Workplace Bullying Against Nurses Health And Social Care Essay

Workplace violence has emerged as an area of huge interest to both small and large business recently. Some employers are denying that their business is affected by this problem but the fact that workplace violence has strike all businesses including the health sector. Workplace violence is a multifaceted problem that it is so pervasive that the Centers for Disease Control (CDC) have classified it as a national epidemic.

Healthcare workers are surrounded by a wide range of occupational hazards including but not limited to back injuries, needle stick injuries, contact with contagious, stress and violence. (Sullivan, E. & Decker, P. 2005)

Workplace violence includes both physical and non physical violence it could vary from physical assault, homicide to non-physical violence, like verbal abuse, sexual or racial harassment or making threats.

Non-physical type of violence is rarely discussed. It is harassment but not recognized as such because there is no discernible discrimination. When the harasser and targeted person are both members of protected status groups, there is no prohibition, no protection. The offensive, intimidating, threatening work environment is certainly hostile, just not illegally hostile. (Namie, 2005)

The term workplace bullying has been described as an umbrella term that incorporates harassment, intimidation and aggressive or violent behaviors (Hadikin & O’Driscoll, 2000). Einarsen (2000) defines workplace bullying as:

“When one or more individuals, repeatedly over a period of time, are exposed to negative acts (be it sexual harassment, tormenting, social exclusion, offensive remarks, physical abuse or the like) conducted by one or more other individuals. In addition, there must be an imbalance in the power-relationships between parties. The person confronted has to have difficulties defending himself/herself in this situation”. (pp. 383-384). Clearly, a person would not allow themselves to be bullied if they had the ability to defend themselves (Niedl as cited in Einarsen, 2000).

Workplace bullying evolves in harmful effects on healthcare providers, patients the organization and the health system as a whole. It has particular importance to the nursing profession, in view of the growing concern over the poor professional practice environment of nurses in many countries. Such environment leads to problems in retaining and recruiting nurses, contributing to the overall nursing shortage, and ultimately resulting in decline in quality patient care. (ICN) The phenomenon of workplace bullying is quite new and has only been studied for a little over two decades. (Rayner, Hoel, & Cooper, 2002)

“Violence in the workplace is a major source of inequality, discrimination, stigmatization and conflict at the workplace. Increasingly it is becoming a central human rights issue” (WHO). At the same time, workplace violence is increasingly appearing as a serious, sometimes lethal threat to the efficiency and success of organizations. Violence causes immediate and often long-term disruption to interpersonal relationships, the organization of work and the overall working environment (ILO, 2002).

Despite the frequency of workplace violence, studies suggest that most incidents in hospitals and healthcare facilities go unreported. According to the U.S. Department of Justice, Federal Bureau of Investigation, “of great concern is the likely under-reporting of violence and persistent perception within the healthcare industry that assaults are part of the job. Under-reporting may reflect a lack of institutional reporting policies, employee belief that reporting will not benefit them, or employee fears that employers may deem assaults the result of employee negligence or poor job performance”. (

Many nurses do not recognize the multiplicity and the broad definition of workplace violence. Understanding the type and frequency of violent behaviors experienced in the healthcare setting will provide the foundation for early recognition and prevention of violence. Creating an environment that does not accept nor tolerate acts of violence will increase staff satisfaction, reduce medical error and improve clinical outcomes. In this study, workplace bullying will be highlighted as major ethical problem, experienced by nursing personnel but simultaneously overlooked.

Project aim

To determine the prevalence, impact, context, consequences of workplace bullying among nursing personnel, in order to assist in developing legal and programmatic response to improve nurses’ safety and satisfaction.

Specific objective for the study:

In order to determined the incidence, prevalence, impact, context, consequences and prevention strategies of workplace bullying against nursing personnel.

To analyze victims’ reaction to violence and the consequences of workplace violence.

To assist in developing legal and programmatic response to improve providers’ safety, satisfaction and retention.

Problem statement:

Violence and physical assault are recognized as significant occupational hazards for the healthcare providers worldwide. Violence in societies increases and become a second leading cause of death in some societies (Mayer et al 1999). Bulling is on form of violence that has a devastating effect on employee’s life, family and career. To detect the scope and the prevalence of workplace bullying, to increase staff awareness of violence with the objective of identifying the perpetrator characteristics, this study will be conducted. To ensure safe working environment in Salmaniya Medical Complex, managers should provide training for healthcare providers in relation to prevention and responding to bullying and aggression. Healthcare providers should understand that violence result from a number of variables, like stress, pain, fear of unknown, extended waiting time to be seen and treated and unpleasant environment

Research questions:

What is the incidence of bullying of nursing personnel during the past six months?

Did the variables of age, gender and experience as alter the nurse’s experience of bullying?

Dose nurses job satisfaction affected by bullying behavior?

The conceptual framework:

The Psychological Harassment Model will be used. Psychological harassment is a heterogeneous phenomenon. Each bullying action shows a different frequency, has different determinant motivations (e.g. remove someone from the company, competition for tasks, status, advancement, gain a supervisor’s favor, or play a joke on someone), a variety of consequences, and the phenomenon occurs in different circumstances. From this paper’s standpoint, psychological harassment is first a dynamic linear process with four phases, which is illustrated in Figure 1. The interaction of three types of antecedents (phase 1) can develop psychological harassment behavior (phase 2), which creates response from the victim and the organization (phase 3), and produces three types of effects (phase 4). But, it is also a uni-linear process. For instance, the antecedents (phase 1) can directly influence the responses (phase 3) of an individual (e.g. personality) or an organization (e.g., culture). For example, the personality of the victim can influence the nature of the individual response, or the culture of the firm can influence the characteristic of the organizational response. In the same way, the antecedents (phase 1) can directly influence the effects (phase 4). For instance, the personality of the victim can influence the psychological harassment health effects.

Figure 1 The Psychological harassment process phase. (Adapted from Polipot-Rocaboy, G. 2006)

Definition of terminology:

Workplace: Any health care facility, whatever the size, location (urban or rural) and the type of service(s) pro-vided, including major referral hospitals of large cities, regional and district hospitals, health care centers, clinics, community health posts, rehabilitation centers, long-term care facilities, general practitioners offices, other independent health care professionals. In the case of services performed outside the health care facility, such as ambulance services or home care, any place where such services are performed will be considered a workplace. (ILO et al 2002)

Satisfaction: is generally understood to be an individual’s emotive or affective response, either in a positive or in a negative direction, to some experience or situation. There is some debate regarding whether satisfaction is a uni-dimensional concept or a multidimensional one. Some useful reviews of the literature in this connection have been offered by Prichard (1960), Vroom (1964), and Napior (1969) .

Workplace violence: incidents where staff are abused, threatened or assaulted in circumstances related to their work, including commuting to and from work, involving an explicit or implicit challenge to their safety, well-being or health. (Adapted from European Commission, ICN 2007)


Bullying is a sub-lethal, non-physical form of violence psychological in both its execution and impact on targeted individuals, bullying is a kind of long-term hostile behavior detected in employees at workplaces. It involves hostile and unethical communication which is directed in a systematic manner by one or more individuals, mainly toward one individual, who, due to mobbing, is pushed into a helpless and defenseless position and held there by means of continuing mobbing activities. These actions occur on a frequent basis (at least once a week) and over a long period of time (at least six months’ duration). (Angeles, M. et al 2006)

Literature review

Through their national work environmental acts Sweden, Finland and Norway support the rights of workers to remain both physically and mentally healthy at work. Yet, in recent years, a work environment problem has been discovered, the existence and extent of which was not known previously. This phenomena has been called “mobbing,” “ganging up on someone” or psychic terror. It occurs as schisms, where the victim is subjected to a systematic stigmatizing through, inter alia, injustices (violation of a person’s rights), which after a few years can mean that the person in question is unable to find employment in his/her specific trade. Those responsible for this tragic destiny can either be co-worker or management. (Leymann, 1990)

Women and men are bullies. Women comprise 58% of the perpetrator pool according to a research done at the Workplace Bullying Institute (WBI). Half of all bullying is woman-on-woman. Overall, women comprise the majority of bullied people (80%). Without laws and none exist in the U.S., employers are reluctant to recognize, let alone correct or prevent destructive behavior, preferring to dismiss bullying as “personality clashes.” (Namie, 2005)

Because of the predominance of women in the nursing profession, subsequent attempts to explain intimidation in nursing focused on gender-based theories of the behavior of oppressed groups. More recently it has been proposed that intimidation may be the result of nurses who feel a lack of control attempting to gain control through bullying others. External pressures are often held responsible, such as health care workers’ need to find a scapegoat for errors. The impact of the reform of the health care industry on staff is another reason cited for the existence of this behavior. The financing and downsizing of hospitals for example, leads to greater levels of acuity in the hospital patient population and hence increased workloads for nurses. Increased stress is often the result, and this is said to contribute to an increased tendency for bullying in the nursing workforce. (Stevens, 2002)

According to ILO/ICN/WHO/PSI they identified workplace violence “Incidents where staff are abused, threatened, or assaulted in circumstances related to their work, including commuting to and from work involving explicit or implicit challenges to their safety, well being or health”. The Californian Occupational Safety and Health Administration (Cal/OSHA), categorized workplace violence into three types

Type I: the aggressor has no legitimate employment relationship to the worker or the workplace and, usually, the main object of the violence is obtaining cash or valuable prosperity or demonstrating power. Examples are robbery, mugging, and road rage.

Type II: the aggressor is someone who is the recipient of a service provided by the affected workplace or by the worker. Examples are assault or verbal threats by patients, carers or relatives of the patient.

Type III: the aggressor is another employee, a supervisor or manager. Examples are bullying and harassment.

Type I is referred to as “external violence”, Type II as “client initiated” violence and Type III as “internal” violence. The internal violence will be tackled in this study.

Bullying is a sub-lethal, non-physical form of violence psychological in both its execution and impact on targeted individuals, bullying is a kind of long-term hostile behavior detected in employees at workplaces. It involves hostile and unethical communication which is directed in a systematic manner by one or more individuals, mainly toward one individual, who, due to mobbing, is pushed into a helpless and defenseless position and held there by means of continuing mobbing activities. These actions occur on a frequent basis (at least once a week) and over a long period of time (at least six months’ duration). Because of the high frequency and long duration of hostile behavior, this maltreatment results in considerable mental, psychosomatic and social misery”. These hostile behaviors include verbal aggressions, rumors, humiliations, and so on. Three types of bullying can be considered depending on the power of victims and aggressors: horizontal, up-down and down-up bullying. Up-down bullying occurs when a superior harasses one of her subordinates. Down-up bullying occurs when a worker or a group or workers harasses his/their superior. When bullying occurs between co-workers at the same hierarchical level it is called horizontal bullying.

Workplace violence is often considered part of the job in the health sector and therefore been more frequently overlooked than in another sectors until recently.

Workplace violence has an impact on the providers’ health, productivity and dignity. The impact of violence is not just on individual level but extend to organizational and social levels.

The consequences of violence in the workplace are serious for both an organization and the employee. Victims of workplace violence have an increased risk of long-term emotional problems and post-traumatic stress disorder (PTSD), a disorder which is common in combat veterans and victims of terrorism, crime, rape and other violent incidents. Symptoms experienced by victims include self doubt, depression, sleep disturbances, irritability, decreased ability to function at work, increased absenteeism, and disturbances in relationships with family, friends and co-workers (American Federation of State, County and Municipal Employees, n.d). Organizations are significantly affected financially due to low worker morale, increased job stress and turnover, reduced trust of management and coworkers, and hostile work environments (NIOSH, 2002).

A report from the ILO (1998) concluded that workplace violence is becoming increasingly global and crosses boarders; moreover it also reported that women are especially at risk of violence as they work in high risk occupations.

Healthcare workers especially nurses are at high risk of workplace violence. Half of all claims of aggression in the workplace come from the health sectors (bureau of Justice Statistics, 1992-1996). Healthcare workers face 16 times the risk of violence from patient/clients than other service workers (Elliot, P. 1997. Nursing Management, 28, 12, 38-41). The Joint Commission’s survey found that more than 50 percent of nurses have been the target of some form of abuse at work and more than 90 percent report having witnessed abusive behavior. Furthermore, 75 percent of nurses who responded believed that this type of behavior can reduce patient satisfaction and disrupt care.

Despite the severity of the situation, neither the management nor the coworkers are likely to interfere or take action to support the victim. On contrary if the victim complains they often faces disbelief and questioning their own role. (Einarsen, S. et al.2003)

Workplace violence is thought to be heavily underreported, as a result of lack of consensus on taxonomy of violence; cultural acceptance of violence; lack of an appropriate reporting system; lack of employment interest; and fear of blame or reprisal (Daniels C. & Marlow P. 2005).

Although a bullying culture in nursing is not often specifically referred to in large-scale studies of hospitals’ nursing dissatisfaction and retention strategies, it is clear that tackling this issue may be critical. The literature indicates that this sort of nursing culture may be more prevalent than the profession may care to admit.


Organization of the study:

A well known nonprofit secondary care facility in the Kingdom of Bahrain will be selected to conduct this study.

The primary provides for health care in Kingdome of Bahrain is the public health sector; Salmaniya Medical complex (SMC) is the main hospital in the kingdom, meets the secondary and tertiary health care needs of the entire citizens and residents. The majority of the healthcare providers are working in SMC.

Study population:

From the total number of staff nurses working in SMC 300 staff will be selected randomly.

All major discipline in the hospital will be covered (medicine, surgical, emergency, pediatrics etc.)

Study Design:

Quantitative study design will be used to explore the relationship between the workplace bullying and job satisfaction.

Data collection methods:

To assess workplace bullying, the Negative Acts Questionnaire (NAQ) developed by Einarsen and Raknes (1997), will be used.

The Negative Acts Questionnaire comprises 22 items referring to particular behaviors in the workplace that may be perceived as bullying as well as a self-report item on victimization. The behaviors or negative acts are descriptive without labeling the actions as bullying. The behaviors include; being shouted at, being humiliated, having opinions ignored, being excluded, repeated reminders of errors, intimidating behavior, excessive monitoring of work, and persistent criticism of work and effort.

Participants will be requested to complete a 5-point Likert scale on how often they had been subjected to these behaviors over the last six months, with response categories ranging from never (1), now and then (2), monthly (3), weekly (4) and daily (5). To estimate the frequency of exposure to bullying behavior, Leymann’s operational definition of workplace bullying of one incident per week over a period of at least 6 months was employed. The questionnaire is devided into three parts section A. demographic data, section B. the Negative Act Questionnaire and section C. is about the nurses job satisfaction.

Place and time:

The questionnaire will be distributed to the target population with a cover letter ensuring anonymity.

Pilot study:

The questionnaire will be tested in a pilot study of 50 nurses working in SMC to test the validity. The employee in the pilot study will not be included in the actual study. Ethical approval will be obtained for this study.

Data management and analysis plan:

The data will be analyzed using the Statistical Package for the Social Sciences (SPSS).

Plan expected and Agenda

Design research plan

1 month

Pilot study, analyze data and revise

15 days

Implementation of the study

1 month

Data analysis