Read, Emily MSc, RN; Laschinger, Heather K. PhD, FAAN, RN
Nursing is facing a human resource shortage because of an aging workforce and increasing demands for healthcare services. In Canada, the estimated shortfall is projected to be 60000 registered nurses (RNs) by 2022.1 In the United States, shortfalls of up to 1 million nurses are expected by 2030.2 Newly graduated nurses represent the future of the nursing profession yet turnover is high among this group of nurses.3-5 The transition from student to professional nurse can be a stressful time for novice nurses as they assume new roles and responsibilities.6 Many report feeling underprepared for practice7 and have difficulty adjusting to the realities and time pressures of current health care workplaces.6 As a result, new graduate nurses may find themselves the targets of criticism and unsupportive behaviors from more experienced colleagues.
Recent reports of workplace mistreatment, such as bullying and uncivil behaviors targeting new graduate nurses, are unsettling.8,9 During their 1st year of practice, novice nurses reported high rates of negative behaviors directed at them.10 These included undervaluing by others, blocking learning opportunities, emotional neglect, being given too much responsibility without support, rude or humiliating comments, and verbal threats. Negative work experiences and their secondary effects may contribute to decreased retention of these new professionals.11,12 This is worrisome at a time when the nursing profession is experiencing a workforce shortage.1,13 The purpose of this study was to examine personal and organizational correlates of 3 forms of workplace mistreatment.
Exploratory Conceptual Framework
Based on our review of the literature, we developed an exploratory conceptual model of organizational and personal correlates of new graduate nurses’ experiences of workplace mistreatment (incivility and bullying). We propose that the presence of authentic leadership, structural empowerment, person-job fit with 3 areas of work life (community, values congruence, and fairness), and positive psychological capital will be inversely related to new graduate nurses’ experiences of incivility and bullying in the workplace. In addition, we expect that incivility and bullying will be related to decreased job and career satisfaction, increased intent to leave, increased emotional exhaustion, and decreased work engagement, and lower perceptions of mental and physical health. Thus, we classified these correlates as logical precursors and outcomes of workplace mistreatment in this exploratory model (Figure 1).
Forms of Workplace Mistreatment
Despite efforts to maintain respectful work environments, employees often experience workplace mistreatment such as incivility and bullying by coworkers and supervisors. Incivility describes low-intensity rude or disrespectful behaviors with an ambiguous intent to harm others.14 Exposure to workplace incivility is linked to detrimental personal outcomes, such as poor mental health,15 emotional exhaustion, and burnout,16 and negative organizational outcomes, including job dissatisfaction and turnover intentions.17 Recent studies have shown that new graduate nurses are experiencing incivility in their jobs18 and that these experiences are associated with emotional exhaustion, poor mental health, job dissatisfaction, and turnover intentions.9,11 Workplace mistreatment is an ongoing issue facing new graduate nurses that deserves attention because of the significant negative influences that these behaviors have on their work and health outcomes.
In contrast to the ambivalent disrespect that constitutes incivility, bullying is an intentional and intense form of workplace mistreatment that targets particular individuals and not others. Leymann19 describes bullying as interpersonal conflict in which the target is subjected to systematic stigmatization, harassment, and social isolation over an extended period of time. Work place bullying tends to be sophisticated and involve psychological cruelty.19 The effects of bullying on employees are often severe, long-lasting, and multidimensional and include poor health outcomes, increased absenteeism, and high job turnover.20 Researchers have identified personal and organizational antecedents to workplace bullying. Certain personality characteristics such as neuroticism, conscientiousness, and sensitivity can predispose individuals to become victims of bullying.21 In addition, work environment factors such as job demands, control, and lack of support contribute to workplace bullying.22
Recent reports show that up to 39% of nurses in their 1st year of professional practice witnessed bullying9 and 26.4% to 31% were targets themselves.12,23 Detrimental outcomes of bullying experienced by new graduate nurses include emotional exhaustion,24 feelings of exclusion, and job turnover intentions.25
Proposed Precursors of Workplace Mistreatment
Workplace environment characteristics play an important role in helping nurses transition into their professional careers. As beginning practitioners, new graduate nurses desire support from coworkers and supervisors, opportunities to clarify and expand their knowledge base,26 and a sense of belonging.27 Supportive leadership and an empowering workplace contribute to the creation of positive working environments that meet these needs.
Authentic leadership is a process of building positive working relationships characterized by respect, positive affect, and trust between leaders and followers within organizations.28 An authentic leader is a confident, hopeful, resilient individual of high moral character who is self-aware and recognizes the strengths, weaknesses, values, and knowledge of themselves and others.28 New graduate nurses’ exposure to authentic leadership is related to work engagement, positive relationships with colleagues, and perceptions of autonomy.29 Authentic leaders are more likely to create work environments that do not tolerate bullying and incivility.
Structural empowerment30 involves providing employees with access to 4 structures that allow individuals to accomplish meaningful work. These structures—access to information, opportunities, resources, and support—enhance autonomy and organizational commitment, promoting retention of novice nurses.26 Empowerment has been linked to the quality of nurses’ professional practice environment and job satisfaction.31 Empowerment is inversely related to workplace incivility, supervisor incivility, and emotional exhaustion in the general nursing population,17 as well as to bullying24 among new graduate nurses. Nurses who are empowered to accomplish their work may be less frustrated and less likely to be intolerant of others, leading to lower incidences of incivility and bullying in the workplace.
Leiter and Maslach32 describe 6 areas of work life that influence employees’ relationships with their work. Three of these domains are particularly relevant to how people are treated at work: community (quality of social relationships), values congruence (match between personal and organizational values), and fairness (consistent rules and respect for everyone). These 3 areas of work life play a key role in how nurses perceive the quality of their practice environment, as well as how they interact with others, and have been linked to both emotional exhaustion and bullying experiences of new graduate nurses.22 A strong sense of community promotes feelings of comradely and respect at work, reducing the likelihood of employees engaging in disrespectful behaviors directed at colleagues. Values embody the ideals and principles that an organization or employee strives to achieve through their work. When nurses’ personal values align with those of the organization, they experience less dissonance and conflict in their daily practice, leading to a better quality of work life and less reason to lash out at others because of internal strife or frustration. Lastly, nurses who perceive a high level of fairness at work view opportunities and responsibilities as being equally available to everyone; thus, they are less likely to hold grudges or engage in undermining or disrespectful behaviors.
Psychological capital refers to internal personal resources, including self-efficacy, hope, optimism, and resilience.33 Individuals with higher psychological capital tend to have a positive outlook, accept challenges, identify goals, and respond well to adversity.33 A recent meta-analysis revealed that higher levels of psychological capital were associated with lower incidence of undesirable work behaviors such as incivility and bullying in the general management literature,33 consistent with research linking psychological capital to lower workplace incivility among new graduate nurses.23 Psychological capital is a personal resource to cope with negative situations; therefore, it is likely that new graduate nurses with high levels of psychological capital are less likely to perceive themselves as targets of workplace incivility and bullying. New graduate nurses with strong personal resources are likely to be proactive when facing mistreatment at work, perhaps warding off future incidents of bullying and incivility because of their assertiveness.
Proposed Outcomes of Bullying and Incivility
Job satisfaction and career satisfaction are important retention factors in the nursing profession.34 Employees with job and career dissatisfaction are more likely to desire a change in employment.34 In the nursing literature, coworker and supervisor incivility has been associated with higher turnover intent and lower job satisfaction.17,35 Both incivility and bullying have been found to negatively influence job and career satisfaction while increasing career and job turnover intentions.16,36,37
Work engagement and burnout represent positive and negative employee responses to their working conditions. According to Schaufeli and Bakker,39 work engagement is a positive motivational state of fulfillment characterized by vigor, dedication, and absorption in one’s work. Burnout, on the other hand, is a psychological syndrome characterized by overwhelming exhaustion, feelings of cynicism, and a sense of ineffectiveness experienced in response to chronic job stressors.38 Burnout typically begins with emotional exhaustion, considered the core component of the phenomenon, which, when experienced over a prolonged period of time, leads to cynicism and possibly psychological aggression. Evidence shows that incivility and bullying lead to decreased engagement and increased emotional exhaustion among nurses,17 including new graduates.11,23,24 These forms of workplace mistreatment discourage job excellence and drain personal energy, leading to increased stress and eventual emotional exhaustion.
Researchers show that experiences of workplace incivility are associated with poor ratings of mental and physical health.36 The health impacts of bullying are often more severe and may include posttraumatic stress disorder.20 In the nursing literature, bullying is associated with poor mental and physical health,37 highlighting the need to prevent these negative behaviors.
Secondary data analysis was performed on data from a larger study of new graduate’s work life.24 In that study, a random sample of 907 RNs newly registered with the College of Nurses of Ontario within the last 2 years was obtained. Of those eligible for participation in the study, 342 nurses responded (48% response rate). Data for this analysis were collected from July to October 2010 using a modified total design method.40 Survey packages including a letter of information, a study questionnaire, an addressed, stamped return envelope, and a coffee voucher were mailed to each nurse’s home address. Four weeks after the initial mailing, nonresponders were sent a reminder letter. Nonresponders were sent a replacement questionnaire package 4 weeks later. The University of Western Ontario’s research ethics board granted approval to conduct the study.
Data Collection Instruments
Data were collected using a survey consisting of several standardized questionnaires of the study variables with Likert scales and acceptable psychometric properties and demonstrated construct validity (Table 1).
Descriptive statistics and Pearson correlational analysis were conducted using the Statistics Packages for the Social Sciences (SPSS, v. 19; Armonk, New York).
Most survey respondents were women (91.5%; mean age, 28.1 ± 6.6 years) with an undergraduate degree in nursing (98.2%) and 1 year of nursing experience in medical-surgical (56.9%) or critical care (23.5%) areas. More than two-thirds of the sample held full-time positions and worked an average of 20 to 39 h/wk (see Table, Supplemental Digital Content 1, http://links.lww.com/JONA/A218).
Overall, new graduate nurses reported low levels of workplace mistreatment. Workplace incivility happened less than once or twice a week and bullying only every now and then (see Table 2 for means and standard deviations).
Proposed Precursors of Workplace Mistreatment
All organizational environment variables were significantly correlated to coworker incivility, supervisor incivility, and bullying (see Table, Supplemental Digital Content 2, for the means, standard deviations, and Pearson’s correlations among all study variables, http://links.lww.com/JONA/A219). Authentic leadership was related to coworker incivility (−0.24), supervisor incivility (−0.32), and bullying (−0.35), as was structural empowerment (r = −0.31, −0.34, and −0.22 for coworker incivility, bullying, and supervisor incivility, respectively). Person-job fit with 3 areas of work life was related to the 3 forms of workplace mistreatment, but most strongly to bullying. Community was strongly correlated to coworker incivility (−0.58), bullying (−0.44), and supervisor incivility (−0.32). Values congruence was correlated to supervisor incivility (−0.23), coworker incivility (−0.17), and bullying (−0.13). Fairness was similarly correlated to the 3 negative work behaviors (supervisor incivility, −0.30; coworker incivility, −0.29; bullying, −0.35) (Table 2).
Psychological capital was significantly related, although less strongly, to the 3 workplace mistreatment behaviors (coworker incivility, r = −0.19; supervisor incivility, r = −0.17; bullying, r = −0.21). Few demographic variables were significantly related to major study variables. Years worked in the organization was significantly related to coworker incivility (r = −0.13) and bullying (r = −0.13).
Proposed Outcomes of Workplace Mistreatment
The proposed organizational outcomes were significantly related to the 3 cited forms of workplace mistreatment with the exception of job and career turnover intentions. Job satisfaction was most strongly linked to bullying (−0.46), followed by coworker incivility (−0.37) and supervisor incivility (−0.24). Career satisfaction was less strongly although significantly related to bullying (−0.21), coworker incivility (−0.16), and supervisor incivility (−0.12). Job turnover was more strongly related to bullying (0.32) than to coworker (0.19) or supervisor (0.19) incivility, whereas career turnover intentions were similarly associated with all 3 variables. Work engagement was significantly related to coworker incivility (−0.23) and bullying (−0.27) but not to supervisor incivility (−0.09). On the other hand, emotional exhaustion was related to bullying (0.46), coworker incivility (0.31), and supervisor incivility (0.35).
Workplace mistreatment was significantly related to mental and physical health. Correlations between bullying and negative health outcomes were consistently higher than those with coworker and supervisor incivility; coworker incivility had stronger relationships with these outcomes than supervisor incivility did. Poor physical health was associated with higher levels of bullying (0.39), supervisor incivility (0.33), and coworker incivility (0.28). Poor mental health was also related to higher levels of bullying (0.32), supervisor incivility (0.28), and coworker incivility (0.25).
Overall, new graduate nurses’ experiences of coworker incivility, supervisor incivility, and bullying in the workplace have similar relationships with personal and organizational factors examined in our study. This is not surprising, considering that incivility and bullying are closely related concepts that may at times be difficult to differentiate from one another. Although our findings predominantly showed similar patterns between incivility and bullying behaviors, bullying was more strongly related to most of the negative outcomes than incivility was, likely because of the increased severity and intensity of this type of workplace mistreatment.
Proposed Precursors of Workplace Mistreatment
The magnitude of the relationships between the proposed precursors of workplace mistreatment was similar across the 3 forms of workplace mistreatment. The quality of interpersonal relationships at work or sense of community was most strongly related to all forms of workplace mistreatment. A strong sense of community was associated with lower levels of workplace mistreatment. Because a positive sense of community fosters respect and positive social relations (civility), it is not surprising that high levels of community are linked to low levels of incivility and bullying. These results are similar to those of an intervention study to promote civility among nurses41 that showed improving social relationships within work groups can reduce workplace incivility. The magnitude of the relationships between values congruence and fairness with incivility and bullying was similar, suggesting that these areas of worklife similarly influence these 3 types of workplace mistreatment.
Perceived supervisor authentic leadership style was inversely related to perceptions of bullying and supervisor incivility, suggesting that, in part, bullying experienced by new graduate nurses may be prompted by an absence of authentic leadership. Supervisors engaging in authentic leadership behaviors are respectful toward others and foster a culture of respect, rather than one of bullying. Authentic leadership promotes job satisfaction and work engagement in new graduate nurses28; however, this is the 1st study to link authentic leadership to both supervisor incivility and workplace bullying in the new graduate population.
Structural empowerment was more strongly related to bullying and coworker incivility than to supervisor incivility. According to Kanter,30 empowering employees involves providing access to information, support, resources, and opportunities, which contributes to their formal and informal power. Acts of bullying and incivility serve to take away power from others; therefore, it is not surprising that structural empowerment is related to lower levels of bullying and incivility. Our findings support results from a previous study showing significant relationships between structural empowerment, supervisor incivility, and coworker incivility in staff nurses.11
Finally, new graduate nurses’ psychological capital was significantly related to workplace mistreatment, although less strongly than work environment factors. Psychological capital may have a protective effect for new graduate nurses, possibly reducing the negative impact of exposure to workplace mistreatment. This may be due to an increased ability to cope with adversity and face challenging situations with hope and positivity.33
These results suggest modifiable work environment factors for nurse managers to target as a means of addressing workplace mistreatment. When managers are authentic in their relationships with their staff and create empowering, supportive work conditions, workplace mistreatment may be less likely to occur. However, the results also suggest that efforts to strengthen new graduates’ personal resources such as self-efficacy and resilience (psychological capital) may help mitigate the negative effects of workplace bullying and incivility.
Workplace incivility was also associated with job and career dissatisfaction, lower work engagement, higher emotional exhaustion, and poor physical and mental health, and increased job and career turnover intentions. Importantly, workplace incivility had weaker relationships with negative organizational and personal health outcomes than bullying did. This may simply reflect the fact that bullying behavior is more intense, prolonged, and targeted than uncivil acts. However, Hoel et al42 suggest that unchecked uncivil behaviors may escalate to stronger forms of workplace mistreatment. Thus, it is wise to initially address more subtle forms of workplace mistreatment.
Supervisor incivility and coworker incivility are similar forms of workplace mistreatment, but interestingly, our findings showed that work engagement was associated only with coworker incivility. One possible explanation for this finding is that new graduate nurses spend more time with their coworkers than with their supervisors while engaging in nursing work. This may speak not only to the significance of coworkers’ behaviors on new graduate nurse’s feelings of engagement at work but also to the distance between supervisors, who often spend a lot of time fulfilling their administrative duties, and staff nurses working at the bedside.
Bullying was more strongly related to all outcome variables than other forms of workplace mistreatment were. This is not surprising considering the increased intensity and duration of bullying compared with acts of workplace incivility. Our results show that new graduate nurses’ experiences of bullying are strongly related to both organizational and health outcomes. Although bullying was related to all outcome variables, strong associations with emotional exhaustion and job satisfaction were particularly concerning. New graduate nurses who find themselves emotionally drained and dissatisfied with their jobs are unlikely to remain in their positions and may even leave nursing. According to Johnson and Rea,8 nurses targeted by workplace bullying were twice as likely to want to leave their job.
Finally, all 3 forms of workplace mistreatment were associated with poor mental and physical health among new graduate nurses. This highlights the personal costs of workplace incivility and bullying on new graduate nurses. For many new nurses, the transition into the workplace is already a time of uncertainty and overwhelming change, which can be tremendously stressful. Experiencing bullying or incivility can make this transition even more difficult, especially when mental health and physical health are compromised as a result.
Our results suggest that both bullying and incivility have a negative impact on new graduate nurses’ work and health. Beginning nurses who experience workplace mistreatment at work are less likely to want to stay in their current job and may even end up leaving the profession as a result of the negative effects of these experiences. New graduate nurses are a valuable resource that the profession cannot afford to lose, especially in the context of an aging population and a shortage of nurses. Our results suggest that authentic leadership and empowering work environments that foster the personal growth of new graduate nurses may be promising retention strategies. Implementing practices to prevent and reduce workplace mistreatment targeting new graduate nurses is an important tactic for retaining new graduates, thereby contributing to the sustainability of the nursing workforce.
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