bullying in nursing: implementing solutions for practice
TRANSCRIPT
Bullying in Nursing: Implementing Solutions
for PracticeMatthew S. Howard, DNP, RN, CEN, CPEN, CPN
Director of Educational Resources – SigmaStaff Nurse II – Eskenazi Health
Jennifer L. Embree, DNP, RN, NE-BC, CCNSClinical Associate Professor – Indiana University School of Nursing
Magnet Coordinator – Eskenazi Health
Background
2
○ Incivility and bullying is increasing
○ Interpersonal hostility, bullying, toxic work environments are documented in nursing
(Al- Hamdan , Manojlovich , & Tanima , 2017; Attell , Brown, & Treiber , 2017; Butler, Prentiss, & Benaamor , 2018; Chang, Carter, Ng, Flynn, & Tan, 2017; Edmonson, Bolick, & Lee, 2017; Hoguh et al., 2016; Manton, 2017; Meires , 2018; Salin & Notelaers , 2017)
(Adriaenssens , De Gucht, & Maes , 2015; Christie & Jones, 2014; Dellasega, Volpe, Edmonson, & Hopkins, 2014; Elmblad , Kodjebacheva , & Lebeck , 2014; Flinkman & Salanterä , 2015; Park, Cho, & Hong, 2015)
Background○ Define the problem○ Multiple names – multiple meanings
3
Background○ Frequently examined within the literature ○ Recognized epidemic○ Still continues
4(Castronovo , Pullizzi, & Evans, 2016; Coile , 2016; Edmonson et al., 2017; Fleming, 2016; Giorgi et al., 2016; Granstra , 2015; Manton, 2017; Wilson, 2016; Wolf, Perhats , Clark, Moon, & Zavotsky , 2017)
Background○ Turnover as a result of bullying
○ Incivility and bullying becoming more rampant
5
(Bruyneel , Thoelen , Adriaenssens , & Sermeus , 2017; Blackstock, Harlos , Macleod, & Hardy, 2015; Fitzpatrick, Campo, & Lavandero , 2011; Flinkman & Salanterä , 2015; Flinkman , Isopahkala -Bouret , & Salanterä , 2013; Oyeleye , Hanson, O'Connor, & Dunn, 2013; Tarcan , Hikmet , Schooley, Top, & Yorgancıoglu Tarcan , 2017).
Background○ Incivility, interpersonal hostility, lateral and
horizontal violence, and toxic work
environments are issues many nurses deal
with daily
6
(Adriaenssens et al., 2015; Christie & Jones, 2014; Dellasega et al., 2014; Elmblad et al., 2014; Park et al., 2015)
Background ○ Negative outcomes as a result of
bullying behaviors have been identified to increase:
○ In te n t to le a ve th e p ro fe ss io n
○ De p a rtm e n t tu rn o ve r
○ He a lth is sue s
○ Me n ta l h e a lth is sue s (d e p re ss io n )
7(Al- Ha m d a n e t a l., 2017; Arn o ld & Wa lsh , 2015)
Ne w Yo rk Po s t
Evidence○ Descriptive study:
○ Survey using six validated tools○ RNs in southeastern US ○ N = 345 ○ Findings:
○ 40% victims of bullying behavior within the previous six months
○ 68% witnessed co - workers being bullied
8(Sauer & McCoy, 2018)
• Negative Acts Questionnaire• Perceived Stress Scale • Resilience Scale
Evidence○ Descriptive study:
○ Survey using four tools○ RNs at western Canadian hospital ○ N = 103○ Findings:
○ Found positive association between bullying acts and intent to leave the organization
9(Blackstock et al., 2015)
Evidence○ Descriptive cross - sectional design study:
○ Survey using two tools○ RNs in tertiary hospitals in South
Korea ○ N = 508○ Findings:
○ Direct relationship between
jo b sa tis fa c tio n (d ue to b u llyin g
b e h a vio rs ) a n d in te n t to le a ve10
• Ne g a tive Ac ts Que s tio n n a ire• La te ra l Vio le n c e sc a le
(Oh , Uh m , & Yo o n , 2016)
“
Evidence
(Porath & Pearson, 2010, p.64 - 65)
48% intentionally
their work effort.38%
intentionally the quality of
their work. 80% lost work time
worrying about the incident.63%
lost work time avoiding the
offender.
66% said that their performance
declined.
78% said that their
commitment to the organization declined.
12% said that they
left their job because of the uncivil treatment.
11
Am o n g wo rke rs wh o h a ve b e e n o n th e re c e ivin g e n d o f in c ivility:
EvidenceAmong workers who have been on the receiving end of incivility:
(Porath & Pearson, 2010, p.64 - 65)12
94% of targets, get even with bullies
88% of targets, get even with their organization
Lewis and Malecha
o Workplace bullying and incivility cost facilities on average of $11,581 per nurse, per year If only 10% of nurses at the
facility experienced incivility or bullying in the workplace, the cost would be > $1.3M per year in lost productivity.(Lewis & Malecha, 2011)
Background○ Communicating is often uneasy
○ A positive work culture relies on effective
and civil communication
14(Blosky & Spegman , 2015; Brockman- Weber, 2016; Drahnak, Hravnak , Ren, Haines, & Tuite, 2016; Hartung & Miller, 2013; Liaw, Zhou, Lau, Siau, & Chan, 2014)
Gaps○ Descriptive studies
○ Solutions needed
15
Purpose○ Examine if an educational activity can:
1. Increase civility
2. Increase comfort level in holding
conversations
16
Conceptual Framework
17(Ren & Kim, 2017, p. 702)
Bullying Experience
Psyc h o lo g ic a l Em p o we rm e n t
Co n flic t Ma n a g e m e n t
Style s
Psychological
Well-being
Depression
Self-esteem
Clinical Satisfaction
Model
18The Johns Hopkins Nursing Evidence - Based Practice Model ( Dearholt & Allan, 2018, p. 36)
Logic Model
Visual tool to represent the relationships between resources and ultimate impact of the project19
Project Design
20
○ A quasi - experimental mixed methods design study
EG 2InterventionEG 1
CG 2CG 1
Non-random assignment to groups
Control Group
Experimental Group
EG 1, CG 1 = Pre-intervention data collection pointEG 2, CG 2 = Post-intervention data collection point
Pre-intervention Post-intervention
Project Design
21
○ Inclusion criteria
Control Group
Experimental Group Eskenazi Health RN’s
Currently in standard nursing orientation (between April 2018 and June 2018)
Eskenazi Health RN’s Completed standard nursing orientation
within the last calendar year(between April 2017 and March 2018)
Sent to all nurses who meet inclusion criteria:
Burn Critical Care (ICU)
Emergency DepartmentAcuity Adaptable
ClinicsOB
Operating SuitePsychiatry
Interventional Suites
Non-random assignment to groups
Over 250 met inclusion criteria (N = 266)
Project Design
22
○ Data collection information
EG 2InterventionEG 1
CG 2CG 1
Non-random assignment to groups
Control Group
Experimental Group
EG 1, CG 1 = Demographics, Workplace Civility Index, Negative Acts Questionnaire- RevisedEG 2, CG 2 = Workplace Civility IndexEG 2 = Intervention specific questions
Pre-intervention Post-intervention
Validated Data Collection Tools Utilized
23
Negative Acts Questionnaire - Revised• A validated 22 - item instrument that
was developed at a university in Bergen, Norway. This instrument measures perceived exposure to bullying and harassment while at work. The tool can identify targets of bullying who will have a larger score compared to non - targets.
Workplace Civility Index • A validated evidence - based
questionnaire constructed to assess a nurses’ personal civility and increase personal awareness related to personal actions and intentions .
(Clark, 2017; Clark, Sattler, & Barbosa - Leiker, 2018) (Einarsen , Hoel , & Notelaers , 2009)
Project Design
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○ The intervention
EG 2InterventionEG 1
Non-random assignment to groups
Experimental Group
Pre-intervention Post-intervention
Developed by Sigma Theta Tau International Honor Society of Nursing (Sigma)
Bullying in the Workplace: Solutions for Nursing Practice
Time: ~2 hours 40 minutes
Evidence based solutions
Authors from around the world
Innovative branching scenarios
Branching Scenarios○ Case studies
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Branching Scenario Development Slides
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Best Ending
Go here only if all
great options picked
Most helpful choicesModerately helpful choicesLeast helpful choices
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AuthorsLaura Dzurec, PhD, RN, PMHCNS-BC, ANEF, FAAN
Cheryl Dellasega, PhD, MSN, CRNPPenn State College of MedicineProfessor
Matthew S. Howard, MSN, RN, CEN, CPEN, CPNSigma; Eskenazi Health Director, Educational Resources; Staff Nurse II
Patricia Gillen, PhD, RN, RM, FHEAUlster UniversityLecturer/ Head of Research and Development
Jennifer L. Embree, DNP, RN, NE-BC, CCNSIndiana University; Eskenazi Health Clinical Associate Professor; Magnet Coordinator
Joanne Navarroli, MSN, RN, CENChandler Regional Medical Center – Dignity HealthStaff/Trauma Nurse
Cheri Clancy, MSN, RN, NEA-BC, CPXPCheri Clancy & Associates, LLCAuthor and speaker
EditorsCynthia Clark, PhD, RN, ANEF, FAAN
ATI Nursing Education+Nurse Consultant
Monica Kennison, EdD, MSN, RNBerea CollegeSusan V Clayton Nursing Chair and Professor
Boston College Senior Scholar and Professor
Project Design
29
○ Measure of success
EG 2InterventionEG 1
Non-random assignment to groups
Experimental Group
Pre-intervention Post-intervention
More than 80% of participants will have increased their WCI score.
More than 80% of participants will have implemented at least one positive conflict management
strategy effectively.
SMART goals to measure success
Data Analysis ○ Survey’s via Qualtrics ○ Data analysis via Microsoft Excel
30
Study Participants:
• Control Group 28
• Experimental Group 21
• Total 49
Invited 266
Responded 70
Completed 49
Rate 18%
Data Analysis ○ Educational Background
31
Associate Degree
Baccalaureate Degree
Master’s Degree
Doctoral Degree
Control Experimental Total
25.0% 23.8% 24.5%
60.7% 61.9% 61.2%
14.3% 9.5% 12.2%
0.0% 4.8% 2.0%
Data Analysis ○ Demographics
32
Data Analysis ○ Demographics
33
As Nurse In HC
Total Total0- 1 years 41% 8%2- 3 years 27% 22%4- 5 years 6% 24%6- 7 years 10% 10%8- 9 years 2% 6%10- 15 years 2% 12%16- 20 years 6% 6%21- 25 years 2% 6%26- 30 years 4% 2%31- 35 years 0% 2%
Validated Data Collection Tools Utilized
34
Workplace Civility Index • A validated evidence - based
questionnaire constructed to assess a nurses’ personal civility and increase personal awareness related to personal actions and intentions .
Scoring the Civility IndexVery civil 90- 100Civil 80- 89Moderately civil 70- 79Minimally civil 60- 69Uncivil 50- 59Very uncivil <50
(Clark, 2017; Clark, Sattler, & Barbosa - Leiker, 2018)
Data Analysis
35
Control GroupWCI Pre
Test TotalWCI Post Test Total
Mean 88.21 80.21Variance 44.62 103.06Observations 28 28Pearson Correlation 0.26df 27t Stat 3.99P(T<=t) one- tail 0.00022t Critical one - tail 1.703P(T<=t) two- tail 0.000454t Critical two - tail 2.052
Experimental GroupWCI Pre
Test TotalWCI Post Test Total
Mean 91.57 95.43Variance 26.76 5.86Observations 21 21Pearson Correlation 0.97df 20t Stat - 6.16P(T<=t) one- tail 2.54t Critical one - tail 1.725P(T<=t) two- tail 5.09t Critical two - tail 2.056
Workplace Civility Index • Pa ire d two sa m p le t- te s t • Th e se c h a n g e s we re s ig n ific a n tly
s ig n ific a n t
(t = - 6 .16 , p = < 00001) (t = 3.99 a n d p = .000227)
Data Analysis ○ Mean WCI scores
by age ranges by grouping
36
- 8.0- 21.0- 5.8- 9.4- 5.0
2.0 – 4.3
Workplace Civility Index
Results ○ Differences in the pre -
and post - intervention
37Box and Whisker Chart
Workplace Civility Index
Validated Data Collection Tools Utilized
38
Negative Acts Questionnaire -Revised• A validated 22 - item instrument that
was developed at a university in Bergen, Norway. This instrument measures perceived exposure to bullying and harassment while at work. The tool can identify targets of bullying who will have a larger score compared to non - targets.
Scoring the NAQ - RNot bullied ≤ 32
Oc c a s io n a lly b u llie d
33 – 45
Bu llie d ≥ 46
Sc o re s ra n g e fro m22 - 110
(Einarsen et al., 2009; Notelaers & Einarsen, 2013 )
Results
Overall Mean = 33.59
39
Scoring the NAQ - RNot bullied ≤ 32
Oc c a s io n a lly b u llie d
33 – 45
Bu llie d ≥ 46
Sc o re s ra n g e fro m22 - 110
Co n tro l Gro up M = 32.54 , SD = 8 .88
Exp e rim e n ta l Gro up M = 35 .00 , SD = 21.16
Negative Acts Questionnaire - Revised
Results Mean NAQ - R scores by group
40
0
10
20
30
40
50
60
70
80
Not Bullied Occassionally Bullied Bullied
Control Group Experimental Group
Perc
enta
ge
Negative Acts Questionnaire - Revised
Th e p ro p o rtio n in th e th re e c a te g o rie s a re n o t s ig n ific a n tly d iffe re n t b e twe e n th e two g ro up s .
Results ○ The P- Value is 0.714623. The result is not significant
at p < 0.05.○ The proportion in the three categories are not
significantly different between the two groups.
41
Chi - square statistic χ2 0.672048611D.f. 2p- value 0.714605737
Negative Acts Questionnaire - Revised
Results
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Negative Acts Questionnaire - RevisedHave you been bullied at work over the
last six months?
Control Group• No 75.0%• Yes, but only rarely 14.3%• Yes, now and then 7.1%• Yes, several times per week 3.6%• Yes, almost daily 0.0%Experimental Group• No 81.0%• Yes, but only rarely 4.8%• Yes, now and then 0.0%• Yes, several times per week 9.5%• Yes, almost daily 4.8%
Results – connection to framework and purpose
43(Ren & Kim, 2017, p. 702)
Bullying Experience
Psychological Empowerment
Conflict Management
Styles
Psychological Well-being
Depression
Self-esteem
Clinical Satisfaction
Recommendations ○ Review measures of success:
44
Mo re th a n 80% o f p a rtic ip a n ts will h a ve in c re a se d
th e ir WCI sc o re .
100% e xp e rim e n ta l g ro up in c re a se d WCI sc o re s (p re - in te rve n tio n M= 91.6 , p o s t- in te rve n tio n M= 95)
(t = - 6 .16 , p = < 00001)
Recommendations ○ Review measures of success:
45
Mo re th a n 80% o f p a rtic ip a n ts will h a ve
im p le m e n te d a t le a s t o n e p o s itive c o n flic t
m a n a g e m e n t s tra te g y e ffe c tive ly.
An o th e r p a rtic ip a n t s ta te d , “I to o k th e o p p o rtun ity to h a ve a c o n ve rsa tio n with a te c h th a t h a s b e e n ve ry d ism iss ive . Th e c o n ve rsa tio n we n t we ll, b u t tim e will te ll”.
On e p a rtic ip a n t n o te d , “I fe lt c o m fo rta b le h a vin g a c o n ve rsa tio n th a t n e e d e d to h a p p e n a lo n g tim e a g o ”.
An o th e r p a rtic ip a n t n o te d , “th e c o u rse d id g ive m e th e to o ls to sp e a k with a p h ys ic ia n in a p o s itive wa y”.
Conclusions ○ The implementation of Sigma’s “ Bullying in the
Workplace: Solutions for Nursing Practice ” p ro vid e d
e a rly e vid e n c e to sup p o rt th a t a n a syn c h ro n o us
p ro vid e r- d ire c te d , le a rn e r- p a c e d e - Le a rn in g
e d uc a tio n a l a c tivity can effectively d e c re a se
in c ivility a n d in c re a se p e rc e ive d c o m fo rt with
h o ld in g c ritic a l c o n ve rsa tio n s b e twe e n n u rse s .46
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