Strategies for New Graduate Nurses to Combat Bullying & Incivility

This literature review explores the pervasive issues of incivility, bullying, and violence in the nursing profession, highlighting their detrimental effects on healthcare professionals' performance and well-being. It addresses the prevalence of these issues in the Australian nursing context, referencing studies and legislative amendments aimed at combating workplace bullying. The central research question focuses on identifying primary and secondary strategies that new graduate nurses can utilize to overcome incivility and bullying. The review employs a comprehensive search strategy across multiple databases, utilizing specific inclusion and exclusion criteria to select relevant research articles. Key coping strategies identified include self-reflection, mindfulness, education, mentoring, and teamwork. The review emphasizes the importance of creating a supportive and positive work environment to mitigate employee turnover and promote the professional growth of new nurses. Desklib provides access to this assignment and other resources for nursing students.

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Name of the Student
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Introduction
Incivility, bullying and violence are one of the major issues in nursing profession that affects the performance and
concentration of healthcare professionals working in the facility (Griffin & Clark, 2014). Where bullying and violence are acts that
affect the person’s self-confidence and harm them physically, incivility is termed as the rude, disrespectful and discourteous behavior
that affect the person in the process negatively which lead them to several actions that can harm them as well as others in the
healthcare environment (Lachman, 2014). The American Nursing Association has described the definition of bullying as the repeated
and unwanted harmful humiliation, due to which the recipient feels humiliation and distress and affects their self-confidence and self-
esteemed (Spector, Zhou & Che, 2014). On the other hand, the world health organization determines violence as the verbal or physical
act, which is delivered by the patients or colleagues within healthcare related workplace and these activities are responsible for their
health and wellbeing deterioration (D'ambra & Andrews, 2014). Due to these factors within the healthcare facility blaming,
sabotaging, disclosing personal information or unfair activities happen. The type of violence that occurs in this society that occurs in
the nursing profession are customer and client related violence, criminal activities against nursing professionals, such actions due to
personal relationship and act of bullying due to worker on worker violence or action (Clark, Ahten & Macy, 2013). These acts of
violence, bullying and incivility are as Lachman (2014) mentioned that the root of bullying and violence depends on the unvalued,
isolation, disrespectful and lack of self-esteemed are in the nursing profession due to the availability of female professionals in nursing

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profession and powerful male physicians and doctors in higher positions. Therefore, this power distribution determined the prevalence
of such act of bullying and violence in nursing profession (Ariza-Montes et al., 2013).
Background
While discussing this issue in the context of nursing profession, it should be mentioned that bullying, incivility and violence is
not a recent phenomenon in this profession as in the year 1987, a researcher Cox warned the healthcare fraternity about the damages
they are going to face due to increasing violence and bullying in the profession (Allen, Holland & Reynolds, 2015). Further, in the
Australian nursing context as well there are plenty incidences and events analyzing which can determine the prevalence and
occurrence of these unwanted phenomena in the facility (Carter et al., 2013). In the year 2012, the researchers Kvas and Seljak (2014)
included a survey in their research paper that determined that 52% of the registered nurses and midwifes of healthcare facilities in
Victoria were facing trouble in their profession due to the occurrence of violence, incivility and bullying in the workplace (Hayward et
al., 2016). Further, recently in the year 2013, the Australian federal government passed an amendment in the parliament related to the
Fair Work Act that added several new standards and specific provisions about workplace bullying and violence and the Nursing and
Midwifery Board of Australia reflected the changes in policy by making amendments as per the act (Peters, 2014).
The negative affect the new graduate nurses would face due to such prevalence of violence is easily visible by going through
the statistics that determines that the number of nursing professions dropping out first few years of service is increasing in recent time

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(Carter et al., 2013). Further, these violence and bullying activities are difficult to control because nursing colleagues, patient, family
members and visitors and members of interdisciplinary teams, could have carried out such activities and hence, majority of the cases
are not even being disclosed to the higher authority of the healthcare authority (Hayward et al., 2016). Besides these issues are much
more broader than the activity of bullying as majority of the victim nursing professionals are female and new joiners to the facility and
they do not disclose such events as they think it will affect their professional career. Therefore, the prevalence of these unwanted
activities affect majority of the female and fresh graduate nurses who transform themselves to professionals in such facility (Hurley et
al., 2016).
Research question
The research question for this narrative literature review assignment will be as follows:
What are the primary and secondary strategies that new graduate nurses can utilize to overcome incivility and bullying
in their nursing profession?
Search strategy
Search strategy is an important tool to identify research articles analyzing which the answer of research question are found and
those articles are chosen on the basis of several factors specificity of which determines authenticity of search strategy. For this

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assignment several databases, which will be used to search research articles, are: PubMed, Cochrane, CINAHL, Google Scholar and
predefined key terms related to the research questions will be searched in these databases. The key terms that were used to search for
the articles are: strategies of nurses to overcome incivility and bullying, nursing strategies to overcome bullying and incivility in
workplace, nursing profession and bullying and violence, strategies to overcome bullying and violence in workplace and
nursing profession and associated bullying and violence. Further searching these key terms in CINAHL, Cochrane, PubMed
and Google scholar provides results 120, 247, 1418, 90070 respectively. After this, all these articles were sieved through several
inclusion and exclusion criteria so that required and appropriate research articles could be used for the literature review.
Inclusion and exclusion criteria
As the articles obtained from research included several relevant and irrelevant search results, the necessary research articles
were separated from the group of obtained results using different inclusion and exclusion criteria. The inclusion criteria included
required timeline, which was from 2013 to 2018. This was important as it determined the relevancy and authenticity of the research.
Further, English language, was preferred as the inclusion criteria to increase its relativity. Finally, articles, where strategies related to
coping from bullying and incivility and violence were used for prevention of such unwanted actions in healthcare facility were
included in the assignment.

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On the other hand, research articles beyond the decided timeline for the narrative literature review, language other than English
and having partial aspect of the research question were expelled from the assignment, as it would affect the primary aim of the
research. Finally, articles, which were non-specific with strategies about workplace bullying, harassment violence, books and
informative research articles, were excluded.
Literature Review
Self-Reflection:
Two out of ten research papers reviewed by us critically talked about the experience of nursing professionals with regard to
workplace bullying (Bowllan &Nancy,2015; Meires, 2018) .workplace bullying and violence have been reported to be the most
common concerns among healthcare professionals. Statistical evidences have reported the prevalence of approximately 70% newly
employed nursing professionals being bullied and humiliated at workplace (Meires,2018). It has also been suggested that in most of
the cases there is nil availability of social support to deal with workplace bullying. 1 out of 6 nursing professionals have confirmed
being exposed to workplace violence in Australia. Numerous determinant factors such as unavailability of peer support, being yelled
upon and negative team coordination have been reported to be determinants of workplace violence.

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According to the study conducted by Bowlan and Nancy (2015), workplace violence has been on the increase in comparison to
the recent scientific trends. The research paper critically evaluates the national and international prevalence rates of workplace
bullying. In this context, the authors of the paper have effectively suggested strategies such as incorporating effective training and
framing strict policies to reduce the rate of bullying and ensure cooperation to fresh nursing professionals.
Coping Strategies:
According to Green (2018), workplace incivility has been counted as the most common form of element that disturbs the
professional environment. The paper highlights the presence of uncivilized behavior across reputed health care organizations. The
paper further suggests interventions such as mindfulness strategies to effectively cope with the problem and avoid the worsening of
the scenario at the professional front. Inclusion of meditation has been reported as an effective intervention to channelize negative
thoughts into positive outlook and create a positive work environment. Further training and intimidation by seniors can further help in
effectively dealing with the occurrence of inappropriate behavior.
Education:

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A total of 3 out of the ten research articles reviewed have focused on education and awareness to reduce the prevalence of
workplace violence (Jenkins et al., 2013, Darla et al., 2013 & Hogan et al., 2018). A research study conducted by Jenkins, Kerber and
Woith (2013) has revealed the responses of healthcare professionals to effectively change with awareness strategy aimed at
highlighting the negative implication of workplace bullying. Incorporation of a blended learning procedure to spread awareness
related to the aggressive behavior and spreading awareness about workplace harassment has effectively helped in reducing the rate of
bullying events across healthcare organizations. It has been stated in this regard that an effective visual presentation about workplace
bullying and the associated negative impact that it can create can help in spreading awareness on large scale (Hogan et al., 2018).
Educating nursing professionals about the appropriate ethical code of conduct and nursing standard can help in dealing with the
seriousness of the issue (Jenkins, Kerber & Woith ,2013). Proper training to maintain team-coordination and extend support to
individuals has been documented to elicit positive outcomes. It is pivotal to identify and prioritize the need to check workplace
bullying so as to create and maintain a positive and healthy environment that would help enhance the professional experience of fresh
nursing professionals. In addition to this, scientific studies have also reported that on account of negative workplace bullying there
have been numerous cases of employee turnover (Hogan et al., 2018).
Nursing profession has been affected greatly with the problem of employee turnover. The major issue identified with employee
turnover is the amount of workload and non-cooperative behavior by the supervisors. Insufficient support from team leaders and co-
workers has also been reported as major contributors of negative workplace experience. Lateral violence has been reported to be one

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of the major causes of workplace violence in the nursing profession. Lateral violence primarily involves in indulging violence against
members of the peer group rather than engaging in violence with the offenders.
There is an increasing need to address the concern by adopting a strategy to address workplace abuse and violence related
concerns. Workplace violence can be classified as any form of physical or verbal abuse that affect the self-esteem and emotional
feelings of the professionals. Typically, a study conducted by the authors Darla, Susan, Edwards and Cristopher (2013) has identified
three major concerns that contribute to the cause of adverse violence. The contributing factors identified were listed as humiliating
behavior by the patient and the associated family members and non-cooperative behavior shown by colleagues and physicians. The
study followed a qualitative design and proceeded with the documentation of the negative experiences of nursing professionals at a
hospital setting. The authors proceeded with documenting the negative experiences of the professionals based upon a questionnaire
response (Darla et al., 2013). The findings of the study indicated that the negative environment at workplace has led to a serious case
of employee turnover. Recent trends in the nursing profession have witnessed an excessive amount of employee turnover which must
be addressed on immediate basis. According to the authors, inclusion of awareness programs can help in combating issues related to
employee turnover. Effective strategies that could be used to deal with the critical scenario would make use of the constructivist
grounded theory. The constructivist grounded theory aims at creating a positive work environment with the inclusion of cooperative
seniors and supervisors to guide the new registered nurses and make the professional experience a better one (Darla et al., 2013).

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Mentoring and Team work:
A total of 4 research articles have focused on devising effective team support strategies to deal with workplace bullying
(Vogelpohl et al., 2013;Strandmark et al., 2013;Melanio,2014;Del Pratto,2013 &Tee,2016). Research studies have further stated that
the employee turnover rate in the nursing profession is the highest and is almost around 42% (Tee, Ozcetin & Russell, 2016). The
primary need to include education related to the maintenance of ethical standard and involve in cooperative strategies can help in
improving team work and deal with issues related to employee attrition and turnover (Tee et al., 2016). The primary focus should be to
make the professional experience of the newly licensed nursing professionals to be a positive one. In addition to this, it can further be
stated that proper education to help the newly registered professionals to identify and report bullying and violence is pivotal (Del
Pratto,2013). Other strategies to ensure a healthy professional environment would include delivering training to the supervisors,
seniors and tenured employees to be supportive and be proactive in addressing the concerns of the new professionals.
Significant improvement can be witnessed on complying with the strategies and program. The awareness programs would also
help in pinpointing negative aspects of work culture. This would further help in designing strategies to adopt efficient measures and
tackle the associated scenario. Hence, it can be stated that the literary evidences clearly point out towards the fact that workplace
aggression and bullying is on the verge of rise and must steps must be taken to control the issue.

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Discussion
On closely analyzing the evidences furnished by the scientific papers it can be said that workplace aggression and
violence is a primary problem in the nursing profession. Majority of the new registered nurses who have recently entered the
profession have reported to be victims of workplace abuse at least once in their entire tenure of professional experience
(Melanio,2014). In addition to this the research papers have also identified a relationship between the employee turnover rate and
negative workplace experience. Violence in different forms has been reported by nursing professionals (Melanio,2014). Non-
cooperation from team members, verbal abuse and ill treatment by the immediate family members of the patients has been recorded to
be some of the negative experiences. Uncivil behavior by peers and engaging in lateral violence has also been defined as negative
elements tightly linked to workplace violence (Vogelpohl, Rice Edwards& Bork,2013). The findings of the research papers highlight
the need to adopt stringent measures to check workplace bullying. Effective strategies such as mindfulness based practices like
indulging in yoga has been reported to be effective in dealing with work stress (Egues & Leinung, 2013).
The primary requirement to deal with the criticality of the issue, based upon the evidence furnished by the research studies can
be defined as the lack of awareness. Nursing educators and supervisors must actively engage in dispensing training to the subordinates
about the maintenance of a positive work environment. In addition to this, it is also important to train the new professionals about the
difference between a bullying and job responsibility (Egues & Leinung, 2013). Inclusion of anti-bullying committees across various

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healthcare organizations can help in stringent monitoring of case related to bullying and workplace aggression. Strong HR policies to
ensure zero incidence of bullying should be included on a mandatory basis across various hospitals and care homes. In addition to this
the employees must be made aware about the perception of workplace bullying as a punishable offence. Offenders detected in
practicing any form of bullying must be treated with severity. This is expected to make other employees aware about the critical
implication of the offence and strictly adhere to the ethical standards.
Installation of anti-bullying posters across various healthcare organizations can help in creating awareness to the maximum and
successfully attract the attention of all the healthcare professionals. Therefore, it can be said that on complying with the discussed
strategies the workplace environment can be improved significantly. Improved work environment would encourage the professionals
to continue with the noble profession and the problems related to employee turnover would also be tackled in a smooth manner (Egues
& Leinung, 2013).
Conclusion
Hence, to conclude it can be said that work place aggression and bullying elicits a negative impact on the mind-set of the
employees. On an average a major proportion of nursing professionals have expressed discontent with the job role. The responses
have mainly revealed negativity in terms of work environment, stress and insulting behavior from superiors. In order to ensure a
positive working environment it is essential to eradicate workplace bullying completely. Strategies such as spreading awareness and