Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Nurse-Reported Bullying and Documented Adverse Patient Events

An Exploratory Study in a US Hospital

Arnetz, Judith E. PhD; Neufcourt, Leo PhD; Sudan, Sukhesh MPH; Arnetz, Bengt B. MD; Maiti, Tapabrata PhD; Viens, Frederi PhD

doi: 10.1097/NCQ.0000000000000442
Original Article: PDF Only

Background: Negative nurse work environments have been associated with nurse bullying and poor nurse health. However, few studies have examined the influence of nurse bullying on actual patient outcomes.

Purpose: The purpose of the study was to examine the association between nurse-reported bullying and documented nursing-sensitive patient outcomes.

Methods: Nurses (n = 432) in a large US hospital responded to a survey on workplace bullying. Unit-level data for 5 adverse patient events and nurse staffing were acquired from the National Database of Nursing Quality Indicators. Generalized linear models were used to examine the association between bullying and adverse patient events. A Bayesian regression analysis was used to confirm the findings.

Results: After controlling for nurse staffing and qualification, nurse-reported bullying was significantly associated with the incidence of central-line-associated bloodstream infections (P < .001).

Conclusions: Interventions to address bullying, a malleable aspect of the nurse practice environment, may help to reduce adverse patient events.

Department of Family Medicine, Michigan State University College of Human Medicine, Grand Rapids (Drs J. E. Arnetz and B. B. Arnetz and Mr Sudan); Department of Statistics and Probability, Michigan State University, East Lansing (Drs Neufcourt, Maiti, and Viens); and Facility for Rare Isotope Beams, Michigan State University, East Lansing (Dr Neufcourt).

Correspondence: Judith E. Arnetz, PhD, Department of Family Medicine, Michigan State University College of Human Medicine, 15 Michigan St NE, Grand Rapids, MI 49503 (

This study was funded by a grant from the Sparrow/Michigan State University Center for Innovation and Research.

The authors thank Julien Chhor for technical assistance with this article.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

The authors declare no conflicts of interest.

Accepted for publication: September 1, 2019

Published ahead of print: September 30, 2019

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved