Introduction/Background
Bullying encompasses the utilization of excessive force, threats, coercion, and abuse to intimidate or aggressively dominate. While in contemporary society, diverse forms of bullying exist in all socio-cultural, economic, and political sectors, workplace bullying adamantly dominates (Ariza-Montes, Muniz, Montero-Simó, & Araque-Padilla 2013, p. 3129). The tenacious patterns of mistreatment, exploitation, or oppression, which often result in physical, emotional, psychological, and mental harm, continues to rise in the nursing profession (Rocker 2008). Approximately 48% of the newly registered nurses experience bullying in their various institutions across America, while nearly half fear to be targets of workplace bullying (Ariza-Montes et al. 2013, p. 3132). Being a female-dominated profession, many nurses become subjects of oppression and frustration as the experienced nurses release their exasperations on the newly graduated nurses. According to the Health Service Executive’s (H.S.E.) Code of Conduct, bullying usually happens over time (Al Omar, Salam & Al-Surimi 2019, p. 89). It accounts for the persistent and regular inappropriate behavior targeted towards one or a group of employees (Al Omar et al. 2019, p. 89). Furthermore, despite the dominant preconceived notion that only individuals in a position of authority propagate workplace bullying, such as an administrator towards an employee, it is increasingly happening between the employees towards each other (Ariza-Montes et al. 2013, p. 3132). It connotates that bullying is not only confined to the manager towards subordinates but also can happen as horizontal violence (between employees of the same grade) or vertically (upwards or downwards in an organizational structure).
The narrative literature review aims to identify and examine the effects of workplace bullying amongst nurses working in the acute setting. Since workplace bullying has a massive impact on nurse’s productivity, mental well-being, emotional stability, and increases employee turnover in the nursing profession, the research will help to identify the gravity on workplace bullying in nursing and provide appropriate recommendations. According to the World Health Organization, nurse’s retention of jobs is becoming a critical issue due to the increasing rate of employee turnover (Serafin & Czarkowska-Pączek 2019, p. 1). The World Health Organization (WHO) affirms that nurses and midwives make up around 50% of the global health workforce, which indicate the vitality of the population and influence in the healthcare industry (Serafin & Czarkowska-Pączek 2019 p. 1). However, the healthcare profession has been experiencing an acute shortage of nurses in the profession; it continues to projects a global shortage of both midwives and nurses to increase to 9 million by 2030 (Serafin & Czarkowska-Pączek 2019 p. 1). With an increase in life expectancy and a current aging population of Baby Boomers, more nurses are needed in the workforce to care for them (Rocker 2008). Hence it is important to examine the effects of workplace bullying to discover a solution that could lead to increased retention of nurses and their job satisfaction.
Although previous research on workplace bullying exists in other professions, they provide limited information on the effects of workplace bullying on nurses and its impact, especially on employee turnover and dissatisfaction in the healthcare profession. The healthcare sector exerts massive pressure and oppression on nurses, which has often gone unnoticed due to the silent treatment among nurses (Al Omar et al. 2019, p. 89). Conducting the research opens a platform to expose the degradation in the working condition of nurses despite the importance and vitality of their role in the medical industry. Noting that in research, bullying tends to focus on both direct bullying such as verbal harassment, criticism or humiliation, and indirect bullying, which is more subtle, involving exclusion, isolation, or having to deal with false accusations from others. Addressing such impact of nurse bullying of job satisfaction and employee retention will help mitigate the problem of nurse shortage.
Search Strategy
The strategies used for this literature review include a search of multiple databases to gather enough literature presented on the topic. A systematic review was based on electronic search and review of the citations in the relevant articles found on the databases. The search for citations in the articles was completed using Google Scholar and Scopus. The electronic databases searched included CINAHL, Scopus, Pubmed/MEDLINE, PsychINFO, PsychARTICLES, and Academic Search Complete. Unpublished studies were searched in Mednar and Google Scholar. Before beginning the search, the research question was refined to ensure the accuracy and relevance of the results of the topic being explored. The initial key terms and phrases used in the search included harassment, bullying, violence, workplace bullying, nursing, nurses, registered nurse, evaluation, and implementation.
The research question was split into two main concepts for the formation of search strings; these were ‘Nurses’ and ‘bullying.’ A third concept of ‘Effects’ was considered, but it was dropped with the assumption that any research involving both of the previous concepts will automatically discuss the effects, so it was unnecessary. The concepts were decided after some preliminary trial-and-error searches. A ‘super search’ of each concept was created using each of the databases by searching for the indexed concept of ‘Nurses’ and ‘Bullying,’ then searching for the relevant keywords including any synonyms that could be used separated with the Boolean ‘OR’ (nurse OR nurses OR ‘’Registered nurses” OR “Registered nurse” OR “nursing staff” OR “nursing personnel”) (bullying OR harassment OR “horizontal violence” OR BHHV OR aggression OR “workplace bullying” OR incivility). After combining the search for each Indexed concept with it is relevant keyword search using OR, the two ‘super searches’ were combined using the Boolean AND to show the relevant literature, including both of the research concepts.
The search for Pubmed produced 251 results, CINAHL Plus 540, 440 for PsycINFO, 85 for Academic Search Complete, and 57 from PsychARTICLES. To narrow down the results, the articles were evaluated and included those that presented the effects of bullying on nurses. Also, those articles three or fewer pages were excluded since they were less likely peer-reviewed or research-based. Also, dissertations were excluded from the study due to the inability to access the entire documents. Articles published within ten years were also included. Journals published in other languages were also included only if they were translated into English. Other inclusion criteria were studies that were conducted in the acute setting, studies that focused on nursing specifically, and studies that followed the same definition of workplace bullying as previously stated. Finally, the exclusion and inclusion criteria resulted in 15 articles, among which were ten original research studies, five systematic reviews. Five of the materials had their searches conducted in Turkey, two in Jordan, one in E.U. member countries, and seven in the United States. The research design of seven of the sources were qualitative experiments; two were meta-analysis, while four were surveys.
Literature Review
Workplace Bullying in Nursing
Workplace bullying in nursing encompasses medical practitioners using violence, coercion, or excessive aggression towards their subordinates or colleagues, which often leaders to emotional, physical, and psychological injury (Ariza-Montes et al. 2013, p. 3125). As of 2017, more than 60.3 million American workers were affected by bullying either directly or indirectly as they associate in their workplaces. Despite the social advancement towards modernity and professionalism, the healthcare industry continually records an increase in nurse bullying. According to the Occupational Safety and Health Administration (OSHA), ensuring civility in the healthcare setting is critical in instigating the delivery of high-quality services (Joint Commission 2016, p.1). Bullying in nursing differs in age, gender, sexual orientation, education, and seniority. In a cross-sectional study comprising of 404 nurses, s and Czarkowska-Pączek (2019, p. 2) ascertained that unlike men, many women succumb to massive ridicule and humiliation in their places of work. The study also stipulated that most nurses are transferred to less satisfying tasks and orders to work on work below their competence level. Moreover, compared to age and seniority, gender-based bullying dominated the nursing profession. The incivility continues to rise, especially in bullying conduct, which deters many nurses from performing their professional duties (Rocker 2008). Occupational Safety and Health Administration (OSHA) affirmed that in 2016, more than 59% reported having experienced direct verbal bullying within the past seven days while 50% within the past 12 months, 21% of the nursing students and newly registered nurses reported physical assault, and 12% emergency nurses reported instances of physical violence (Joint Commission 2016, p.1).
Although many nurses do experience the direct bullying and violent actions in their workplace due to the vulnerable and social discrimination directed towards the female gender. As a female-dominated profession,...
