Abstract
Objective:
To evaluate the studies that approach bullying in the nursing practice environment.
Method:
Integrative review, conducted between April and December 2018, by combining the descriptors "bullying/bullying" AND "nursing/nursing/nurse" AND "workplace/workplace". We identified 224 studies of which 38 met the inclusion criteria.
Results:
The studies on nursing bullying presented three main approaches related to the prevalence in nursing practice, the repercussions for health and professional development, and the construction of theoretical models for bullying and nursing work environment variables.
Conclusion:
Bullying is a negative behavior present in the nursing practice environment and has a direct impact on professional performance, impairing general health and professional performance. Despite being a behavior with recognized negative potential in the work environment, few studies propose effective actions to prevent or control this phenomenon in health institutions.
Keywords:
Bullying; Nursing; Workplace; Review literature as topic
Resumen
Objetivo:
Evaluar los estudios que abordan el bullying en el entorno de la práctica de enfermería.
Método:
Revisión integradora, realizada entre abril y diciembre de 2018, mediante la combinación de los descriptores "bullying / bullying" AND "enfermería / enfermería / enfermera" AND "lugar de trabajo / lugar de trabajo". Se identificaron 224 estudios, de los cuales 38 cumplieron con los criterios de inclusión.
Resultados:
Los estudios sobre el bullying de enfermería presentaron tres enfoques principales relacionados con la prevalencia en la práctica de enfermería, las repercusiones para la salud y el desarrollo profesional, y la construcción de modelos teóricos para las variables de entorno de bullying y trabajo de enfermería.
Conclusión:
El acoso es un comportamiento negativo presente en el entorno de la práctica de enfermería y tiene un impacto directo en el desempeño profesional, lo que afecta la salud general y el desempeño profesional. A pesar de ser un comportamiento con potencial negativo reconocido en el entorno laboral, pocos estudios proponen acciones efectivas para prevenir o controlar este fenómeno en las instituciones de salud.
Palabras clave:
Acoso escolar; Enfermería; Lugar de trabajo; Literatura de revisión como asunto
Resumo
Objetivo:
Avaliar os estudos que abordam o bullying no ambiente de prática da enfermagem.
Método:
Revisão integrativa, realizada no período de abril a dezembro de 2018, por meio da combinação entre os descritores "bullying / bullying" AND "enfermagem / nursing / nurse" AND “local de trabalho / workplace”. Foram identificados 224 estudos dos quais 38 atenderam aos critérios de inclusão.
Resultados:
Os estudos sobre bullying na enfermagem apresentaram três enfoques principais relacionados à prevalência na prática da enfermagem, às repercussões para a saúde e desenvolvimento profissional e construção de modelos teóricos para o bullying e variáveis do ambiente de trabalho da enfermagem.
Conclusão:
O bullying é um comportamento negativo presente no ambiente da prática da enfermagem e apresenta impacto direto na atuação profissional, ao prejudicar a saúde geral e o desempenho profissional. Apesar de ser um comportamento com reconhecido potencial negativo ao ambiente de trabalho, poucos estudos propõem ações efetivas para prevenção ou controle deste fenômeno nas instituições de saúde.
Palavras-chave:
Bullying; Enfermagem; Local de trabalho; Literatura de revisão como assunto
INTRODUCTION
In the last decades of the 20th century, the global economic scenario has undergone profound changes that, in turn, modified the structure of work processes, made the labor environment more competitive and hostile(11. Andrade CB, Assis SG. Assédio moral no trabalho, gênero, raça e poder: revisão de literatura. Rev Bras Saúde Ocup. 2018;43:e11. doi: https://doi.org/10.1590/2317-6369000012917
https://doi.org/10.1590/2317-63690000129...
) and exposed employees to new work-related risks(22. Borges EMN, Ferreira TJR. Bullying no trabalho: adaptação do Negative Acts Questionnaire-Revised (NAQ-R) em enfermeiros. Rev Port Enferm Saúde Mental. 2015 [cited 2019 Jan 10];(13):25-33. Available from: http://www.scielo.mec.pt/scielo.php?script=sci_arttext&pid=S1647-21602015000200004&lng=pt&nrm=i&tlng=pt
http://www.scielo.mec.pt/scielo.php?scri...
).
It is believed that occupational risks have always existed; since the 1980s(33. Cheung T, Lee PH, Yip PSF. Workplace violence toward physicians and nurses: prevalence and correlates in Macau. Int J Environ Res Public Health. 2017;14(8): 879. doi: https://doi.org/10.3390/ijerph14080879
https://doi.org/10.3390/ijerph14080879...
), however, abuse toward workers has been compared to uncivil acts among schoolchildren and thus received the denomination mobbing(44. Park M, Cho SH, Hong HJ. Prevalence and perpetrators of workplace violence by nursing unit and the relationship between violence and the perceived work environment. J Nurs Scholarsh. 2015;47(1):87-95. doi: https://doi.org/10.1111/jnu.12112
https://doi.org/10.1111/jnu.12112...
), consequently leading to more critical analyses on the part of the researchers(33. Cheung T, Lee PH, Yip PSF. Workplace violence toward physicians and nurses: prevalence and correlates in Macau. Int J Environ Res Public Health. 2017;14(8): 879. doi: https://doi.org/10.3390/ijerph14080879
https://doi.org/10.3390/ijerph14080879...
4. Park M, Cho SH, Hong HJ. Prevalence and perpetrators of workplace violence by nursing unit and the relationship between violence and the perceived work environment. J Nurs Scholarsh. 2015;47(1):87-95. doi: https://doi.org/10.1111/jnu.12112
https://doi.org/10.1111/jnu.12112...
-55. Silva IV, Aquino EML, Pinto ICM. Características psicométricas do Negative Acts Questionnaire para detecção do assédio moral no trabalho: estudo avaliativo do instrumento com uma amostra de servidores estaduais da saúde. Rev Bras Saúde Ocup. 2017;42:e2. doi: https://doi.org/10.1590/2317-6369000128715
https://doi.org/10.1590/2317-63690001287...
). It is noteworthy that expressions such as mobbing, harassment, bullying and horizontal violence are used as synonyms to describe personal, moral and psychological violence in the workplace and the preferred term depends on the region of the studies(66. Guimarães LAM, Rimoli AO. »,» ®,® §,§ ­, ¹,¹ ²,² ³,³ ß,ß Þ,Þ þ,þ ×,× Ú,Ú ú,ú Û,Û û,û Ù,Ù ù,ù ¨,¨ Ü,Ü ü,ü Ý,Ý ý,ý ¥,¥ ÿ,ÿ ¶,¶ Mobbing »,» ®,® §,§ ­, ¹,¹ ²,² ³,³ ß,ß Þ,Þ þ,þ ×,× Ú,Ú ú,ú Û,Û û,û Ù,Ù ù,ù ¨,¨ Ü,Ü ü,ü Ý,Ý ý,ý ¥,¥ ÿ,ÿ ¶,¶ (assédio psicológico) no trabalho: uma síndrome psicossocial multidimensional. Psicol: Teor Pesqui. 2006;22(2):183-91. doi: https://doi.org/10.1590/S0102-37722006000200008
https://doi.org/10.1590/S0102-3772200600...
-77. Bobroff MCC, Martins JT. Assédio moral, ética e sofrimento no trabalho. Rev Bioética 2013;21(2):251-8. doi: https://doi.org/10.1590/S1983-80422013000200008
https://doi.org/10.1590/S1983-8042201300...
).
Bullying is characterized as systematic and persistent behavior occurring for more than six months in the form of repeated negative acts such as insulting observations, exposure of the victim, verbal abuse, offensive provocation, isolation and social exclusion or the constant degradation of working conditions and worker effort(88. Einarsen S, Raknes BRL, Matthiesen SB. Bullying and harassment at work and their relationships to work environment quality: an exploratory study. Eur Work Organiz Psychol. 1994;4(4):381-401. doi: https://doi.org/10.1080/13594329408410497
https://doi.org/10.1080/1359432940841049...
).
Negative attitudes caused by bullying can trigger high levels of stress, mental and psychological disorders, including anxiety and depression among workers(99. Sauer PA, McCoy TP. Nurse Bullying: Impact on nurses' health. West J Nurs Res. 2017;39(12):1533-46. doi: https://doi.org/10.1177/0193945916681278
https://doi.org/10.1177/0193945916681278...
). Other physical manifestations include gastrointestinal disorders, hypertension, headache and eating and sleep disorders, which eventually affect the sufferer´s overall health(1010. Ganz FD, Levy H, Khalaila R, Arad D, Bennaroch K, Kolpak O, et al. Bullying and its prevention among intensive care nurses. J Nurs Scholarsh. 2015;47(6):505-11. doi: https://doi.org/10.1111/jnu.12167
https://doi.org/10.1111/jnu.12167...
). In addition, it may result in dissatisfaction with work and social isolation(1111. Karatza C, Zyga S, Tziaferi S, Prezerakos P. Workplace bullying and general health status among the nursing staff of Greek public hospitals. Ann Gen Psychiatry. 2016;15:7. doi: https://doi.org/10.1186/s12991-016-0097-z
https://doi.org/10.1186/s12991-016-0097-...
12. Norton P, Costa V, Teixeira J, Azevedo A, Roma-Torres A, Amaro J, et al. Prevalence and determinants of bullying among health care workers in Portugal. Workplace Health Saf. 2017;65(5):188-96. doi: https://doi.org/10.1177/2165079916666545
https://doi.org/10.1177/2165079916666545...
-1313. Charilaos K, Michael G, Chryssa BT, Panagiota D, George CP, Christina D. Validation of the Negative Acts Questionnaire (NAQ) in a sample of Greek teachers. Psychology 2015;6(1):63-74. doi: https://doi.org/10.4236/psych.2015.61007
https://doi.org/10.4236/psych.2015.61007...
). For the institution, bullying can cause an increase in absenteeism, a reduction in productivity and efficiency and job abandonment(1313. Charilaos K, Michael G, Chryssa BT, Panagiota D, George CP, Christina D. Validation of the Negative Acts Questionnaire (NAQ) in a sample of Greek teachers. Psychology 2015;6(1):63-74. doi: https://doi.org/10.4236/psych.2015.61007
https://doi.org/10.4236/psych.2015.61007...
-1414. Karatza C, Zyga S, Tziaferi S, Prezerakos P. Workplace bullying among the nursing staff of Greek public hospitals. Workplace Health Saf. 2017;65(2):57-64. doi: https://doi.org/10.1177/2165079916657106
https://doi.org/10.1177/2165079916657106...
).
Studies in health care show that bullying accounts for up to a quarter of all work-related cases of violence(33. Cheung T, Lee PH, Yip PSF. Workplace violence toward physicians and nurses: prevalence and correlates in Macau. Int J Environ Res Public Health. 2017;14(8): 879. doi: https://doi.org/10.3390/ijerph14080879
https://doi.org/10.3390/ijerph14080879...
,1515. Bordignon M, Monteiro MI. Violence in the workplace in nursing: consequences overview. Rev Bras Enferm. 2016;69(5):939-42. doi: https://doi.org/10.1590/0034-7167-2015-0133
https://doi.org/10.1590/0034-7167-2015-0...
) and that nursing professionals are more exposed to bullying by their peers, by other professionals and even by patients(1010. Ganz FD, Levy H, Khalaila R, Arad D, Bennaroch K, Kolpak O, et al. Bullying and its prevention among intensive care nurses. J Nurs Scholarsh. 2015;47(6):505-11. doi: https://doi.org/10.1111/jnu.12167
https://doi.org/10.1111/jnu.12167...
,1616. Fontes KB, Santana RG, Pelloso SM, Carvalho MDB. Fatores associados ao assédio moral no ambiente laboral do enfermeiro. Rev Latino-Am Enfermagem. 2013;21(3):758-64. doi: https://doi.org/10.1590/S0104-11692013000300015
https://doi.org/10.1590/S0104-1169201300...
-1717. Hutchinson M, Wilkes L, Jackson D, Vickers MH. Integrating individual, work group and organizational factors: testing a multidimensional model of bullying in the nursing workplace. J Nurs Manag. 2010;18(2):173-81. doi: https://doi.org/10.1111/j.1365-2834.2009.01035.x
https://doi.org/10.1111/j.1365-2834.2009...
).
Nursing is a predominantly female professional category and, as such, still subjected to gender-related workplace inequalities, which have already be related to higher rates of workplace bullying1. Moreover, nursing is the largest and one of the most stressful professional categories in the field of health since nurses must cope with the demands of patients, other professionals and their own coworkers(22. Borges EMN, Ferreira TJR. Bullying no trabalho: adaptação do Negative Acts Questionnaire-Revised (NAQ-R) em enfermeiros. Rev Port Enferm Saúde Mental. 2015 [cited 2019 Jan 10];(13):25-33. Available from: http://www.scielo.mec.pt/scielo.php?script=sci_arttext&pid=S1647-21602015000200004&lng=pt&nrm=i&tlng=pt
http://www.scielo.mec.pt/scielo.php?scri...
). Nursing professionals must endure situations of anguish and pain, work overload and extensive work shifts on a daily basis(1515. Bordignon M, Monteiro MI. Violence in the workplace in nursing: consequences overview. Rev Bras Enferm. 2016;69(5):939-42. doi: https://doi.org/10.1590/0034-7167-2015-0133
https://doi.org/10.1590/0034-7167-2015-0...
), all of which expose them to workplace bullying.
Considering the negative repercussions of bullying on the performance and physical and emotional health of workers, especially nurses, it is important to understand its dimensions in the workplace in order to implement preventive and control actions and favor a positive safety culture in health care institutions. Consequently, the aim of this paper was to assess studies on bullying in the nursing work environment.
METHOD
This is an integrative review conducted according to the stages recommended by Whittemore and Knafl(1818. Whittemore R, Knafl K. The integrative review: updated methodology. J Adv Nurs. 2005;52(5):546-53. https://doi.org/10.1111/j.1365-2648.2005.03621.x
https://doi.org/10.1111/j.1365-2648.2005...
), namely a) problem identification and creation of research question; b) establishment of inclusion and exclusion criteria and literature search; c) definition of information to be collected in the studies obtained in the search; d) categorization of selected studies and analysis of this information; e) interpretation of results and f) review presentation.
In the first stage, the following question was formulated: What is the focus of studies on bullying in the nursing work environment? After defining the guiding question, the study selection stage was initiated.
Prior to selection, the following inclusion criteria were adopted: publications with all the descriptors cited in the title of the study and full-text publications in Portuguese, English or Spanish published between January 2010 and December 2018. Studies of integrative or systematic reviews, editorials, letters, theses and dissertations and duplicate papers were excluded.
In the third stage, the online search for studies was carried out. We consulted the primary source databases Web of Science (WOS), MEDLINE/PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Latin American and Caribbean Literature on Health Sciences (LILACS). The search strategy comprised the operators "bullying/bullying" AND "enfermagem/nursing/nurses" AND "local de trabalho/workplace". The descriptors used are standardized in the Health Sciences Descriptors (DeCS) and the Medical Subject Headings (MeSH).
The database searches resulted in 224 studies, which went through further selection stages. The flow of study selection is shown in Figure 1, based on PRISMA recommendations for preparing a flow diagram of the stages of this integrative review(1919. Moher D, Liberati A, Tetzlaff J, Altman DG. The PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement. PLoS Med. 2009;21;6(7):e1000097. doi: https://doi.org/10.1371/journal.pmed.1000097
https://doi.org/10.1371/journal.pmed.100...
).
Flowchart prepared and adapted from the PRISMA recommendations for mapping the articles that are identified, selected and included.
In the following stage, the studies listed in an Excel spreadsheet were characterized in descending order according to year and country of publication, authors, title, study objectives, methodology and main results. In the fifth stage, the main findings were interpreted and synthesized and, finally, the review was presented.
RESULTS
Based on the descriptors of DeCS and MeSH, we identified 224 articles in the databases, three of which were in LILACS, 18 in CINAHL, 29 in MEDLINE/PubMed, 118 in Embase and 50 in the Web of Science. Of these studies, 186 articles were excluded because they were duplicates, they did not refer to the subject matter or they did not meet the criteria, resulting in 38 articles. The main characteristics of the studies - such as first author, year of publication, country, objectives and main results - are presented in Chart 1.
To analyze the results, the findings were categorized according to the key focal points attributed to bullying in nursing: 1) perception of bullying 2) impact of bullying on health care and professional performance and 3) construction of theoretical models on bullying in nursing.
DISCUSSION
The evaluation of studies addressing bullying in the nursing environment made it possible to systemize some results. It should be noted that most of the studies were published in Asia (39.5%), followed by North America (31.5%). Few publications on the subject were found for South America and Africa, indicating the need for further studies in these localities(1616. Fontes KB, Santana RG, Pelloso SM, Carvalho MDB. Fatores associados ao assédio moral no ambiente laboral do enfermeiro. Rev Latino-Am Enfermagem. 2013;21(3):758-64. doi: https://doi.org/10.1590/S0104-11692013000300015
https://doi.org/10.1590/S0104-1169201300...
,2828. Nwaneri AC, Onoka AC, Onoka CA. Workplace bullying among nurses working in tertiary hospitals in Enugu, southeast Nigeria: implications for health workers and job performance. J Nurs Educ Pract. 2017;7(2):69-78. doi: https://doi.org/10.5430/jnep.v7n2p69
https://doi.org/10.5430/jnep.v7n2p69...
).
Regarding the year of publication, 97.3% of the studies were published from 2014, demonstrating a growing interest of researchers on the subject of bullying in nursing practice environment.
Most articles sought to identify the existence of bullying among nursing professionals using specific data collection instruments in the fields of psychology and health care. In this review, we observed a predominance of the Negative Acts Questionnaire Revised (NAQ-R), used in 21 studies(2,10,11,14,22-26,28,33-37,39,41,44,46-49,52). The original version of this instrument contains 22 items that report negative acts in the work environment and it is widely used in research on bullying(5353. Notelaers G, Einarsen S, De Witte H, Vermunt JK. Estimating the prevalence of bullying at work: a latent class cluster approach. Work Stress. 2006;20(4):289-302. doi: https://doi.org/10.1080/02678370601071594
https://doi.org/10.1080/0267837060107159...
).
The analysis of the objectives of the studies that addressed bullying in nursing allowed us to identify three approaches to this behavior, namely: the perception of the teams regarding the presence of this behavior in the workplace, the influence of bullying on the physical health and professional performance of the victims and the construction of theoretical models to formulate postulates that relate bullying to the determinant factors of this act of violence at work. These approaches are presented in three categories: 1- perception of bullying by professionals, 2- impact of bullying on health and professional performance and 3- construction of theoretical models on bullying behavior in nursing.
Category 1. Perception of bullying by professionals
In the evaluation of the perception of bullying, the studies presented and applied different instruments to identify the indices of this behavior, which were perceived by the nursing professionals. The percentage of bullying among nursing professionals ranged from 9% to 94%(4343. Esfahani AN, Shahbazi G. Workplace bullying in nursing: the case of Azerbaijan province, Iran. Iran J Nurs Midwifery Res. 2014 [cited 2019 Jan 20];19(4):409-15. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4145498/
https://www.ncbi.nlm.nih.gov/pmc/article...
44. Etienne E. Exploring workplace bullying in nursing. Workplace Health Saf. 2014;62(1):6-11. doi: https://doi.org/10.1177/216507991406200102
https://doi.org/10.1177/2165079914062001...
45. Ovayolu O, Ovayolu N, Karadag G. Workplace bullying in nursing. Workplace Health Saf. 2014;62(9):370-4. https://doi.org/10.3928/21650799-20140804-04
https://doi.org/10.3928/21650799-2014080...
46. Schlitzkus LL, Vogt KN, Sullivan ME, Schenarts KD. Workplace bullying of general surgery residents by nurses. J Surg Educ. 2014;71(6):e149-54. doi: https://doi.org/10.1016/j.jsurg.2014.08.003
https://doi.org/10.1016/j.jsurg.2014.08....
47. Yun S, Kang J, Lee YO, Yi Y. Work environment and workplace bullying among Korean intensive care unit nurses. Asian Nurs Res. 2014;8(3):219-25. doi: https://doi.org/10.1016/j.anr.2014.07.002
https://doi.org/10.1016/j.anr.2014.07.00...
48. Vogelpohl DA, Rice SK, Edwards ME, Bork CE. New graduate nurses' perception of the workplace: have they experienced bullying? J Prof Nurs. 2013;29(6):414-22. doi: https://doi.org/10.1016/j.profnurs.2012.10.008
https://doi.org/10.1016/j.profnurs.2012....
-4949. Berry PA, Gillespie GL, Gates D, Schafer J. Novice nurse productivity following workplace bullying. J Nurs Scholarsh. 2012;44(1):80-7. doi: https://doi.org/10.1111/j.1547-5069.2011.01436.x
https://doi.org/10.1111/j.1547-5069.2011...
), and some studies related characteristics of the professional(1414. Karatza C, Zyga S, Tziaferi S, Prezerakos P. Workplace bullying among the nursing staff of Greek public hospitals. Workplace Health Saf. 2017;65(2):57-64. doi: https://doi.org/10.1177/2165079916657106
https://doi.org/10.1177/2165079916657106...
,2929. Ma SC. Hospital nurses' attitudes, negative perceptions and negative acts regarding work-place bullying. Ann Gen Psychiatry. 2017;16:33. doi: https://doi.org/10.1186/s12991-017-0156-0
https://doi.org/10.1186/s12991-017-0156-...
,3131. Tee S, Üzar YO, Russell MW. Workplace violence experienced by nursing students: a UK survey. Nurse Educ Today. 2016;41:30-5. doi: https://doi.org/10.1016/j.nedt.2016.03.014
https://doi.org/10.1016/j.nedt.2016.03.0...
,4949. Berry PA, Gillespie GL, Gates D, Schafer J. Novice nurse productivity following workplace bullying. J Nurs Scholarsh. 2012;44(1):80-7. doi: https://doi.org/10.1111/j.1547-5069.2011.01436.x
https://doi.org/10.1111/j.1547-5069.2011...
) and the environment(2121. Yun S, Kang J. Influencing factors and consequences of workplace bullying among nurses: a structural equation modeling. Asian Nurs Res. 2018;12(1):26-33. doi: https://doi.org/10.1016/j.anr.2018.01.004
https://doi.org/10.1016/j.anr.2018.01.00...
,2424. Olsen E, Bjaalid G, Mikkelsen A. Work climate and the mediating role of workplace bullying related to job performance, job satisfaction, and work ability: a study among hospital nurses. J Adv Nurs. 2017;73(11):2709-19. doi: https://doi.org/10.1111/jan.13337
https://doi.org/10.1111/jan.13337...
,2626. An Y, Kang J. Relationship between organizational culture and workplace bullying among Korean nurses. Asian Nurs Res. 2016;10(3):234-9. doi: https://doi.org/10.1016/j.anr.2016.06.004
https://doi.org/10.1016/j.anr.2016.06.00...
,3333. Giorgi G, Mancuso S, Perez FF, D'Antonio AC, Mucci N, Cupelli V, et al. Bullying among nurses and its relationship with burnout and organizational climate. Int J Nurs Pract. 2016;22(2):160-8. doi: https://doi.org/10.1111/ijn.12376
https://doi.org/10.1111/ijn.12376...
,5252. Laschinger HKS, Wong CA, Grau AL. The influence of authentic leadership on newly graduated nurses' experiences of workplace bullying, burnout and retention outcomes: a cross-sectional study. Int J Nurs Stud. 2012;49(10):1266-76. doi: https://doi.org/10.1016/j.ijnurstu.2012.05.012
https://doi.org/10.1016/j.ijnurstu.2012....
) as factors associated with bullying. It is noteworthy that the lowest percentage of bullying identified in this review corresponds to research based solely on the self-reports of nurses from a province of Azerbaijan, a region marked by strong cultural peculiarities(4343. Esfahani AN, Shahbazi G. Workplace bullying in nursing: the case of Azerbaijan province, Iran. Iran J Nurs Midwifery Res. 2014 [cited 2019 Jan 20];19(4):409-15. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4145498/
https://www.ncbi.nlm.nih.gov/pmc/article...
).
The differences between the prevalence found in studies on bullying may reflect the reality of the working conditions of many nursing professionals, considering particular aspects of their region and culture, although it is possible to find variations due to difficulties in establishing standardized definitions on bullying and appropriate data collection methodologies for bullying in health institutions(5454. Zachariadou T, Zannetos S, Chira SE, Gregoriou S, Pavlakis A. Prevalence and forms of workplace bullying among health-care professionals in Cyprus: Greek version of “Leymann Inventory of Psychological Terror” Instrument. Saf Health Work. 2017;9(3):339-46. doi: https://doi.org/10.1016/j.shaw.2017.11.003
https://doi.org/10.1016/j.shaw.2017.11.0...
).
Regarding the characteristics of the workers who influence the perception of bullying, the variable age was related to bullying in a study conducted in southern Taiwan(2929. Ma SC. Hospital nurses' attitudes, negative perceptions and negative acts regarding work-place bullying. Ann Gen Psychiatry. 2017;16:33. doi: https://doi.org/10.1186/s12991-017-0156-0
https://doi.org/10.1186/s12991-017-0156-...
), in which older nurses, with more professional experience, showed negative behavior in relation to younger nurses and often questioned their skills and ability to resolve conflicts(1414. Karatza C, Zyga S, Tziaferi S, Prezerakos P. Workplace bullying among the nursing staff of Greek public hospitals. Workplace Health Saf. 2017;65(2):57-64. doi: https://doi.org/10.1177/2165079916657106
https://doi.org/10.1177/2165079916657106...
). Furthermore, the variable years of experience influenced the behavior of bullying since newly graduated workers were more exposed to violent behavior at work(4949. Berry PA, Gillespie GL, Gates D, Schafer J. Novice nurse productivity following workplace bullying. J Nurs Scholarsh. 2012;44(1):80-7. doi: https://doi.org/10.1111/j.1547-5069.2011.01436.x
https://doi.org/10.1111/j.1547-5069.2011...
), exemplified by a study in which 19.5% of the acts of bullying were practiced by more experienced nurses(3131. Tee S, Üzar YO, Russell MW. Workplace violence experienced by nursing students: a UK survey. Nurse Educ Today. 2016;41:30-5. doi: https://doi.org/10.1016/j.nedt.2016.03.014
https://doi.org/10.1016/j.nedt.2016.03.0...
). These findings indicate that some nurses use their professional experience as a form of power, while it is expected that the knowledge acquired in the nursing practice environment be passed on to the novice professionals.
In relation to the work environment, studies pointed out that the organizational climate(2424. Olsen E, Bjaalid G, Mikkelsen A. Work climate and the mediating role of workplace bullying related to job performance, job satisfaction, and work ability: a study among hospital nurses. J Adv Nurs. 2017;73(11):2709-19. doi: https://doi.org/10.1111/jan.13337
https://doi.org/10.1111/jan.13337...
,3333. Giorgi G, Mancuso S, Perez FF, D'Antonio AC, Mucci N, Cupelli V, et al. Bullying among nurses and its relationship with burnout and organizational climate. Int J Nurs Pract. 2016;22(2):160-8. doi: https://doi.org/10.1111/ijn.12376
https://doi.org/10.1111/ijn.12376...
) of the institutions and hierarchy-oriented work structures(2121. Yun S, Kang J. Influencing factors and consequences of workplace bullying among nurses: a structural equation modeling. Asian Nurs Res. 2018;12(1):26-33. doi: https://doi.org/10.1016/j.anr.2018.01.004
https://doi.org/10.1016/j.anr.2018.01.00...
,2626. An Y, Kang J. Relationship between organizational culture and workplace bullying among Korean nurses. Asian Nurs Res. 2016;10(3):234-9. doi: https://doi.org/10.1016/j.anr.2016.06.004
https://doi.org/10.1016/j.anr.2016.06.00...
) - to the detriment of personal work-based relationships - were related to acts of bullying. The absence of leadership figures(5252. Laschinger HKS, Wong CA, Grau AL. The influence of authentic leadership on newly graduated nurses' experiences of workplace bullying, burnout and retention outcomes: a cross-sectional study. Int J Nurs Stud. 2012;49(10):1266-76. doi: https://doi.org/10.1016/j.ijnurstu.2012.05.012
https://doi.org/10.1016/j.ijnurstu.2012....
) was also related to the higher probability of acts of violence in the workplace.
Category 2. Impact of bullying on health and professional performance
Bullying mostly affects the overall health status of workers(1414. Karatza C, Zyga S, Tziaferi S, Prezerakos P. Workplace bullying among the nursing staff of Greek public hospitals. Workplace Health Saf. 2017;65(2):57-64. doi: https://doi.org/10.1177/2165079916657106
https://doi.org/10.1177/2165079916657106...
,2929. Ma SC. Hospital nurses' attitudes, negative perceptions and negative acts regarding work-place bullying. Ann Gen Psychiatry. 2017;16:33. doi: https://doi.org/10.1186/s12991-017-0156-0
https://doi.org/10.1186/s12991-017-0156-...
,3939. Laschinger HKS, Nosko A. Exposure to workplace bullying and post-traumatic stress disorder symptomology: the role of protective psychological resources. J Nurs Manag. 2015;23(2):252-62. doi: https://doi.org/10.1111/jonm.12122
https://doi.org/10.1111/jonm.12122...
). The victims of bullying exhibited several physical and emotional manifestations, mainly symptoms of stress, anxiety and depression(2121. Yun S, Kang J. Influencing factors and consequences of workplace bullying among nurses: a structural equation modeling. Asian Nurs Res. 2018;12(1):26-33. doi: https://doi.org/10.1016/j.anr.2018.01.004
https://doi.org/10.1016/j.anr.2018.01.00...
,3636. Berry PA, Gillespie GL, Fisher BS, Gormley D, Haynes JT. Psychological distress and workplace bullying among registered nurses. Online J Issues Nurs. 2016 [cited 2019 Jan 20];21(3). Available from: http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-21-2016/No3-Sept-2016/Articles-Previous-Topics/Psychological-Distress-and-Workplace-Bullying.html
http://ojin.nursingworld.org/MainMenuCat...
,3737. Yokoyama M, Suzuki M, Takai Y, Igarashi A, Noguchi-Watanabe M, Yamamoto-Mitani N. Workplace bullying among nurses and their related factors in Japan: a cross-sectional survey. J Clin Nurs. 2016;25(17-18):2478-88. doi: https://doi.org/10.1111/jocn.13270
https://doi.org/10.1111/jocn.13270...
,4040. Allen BC, Holland P, Bus B, Reynolds R. The effect of bullying on burnout in nurses: the moderating role of psychological detachment. J Adv Nurs. 2015;71(2):381-90. doi: https://doi.org/10.1111/jan.12489
https://doi.org/10.1111/jan.12489...
) and a strong relationship with cases of burnout(4040. Allen BC, Holland P, Bus B, Reynolds R. The effect of bullying on burnout in nurses: the moderating role of psychological detachment. J Adv Nurs. 2015;71(2):381-90. doi: https://doi.org/10.1111/jan.12489
https://doi.org/10.1111/jan.12489...
) was observed in environments where negative acts against workers were reported. These manifestations reveal the high degree of psychological impairment nursing professionals experience in relation to bullying and work.
With regard to nursing, studies show that the effects of this type of violence on workers go beyond the physical and emotional manifestations, often demonstrated by high levels of stress, anxiety and depression(2929. Ma SC. Hospital nurses' attitudes, negative perceptions and negative acts regarding work-place bullying. Ann Gen Psychiatry. 2017;16:33. doi: https://doi.org/10.1186/s12991-017-0156-0
https://doi.org/10.1186/s12991-017-0156-...
). Professional development is also affected by bullying, which can be perceived by an increase in absenteeism that reduces productivity and efficiency and causes social isolation, dissatisfaction with work and coworkers, often resulting in job abandonment(21-22,24,28,38,52).
Therefore, it is important to perceive and address the nursing workplace in order to create standards of quality of life and professional performance. The low level of work satisfaction, especially in health care, causes other negative outcomes related to bullying, such as job abandonment(2020. Logan TR, Michael Malone D. Nurses' perceptions of teamwork and workplace bullying. J Nurs Manag. 2018;26(4):411-9. doi: https://doi.org/10.1111/jonm.12554
https://doi.org/10.1111/jonm.12554...
) and even abandonment of the profession(1414. Karatza C, Zyga S, Tziaferi S, Prezerakos P. Workplace bullying among the nursing staff of Greek public hospitals. Workplace Health Saf. 2017;65(2):57-64. doi: https://doi.org/10.1177/2165079916657106
https://doi.org/10.1177/2165079916657106...
) since workers believe they are not capable of continuing their activities or of adequately performing their duties.
Category 3. Construction of theoretical models on bullying behavior in nursing
In this category, studies on bullying in nursing sought to construct theoretical models(1717. Hutchinson M, Wilkes L, Jackson D, Vickers MH. Integrating individual, work group and organizational factors: testing a multidimensional model of bullying in the nursing workplace. J Nurs Manag. 2010;18(2):173-81. doi: https://doi.org/10.1111/j.1365-2834.2009.01035.x
https://doi.org/10.1111/j.1365-2834.2009...
,2121. Yun S, Kang J. Influencing factors and consequences of workplace bullying among nurses: a structural equation modeling. Asian Nurs Res. 2018;12(1):26-33. doi: https://doi.org/10.1016/j.anr.2018.01.004
https://doi.org/10.1016/j.anr.2018.01.00...
,3333. Giorgi G, Mancuso S, Perez FF, D'Antonio AC, Mucci N, Cupelli V, et al. Bullying among nurses and its relationship with burnout and organizational climate. Int J Nurs Pract. 2016;22(2):160-8. doi: https://doi.org/10.1111/ijn.12376
https://doi.org/10.1111/ijn.12376...
,3535. Oh H, Uhm D, Yoon Y. Workplace bullying, job stress, intent to leave, and nurses' perceptions of patient safety in South Korean hospitals. J Nurs Res. 2016;65(5):380-8. doi: https://doi.org/10.1097/NNR.0000000000000175
https://doi.org/10.1097/NNR.000000000000...
) to identify patterns of bullying behavior according to several factors that could sustain these acts of violence in the nursing environment. The variables organizational culture(1717. Hutchinson M, Wilkes L, Jackson D, Vickers MH. Integrating individual, work group and organizational factors: testing a multidimensional model of bullying in the nursing workplace. J Nurs Manag. 2010;18(2):173-81. doi: https://doi.org/10.1111/j.1365-2834.2009.01035.x
https://doi.org/10.1111/j.1365-2834.2009...
,3333. Giorgi G, Mancuso S, Perez FF, D'Antonio AC, Mucci N, Cupelli V, et al. Bullying among nurses and its relationship with burnout and organizational climate. Int J Nurs Pract. 2016;22(2):160-8. doi: https://doi.org/10.1111/ijn.12376
https://doi.org/10.1111/ijn.12376...
), burnout(3333. Giorgi G, Mancuso S, Perez FF, D'Antonio AC, Mucci N, Cupelli V, et al. Bullying among nurses and its relationship with burnout and organizational climate. Int J Nurs Pract. 2016;22(2):160-8. doi: https://doi.org/10.1111/ijn.12376
https://doi.org/10.1111/ijn.12376...
) and intention to quit the job(2121. Yun S, Kang J. Influencing factors and consequences of workplace bullying among nurses: a structural equation modeling. Asian Nurs Res. 2018;12(1):26-33. doi: https://doi.org/10.1016/j.anr.2018.01.004
https://doi.org/10.1016/j.anr.2018.01.00...
,3535. Oh H, Uhm D, Yoon Y. Workplace bullying, job stress, intent to leave, and nurses' perceptions of patient safety in South Korean hospitals. J Nurs Res. 2016;65(5):380-8. doi: https://doi.org/10.1097/NNR.0000000000000175
https://doi.org/10.1097/NNR.000000000000...
) were related to bullying in the models proposed in this review.
The identification of a category related to bullying in nursing that proposes the construction of theoretical models on the subject shows that researchers still need to identify essential assumptions and characteristics for bullying that can relate several aspects of nursing to the occurrence of bullying in health institutions.
By knowing the variables that determine this behavior in the nursing work environment, it is possible to support the implementation of actions that prevent bullying among nursing professionals and occupational programs that favor a positive perception of the nursing practice in health care.
CONCLUSIONS
The findings of this review indicate that studies on bullying in the nursing work environment sought to identify the profile of this behavior in health institutions and highlight the repercussions of these acts on workers and the institution.
Nursing professionals exposed to bullying may develop negative manifestations in their overall health and feel dissatisfied with their work, peers and superiors, culminating in weak social relations at work and the desire to quit their jobs.
The characteristics of bullying behavior found in the publications of this study justify the need to map social relationships among nursing workers by highlighting the main indicators of bullying. Consequently, the early identification of such behavior in the work environment can help service managers develop programs to prevent and control this behavior in health institutions.
The limitation identified in this review is the absence of studies addressing effective strategies to prevent bullying or proposals for institutional policies that have presented important results in identifying and controlling this behavior in the nursing practice environment.
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Publication Dates
-
Publication in this collection
04 Nov 2019 -
Date of issue
2019
History
-
Received
01 May 2019 -
Accepted
10 July 2019