Research Report: Workplace Bullying in Perioperative Settings

This report critically analyzes workplace bullying within operating rooms, focusing on perioperative nurses, surgical technicians, and unlicensed preoperative workers. The study utilizes questionnaires distributed to respondents, followed by data analysis using statistical methods and software. The research reveals a positive correlation between workplace bullying in the operating room and adverse patient health outcomes. The report details the study's aims, objectives, research methodology including the conceptual model, study design, data collection procedures, and data analysis techniques. It assesses the prevalence of bullying, the impact of demographic variables, the relationship between emotional exhaustion and bullying, and the connection between bullying and patient safety. The findings highlight the negative consequences of workplace bullying, including its effects on organizational culture, work ethics, and the well-being of healthcare professionals. The report also discusses various bullying behaviors, sampling techniques, data collection methods, and data analysis, offering insights into the complexities of workplace bullying in healthcare settings.

Running head: SOCIAL ISSUES
Introduction to Social Research Methods
Name of the student:
Name of the University:
Author Note:

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Executive summary
The main aim of the report is the critically analyze the workplace bullying that occur in an
operating room. The study mainly focusses on the perioperative nurses, surgical technicians and
unlicensed preoperative workers. The sampling techniques are based on delivering cover letter to
each of the respondents, and those data were accumulated in the form of questionnaires. This
data was further analyzed through software and statistical methods. The study showed that there
is a positive relation between the workplace bullying in an operating room and the patient health
outcomes.

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Table of contents
1. Introduction..................................................................................................................................3
2. Background and significance.......................................................................................................3
3. Aims and objectives of the study.................................................................................................5
4. Research methodology.................................................................................................................5
4.1 Conceptual model..................................................................................................................5
4.2 Study design...........................................................................................................................6
4.3 Procedure of data collection..................................................................................................7
4.4 Data analysis..........................................................................................................................8
5. Critical assessment.......................................................................................................................9
Conclusion.....................................................................................................................................11
References......................................................................................................................................12

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1. Introduction
Workplace bullying is a repeated phenomenon in which a person experiences ill
treatment from the people in the workplace, such occurrences lead to harm a person mentally and
physically. There are several different types of bullying which includes physical abuse,
nonverbal, verbal, psychological humiliation. Workplace bullying is different from the bullying
that occur in schools. Workplace bullying occur within the established framework of rules in an
organization and workplace. Studies reveal that the occurrences of bullying often occur when the
person who is getting bullied is authoritatively lower than the person who is bullying. Whereas,
bullying also occurs among the peers and also within the subordinates (Nielsen & Einarsen,
2012). Bullying is of two types; one is overt bullying another is covert bullying. The ill effects of
bullying are not restricted to the affected person, but it also affects the culture in an organization
and also the work ethics among the employees. There are a lot of researches and studies
conducted on the occurrence of bullying in an organization and also bullying occurring at the
group level. These researches mainly focus on the effects and the impacts of bullying on the
affected person (Samnani & Singh, 2012). This study also deals with one such research journal
on the workplace bullying in the operating room. The aim of the study includes critical
assessment of the how the author depicted bullying in the paper, a critical discussion on the
sampling techniques, the methods used during the data collection and how the data was analyzed.
2. Background and significance
The Author emphasized on the negative effects of workplace bullying as the main
rationale behind the study. Workplace bullying is a repeated, totally intentional and isolated
sequence of events that lead to negative impacts of the proper working environment on an
organization or in a hospital. According to Branch, Ramsay & Barker (2013), the workplace

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bullying is categorized solely as personal and work related. Certain behaviors that are considered
unacceptable in the workplace include isolating, excluding and ignoring an individual,
humiliating a person in front of a group of coworkers, undermining a person’s integrity, using
slangs against a person in a workplace, openly attacking a person’s religious belief and making
bad remarks upon a person’s community and skin color, and even the physical abuse is
considered as a workplace bullying. Along with these mentioned practices in the workplace,
there are other type of bullying in the workplace which are work related, like imposing works
that are hard to perform and have impractical deadlines, imposing tasks on an employee which
are beyond the expertise of the concerned employee, also another wrong practice is taking the
credits of another person’s hard work, and criticizing and relieving a person from the
responsibility. It is a known fact that acknowledging the workplace bullying among the nurse is a
difficult part to consolidate (Berry et al., 2012), there are several studies conducted upon the
workplace bullying among the nurses, however the methodologies followed in such studies is
different. Hence, a comparison cannot be established within the studies. Also, the several studies
conducted is based on different sampling techniques in the different healthcare environments.
Studies reflect that, in a workplace the newly graduated nurses experience 20% to 32%, while in
the emergency departments the incidence of bullying is around 22.9%. A study conducted among
the British population of nurses, showed a remarkably higher incidence of bullying is found to be
experienced by the nurses which is around 35.8%. The data is exceptionally high among the
newly graduated nurses in comparison with the nonprofessional and professional coworkers.
While studies conducted among the Turkish nurses revealed that 20% of nurses reported about
intentional bullying. According to Park, Cho & Hong (2015), the operating room is considered as
a part of the workplace in hospitals within which disruptive behaviors, interpersonal conflict,

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bullying behaviors and stress are common occurrences. There are several terminologies that are
used to define bullying under several circumstances like lateral violence, peer incivility,
disruptive behaviors, workplace incivility and horizontal violence. Study conducted among the
perioperative registered nurses revealed that reveal that perioperative registered nurses behave
negatively, and another issue is that often perioperative RNs criticize the work of the other
employee in front of other coworkers. According to Frederick (2014), a higher incidence of
workplace bullying in found in the perioperative environment. Also from the same study, the
disruptive behaviors affected the work quality and increased the medical errors.
3. Aims and objectives of the study
The aims and objectives of the study are segregated into four different points. The first
aim of the study is to illustrate the prevalence of workplace bullying within the perioperative
registered nurses, unlicensed perioperative workers, surgical technicians at the two-different
academic medical hospitals. The second aim is to investigate whether ethnicity, gender, years of
profession, years of experience within a unit, and the title of the job can envision the incidence of
workplace bullying. the third aim is to investigate whether there is a positive relation between the
emotional exhaustion and workplace bullying within the perioperative registered nurses and staff
members. The fourth aim is to investigate whether there is any relation between the workplace
bullying and patient safety in the operating room (Chipps et al., 2013).
4. Research methodology
4.1 Conceptual model
The Author during the conduct of the research, used a model which is based on a model
developed by Hutchinson et al (2010). The model emphasizes on the presence of organizational
antecedents which lets the bullying to coexist in the work environment. Organizational

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antecedents include several others factors which consolidate the effect of workplace bullying.
These factors include unofficial organizational alliances, maltreatment of the legitimate
procedures, authority and processes. Unofficial organizational alliances include the formation of
groups of workers that promote an environment which is favorable for workplace bullying.
Managers, who can actively control the bullying is himself engaged in the activity. While the
managers are authorized to control such ill activities, are engaged in the misuse of the authority.
These activities are an overall effect of the unofficial existence of informal alliances that
promotes workplace bullying. According to Hutchison et al. (2010), the bullying acts are
categorized into 3 different domains: personal bullying, bullying through the works or tasks
assigned, bullying on the competence and reputation. Personal bullying includes the acts of
humiliation, isolation, intimidation and threats. The work-related humiliation includes hindrances
in work, economic sanctions. While bullying on competence and reputation includes tarnishing
the professional image and hindering the career opportunities. The activities of bullying become
normal in a workplace when bullying is accepted as a friendly behavior in the work group. The
consequences of bullying include unwillingness and distress during work, it makes the
employees less engaged resulting in the reduction of productivity. There are other consequences
which are reported by the affected individuals which include higher levels of anxiety,
interruptions and depressions during the progress of career (Rodwell & Demir, 2012).
4.2 Study design
The Author designed a cross-sectional survey. The sample size included 167 registered
nurses, unlicensed perioperative workers that are working in operating room, surgical technicians
at the 2 academic medical institutions. There is also an exclusion criterion which includes the
employees who have worked under 6 months and the employees who work less than half

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percentage of work for a week. Workplace bullying was measured using a Revised- Negative
Acts Questionnaire (NAQ-R) (Vogelpohl et al., 2013). the NAQ-R was developed to measure the
exposure to bullying in any kind of work setting. The respondents were asked whether they
experienced any bullying within the preceding 6 months by answering the 22 questions in the
questionnaire. While the terms harassment and workplace bullying were not used in the
questionnaire instead bullying was mentioned as negative acts. How frequent the respondents
experienced the negative behavior was actually documented in the answer section, and the
validity of the answers was determined with the Cronbach alpha score (Eisinga, Te Grotenhuis &
Pelzer, 2013), which ranged between 0.80 to 0.91. Emotional exhaustion was measured as part of
the study through the emotional exhaustion subscale Maslach Burnout Inventory (MBI). This
scale measures the emotional distress during the job. The participants were further asked to
answer 23 questions among which 8 questions are based on the demographic information, 8 on
the bullying behaviors and the remaining 7 were based on estimating the expectations, errors and
patient safety. The data accumulated from the two-different academic medical hospitals were
collected and further used for data analysis.
4.3 Procedure of data collection
After getting the approval from both the hospitals, then the research team conveyed the
data collection methodology to the perioperative nurse managers and conducted meetings with
the perioperative staffs. The sole purpose is to introduce the whole procedure to the eligible
participants. Before the beginning of each and every survey the research team conveyed a clear
message through a cover letter depicting the aims and objectives of that particular study. There
was also an option for the participants to opt out of the study by not reverting the survey. These
cover letters were sent to all the eligible participants (Chipps et al., 2013). The cover letters as

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returned by the participants from each of the hospitals kept confidential and these surveys were
treated as data sets and were later used for statistical analysis.
4.4 Data analysis
For the data analysis the data accumulated were entered into the IBM SPSS statistics
version 19.0 software. A descriptive statistic for each of the hospital was calculated based on the
demographic data. For the categorical variables, Frequencies and percentages were calculated
while for the continuous variables, standard deviation and means were calculated. The data
collected through the NAQ-R were analyzed for the calculation of intensity, frequency as well as
target scores. the frequency of workplace bullying is calculated by the adding the negative acts
which are experienced by the participants on a daily or weekly basis. The Author considered the
participants as targets of bullying when the participants experienced bullying or the negative acts
twice of more than twice daily or weekly. A logistic regression model is used in order to
determine that the demographic variables have a positive correlation with the target status
(Allison, 2012). The target status is defined as “no means zero” whereas “yes means one”. The
independent variables involve the individual demography of both the hospitals, registered nurses
and the non-registered nurses, age, experience of the employees in terms of year in the medical
unit, and ethnicity. In a similar fashion the author designed multiple regression model in order to
determine that the demographic variables are signifying the intensity of bullying. the continuous
bullying intensity is considered as a dependent variable while the other demographic variables
were considered as independent variables. The author utilized the spearman’s rank correlation
coefficient to establish a relationship between emotional exhaustion and the participants
experiencing the workplace bullying (Zionts, 2012). a logistic model is also developed which
signifies which bullying tendencies resulted in to compromising the patient safety. Within this

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model, the dependent variable included the compromise of patient safety as no and yes responses
with values of zero and one respectively. Also, each of the negative responses from the NAQ-R
is entered separately into the regression model.
5. Critical assessment
According to the author, workplace bullying is a repeated, totally intentional and isolated
sequence of events that lead to negative impacts of the proper working environment on an
organization or in a hospital. Workplace bullying is major problem which is occurring among the
perioperative Registered nurses, unlicensed perioperative workers and surgical technicians in the
operating rooms (OR). While the survey conducted did not have the words like bullying and
harassment in the questionnaire, instead these words are substituted as negative acts. Bullying
was measured or quantified based on the common demographic variables like the gender,
ethnicity and age. The quantification was also based on other important factors like the years of
profession and experience, years of experience in the particular medical unit, title of the job and
the job role. While the study was completely based in the operating room of a hospital
environment. It neglected the general occurrence of workplace environment n the other types of
working environment (Power et al., 2013). The study emphasized on the occurrences of bullying
in the operating rooms which can be considered as a micro environment. Although the other
aspects of bullying that occur within the other medical units and department of a hospital are not
accounted and dealt. Thus, it can be said that although the studies related to bullying in the
operating rooms were very minimal, and this particular gave a detailed and descriptive analysis.
Yet it failed to highlight the other instances of bullying in different circumstances that arise due
to medical emergencies in other units (Gokhman et al., 2012).

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The sampling process is kept confidential by delivering the cover letter to each of the
participants through mail. The participants were employees from two different hospitals which
included the perioperative nurses, surgical technicians and the unlicensed perioperative workers.
It is important to mention that along with the above-mentioned personnel in the operating rooms,
there are other personnel who have a contributory effect on the operating room environment.
Like the scrub nurse, anesthesiologist, circulating nurse (Russ et al., 2013). These personnel are
not taken in to account during the study, which somewhat decreases the effectivity of the study.
The data collection methods were majorly based on the survey conducted through
questionnaires that are based on the negative acts experienced by the participants. The study
even has the option for the participants to opt out from the study process by not submitting the
survey. This somewhat makes the sampling method lose its grip from the effective sampling size.
The questions framed lacked the flexibility of expression. Other sampling methods like
undisclosed interviews with the affected personnel can effectively highlight the exact cause of
work place bullying. The analysis of the data is completely based on statistics and because it did
not take into account of other sampling techniques like interviews (Rowley, 2012). Thus, the
results reflected data based on the negative acts experienced by the respondents on a daily and
weekly basis.
Although the study has its drawbacks which are discussed above, the study does have
strengths. The first major strength is that study on workplace bullying in operating room is not a
well-researched field and not enough studies were done before. This particular study highlighted
and revealed a lot of hidden aspects of workplace bullying in the operating room. The second
major strength is that the workplace bulling not only affects the targeted person but it also has an

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equally negative impact on the patient health outcomes including the patient safety, mortality,
satisfaction and as well as negative patient events (Laschinger, 2014).
Conclusion
Therefore, from the above study it can be concluded that workplace bulling is an
unpleasant phenomenon that occurs within the workplace and work groups. The negative
impacts of workplace bullying not only affects a targeted person mentally but also physically
which hampers his or her productivity. Whereas, such occurrences in a medical unit can have
serious impact on the health outcomes of the patients. The study focusses on the workplace
bullying in operating room and it presented with a detailed an exhaustive analysis of the results.
However, it failed to take into account the other personnel like scrub nurse, circulating nurse and
anesthesiologist that work in an operating room. While the study had drawbacks in the method of
sampling and representation, also it failed to suggest any effective remedy of workplace
bullying. However, the study did mention about the negative impacts on the patient health
outcome due to the incidence of bullying in the operating room.