The Impact of Workplace Bullying on Healthcare Workers

Second Oral Defense of the Dissertation

Walden University School of Public Policy and Administration

LaMont Rouse

Dissertation Chair: A. Victor Ferreros, Ph.D.

Committee: Lori Demeter, Ph.D.

Presentation Will Cover

1. An Overview of the Topic of Workplace Bullying

2. The Significance of the Study3. How the Study Can Impact Social

Change & Public Policy4.The Study’s Research Questions 5. What the Literature Tells Us (and

what it doesn’t)6.The Research Methods 7.Results8.Final Discussions (The challenges for

researchers and policymakers)

Background•Workplace bullying is an emerging

topic of inquiry

•Workplace Bullying Institute (2007) found that 37% reported being victimized

-- An estimated 54 million workers have been subjected to some type of bullying.

•Studies of workplace bullying in health care have focused almost exclusively on nurses (Chapman, Styles, Perry, & Combs, 2010; Hinchberger, 2009)

Background• The intent of this study is to determine rates of bullying throughout an organization by surveying full-time employees

from all job categories

• The study will use the Negative Acts Questionnaire-Revised (NAQ-R) which has been used in over 60 countries

Significance of the Study• A unique attempt to study bullying at work

• It would raise the profile of the issue

• It could yield evidence to support pending bills that would address the problem.

• Healthy Workplace Bill is currently under consideration in 13 states, including New Jersey (the focus of this study)

- State Senator Linda Greenstein (D-14) sponsored the bill, titled S-333

• There are no laws preventing WPB unless the target can make a claim as a protected class (e.g., sexual harassment, racial discrimination)

Social Change• Demonstrates to legislators, administrators, and staff that there is a problem with this form of harassment

• The study indirectly deals with the complex issues of organizational justice at work

• It also can lead to further investigations, specifically ones that deal with a bottom line issue: the true cost of workplace bullying.

Purpose •Originally targeted three

hospitals-Did not receive

permission from any. Instead, used the Walden University Research Participant Pool

•Understand if WPB is a phenomenon experienced primarily by nurses or if others are involved

•Provide evidence for internal organizational change and perhaps support legislative efforts.

Nature of the Study

•Reports the rates of bullying when controlling for various factors

•Occupational Classification•Length of service at the job•Organizational trust •Job status •Witnessing Bullying

• Explores the relationship between these variables

• Explores the link between organizational trust and workplace bullying

Defining Terms Other Terms • Mobbing• Workplace incivility• Workplace aggression• Workplace violence

• Einarsen et. al. (1994) defined bullying as repeated acts with intent to harm

• Lutgen-Sandvik (2008): persistent verbal and nonverbal aggression at work

• WPB can include direct and indirect attacks

-Verbal confrontations-Shouting-Demeaning statements -Indirect attacks includes gatekeeper tactics

Limitation •Brodsky (1976) published The Harassed Worker

•Sporadic American research since-Baron & Neuman (1996)-Keashly (1998)-Keashly & Harvey (2005)-Namie’s work through the 2000s-Yamada’s work on legislation

•Most of the research has been done by international scholars; results from these studies must include the context of the culture.

•Resistance from organizations

Research Questions Q1: Do nurses experience

higher rates of bullying than other types of employees?

Q2 Are there significant differences in rates of bullying when comparing new employees to more established employees?

Q3: Does workplace bullying impact organizational trust?

Q4: Does workplace bullying impact job satisfaction?

Theoretical Framework• Hospital’s chain-of-command structure makes them more susceptible to workplace violence and bullying (Zapf & Einarsen, 2001)

• Management styles contribute to bullying (Leymann, 1996; McKay et al., 2008)

• Organizations experiencing layoffs and cutbacks report higher rates of employee anxiety and internal aggression (Baron & Neuman, 1996; WBI, 2007)

• Organizational structures that lead to role confusion increases the likelihood of this problem (Baillien et al., 2009; Einarsen et al., 1994)

Literature Review Search TermsWorkplace bullyingWorkplace violenceWorkplace incivilityWorkplace aggressionNursing and bullyingBullying in higher education

Other Statistics •Over 100 journal articles examined;•More than two dozen books;•Several dissertations;•Articles found through branching.

Typologies of Bullies• Bullies enjoy higher status positions within the job (Cortina et al., 2001; Namie, 2003, 2007; Ortega, Hogh, Pejtersen, & Olsen, 2008)

• Women are more likely to be both the aggressor and the target (Cortina et al., 2001; Namie, 2003, 2007)

• Aggressors usually have the support of management if they aren’t already management (Namie, 2007; Sutton, 2007)

• Conflicting studies on the self-esteem levels of bullies

-Bullies tend to have low self-esteem (Johnston, 2004; Vickers, 2006)-Bullies have high confidence levels (Namie, 2007)

Tactics of BulliesDirect Tactics• Verbal abuse (Anderson, 2002; Baron & Neuman, 1996; Cemaloglu, 2007; Chapman et al., 2010; Lutgen-Sandvik, 2008)

Indirect Tactics• Enlist co-workers as part of a mobbing process (McKay et al., 2008; Namie, 2003; Vickers, 2001). • Spreading rumors

Indirect Attacks/Gatekeeper• Give work below their ability• Exclude from meetings• Move your office

Targets & the Problems of Bullying• Targets were more introverted, less agreeable and

more emotionally unstable (Glaso, Matthiesen, Nielsen, and Einarsen,2007)

• Victims can have long-term problems that can impact their next job (Cole, Grubb, Swanson, & Lawless, 1997; Fisher-Blando, 2008; Vickers, 2001).

• Victimization can cause problems with non-work relationships, especially family life (Fisher-Blando, 2008)

Characteristics of Targets• Female • Newer Employees• Lower occupational status professions

Cost of Bullying

• The cost of bullying needs attention. - Data is limited, nonexact and/or dated

• Leads to lost productivity (Chapman et al., 2010; Farrell & Salmon, 2009; Merecz et al., 2009)

• Namie (2003) estimated the cost to retain and hire new employees at anywhere from 25% to 200% of the salary depending on the position.

• National Safe Workplace Institute (1993) projected that workplace violence led to approximately 35.4 billion in lost productivity and wages

Prevention

1.Legislative action•Healthy Workplace Bill•The UK modified the Health and Safety Act

2.Training•Sensitivity training for management•Training for new employees

3. Clear policies •Policy guide should clearly state no tolerance

of bullying

4.Internal investigative systems• Systems in place to address accusations.

MethodologyNonexperimental, quantitative study to investigate this phenomenon

Four Research Questions and Hypotheses . Do nurses experience higher rates of bullying than other types of

employees?

HA1: Nurses experience higher rates of bullying.

H01: Nurses do not experience higher rates of bullying.

Are there significant differences in rates of bullying when comparing new employees to more established employees?

HA2: Employees with less than 5 years of experience

report higher rates of bullying than established employees.

H02: Employees with less than 5 years of experience will not report higher rates of bullying than established employees.

Methodology

Does workplace bullying impact organizational trust?

HA3: Higher rates of bullying negatively

correlate with lower levels of organizational trust. H03: Higher rates of bullying do not correlate with lower levels of organizational trust.

Does workplace bullying impact job satisfaction?

HA4: Higher rates of bullying negatively

correlate with lower levels of job satisfaction. H04: Higher rates of bullying do not correlate with lower levels of job satisfaction.

MethodologyThe Study’s Survey • Negative Acts Questionnaire-Revised (Developed by Einarsen)

• The most widely used tool on this subject• Over 40,000 respondents from 60 countries• Internally valid • NAQ-R contains 22 items (19 approved by the IRB)

• Organizational Trust Inventory (Developed by Cummings and Bromily, 1996)

• Three (3) items from the OTI

• There are three (3) additional items that inquire into whether someone has witnessed WPB (2 approved by the IRB). The rest of the survey contains pertinent demographic questions

Original Target Population SelectionAlpha Regional Health Care Center

Large urban hospital3,000 FTE (800 nurses)25,000 annual admits; 300,000 outpatient

visitsApproximately 20% don’t have health

insurancePersistent financial issues

Beta HospitalServes a semirural communityHealthy financial profile Approximately 750 FTE

Gamma HospitalServes a wealthy community Approximately 2,000 FTE (500 nurses)Stable financial outlook and is looking to

expand

Changes to the Target Population

All three hospitals declined to participate.

* The study then focused on health care workers in Walden’s participant pool.

Getting Respondents

The survey was approved for uploading onto the Walden participant pool in December, 2012

• Data gathering phase went from early January 2013 through late March, 2013

Protecting People & Data• Participation in this study was voluntary

• The study made no attempts to collect names

• All survey responses were anonymous

• The data is housed in a private Qualtrics account

• All data from the study is kept in a locked safe (hard copy & USB)

Results Demographics of Respondents by Nurses and Non-Nurses (N=67)

    Nurse Non-NurseGender Female 27 32  Male 2 6Educational Attainment

Less than Associate 0 2

Associates 5 0Baccalaureate Degree 13 16Master's Degree 10 17Doctorate (Ph.D.) 1 1

 Professional Degree (M.D., J.D.)

0 2Length of Service

Less than 1 year 2 4

Between 1 and 1.9 years 3 4Between 2 and 4.9 Years 10 11Between 5 and 9.9 Years 8 9Between 10 and 19.9 Years 3 8

  More than 20 Years 3 2

Results Item N Mean

Std. Deviation

Skewness

Working below competence 67 1.39 1.477 0.779Rumors about you 66 1.29 1.274 0.769Withholding Info. 67 1.25 1.235 0.79Views Ignored 67 1.25 1.21 0.813Being excluded 67 1.09 1.276 1.045Hostile Reaction 67 1.07 1.132 0.947Excessive monitoring 65 1.02 1.329 1.291Being ridiculed 66 0.94 1.175 1.294Areas Removed 67 0.93 1.247 1.353Offensive remarks 67 0.84 1.109 1.365Shouted 67 0.84 0.994 1.486Reminded of Errors 67 0.82 1.167 1.54Critic of Work 67 0.78 1.165 1.519No claim 67 0.73 1.136 1.576Unreasonable tasks 66 0.71 1.193 1.602Allegations 67 0.55 0.958 2.085Quit job 67 0.42 0.762 2.3Sarcasm 67 0.42 0.781 2.442Jokes about you 67 0.35 0.942 2.135

Results Item N

At Least Now and

Then

Never

Views Ignored 67 69% 31%Withholding Informing

67 67% 33%Rumors about you 66 67% 33%Working below competence

67 64% 36%Being excluded 67 57% 43%Shouted 67 57% 43%Being ridiculed 66 54% 46%Excessive monitoring

65 52% 48%Areas Removed 67 49% 51%Offensive remarks 67 49% 51%Reminded of Errors 67 46% 54%Unreasonable task 66 45% 55%Critic of Work 67 42% 58%No claim 67 39% 61%Hostile Reaction 67 37% 63%Allegations 67 34% 66%Quit job 67 30% 70%Sarcasm 67 30% 70%Jokes about you 67 16% 84%

Results RQ1

Group Score for Aggregated Workplace Bullying

 

Job

Category

N Mean Std.

Deviation

Std.

Error

Mean

NAQ-R Total Nurse 29 16.2759 14.53542 2.69916

Not a Nurse 38 16.6316 14.44172 2.34276

Results RQ1

Independent Samples T-Test by Job Category

 

Levene's Test for Equality of Variances

t-test for Equality of Means

F Sig. T df

Sig. (2-tailed)

Mean Differen

ce

Std. Error

Difference

95% Confidence Interval of

the DifferenceLower Upper

NAQ-R

Equal variances assumed

0.038 0.845 -0.1 65 0.921 -0.35572 3.57092

-7.4873

36.7759

Equal variances not assumed

    -0.1 60.22 0.921 -0.35572 3.57407

-7.5043

9

6.79296

Results RQ2

Mean Score of WPB by Length of Service

  Length of Service N Mean

Std. Deviatio

n

Std. Error Mean

NAQ-R

New Employees 34 17.1765 16.1479 2.76935

Longer Tenure 33 15.7576 12.4951 2.17511

Results RQ2

Independent Samples T-Test by Length of Service

 

Levene's Test for

Equality of Variances

t-test for Equality of Means

F Sig. T df

Sig. (2-

tailed)

Mean Difference

Std. Error Difference

95% Confidence Interval of

the DifferenceLower Upper

NAQ-R

Equal variances assumed

2.759 0.102 0.401 65 0.6891.418893.5348

4

-5.6406

7

8.47846

Equal variances not assumed

    0.40361.958 0.6881.418893.5214

2

-5.6204

2

8.45821

Results RQ3

Relationship Between WPB and Organizational Trust

Model Sum of Squares

df Mean Square

F Sig.

1

Regression 24.933 1 24.933 8.497 .005b

Residual 190.738 65 2.934    

Total 215.672 66      a. Dependent Variable: organizational trust numberb. Predictors: (Constant), workplace bullying aggregate number

Results RQ3

Relationship Between WPB and Organizational Trust Aggregate Score

Model Sum of Squares

df Mean Square

F Sig.

1

Regression 263.303 1 263.303 11.837 .001b

Residual 1445.891 65 22.244    

Total 1709.194 66      

a. Dependent Variable: organizational trust inventory aggregate numberb. Predictors: (Constant), workplace bullying aggregate number

Results RQ3

Relationship Between WPB and Organizational Trust

Results RQ4

Relationship Between WPB and Job Satisfaction

Model Sum of Squares

df Mean Square

F Sig.

1

Regression 20.256 1 20.256 7.877 .007b

Residual 167.147 65 2.571    

Total 187.403 66      Dependent Variable: Job satisfaction overall numberPredictors: (Constant), Workplace bullying overall number

Results RQ4

Multiple Regression Analysis of WPB and Job Satisfaction

Model Sum of Squares

df Mean Square

F Sig.

1

Regression 22.609 3 7.536 3.088 .034b

Residual 151.331 62 2.441    

Total 173.939 65      a. Dependent Variable: Overall job satisfaction numberb. Predictors: (Constant), Education number, WPB aggregate number, third party bullying number

Results RQ4

Impact of Multiple Variables on Job Satisfaction

Model Unstandardized Coefficients

Standardized

Coefficients

T Sig.

B Std. Error

Beta

1

(Constant) 5.554 .953   5.828 .000NAQ-R -.025 .015 -.224 -1.645 .1053rd Party WPB -.152 .108 -.193 -1.410 .164Educational Attainment

.019 .258 .009 .073 .942

a. Dependent Variable: Job satisfaction number

Implications for Future Research• Originally had targeted 3 hospitals

• Overcoming resistance from institutions to conduct these types of investigations.

• Still a need to gather additional data to make a compelling case

Implications for PolicymakersTrying to advance legislation

with considerable gaps remaining;

The issue does not have a traditional advocate that would make it more likely to pass.

No Political Action Committees

No National Organization developing a scorecard

Waiting for Opportunity Windows (critical incidents)

**Short public media life cycle

Thank You.

Any questions?

ReferencesAnderson, C. (2002). Workplace violence: Are some nurses more vulnerable? Issues in Mental Health Nursing, 23, 351-366.

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Brodsky, C. M. (1976). The harassed worker. Lexington, MA: Lexington Books.

Cemaloglu, N. (2007). The exposure of primary school teachers to bullying: An analysis of various variables. Social Behavior and Personality, 35, 789-802.

Chapman, R., Styles, I., Perry, L., & Combs, S. (2010). Examining the characteristics of workplace violence in one non-tertiary hospital. Journal of Clinical Nursing, 3(4), 479-488.

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References

Glaso, L., Matthiesen, S., Nielsen, M., & Einarsen, S. (2007). Do targets of workplace bullying portray a general victim personality profile? Scandinavian Journal of Psychology, 48, 313-319.

Hinchberger, P. A. (2009). Violence against female student nurses in the workplace. Nursing Forum, 44(1), 37-46. doi: 10.1111/j.1744-6198.2009.00125.x

Johnston, J. (2004). Those who can, do. Those who can't, bully. AIIRSM Conference, 1-14.

Keashly, L. (1998). Emotional abuse in the workplace: Conceptual and empirical issues. Journal of Emotional Abuse, 1(1), 85-117. doi: 10.1300/J135v01n01_05

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McKay, R., Arnold, D., Fratzl, J., & Thomas, R. (2008). Workplace bullying in academia: A Canadian study. Employee Responsibilities and Rights, 20, 77-100.

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Namie, G. (2007). The challenge of workplace bullying. Employee Relations Today, 34, 2.

Ortega, A., Hogh, A., Pejtersen, J., & Olsen, O. (2008). Prevalence of workplace bullying and risk groups: A representative population study. International Archives of Occupational and Environmental Health, 82(3), 417-426.

Sutton, R. (2007). Building a civilized workplace. McKinsey Quarterly, 30-39.

References Vickers, M. (2006). Writing what’s relevant: Workplace incivility in public administration—A wolf in sheep’s clothing. Administrative Theory and Praxis, 38, 69-88.

Workplace Bullying Institute. (2007). Results of the 2007 WBI U.S. Workplace Bullying Survey. Retrieved from http://bullyinginstitute.org/zogby2007/wbi-zogby2007.html

Yamada, D. (2000). The phenomenon of 'workplace bullying' and the need for status-blind hostile work environment protection. Georgetown Law Journal, 88, 475.