On 2017 Mar 23, University of Kansas School of Nursing Journal Club commented:

Team Members: Hayley Janner, Annie Yungmeyer, Katherine Barnthouse, McKenzie Baker, Dylan Severson, Macy McKee [Class of 2017]

Background

Our team selected this article due to the significant role that workplace bullying plays in establishing and maintaining a healthy work environment. Nursing had been historically associated with high rate of workplace bullying, especially towards new or inexperienced nurses--best known by the common expression “nurses eat their young.” Because of this reputation, the effect of bullying on work environments and nursing satisfaction should be explored. 

Thus, this study fills a vital gap in the literature by examining both the causes and effects of workplace bullying in the microsystem. This article applies to several of the modules for processes of a healthy work environment, including authentic leadership, as Yokohoma et al. (2016) found that lack of authentic leadership contributes to a work environment that fosters bullying, and creating a motivating environment, as workplace bullying has been found to be acutely and chronically demotivating for nurses.

Methods

This article was found via a literature search of CINAHL. The study design was a cross-sectional design and data was collected via a distributed self-administered questionnaire. The questionnaire was distributed to nurses in Japan attending various nursing conferences, all of which were unaffiliated with any nursing workplaces. The survey distributed consisted of the Negative Acts Questionnaire-Revised (NAQ-R), which assesses for workplace bullying behaviors, and the Practice Environment Scale of the Nursing Work Index (PES-NWI), which assesses quality of work environment. Participant demographics and other workplace factors (such as average hours of overtime work, average days off in a month, opportunity to request work off, and more) were also collected in the questionnaire (Yokohama et al., 2016). The issue of workplace bullying impacts all nurses in all areas of the world. However, because the population surveyed was Japanese nurses, this study directly represents the work environments of Japanese nurses. Nonetheless, this study is still significant as the results of this study could generate a starting point for researchers in other countries studying the relationship of workplace bullying and a healthy work environment.

Findings

The study found that workplace bullying in Japan is a significant issue, as 18.5% of participants were classified by survey responses as being a victim of bullying. Bullying was considered to have taken place when participants reported that any negative behavior mentioned in the NAQ-R was directed towards them either on a “weekly” or “daily” basis. The most common bullying behaviors that took place were “someone withholding information that affects your performance,” “being exposed to an unmanageable workload,” and “being shouted at or being the target of spontaneous anger (or rage)” (Yokohama et al., 2016, p. 2481). Demographic and workplace factors determined to be associated with being a victim of bullying included being “unmarried, holding a bachelor’s degree or higher, having registered nurse and additional qualifications, fewer years of nursing experience, fewer years of experience in current workplace, more overtime hours per day, not always having the opportunities to request days off, working on more days off, and a less HWE (defined by lower than average scores on the five PES-NWI subscales)” (Yokohama et al., 2016, p. 2481-2482). Workplace bullying was also associated with lower scores on the nurse manager section of the PES-NWI, including leadership, ability, and support of nurses.

There are several limitations with this study. One limitation was the cross-sectional design of the study, which prevented the authors from proving causal factors for bullying--only correlational factors can be described. Secondly, because the study was personally answered by nurses, results may be subjective depending on the nurses’ mindset and personal evaluation of appropriate workplace conduct and bullying, among other factors. Finally, this study was performed exclusively via surveying of Japanese nurses. Thus, while the study may be representative of workplace bullying in Japanese nursing environments, it may not be possible to generalize this to all nursing workplace bullying.

Implications

Workplace bullying is an important issue in nursing due to the numerous negative consequences it has been linked with, most importantly with nurse retention, satisfaction, nurse depression and lowered quality of patient care. Nurse depression contributes to burnout and frequent turnover, adding to the ever-rising costs of the healthcare industry. Additionally, depression can result to decreased patient care quality leads to increased medical error and negative patient outcomes. Thus, workplace bullying in nursing is a vital issue that needs to address, as its consequences run contrary to the purpose of medicine and nursing as a whole.

This issue is important to us on a personal level as graduating nursing students since we came into nursing to help and heal patients because we care deeply about them. This caring values and attitudes should extends to our coworkers as well. It is utterly unacceptable to comprehend that a significant number of individual in an industry known for helping people heal instead choose to tear each other down. Our efforts should be focused instead on banding together to provide not only the best care possible to patients, but to care and nurture each other—the same reason that majority of us in nursing entered the industry. 

This study is also important in presenting the importance of the microsystem leadership development and the leadership role implications on the contribution of poor nursing leadership to workplace bullying. In their study, Yokohama et al. (2016) found that individuals who scored their managers low on leadership, ability, and support of nurses were more likely to be victims of workplace bullying. In the PES-NWI, leadership specifically is comprised of five items that are similar to traits held by authentic leaders. Nurse Managers who are not effective leaders are less effective at dismantling a culture of bullying on their unit. Thus, development of authentic leadership in nurse managers carries the possibility of reducing workplace bullying that nurses experience.

This article contributes greatly to our future nursing practice because it has clearly displayed to us the far-reaching impact that poor leadership can have on several unit factors, such as inability to change a toxic and bullying workplace culture leading to poor patient outcomes. This publication has re-emphasized to us the importance of practicing authentic leadership in our own careers, especially if we advance into leadership positions such as nurse manager. Finally, we will not turn a blind eye to workplace bullying in my own future employment, as the consequences for patients are simply not acceptable.

References Yokoyama, M., Suzuki, M., Takai, Y., Igarashi, A., Noguchi-Watanabe, M. and Yamamoto- Mitani, N. (2016). Workplace bullying among nurses and their related factors in Japan: a cross-sectional survey. Journal of Clinical Nursing, 25: 2478–2488. doi:10.1111/jocn.13270

On 2017 Mar 23, University of Kansas School of Nursing Journal Club commented:

Team Members: Hayley Janner, Annie Yungmeyer, Katherine Barnthouse, McKenzie Baker, Dylan Severson, Macy McKee [Class of 2017]

Background

Our team selected this article due to the significant role that workplace bullying plays in establishing and maintaining a healthy work environment. Nursing had been historically associated with high rate of workplace bullying, especially towards new or inexperienced nurses--best known by the common expression “nurses eat their young.” Because of this reputation, the effect of bullying on work environments and nursing satisfaction should be explored. 

Thus, this study fills a vital gap in the literature by examining both the causes and effects of workplace bullying in the microsystem. This article applies to several of the modules for processes of a healthy work environment, including authentic leadership, as Yokohoma et al. (2016) found that lack of authentic leadership contributes to a work environment that fosters bullying, and creating a motivating environment, as workplace bullying has been found to be acutely and chronically demotivating for nurses.

Methods

This article was found via a literature search of CINAHL. The study design was a cross-sectional design and data was collected via a distributed self-administered questionnaire. The questionnaire was distributed to nurses in Japan attending various nursing conferences, all of which were unaffiliated with any nursing workplaces. The survey distributed consisted of the Negative Acts Questionnaire-Revised (NAQ-R), which assesses for workplace bullying behaviors, and the Practice Environment Scale of the Nursing Work Index (PES-NWI), which assesses quality of work environment. Participant demographics and other workplace factors (such as average hours of overtime work, average days off in a month, opportunity to request work off, and more) were also collected in the questionnaire (Yokohama et al., 2016). The issue of workplace bullying impacts all nurses in all areas of the world. However, because the population surveyed was Japanese nurses, this study directly represents the work environments of Japanese nurses. Nonetheless, this study is still significant as the results of this study could generate a starting point for researchers in other countries studying the relationship of workplace bullying and a healthy work environment.

Findings

The study found that workplace bullying in Japan is a significant issue, as 18.5% of participants were classified by survey responses as being a victim of bullying. Bullying was considered to have taken place when participants reported that any negative behavior mentioned in the NAQ-R was directed towards them either on a “weekly” or “daily” basis. The most common bullying behaviors that took place were “someone withholding information that affects your performance,” “being exposed to an unmanageable workload,” and “being shouted at or being the target of spontaneous anger (or rage)” (Yokohama et al., 2016, p. 2481). Demographic and workplace factors determined to be associated with being a victim of bullying included being “unmarried, holding a bachelor’s degree or higher, having registered nurse and additional qualifications, fewer years of nursing experience, fewer years of experience in current workplace, more overtime hours per day, not always having the opportunities to request days off, working on more days off, and a less HWE (defined by lower than average scores on the five PES-NWI subscales)” (Yokohama et al., 2016, p. 2481-2482). Workplace bullying was also associated with lower scores on the nurse manager section of the PES-NWI, including leadership, ability, and support of nurses.

There are several limitations with this study. One limitation was the cross-sectional design of the study, which prevented the authors from proving causal factors for bullying--only correlational factors can be described. Secondly, because the study was personally answered by nurses, results may be subjective depending on the nurses’ mindset and personal evaluation of appropriate workplace conduct and bullying, among other factors. Finally, this study was performed exclusively via surveying of Japanese nurses. Thus, while the study may be representative of workplace bullying in Japanese nursing environments, it may not be possible to generalize this to all nursing workplace bullying.

Implications

Workplace bullying is an important issue in nursing due to the numerous negative consequences it has been linked with, most importantly with nurse retention, satisfaction, nurse depression and lowered quality of patient care. Nurse depression contributes to burnout and frequent turnover, adding to the ever-rising costs of the healthcare industry. Additionally, depression can result to decreased patient care quality leads to increased medical error and negative patient outcomes. Thus, workplace bullying in nursing is a vital issue that needs to address, as its consequences run contrary to the purpose of medicine and nursing as a whole.

This issue is important to us on a personal level as graduating nursing students since we came into nursing to help and heal patients because we care deeply about them. This caring values and attitudes should extends to our coworkers as well. It is utterly unacceptable to comprehend that a significant number of individual in an industry known for helping people heal instead choose to tear each other down. Our efforts should be focused instead on banding together to provide not only the best care possible to patients, but to care and nurture each other—the same reason that majority of us in nursing entered the industry. 

This study is also important in presenting the importance of the microsystem leadership development and the leadership role implications on the contribution of poor nursing leadership to workplace bullying. In their study, Yokohama et al. (2016) found that individuals who scored their managers low on leadership, ability, and support of nurses were more likely to be victims of workplace bullying. In the PES-NWI, leadership specifically is comprised of five items that are similar to traits held by authentic leaders. Nurse Managers who are not effective leaders are less effective at dismantling a culture of bullying on their unit. Thus, development of authentic leadership in nurse managers carries the possibility of reducing workplace bullying that nurses experience.

This article contributes greatly to our future nursing practice because it has clearly displayed to us the far-reaching impact that poor leadership can have on several unit factors, such as inability to change a toxic and bullying workplace culture leading to poor patient outcomes. This publication has re-emphasized to us the importance of practicing authentic leadership in our own careers, especially if we advance into leadership positions such as nurse manager. Finally, we will not turn a blind eye to workplace bullying in my own future employment, as the consequences for patients are simply not acceptable.

References Yokoyama, M., Suzuki, M., Takai, Y., Igarashi, A., Noguchi-Watanabe, M. and Yamamoto- Mitani, N. (2016). Workplace bullying among nurses and their related factors in Japan: a cross-sectional survey. Journal of Clinical Nursing, 25: 2478–2488. doi:10.1111/jocn.13270