review Population- none. Draws on many

research publications and the author’s opinion

Novice Nurse, Carol

Purpose

To present the history and seriousness of workplace bullying in nursing and to offer potential

solutions

Content and Results Abusive workplaces result in lack of job

satisfaction, poor retention, and adverse patient outcomes

Negative effects: on nurses, patients in their care, family, friends, coworkers, and health care organizations

Characteristics of bullies and protection No Tolerance Act

Conclusion Standards against bullying

set in place Not completely relevant,

not focused on novice nurses

Recommendations

Study 3

Survey

Cross Sectional Survey Newly graduated nurses

– working less than two years

In acute care hospital in Ontario Canada

Mailed to participants homes

342 nurses surveys were returned meeting criteria

Purpose

The purpose of the survey was to link authentic leadership to new graduate nurses’ experience of workplace bullying, burnout, & job satisfaction

Results

The results were that authentic leadership has a direct negative effect on workplace bullying, and that was significantly related to better job satisfaction and job turnover intention.

Relevancy Because of our definition of quality of care,

this survey was relevant to our study. Nurses’ with authentic leadership that

condones bullying had better job satisfaction which leads to better quality of care for the patients

However, more research would need to be done on the direct effects on the quality of care

Study 4

Bullying and Productivity

Primary research Survey New nurses registered in 2009 or 2010 Sample size=197

Purpose of Study “to determine the prevalence and effects of WPB

on the productivity of novice nurses” (Berry et al., 2012)

Content/Results 23.9%-bullying did not affect productivity 29. 4%-more productive following bullying 46.7%-less productive following bullying Effect of bullying on non-white v. white

No Change In Productivity More Productive Less Productive

Limitations Nurses subjected to bullying may have been

more likely to take survey May not have provided accurate information

about bullying

Relevancy/Conclusion Highly relevant Links bullying with diminished ability of new

nurses to fulfill responsibilities Supports that it’s crucial to reduce bullying to

minimum levels

Study 5

Intimidation and Workplace Bullying

Type of study: concept analysiso 136 articles were

examined o 56 representative

publications Population:

o novice nurses, nursing students, doctors

Sample size: o Cases, interviews, and

surveys that consisted of a wide variety from 1 person to 1,565 people.

Purpose To clarify the meaning

of intimidation within the context of the healthcare environment.

Identify the role that intimidation & workplace bullying play in undermining patient safety (e.g. medical errors) and complete quality of patient care (Lamontagne, 2010).

Results Workplace bullying,

intimidation and hostile behavior can foster medical errors and decrease patient safety.

Deaths yearly because of preventable medical errors?

How much do these medical errors cost per patient?

Negative effects on healthcare providers.

Results Disruptive behaviors can

contribute to:o Poor patient satisfactiono Preventable adverse outcomeso Increased cost of careo Decreased patient safetyo Clinicians to seek new positions

What is the safety quality of patient care dependent on?

Health care organizations need to address the problem of behaviors that threaten the performance of the healthcare team.

Novice nurses reported feelings of:o Being undervaluedo Blocked from opportunitieso Being unsupported, and

neglected

Conclusion Recognize and take specific

steps to immediately halt the occurrence of intimidation. 

Adverse affect on healthcare providers, patients, and their families.

Further research is needed to provide a method to quantitatively measure the effect of intimidation by nursing superiors on novice nurses' ability to provide safe patient care. 

 It is in the best interest of the patient, nurse, and organization to eliminate workplace bullying from the workplace.

RecommendationsClearly, the bullying of new nurses has far reaching consequences. Current practice must focus on minimizing bullying to: provide greater patient safety increase nurse productivity increase nurse job satisfaction Ultimately provide greater quality of care

Preventative strategies and ongoing interventions for eliminating workplace bullying are paramount in the healthcare setting.

ConclusionBullying has a negative effect and it must be minimized to improve overall quality of care. There are many adverse effects that not only involve the nurse, but also patients, families, and healthcare providers.

More research needs to be conducted to identify effective interventions to eliminate bullying in the healthcare setting and the negative effects that it has.

References Berry, P. A., Gillespie, G. L., Gates, D., & Schafer, J. (2012). Novice

Nurse Productivity Following Workplace Bullying. Journal of Nursing Scholarship, 44(1), 80-87. doi:10.1111/j.1547-5069.2011.01436.x

Grau, A. L., Laschinger, H. K. S., Wong, C. A. (2012). The influence of authentic leadership on newly graduated nurses experiences of workplace bullying, burnout and retention outcomes: A cross sectional study. International Journal of Nursing Studies, 49, 1266-1276. http://www.sciencedirect.com/science/article/pii/S002074891836#

Lamontagne, Clare, MS,R.N., C.N.E. (2010). Intimidation: A concept analysis. Nursing Forum, 45(1), 54-65. Retrieved from http://search.proquest.com/docview/194999595?accountid=27045

Murray, J. S. (2009). Workplace bullying in nursing: A problem that can’t be ignored. Medsurg Nursing, 18(5), 273-6.

Simons, S. R., & Mawn, B. (2010). Bullying in the workplace--A qualitative study of newly licensed registered nurses. AAOHN Journal, 58(7), 305- 11. doi:http://dx.doi.org/10.3928/08910162-20100616-02