| BackgroundWorkplace bullying(WPB)involves systemic aggression with negative behavior acts targeted towards an individual on a repeated basis.WPB amongst nursing colleagues manifests in different forms such as gossiping,false allegations,irrational work assignment,strict supervision,and intimidation.In the nursing profession,studies on exposure to WPB have been increasing rapidly over the past two decades.However,limited studies have been undertaken to investigate the prevalence of exposure to WPB amongst nursing colleagues and its associated impacts on nurses’ health and patient safety culture within the Chinese healthcare system.Also,the influence of Chinese workplace culture in shaping nurses’ perceptions,responses/coping,and prevention of WPB remain less extensively studied especially in Shandong Province.ObjectiveWe aimed to determine and describe the prevalence and risk factors for exposure to WPB amongst nursing colleagues and its impacts on victims’ mental health,and hospital patient safety culture in the Chinese healthcare system.Also,we aimed to explore the influence of Chinese workplace culture in responding to and preventing WPB in the clinical nursing environment.MethodologyWe adopted a mixed-methods design with a dominant arm descriptive cross-sectional design.In phase one,we surveyed 521 full-time registered nurses at a tertiary teaching hospital in the Peoples’ Republic of China.Data were collected from May 1st to July 30th,2021 via an online questionnaire.We used the Negative Acts Questionnaire(NAQ-R 22)to assess the prevalence of WPB;General Health Questionnaire(GHQ-12)to assess nurses’ mental;and the Hospital Survey on Patient Safety Culture(HSOPSC)to assess hospital patient safety culture.Quantitative data were analyzed using descriptive statistics,correlational analysis,linear regression,and mediation analysis by using SPSS version 24.0.During analyses,a p-value of<0.05 and 95%Confidence Intervals were regarded as statistically significant indicators.In phase two,we conducted a focused ethnographic study with field observations,four informal interviews,five qualitative narratives,and one semi-structured face-to-face focus group discussion with a purposive sample of seven nurses.Qualitative data were analyzed by a fourstep qualitative content analysis method.Coding was done line-by-line to generate a thematic map that forms the basis of our qualitative findings.ResultsAbout 521 nurses participated in the quantitative survey.Ninety-four(18%)nurses were exposed to at least one negative behavior weekly.The risk factors for WPB were young age,having direct interaction with patients,and having temporary employment.Multivariate linear regression analysis show that WPB positively predicted nurses’ mental health symptoms(B=0.101,p<0.001).Unfortunately,nearly half of participants(n=234,44.9%)reported experiencing mental health problems,with the bedside nurses being the common victims once exposed to WPB(B=1.385,p=0.043).Senior nurses perceived good hospital patient safety culture while nurses from the Intensive Care Unit(ICU)were less likely to perceive good hospital patient safety culture than their counterparts.Furthermore,exposure to WPB directly(B=-0.749,p<0.001)decreased hospital patient safety culture.The qualitative ethnographic content analysis produced one overarching theme that contains six sub-themes that complement the quantitative findings:frequency and the manifestation of WPB;perceived risk factors for WPB;nurses’ perceived responses to WPB;perceived impacts of WPB on nurses’ mental health and patient safety;perceived individual and leadership levels bullying prevention strategies;and nursing organizational culture in shaping WPB.ConclusionWPB amongst nursing colleagues was contemplated to be a silent issue within the Chinese nursing workforce.However,the current study shows that Chinese nurses have started to reveal their experiences with exposure to WPB whereby junior nurses are the common targets.This acknowledgment of the problem is crucial in setting a better nursing work environment.Implications for nursing practiceNurse leaders and administrators should encourage staff nurses to report the possible workplace toxic environment that may affect nurses’ mental health which may jeopardize patient care outcomes.Furthermore,nurse leaders should embrace an authentic leadership style that enhances an open-door policy and implementation of zero-tolerance to WPB.Finally,victims of WPB should adopt positive coping mechanisms to reduce the adverse consequences of WPB. |
