Nurse Bullying: Impact on Patient Safety and Quality Care

This article discusses the impact of nurse bullying on patient safety and quality care. It covers the competencies for graduate nursing programs, lateral violence, caring model of care, issues identified, and best practices for registered nurses and employers.

Running head: NURSE BULLYING
NURSE BULLYING
Name of the student
Name of the university
Author’s name

1NURSE BULLYING
Question 1:
Nurses while working in clinical settings must possess the core competencies in order to
deliver a quality care that eventually improves patient’s health outcome and increases patient’s
satisfaction. In order to facilitate the delivery of an enhanced nursing care nurses need to be
competent enough and possess the skill set required to provide care to the patients. For a
graduate nurse it is important to have adequate skills to problem solving and possess the
competencies essential for giving an enhanced nursing care to the patients. Therefore, the goal of
the Quality and Safety Education for Nurses aims at preparing the future nurses by giving them
proper knowledge, skills and attitudes that are necessary for improving the quality of care and
promote safety of the health organizations of their work.
The competencies for graduate nursing programs for an advanced nursing practice are
recognized in the following area:
Patient centred care, Evidence Based Practice (EBP), Quality improvement (QI), Safety,
Teamwork and Collaboration and Informatics.
Patient Centred Care:
The nurses must work within the framework of patient centred care by recognizing and
respecting patient’s preferences, belief, values and needs and treat them accordingly. The nurses
are also taught to integrate in their care, the understanding of all the dimensions of patient
centred care that is, patients, their family and community and their values and preferences. The
victims of bullying are subjected to terror, anger, exclusion, deprivation of funds, isolation and
prevented from claiming rights. Working satisfaction, working output, motivations and

2NURSE BULLYING
productivity reduces that act as a barrier in providing patient centred and high quality nursing
care.
Quality improvement (QI): nurse bullying and workplace violence have negative consequences
on nursing practice and act as a barrier in delivering optimal patient care. These kind of
aggressive and repetitive behaviours are common in nursing workplace and can cause both
psychological as well as physical harm that eventually disrupts nursing care and threaten patient
safety and quality care (Yıldırım, 2009).
Teamwork and Collaboration: Bullying decreases patient safety through interference in
cooperation, interaction and teamwork which are essential in nursing care.
Question 2:
Nursing is a profession that requires a compassionate and sympathetic attitude in the
workplace to care for people from a holistic point of view. However, despite of the presence of
core values and attitudes among the nurses, workplace bullying and lateral violence are
inevitable in healthcare settings. Lateral violence involve the actions that demonstrate deliberate
harmful behaviours by one employee towards the other. This creates unnecessary stress for the
nurses who are bullied that eventually impacts their performance leading to an ineffective and
poor outcome. This type of harmful behaviours have negative consequence on nursing practice
and act as a barrier in delivering optimal patient care (Christie & Jones, 2014). Although these
behaviours does not implicate any physical harm but the cumulative effects of these actions have
serious consequences in the nursing practice that eventually compromises with patient’s safety.
American Nurses Association defines Lateral Violence as a deliberate act between colleagues
that involves covert acts of both verbal and nonverbal aggression showing dissatisfaction

3NURSE BULLYING
towards one another and towards those who are less powerful than themselves. The attitudes and
behaviours that contribute to lateral violence includes being hypercritical, blaming in every
situations, criticizing, gossip, exclusion from group or group clique behaviour, shouting at
others, refusing to help and showing disrespect. These kind of aggressive and repetitive
behaviours are common in nursing workplace and can cause both psychological as well as
physical harm that eventually disrupts nursing care and threaten patient safety and quality care
(Ariza-Montes et al., 2013).
Question 3:
Caring model of care encompasses a humanitarian caring process by involving
transpersonal caring as a framework for delivering care that involves science, arts, humanities,
and spirituality that are central to quality nursing practice. The Caring theory was developed by
Jean Watson that focuses on holistic approach to care and believes that an individual is fully
recovered or healed from illness given a care from a holistic point of view. The theory believes
that nurses must deliver care by building a caring relationship that promotes health of the patient
and facilitate the delivery of an enhanced nursing care (Clark, 2016). The caring theory mainly
focuses on the areas of transpersonal relationship which must be maintained by the nurses to
promote health of the patients and enabling a faster recovery of the patients. The caring theory
guides the nurses to focus on the psychological and spiritual needs of the patients following an
individualized and patient centred care to restore inner harmony of the patients by providing a
high quality nursing care that satisfies the mind, body and soul of the patients thereby promoting
their health (Clark, 2016). The theory is applied to the nursing practice with the primary
objective to help other individuals by reaching a state of harmony and peace within mind and

4NURSE BULLYING
soul hat can be achieved by a holistic and enhanced nursing care. The application of this theory
in nursing practice requires attitudes of concern and empathy towards the patients in order to
achieve the desired outcome.
Question 4:
The two issues identified in this area are:
Poor performance and compromising patient safety: Nursing professionals with workplace
violence may face physical and psychological distress, which can influence their ability to
conduct daily operations, relationships with other individuals, standard of lives and the
healthcare system (Gaffney et al., 2012). In addition, violence in the workplace affects the entire
employer health institution, affecting its staff, which may lead to reduction in workforce rates,
compromise the quality of the care provided and lead to costs. Bullying provides a toxic
environment for victims, organizations and finally patients with severe effects (Gaffney et al.,
2012). Their self-esteem is diminishing and their doubts are undermining their initiative and
innovation. Many new nurses are unaware of their results and require favourable feedbacks,
making them feel unseen, incompetent and inferior. Stress issues, such as nausea, headache,
insomnia, anxiety, depression, change in weight and alcohol and consumption of drugs, are
susceptible to bullying victims. Bullying decreases patient safety through interference in
cooperation, interaction and teamwork.
Increasing Nurse Turnover: The availability of health care workers in clinics remains to
influence medical care schemes ' capacity to provide efficient care and to guarantee patient
safety. Bullying is a variable which is recognized to exacerbate nurse turnover. Nurses should

5NURSE BULLYING
increase their understanding of the adverse effects of bullying at work (Tsai et al., 2014). In
addition, nurses should put in place suitable processes to reduce the occurrence of interpersonal
bullying and violence, enhance the environment in compassionate jobs and reduce the turnover
target. Many nurses leave their jobs when they are confronted to bullying and workplace
violence instead of raising their voice (Weaver, 2013).
Question 5:
The Occupational Health and Safety Agency (OSHA) define violence in the workplace as
any physical act or risk of harassment, intimidation or other disruptive behaviour, occurring at a
workplace (Osha.gov, 2019). In every setting, including practice, academics and research, every
RN and employer must work together to create a culture of respect free from incivility, bullying
and violence in the workplace. Best practice-based evidence must be introduced to avoid, and
mitigate incivility, intimidation, and violence in the workforce to support health, safety and
wellness of RNs (Osha.gov, 2019).
When it is about workplace violence, organizations must work out an implementation
plan for handling workplace violence. The common and best practices that are identified for
reviewing workplace violence prevention program include:
Best practices for Registered Nurses:
 RNs must commit to establishing and encouraging good interactions between themselves
and with all of the health-care group employees — and embrace accountability for them.
 RNs must be aware of their own relationships, including behaviour and communications
with others. This involves insisting on and participating in efficient interaction, diversity

6NURSE BULLYING
and inclusiveness as well as dispute negotiation, conflict resolution and employer-led
coaching, an academic program or ongoing training classes.
 If RNs encounter uncivility and bullying, they can either answer the perpetrator straight,
or pursue assistance via the suitable channels. Incivility and intimidation offenders should
be treated publicly if feasible.
Best practices by the Organization or employer:
 Employers need to ensure a close alignment between the organizational vision, mission,
philosophy and common values and the culture of respect and safety.
 Employers shall establish a policy on zero tolerance of incitement and abusiveness, in
which all incivilities and harassment cases, irrespective of who is involved, are treated in
the same manner. This strategy must provide corrective measures and must timely and
efficiently mitigate inappropriate behaviour. Employers must encourage supportive
workplaces where respectful communication is the norm, corporate policies and
professional codes are respected and understood and followed.
 Employers should develop an extensive program of prevention of violence that is in line
with the "Guidelines for Preventing Workplace Violence for Healthcare and Social
Service Workers” of the Occupational Safety and Health Administration
 Employers must provide training to define incivility, tolerance strategies, to discuss the
zero-tolerance policy of the organization and to explain the consequences that policy
failure can lead to.

7NURSE BULLYING
Question 6:
I have learnt the ways to manage such situations and respond by applying effective
measures. As a nurse, I will try to educate other nurses regarding the negative impacts or
consequences nurse bullying can have on the performance of the victim that eventually
contributes to an impaired and a low patient health outcome and compromise patient’s safety. I
will make them aware of the nursing ethics and standards that are applied while working in
clinical settings and how the nurses must work by aligning with those standards in order to get an
improved heat outcome of the patients.

8NURSE BULLYING
References:
Ariza-Montes, A., Muniz, N., Montero-Simó, M., & Araque-Padilla, R. (2013). Workplace
bullying among healthcare workers. International journal of environmental research and
public health, 10(8), 3121-3139. Doi: 10.3390/ijerph10083121
Christie, W., & Jones, S. (2014). Lateral violence in nursing and the theory of the nurse as
wounded healer. Online journal of issues in Nursing, 19(1), 27-36. Doi:
10.3912/OJIN.Vol19No01PPT01
Clark, C. (2016). Watson’s human caring theory: Pertinent transpersonal and humanities
concepts for educators. Humanities, 5(2), 21. Doi: 10.3390/h5020021
Gaffney, D. A., DeMarco, R. F., Hofmeyer, A., Vessey, J. A., & Budin, W. C. (2012). Making
things right: Nurses' experiences with workplace bullying—A grounded theory. Nursing
research and practice, 2012. Doi: 10.1155/2012/243210
Osha.gov. (2019). Safety and Health Topics | Workplace Violence | Occupational Safety and
Health Administration. Retrieved 18 September 2019, from
https://www.osha.gov/SLTC/workplaceviolence/
Tsai, S. T., Han, C. H., Chen, L. F., & Chou, F. H. (2014). Nursing workplace bullying and
turnover intention: an exploration of associated factors at a medical center in Southern
Taiwan. Hu Li Za Zhi, 61(3), 58. Doi: 10.6224/JN.61.3.58.

9NURSE BULLYING
Weaver, K. B. (2013). The effects of horizontal violence and bullying on new nurse retention.
Journal for nurses in professional development, 29(3), 138-142. Doi:
10.1097/NND.0b013e318291c453
Yıldırım, D. (2009). Bullying among nurses and its effects. International nursing review, 56(4),
504-511. Doi: 10.1111/j.1466-7657.2009.00745.x