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Bullying among nursing staff: Relationship with psychological/behavioral responses of nurses and medical errors

Wright, Whitney; Khatri, Naresh

doi: 10.1097/HMR.0000000000000015

Aim: The aim of this article is to examine the relationship between three types of bullying (person-related, work-related, and physically intimidating) with two types of outcomes (psychological/behavioral responses of nurses and medical errors). In addition, it investigates if the three types of bullying behaviors vary with age or gender of nurses and if the extent of bullying varies across different facilities in an institution.

Background: Nurses play an integral role in achieving safe and effective health care. To ensure nurses are functioning at their optimal level, health care organizations need to reduce negative components that impact nurses’ job performance and their mental and physical health. Mitigating bullying from the workplace may be necessary to create and maintain a high-performing, caring, and safe hospital culture.

Methods: Using an internal e-mail system, an e-mail requesting the participants to complete the questionnaire on Survey Monkey was sent to a sample of 1,078 nurses employed across three facilities at a university hospital system in the Midwest. Two hundred forty-one completed questionnaires were received with a response rate of 23%. Bullying was measured utilizing the Negative Acts Questionnaire-Revised (NAQ-R). Outcomes (psychological/behavioral responses of nurses and medical errors) were measured using Rosenstein and O’Daniel’s (2008) modified scales.

Results: Person-related bullying showed significant positive relationships with psychological/behavioral responses and medical errors. Work-related bullying showed a significant positive relationship with psychological/behavioral responses, but not with medical errors. Physically intimidating bullying did not show a significant relationship to either outcome. Whereas person-related bullying was found to be negatively associated with age of nurses, physically intimidating bullying was positively associated with age. Male nurses experienced higher work-related bullying than female nurses.

Conclusion: Findings from this study suggest that bullying behaviors exist and affect psychological/behavioral responses of nurses such as stress and anxiety and medical errors. Health care organizations should identify bullying behaviors and implement bullying prevention strategies to reduce those behaviors and the adverse effects that they may have on psychological/behavioral responses of nurses and medical errors.

Whitney Wright, MHA, is Business Manager, Therapy Services, University of Missouri Hospital & Clinics, Columbia.

Naresh Khatri, PhD, is Associate Professor, Department of Health Management and Informatics, University of Missouri, Columbia. E-mail:

The authors have disclosed that they have no significant relationship with, or financial interest in, any commercial companies pertaining to this article.

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved