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Workplace Bullying in
Nurses
LYN QUINE
University of Kent at Canterbury, UK
Abstract
is Reader in Health Psychology at the
Centre for Research in Health Behaviour, Department
of Psychology, University of Kent at Canterbury. Her
research interests include occupational health, stress
moderators and mediators, and the application of
social cognition models to health-related behaviour.
LY N Q U I N E
AC K N OW L E D G E M E N T S :
COMPETING INTERESTS:
A D D R E S S.
None declared.
Keywords
nurses, stress moderators,
support at work, workplace
bullying
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The study
In 1996 a community NHS trust in the south-east
of England commissioned an examination of the
prevalence of workplace bullying as part of a
The questionnaire
The questionnaire contained four sections.
Section 1 collected profile information about the
participants job, qualifications, professional
group, hours worked, and supervisory responsibilities. Section 2 contained measures of the
occupational health outcomes: job satisfaction
(Quinn & Staines, 1979), propensity to leave
(Cammann, Fichmann, Jenkins, & Klesh, 1979)
and anxiety and depression (Zigmond & Snaith,
1983). A scale measuring support at work
adapted from Payne (1979) was also included.
The Job Satisfaction Scale uses five items to tap
a workers general affective reaction to the job
(Quinn & Staines, 1979). Propensity to leave
was measured by the subscale of the Michigan
Organizational Assessment Questionnaire
(Cammann et al., 1979). It provides a three-item
index of employees intention to leave their job.
The Hospital Anxiety and Depression Scale is a
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Results
A total of 1100 completed questionnaires was
returned, representing a response rate of 70
percent. Seventy-three percent (n = 778) of participants held professional qualifications: 36
percent of the sample (n = 396) were qualified
nurses from a range of disciplines, for example
registered general nurses, registered mental
health nurses, registered learning disabilities
nurses and health visitors; 12 percent (n = 132)
had secretarial or administrative qualifications;
10 percent (n = 111) had qualifications in the
therapies (occupational, speech and language,
chiropody, physiotherapy); 5 percent (n = 49)
had medical degrees; 1 percent (n = 11) had
qualifications in clinical psychology; and 9
percent (n = 101) had a range of qualifications in
other areas such as social work, residential care
or health promotion. Twenty-seven percent of
staff (n = 300) were unqualified. These staff comprised unqualified residential care staff, porters
and catering, cleaning and maintenance staff.
Table 1 shows the profile of the participants,
including the distribution by age, gender and
hours worked. Note that participant numbers do
not always add up to 1100 because questions
Table 1. Profile of participants
%
Occupational group
Nurses
Therapists
Administrative staff
Doctors
Clinical psychologists
Other professionals
Unqualified staff
Total
36
10
12
5
1
9
27
100
396
111
132
49
11
101
300
1100
Gender
Male
Female
Total
16
84
100
176
915
1091
Hours
Full time
Part time
Total
51
49
100
560
537
1097
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Scale reliability
Scales were constructed of all the main measures
and their reliability was investigated using
Cronbachs alpha (see Table 2). Satisfactory
alphas were found for all scales.
Prevalence of bullying
Qualified nurses were more likely to have been
subjected to bullying than other staff in general.
Overall, significantly more nurses (44 percent, n
= 174) reported experiencing one or more types
of bullying in the previous 12 months, compared
with other staff (35 percent, n = 247, 2 = 8.4,
d.f. = 1, p < .01). Nurses also reported experiencing significantly more types of bullying than
other staff (nurses M = 2.2, SD = 3.8; other staff
M = 1.5, SD = 2.9, t = 3.5, p < .001). Table 3 shows
the percentage of nurses and other staff experiencing each category and type of bullying behaviour. Thirty-three percent of nurses had
experienced destabilizing behaviours, compared
to 23 percent of other staff. Twenty-seven
percent had experienced behaviours designed to
isolate, compared with 21 percent of other staff.
Twenty-two percent had experienced threats to
personal standing, compared with 18 percent of
other staff. Nineteen percent of nurses had
experienced threats to professional status, compared to 16 percent of other staff and 19 percent
had experienced pressure to overwork, compared to 13 percent of other staff. There was no
statistically significant difference between
nurses and other staff in the category Threat to
professional status, though one item, Persistent
Items
SD
5
3
7
7
17
20
0.84
0.71
0.85
0.81
0.91
0.81
12.5
7.6
6.8
3.9
54.7
3.1
2.7
2.8
4.0
3.3
12.7
3.3
1064
1083
1079
1078
1093
1093
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Other staff
n = 396
n = 704
Threat to professional
1. Persistent attempts to belittle and undermine your work
2. Persistent unjustified criticism and monitoring of your work
3. Persistent attempts to humiliate you in front of colleagues
4. Intimidatory use of discipline/competence procedures
19
15
11
10
7
(76)
(57)
(41)
(37)
(26)
16
10
10
8
4
(109)
(67)
(68)
(53)
(31)
2.5
6.0
0.2
1.2
2.5
NS
**
NS
NS
NS
22
14
14
7
6
4
2
1
(88)
(53)
(54)
(26)
(25)
(15)
(7)
(4)
18
9
10
5
3
2
2
2
(129)
(61)
(69)
(37)
(24)
(17)
(11)
(12)
2.4
6.1
3.8
0.8
5.1
1.7
0.1
0.8
NS
**
*
NS
*
NS
NS
NS
Isolation
12. Withholding necessary information from you
13. Freezing out/ignoring/excluding
14. Unreasonable refusal of applications for leave, training
or promotion
27
20
15
12
(107)
(78)
(58)
(47)
21
14
12
5
(148)
(100)
(85)
(31)
5.1
5.8
1.5
21.7
*
**
NS
***
Overwork
15. Undue pressure to produce work
16. Setting of impossible deadlines
19
17
10
(74)
(66)
(39)
13
11
7
(92)
(73)
(50)
6.2
9.2
2.5
**
**
NS
Destabilization
17. Shifting goalposts without telling you
18. Constant undervaluing of your efforts
19. Persistent attempts to demoralize you
20. Removal of areas of responsibility without consultation
33
27
14
13
10
(132)
(105)
(56)
(49)
(40)
23
14
10
9
6
(162)
(99)
(70)
(65)
(44)
13.8
26.1
4.5
2.7
5.4
***
***
*
NS
*
status
work because of bullying. A wide range of symptoms of malaise were described, including feeling
unwanted or devalued (71 percent, n = 70), thinking about leaving the job (76 percent, n = 60),
feeling miserable and depressed (87 percent, n =
69), feeling as if they did not want to go to work
(82 percent, n = 65), feeling easily upset (73
percent, n = 58), having difficulty sleeping (70
percent, n = 55), feeling worthless (60 percent, n
= 47), feeling constantly keyed up and jittery (54
percent, n = 43), and feeling anxious most of the
time (51 percent, n = 40). Forty-three percent (n
= 20) of smokers who had experienced bullying
reported an increase in their smoking in the
previous year, and 43 percent (n = 39) of drinkers
reported an increase in their drinking habits.
Eighty-three percent (n = 143) of nurses who had
been bullied reported an increase in stress levels.
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Correlations between
occupational health outcomes
and categories of bullying
Correlations between the five categories of
bullying and occupational health outcomes conducted for nurses only are presented in Table 4.
Each of the categories of bullying was significantly positively correlated with anxiety, depression and propensity to leave, and negatively
correlated with job satisfaction. The categories
of bullying that proved to have the highest
correlations with occupational health outcomes
for nurses were pressure to overwork and destabilization.
Job satisfaction
Anxiety
Depression
Propensity to leave
0.27***
0.20***
0.30***
0.26***
0.39***
0.25***
0.26***
0.41***
0.23***
0.31***
0.21***
0.25***
0.37***
0.25***
0.33***
0.21***
0.11*
0.17***
0.21***
0.26***
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Discussion
Almost one in two nurses reported experiencing
one or more types of bullying, compared with
one in three other staff in the trust. This compares with about one in five found in a recent
UNISON survey of union members (UNISON,
1997) and one in three in a Royal College of
Nursing Survey (Alderman, 1997), though such
comparisons should be treated with caution
because of differences in definition and timeline.
A higher proportion of nurses than other staff
reported 13 of the 20 bullying behaviours. The
behaviours reported most frequently were shifting the goalposts, withholding necessary information, undue pressure to produce work,
freezing out, ignoring or excluding, and persistent attempts to belittle or undermine the
persons work. Nurses were also more likely to
have witnessed the bullying of others.
A quarter of nurses who had been bullied
reported that their health had been affected, and
8 percent had taken time off work because of it.
A wide range of illness symptoms was reported,
from feeling miserable and depressed, and
feeling unwanted or devalued, to having difficulty sleeping. Nearly 70 percent of those bullied
had tried to take action to stop the bullying, but
only 22 percent were satisfied with the outcome.
The most likely bully was a manager who was
older than the victim. Nurses who had been
bullied had less positive perceptions of the
organizational climate than other nurses. They
were more likely to report having higher work-
Interaction effect
Job satisfaction
Anxiety
Depression
Propensity to leave
NS: not significant, * p < .05, ** p < .01, *** p < .001
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