Paper Sample on Workplace Bullying: A Culture of Silence in Many US Health Care Settings

Introduction

Workplace bullying is extensive in many organizations, consequently creating a challenging working environment for their employees and workers. Bullying in the healthcare setting has been acknowledged internationally; nonetheless, a culture of silence still exists in many health care workplaces in the United States, resulting in underreporting, unproven, and insufficient interventions. Intentional and aggressive bullying behaviors can cause physical and psychological harm to the professionals, thus disrupting nursing care and threatening quality outcomes and patient safety. The practice drains the nurses' productivity and energy. Bullying in health care can lead to higher rates of employee turnover hence leading to staff shortages. According to Perry et al. (2017), workplace bullying is a symptom of emotional distress and is not associated with gender or race. Workplace bullying makes nurses feel they are at a loss when attempting to control bullying behaviors. These helplessness feelings among the nurses' result to stress leaves, absenteeism, and resignations hence contributing to nursing shortages.

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Key Stakeholders

In the issue of bullying in the healthcare setting, the stakeholders include the victim, the offender, the patient, the healthcare facility, and the witness. Workplace bullying affects stakeholders in various ways. The results of bullying on the victims range from compromised performance to increased staff turnover rates. Bullying nurses has been recognized as a threat to the delivery of quality health care. The nurse that has fallen victim of bullying can be affected by suffering from anxiety, low self-esteem, and even depression. Sometimes bullying results in extreme impacts such as illnesses and suicides. The offender may feel they have control over the situation and ultimately lead to decreased quality of patient care and potential litigation for their actions. The offenders often include Fellow nurses and administrative personnel. Bullying affects the quality of services that the patient receives, therefore, putting their health and lives at risk. Workplace bullying affects healthcare facilities and organizations. If measures are not taken to address bullying, the facility's productivity is significantly impacted. Bullying causes fear, and victims opt to be absent from the facilities or resignation. Absenteeism and resignation cause shortage of staff. Bullying not only affects the victims but even the witnesses (Trepanier et al., 2016). Bullying witnesses often think they are the next victims. Afterward, the witnesses' self-esteem decreases, leading to depression and anger. Bullying recurrence depends on the offenders and the ability of the victims to defend themselves. This is where the health care system and facility are responsible for reporting, educating, and controlling workplace bullying. Whereas individual stakeholders have their role to play, support and education are significant in minimizing and controlling bullying.

Evidence Critique

Full APA citation for 5 sources. Evidence Strength (I-VII) and Evidence Hierarchy.

1. Berry, P. A., Gillespie, G. L., Fisher, B. S., & Gormley, D. K. (2016). Recognizing, confronting, and eliminating workplace bullying. Workplace health & safety, 64(7), 337-341. https://doi.org/10.1177%2F2165079916634711 Level VII

2. Perry, L., Nicholls, R., Duffield, C., & Gallagher, R. (2017). Building expert agreement on the importance and feasibility of workplace health promotion interventions for nurses and midwives: a modified Delphi consultation. Journal of advanced nursing, 73(11), 2587-2599.https://doi.org/10.1111/jan.13345 Level VI

3. Hayward, D., Bungay, V., Wolff, A. C., & MacDonald, V. (2016). A qualitative study of experienced nurses' voluntary turnover: Learning from their perspectives. Journal of clinical nursing, 25(9-10), 1336-1345.https://doi.org/10.1111/jocn.13210. Level VI

4. Trepanier, S. G., Fernet, C., Austin, S., & Boudrias, V. (2016). Work environment antecedents of bullying: A review and integrative model applied to registered nurses. International journal of nursing studies, 55, 85-97. https://doi.org/10.1016/j.ijnurstu.2015.10.001 Level I

5. Keller, R., Allie, T., & Levine, R. (2019). An evaluation of the "BE NICE Champion" program: A bullying intervention program for registered nurses. Journal of nursing management, 27(4), 758-764. https://doi.org/10.1111/jonm.12748 Level VI

Evidence Summary

Summary reports are essential in nursing research. The summaries are used to decipher the quality of the study. Discussing articles as presented in the evidence critique table, the article I is a level VII written by expert opinion. Experts do not rely on rules, guidelines, or principles to connect situations and determine actions. Experts use their experience to perform fluently in clinical conditions. In article 1, the authors show that workplace bullying behaviors have a negative impact on nurses' satisfaction, productivity, safe patient care, and retention. These behaviors include humiliation, exclusion, gossip, unfair workload assignments, and belittlement.

The authors determined that skilled occupational health nurses and leaders confront behaviors that they deemed unprofessional and empowered other nurses to do the same. Recognizing, confronting, and eliminating bullying behaviors in healthcare is an essential step towards achieving improvements in the quality of patient care and the safety of healthcare personnel. Workplace bullying is not an isolated event but repeated behaviors that target the nurses. Often, the perpetrators change tactics to minimize the ability of the victims to defend themselves. The authors view occupational health nurses as sources that can be used to identify and quantify the effects of workplace bullying behaviors to the organization's image and productivity.

Article 2 is a qualitative study that was used to determine the feasibility and essence of health-promoting interventions in enhancing and supporting the nursing workforce. Eleven panelists that were purposefully selected gave feedback through electronic questionnaires. The author determined that mental health strategies were regarded as essential intervention topics. However, physical activity and healthy eating were also identified to be necessary. The authors identified that consensus was achieved on the essence and feasibility of some of the interventions.

Article 3 is a qualitative study conducted to examine the contributors to turnovers among experienced workers. The researchers sought to find out what contributed to their resignation and seek alternative employment. Environmental and personal factors were that influenced their decisions were scrutinized. The authors' found out that work interrelated factors influenced their decisions to leave the nursing practice. Ineffective working relationships that were contributed by bullying, among other factors made the nurses feel ill-equipped and dissatisfied for their job. High stress as a result of bullying was evident in the emotional and health well-being of the nurses.

Article 4 is an integrative review that gives an overview of the state of knowledge on workplace bullying antecedents. The authors conducted literature research on ProQuest, CINAHL, and PsycInfo databases to determine the antecedents of bullying in nurses' workplaces. They also included empirical studies in their review. The author's investigation identified the main categories of antecedents of bullying, namely: interpersonal relationships quality, leadership styles, job characteristics, and organizational cultures. The analysis highlights the interplay between bullying and these factors.

Article 5 is a qualitative study which explores the perceptions, attitudes, and experiences of registered nurses. The registered nurses are presented with intervention tools whenever bullying was observed in their healthcare facilities which comprised of support, stand by, sequester, and speak up (4S). The overall consistent themes that were identified were applying the 4S, awareness, and understanding, and feeling empowered and prepared. The authors determined that the use of 4S gave the nurses the confidence to intervene whenever they encountered bullying cases. Ultimately, the researchers observed that the registered nurses developed bullying situational awareness which was mainly achieved through role-playing exercises.

Evidence-Based Practice Recommendation

"Recognizing, Confronting, and Eliminating Work Place Bullying" article was used in the research. The authors acknowledge that workplace bullying has a significant impact on nurses' retention, productivity, and retention. The level VII evidence seeks to give a clear difference between workplace bullying and incivility. The article also provides actions that will be used to prevent bullying behaviors. Patient care is increasingly becoming stressful, extensive, and time-consuming because essential job functions and healthcare organization descriptions are out of date and cannot meet the current demands. Occupational health nurses should, therefore, use illness and illness surveillance to identify units that are at risk within the healthcare set-up. Cost-benefit studies of health risks related to workplace bullying can be used to estimate the benefits of use and attrition costs. Information provided by cost-benefit reviews can be used by occupational health nurses to determine bullying behaviors and conflicts at workplaces that are unresolved. Through the use of productivity, cost savings, and corporate image as concerns, the occupational health nurses can, therefore, lobby for interventions to solve workplace bullying behaviors. Nurse leaders and vocational nurse leaders should model and communicate professional and appropriate actions in the workplace.

When a culture of disrespect is regularly seen at healthcare facilities, the nurses should monitor and focus on bullying while striving to enhance interventions while establishing and advocating for culture change (Berry et al., 2016). The administrative and nurse leaders need to be attentive to the communication in the facilities as workplace bullying behaviors happen anywhere. Contact with the nurses provide opportunities for them to share issues arising at the workplace. Private focus groups are essential as they encourage nurses to share their daily experiences in a comfortable environment. According to (Berry et al., 2016) education that is skill-based is critical to nursing leaders' abilities to effectively manage their staff as they equip them with knowledge on conflict resolution, building collaborative relationships and dealing with uncivil behaviors. Although workplace bullying is recognized and denounced internationally, it continues in many organizations. Workplace bullying behaviors are often tolerated, rewarded, or enables in some organizations, thus leading to cultural and social acceptance in healthcare workplaces (Berry et al., 2016). Bullying behaviors, organizational social norms, response to stress are often learned and acquired as people grow and develop their carriers so that these behaviors can be unlearned. Nurse leaders and occupational health nurses must define workplace bullying as unacceptable and confront such practices. If corrective action and coaching fail to prevent bullying behaviors, termination can be used as an appropriate intervention as a consequence of constant bullying (Keller, Allie, & Levine, 2019).

Barriers to reporting issues and power imbalance within hierarchical organizations create an environment that is accommodating for workplace bullying. Active nurse empowerment and education can be used to reduce the pow...