Research contacted by different cultures in the last decade has identified nurse bullying as a widespread and series problem (Wright & Khatri, 2015). Many countries have focused on the raising awareness and addressing this particular problem with the aim of preventing negative implications associated with workplace bullying. Bullying encompasses the behavior targeted at an individual to stigmatize and humiliate them socially. It is also aimed at sabotaging the reputation of the victim by attacking the victim’s professional competence and character. A person can experience bullying at the workplace by co-workers, supervisors, and managers. There are two forms of bullying: intentional bullying and experienced bullying. The primary difference between these two forms of bullying is the longevity and frequency of negative behaviors. Bullying has to occur repeatedly and regularly to be applied to a particular process, interaction, activity.

The impact of systematically repetitive and psychological subjugation becomes evident as a collection of injuries which slowly develop into a person. These victims experience a wide range of social, mental, and physiological problems associated with the intense anxiety and stress for bullying. Individuals who are exposed to long-term bullying at work are likely to have low confidence and self-esteem and suffer from ill-adjustment, stigmatization, and social isolation (Wright & Khatri, 2015). The purpose of this paper is to discuss nurse bullying, the significance of the problem, current practice related to the problem, how nurse bullying impacts patients’ cultural background, to develop a PICO question, to describe the search strategy, and keywords used to search.

The significance of Nursing Bullying

Incidences of attacks and acts of violence health professionals among nurses at the place of work are alarmingly high. Statistical studies and analysis indicate that this problem is disturbing to the workers and damaging to the hospitals (Bowllan, 2015). International studies have identified that there are more victims of workplace psychological than any other type of harassment and violence. Individuals who have been exposed to persistent and long-term bullying, at work have low self-confidence and self-esteem. Most of the bullying victims have been known to attempt suicide and demonstrate symptoms of post-traumatic stress disorder. Individuals experiencing bullying at work have poor job efficiency, motivation, work performance, and job satisfaction. These victims have impaired social relations both at home and at work (Bowllan, 2015).

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Incidences of bullying at work are increasingly alarming and cannot be ignored. Statistical studies and analyses indicate that bullying of workers is alarming across in a wide arrange of industries. In nursing, bullying of workers has obvious detrimental effects on health professionals which make it call for urgent intervention to prevent further bullying which impacts the operations of a health system and delivery of care.  Except for a few countries such as Norway and Sweden workplace bullying is usually not covered by specific legislation in most of the countries. The British Medical Association (BMA) in the United Kingdom has called for zero tolerance on bullying (Wright & Khatri, 2015). Whereas governments have adopted anti-bullying policies in various countries, the enactment of these policies has not been valid, and these policies have been criticized as a just a show business.

According to a report by BMA, one out of six National Health Service staff are reported being bullied by other staff. Nurses and physicians have been exposed to workplace bullying. In the report, 27-51% of the nurses and 18-38% of the physicians reported bullying their workplace (Bowllan, 2015). Also, 60-84% of healthcare professionals reported to have bullying at their workplace, and 69% reported to have witnessed their co-workers bullied. Higher prevalence was reported by non-European healthcare professionals operating in western countries where incidences are less likely to be addressed (Bowllan, 2015).

Current Problem

Bullying has been a part of working life for a couple of decades. According to Laschinger (2014), workplace bullying entails repetitive offensive behavior through humiliating or malicious, cruel and vindictive attempts to undermine an individual. Workplace bullying has a wide range of negative impacts. Victims routinely struggle with physical health problems, poor occupational situation, maintaining their reputation, maintaining social contacts, and communications (Laschinger, 2014).

Workplace bullying can be categorized into five groups: subversion (e.g. assigning meaningless tasks); overwork (e.g. undue pressure); isolation (e.g. social and physical isolation and preventing access to resources); threats to personal standing (e.g. intimidation, and insults), and threats to professional status (e.g. belittling and accusation of lack of effort). These behaviors can be inflicted by on an individual by subordinates, co-workers at the same level, supervisors, and facility administrators. People who are psychologically abused create an organized from again a person with normal, long-term, and systemic occurring bullying behavior. Victims of workplace bullying usually feel helpless facing so many powerful especially when mobbing occurs (Laschinger et al. 2014).

Bullying is both pervasive and destructive and does not belong to any profession which embraces compassion and care. The effect of bullying at the workplace reaches beyond the incident of bullying. Like a virus, bullying infects the culture of an organization and destroys the work environment from the inside out. For instance, bullying has an impact on employees. Victim of bullying undergoes emotional pain that can result in high absenteeism and physical pain. Victims experience a wide range of emotions including loss of self-worth, lack of confidence, incompetence, and humiliation (Laschinger et al. 2014).

Bullying impacts nursing profession. Nursing bullying can make a nurse quit from the nursing profession increasing nurse shortage hence impacting the delivery of patient. As people outside the healthcare system are learning about nurse bullying, it is becoming nursing’s “black-eye.” This health problem has jeopardized the noble profession of nursing (Hogh, Baernholdt & Clausen, 2018).

Bullying also has serious impacts on the organization. For instance, some employees may opt to absent themselves from work due to bullying. Many nurses do not have skills bear with incidences of bullying and may opt to miss work to avoid the nasty experience. Absenteeism is associated with many with unnecessary costs to the organization and adds burden to the other healthcare staff resulting in nursing disengagement and high turnover. High turnover is the bottom line of an organization, and it leads to higher operational costs (Hogh, Baernholdt & Clausen, 2018).

Bullying also affects patient care which is the most concerning in nursing care. A nursing environment which is plagued by high incidences of patient mortality rates. Nurses in such environment are unlikely to call upon co-workers for assistance because they may feel uncomfortable a colleague for help creating situation which does not favor provision of quality patient care (Hogh, Baernholdt & Clausen, 2018).

Interventions for Bullying Behavior

Various strategies are used by healthcare providers to eradicate and discourage bullying behavior. These interventions include confronting the behavior, speaking up, isolation from the bullying, and recognizing the bullying behavior.

Confronting the Bully

The major reasons why bullying is a serial problem in a workplace is because individuals avoid antagonizing the bullies regarding behavior. One way in which an individual can confront a bully is to speak about the behavior when they encounter it. Naming a bullying behavior helps to send a message to the bully which the victim is aware of the bully’s tactics. The bullying behavior will reduce and finally stop with time (Blackstock et al. 2015).

Speaking up to the bully

Victims of bullying may suffer in silence, and some may opt to leave the nursing profession and become distraught altogether. Thus, nurses who are victims of bullying are advised to speak up. Telling an individual about bullying can provide support to the victim, can validate feelings, and incredibly cathartic. The essence of this act is to let an individual know that they are bullying you. Nurses are often victimized and may suffer in silence. However, it does not have to be this way; these nurses deserve to work in a supportive and nurturing environment (Blackstock et al. 2015).

 Separating from the Bully

Victims of bullying apt to believe and internalize the message of their bullies. Accusations such as such as “didn’t they teach you anything in nursery school” or “that’s stupid” can be devastating especially for a new nurse. Individuals who are exposed to this criticism create feelings of worthlessness insecurities, and doubt their competence. Separating from the bully can be a powerful step in decreasing the impact of such criticism. When an individual encounters a bad behavior from a colleague, they are encouraged to take a mental step back and observe the behavior (Blackstock et al. 2015).

Recognizing the Behavior

Recognizing a bullying behavior is the first step in eliminating bullying. The reason as to why bullying behavior continues is because individuals consider it as a rite of passage into a profession. Behaviors such as being openly criticized, being made to feel stupid, eye rolling, gossiping, getting the toughest assignment, and being unapproachable are seen as norms. Newly graduated nurses have been seen to accommodate these behaviors. These behaviors are unprofessional, inappropriate, and destructive (Blackstock et al. 2015).

Impact of Nurse Bullying

The health profession has been reported to have one of the highest levels of bullying in the workplace. Bullying behavior not only impacts an individual victim’s health but it also affects organization’s productivity and affects workplace morale. Workplace bullying a significant burden on a country’s economy. Workplace bullying has been existing in nearly all professionals and can occur at any level within an organization. The prevalence of nurse bullying in all facets of the healthcare profession documented. Irrespective of their field, healthcare professionals experience one of their highest levels of workplace bullying. Bullying is pervasive, destructive and is not associated with any profession which exemplifies compassion and caring. Like a virus, the bullying affects the work environment from the inside out, and its impacts reach beyond each bullying incident.

Impact on Individuals

Victims of bullying suffer emotional pain which can result in high absenteeism and physical pain. Victims experience a variety of emotions including loss of self-worth, lack of confidence, incompetence, and humiliation.

Impact on the Nursing Profession

Healthcare professionals who are victims of bullying are likely to quit from their profession resulting in a shortage of workforce available to deliver patient care. The resignation of these healthcare professionals as a result of bullying impacts which remain working in such unhealthy working environments. Recently, nurse bullying has been identified as a “black-eye” as people outside the profession begin to learn the prevalence of bullying in the nursing profession. Nursing bullying has rendered the profession’s image in jeopardy (Buthelezi et al. 2015).

Impact on the Organization

Workplace bullying is associated with increased absenteeism. Many individuals do not have skills or the support to cope with workplace bullying and may opt to absent themselves from work to avoid bullying experience. Absenteeism is associated with unnecessary costs to an organization and creates a burden to the remaining staff leading to nurse disengagement and high turnover which is the bottom line of the operational costs (Buthelezi et al. 2015).

Impact on Patient Care

Nursing bullying has a significant effect on the delivery of patient care. High patient dissatisfaction and mortality rates characterize healthcare settings plagued with bullying behaviors. Healthcare professionals are unlikely to call for help from their colleagues if they feel uncomfortable seeking for help. This lack of cooperation leads to situations where a patient may not receive quality care which they need (Blackstock et al. 2015).

PICO Table

P (Problem) Nurse bullying
I (Intervention) Anti-bullying policies
C (Comparison) No anti-bullying policies
O (Outcome) Improved delivery of patient care and patient satisfaction

PICO Question

In nursing care environments, such as hospitals and ambulatory clinics, what is the effect of anti-bullying policies on the delivery of care compared with nursing environments where there are no strategies to eliminate bullying?

Literature

Keywords

The study involved a literature search of articles which contained relevant information on nurse bullying. The search involved the use of specific keywords to improve the relevance of information. The keywords included bullying, nurses, physicians, work performance, and depression. The literature search was conducted in various databases such as PubMed, NCBI, and Medscape. A total of five articles which were relevant to the topic of discussion were identified. Three of the articles were research articles, and two of the articles were non-research articles.

Research Evidence

Article 1

Fontes and his colleagues carried out a study to identify nurses who were victims of workplace bullying and factors which are associated with the bullying behavior. The exploratory and descriptive study was conducted in Maringa’ in Brazil. The researchers sought approval from the Permanent Research Ethics Committee in Maringa’. The study involved 199 participants from a population of 388 nurses who worked in public and private healthcare facilities. The participants were nurses working at private and hospitals, private healthcare clinics, fire departments, prison, regional healthcare units, council health department, and public health units. Nurses working at eight healthcare facilities were excluded from the study due to non-authorization by the directors. The exclusion criteria were the nurses who were in sick leave, maternity leave and those who were on holiday, those who participated in the pilot test, and those with less than one year of professional experience.

Data from the participants was collected by use of a questionnaire which consisted of various question which prompted to collect data on workplace bullying. This tool entailed a total of 45 questions categorized into five dimensions which exemplify the different behaviors of workplace bullying.

From the data collected, 11.5% of the participants reported having been victims of workplace bullying. Multivariate analysis showed that working at an institution for a period of one to three years, working in Public Healthcare Units, currently feeling acts of bullying and having children are risk factors for bullying.

Article 2

Ekici and Beder conducted a study to access workplace bullying and its impacts on depression status and work performance of nurses and physicians in a university hospital in Turkey. The study was carried out in a hospital with 722 beds and operating theaters. The facility had a mean bed occupation rate of 81% and an average of 136 operations per day. The participants of the study consisted of 309 nurses and 201 physicians. The variables were the participants’ perception of bullying, demographic characteristics, the impact of workplace bullying on depression status and work performance, and workload. Analysis of the data was done using SPSS software. A large percentage of the nurse (82%) reported, and physicians (74%) reported to be victims of workplace bullying. The findings of the study did not show significant differences between nurses and physicians regarding bullying experiences in the workplace. However, there was a correlation between experienced violent behavior, depression, and performance.

To address the problem associated with workplace bullying, the researchers emphasized raising the awareness among healthcare professionals. The researchers believe that it is not easy to overcome the problem of workplace bullying unless healthcare institutions realize the harmful effects of workplace bullying. Thus bullying in the workplace should be addressed not only at a personal level but also at institutional levels.

Article 3

An and Kang conducted a research study to determine the correlation between workplace bullying and organizational culture among Korean nurses. The study involved 298 participants who were nurses in Busan in Korea. The study entailed an assessment of workplace bullying among nurses and organizational bullying using structured questionnaires between July and August in 2014. Out of the total participants who participated in the study, 8.1% considered their organizational culture as task-oriented, 10.4% innovation oriented, 36.0% relation oriented, and 45.5% hierarchy oriented. The incidence of workplace bullying was 15.8% as per the operational bullying criteria. A multivariate logistic analysis revealed that bullying victims were 2.58 times as high in relation oriented culture as among hierarchy-oriented culture. The findings from the study suggested workplace bullying was related to nursing organizational culture among Korean nurses. The researchers suggested the need for further research to develop interventions which can create good relationship culture to prevent nurses from workplace bullying.

Article 4

Seyrek and Ekici carried out a research study to determine the perception of nurses on organizational justice and its impact on bullying behavior they are exposed. The study was carried out on nurses in a private hospital in Ankara. A total of 250 nurses who had served the hospital for more than 6 months participated in the study. The study aimed at measuring two variable: perception of organizational justice and bullying. To determine the bullying behavior and what causes the nurses’ justice perceptions, the researchers carried out a regression analysis.

From the findings of the survey, it was found that nurses are likely to perceive injustice in the area of distributional justice. The results from the study showed that 28% of nurses were exposed to bullying in the workplace. There was a negative and significant relation between and bullying they are exposed to and nurse’s perception of distributive justice. The study concluded that employee whose organization perception are low display negative and threatening behavior towards their institution and colleagues.  When the employee think that they can’t communicate with upper management respectfully, they feel themselves to be threatened.

Article 5

Etienne carried out a descriptive study to determine a workplace in bullying. The study was carried out in the Pacific Northwest state. The participants of the study were about 10,000 registered nurses from the state’s professional nurses’ association who were invited to participate. Participation in the survey was purely voluntary and the information collected was maintained confidential.

Data were generated through participants of the Negative Acts Questionnaire-Revised (NAQ-R). A total of 95 completed surveys (1%response rate) were submitted online. Forty-eight per cent of the participants reported having been victims of bullying. Twenty-four per cent of the participants are reported to have been rarely bullied, 4% said to on a daily basis, 12% reported to have been bullied several times a week, and 20% said to have been bullied now and then. The study concluded that workplace bullying of nurses continues to occur and should be addressed through educational programs which are focused on curbing and ultimately eradicating bullying.

Conclusion

Bullying encompasses the behavior targeted at an individual to stigmatize and humiliate socially. It is also aimed at sabotaging the reputation of the victim by attacking the victim’s professional competence and character. Incidences of attacks and acts of violence workers among nurses at the place of work are alarmingly high. Statistical studies and analysis indicate that this problem is alarming for the workers and damaging to the hospitals. According to a report by BMA, one of in six National Health Service staff are reported being bullied by other staff. Nurses and physicians have been exposed to workplace bullying. In the report, 27-51% of the nurses and 18-38% of the physicians reported bullying their workplace. The health profession has been reported to have one of the highest levels of bullying in the workplace. Bullying behavior not only impacts an individual victim’s health but it also under organization productivity and affects workplace morale. There are at least four steps which healthcare providers can take to eradicate and discourage bullying behavior. These interventions include confronting the behavior, speaking up, isolating oneself from the bullying, and recognizing the behavior.

References

An, Y., & Kang, J. (2016). Relationship between organizational culture and workplace bullying among Korean nurses. Asian nursing research, 10(3), 234-239.

Blackstock, S., Harlos, K., Macleod, M. L., & Hardy, C. L. (2015). The impact of organizational factors on horizontal bullying and turnover intentions in the nursing workplace. Journal of Nursing Management, 23(8), 1106-1114.

Bowllan, N. M. (2015). Nursing students’ experience of bullying: Prevalence, impact, and interventions. Nurse educator, 40(4), 194-198.

Buthelezi, S. F., Fakude, L. P., Martin, P. D., & Daniels, F. M. (2015). Clinical learning experiences of male nursing students in a Bachelor of Nursing programme: Strategies to overcome challenges. curationis, 38(2), 1-7.

Ekici, D., & Beder, A. (2014). The effects of workplace bullying on physicians and nurses. Australian Journal of Advanced Nursing, The, 31(4), 24.

Etienne, E. (2014). Exploring workplace bullying in nursing. Workplace Health & Safety, 62(1), 6-11.

Koh, W. M. S. (2016). Management of work place bullying in hospital: A review of the use of cognitive rehearsal as an alternative management strategy. International Journal of Nursing Sciences, 3(2), 213-222.

Fontes, K. B., Santana, R. G., Pelloso, S. M., & Carvalho, M. D. D. B. (2013). Factors associated with bullying at nurses’ workplaces. Revista latino-americana de enfermagem, 21(3), 758-764.

Hogh, A., Baernholdt, M., & Clausen, T. (2018). Impact of workplace bullying on missed nursing care and quality of care in the eldercare sector. International archives of occupational and environmental health, 1-8.

Laschinger, H. K. S. (2014). Impact of workplace mistreatment on patient safety risk and nurse-assessed patient outcomes. Journal of Nursing Administration, 44(5), 284-290.

Seyrek, H., & Ekici, D. (2017). Nurses’ Perception of Organisational Justice and its Effect on Bullying Behaviour in the Hospitals of Turkey. Hospital Practices and Research, 2(3), 72-78.

Wilson, J. L. (2016). An exploration of bullying behaviours in nursing: A review of the literature. British journal of nursing, 25(6), 303-306.

Wright, W., & Khatri, N. (2015). Bullying among nursing staff: Relationship with psychological/behavioral responses of nurses and medical errors. Health Care Management Review, 40(2), 139-147.

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