 By: Ashley, Brita, Dani, Sarah, Kortni

Among novice nurses, how does workplace bullying effect quality of care? We define quality of care as patient safety, productivity of the nurse, and the well- being of patients and nurses

 P- novice nurses, 0-3 years of experience  I- workplace bullying  C- n/a  O- quality of care  Question type: Prognosis o Long term effects of workplace bullying

 Workplace bullying  Novice nurse  Quality of care  Patient safety  Productivity  Working culture  Nursing outcomes

 Proquest  Science Direct

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 Type of study: Qualitative o surveys sent out through the mail to nurses in the area  Population: Nurses licensed in Massachusetts from  Sample size: 511 (1000 surveys sent out, 511 returned)

 To determine if bullying had any effect on nurses leaving their jobs  Found out more about the types of bullying going on among nurses

 511 surveys were returned, 184 with extra comments about being bullied or seeing bullying happen.  4 themes describing bullying o “Structural bullying” o “Nurses eating their young” o “Feeling out of the clique” o “Leaving the job”

 “Bullying has been part of workplace culture since the beginning of professional nursing and has been tacitly accepted by nurses for too long. Nurses are only just beginning to understand the root of this unfortunate phenomenon”  Important 4 themes  More research needed

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WORKPLACE BULLYING IN NURSING: A PROBLEM THAT CAN’T BE IGNORED  Systematic Review  Population- none. Draws on many research publications and the author’s opinion  Novice Nurse, Carol

To present the history and seriousness of workplace bullying in nursing and to offer potential solutions

 Abusive workplaces result in lack of job satisfaction, poor retention, and adverse patient outcomes  Negative effects: on nurses, patients in their care, family, friends, coworkers, and health care organizations  Characteristics of bullies and protection  No Tolerance Act

 Standards against bullying set in place  Not completely relevant, not focused on novice nurses  Recommendations

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 Cross Sectional Survey  Newly graduated nurses – working less than two years  In acute care hospital in Ontario Canada  Mailed to participants homes  342 nurses surveys were returned meeting criteria

 The purpose of the survey was to link authentic leadership to new graduate nurses’ experience of workplace bullying, burnout, & job satisfaction

 The results were that authentic leadership has a direct negative effect on workplace bullying, and that was significantly related to better job satisfaction and job turnover intention.

 Because of our definition of quality of care, this survey was relevant to our study.  Nurses’ with authentic leadership that condones bullying had better job satisfaction which leads to better quality of care for the patients  However, more research would need to be done on the direct effects on the quality of care

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 Primary research  Survey  New nurses registered in 2009 or 2010  Sample size=197

 “to determine the prevalence and effects of WPB on the productivity of novice nurses” (Berry et al., 2012)

 23.9%-bullying did not affect productivity  29. 4%-more productive following bullying  46.7%-less productive following bullying  Effect of bullying on non-white v. white

 Nurses subjected to bullying may have been more likely to take survey  May not have provided accurate information about bullying

 Highly relevant  Links bullying with diminished ability of new nurses to fulfill responsibilities  Supports that it’s crucial to reduce bullying to minimum levels

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 Type of study: concept analysis o 136 articles were examined o 56 representative publications  Population: o novice nurses, nursing students, doctors  Sample size: o Cases, interviews, and surveys that consisted of a wide variety from 1 person to 1,565 people.

 To clarify the meaning of intimidation within the context of the healthcare environment.  Identify the role that intimidation & workplace bullying play in undermining patient safety (e.g. medical errors) and complete quality of patient care (Lamontagne, 2010).

 Workplace bullying, intimidation and hostile behavior can foster medical errors and decrease patient safety.  Deaths yearly because of preventable medical errors?  How much do these medical errors cost per patient?  Negative effects on healthcare providers.

 Disruptive behaviors can contribute to: o Poor patient satisfaction o Preventable adverse outcomes o Increased cost of care o Decreased patient safety o Clinicians to seek new positions  What is the safety quality of patient care dependent on?  Health care organizations need to address the problem of behaviors that threaten the performance of the healthcare team.  Novice nurses reported feelings of: o Being undervalued o Blocked from opportunities o Being unsupported, and neglected

 Recognize and take specific steps to immediately halt the occurrence of intimidation.  Adverse affect on healthcare providers, patients, and their families.  Further research is needed to provide a method to quantitatively measure the effect of intimidation by nursing superiors on novice nurses' ability to provide safe patient care.  It is in the best interest of the patient, nurse, and organization to eliminate workplace bullying from the workplace.

Clearly, the bullying of new nurses has far reaching consequences. Current practice must focus on minimizing bullying to:  provide greater patient safety  increase nurse productivity  increase nurse job satisfaction  Ultimately provide greater quality of care Preventative strategies and ongoing interventions for eliminating workplace bullying are paramount in the healthcare setting.

Bullying has a negative effect and it must be minimized to improve overall quality of care. There are many adverse effects that not only involve the nurse, but also patients, families, and healthcare providers. More research needs to be conducted to identify effective interventions to eliminate bullying in the healthcare setting and the negative effects that it has.

 Berry, P. A., Gillespie, G. L., Gates, D., & Schafer, J. (2012). Novice Nurse Productivity Following Workplace Bullying. Journal of Nursing Scholarship, 44(1), doi: /j x  Grau, A. L., Laschinger, H. K. S., Wong, C. A. (2012). The influence of authentic leadership on newly graduated nurses experiences of workplace bullying, burnout and retention outcomes: A cross sectional study. International Journal of Nursing Studies, 49,  Lamontagne, Clare, MS,R.N., C.N.E. (2010). Intimidation: A concept analysis. Nursing Forum, 45(1), Retrieved from  Murray, J. S. (2009). Workplace bullying in nursing: A problem that can’t be ignored. Medsurg Nursing, 18(5),  Simons, S. R., & Mawn, B. (2010). Bullying in the workplace--A qualitative study of newly licensed registered nurses. AAOHN Journal, 58(7), doi: