Lesley M Wilkes

Integrating individual, work group and organizational factors: testing a multidimensional model of bullying in the nursing workplace

AIM The aim of the present study was to test a multidimensional model of bullying in the nursing workplace. BACKGROUND This paper is part of a larger study of bullying in the Australian nursing workforce. While a number of studies have documented the frequency and consequences of bullying among nurses, there have been few attempts to develop integrated theoretical models that identify individual, work group and organizational factors. METHOD In the third stage of this sequential mixed methods study, data were collected from a randomized survey of Australian nurses. Structural equation modelling and confirmatory factor analysis on 370 completed surveys was used to test a multidimensional model of bullying. RESULTS Organizational characteristics were confirmed to be critical antecedents of bullying, influencing both the occurrence of bullying and the resultant consequences. CONCLUSIONS The findings have important implications for the management and prevention of bullying, suggesting that, if they are to be effective, strategies to address the problem need to focus upon work group and organizational factors. IMPLICATIONS FOR NURSING MANAGEMENT The findings draw in question the usefulness of current approaches to managing bullying and will be of use to nurse managers, particularly those tasked with providing safer and more productive workplaces.

A new model of bullying in the nursing workplace: Organizational characteristics as critical antecedents

Providing a safe work environment where nurses can practice without fear or threat of aggression is acknowledged as a critical global issue for healthcare organizations. Although there has been growing recognition that workplace bullying is one of the most concerning forms of aggression experienced by nurses, to date, there has been little progress in developing explanatory models. In this article, we outline our recently validated model of bullying, which specifies organizational characteristics as critical antecedents. The model has important implications for the management of bullying, identifying that to be effective, interventions need to address features of workplace climate.

‘They stand you in a corner; you are not to speak’: Nurses tell of abusive indoctrination in work teams dominated by bullies

Abstract This paper reports some of the findings from the first qualitative stage of a large national study of bullying in the nursing workplace currently being undertaken in Australia. The findings reported here reveal how relationships between bullies were embedded within informal organizational alliances, enabling bullies to control work teams and use emotional abuse and psychological violence as a means of enforcing bully-defined ‘rules of work’. Within nursing teams, bullies controlled work roles, tasks, and status in the nursing hierarchy through enforcing their ‘rules’. Bullies enforced these rules through a process of ritual indoctrination, destroying the self-confidence and self-image of those targeted, and forcing them to eventually resign their position or acquiesce to survive. The merciless, calculated and deliberate nature of the bullying resulted in profound harm for many of those targeted. The findings of this research have implications for the understanding and management of workplace bullying.

A typology of bullying behaviours: The experiences of Australian nurses

AIM AND OBJECTIVE This study sought to explore the nature of bullying in the Australian nursing workplace. BACKGROUND While there is widespread concern about the extent and consequences of bullying among nurses, to date, there have been no published reports cataloguing the types of behaviours that constitute bullying. DESIGN Reported here are findings from the first stage of a three-stage sequential mixed methods study. METHODS The first, qualitative stage of this study employed in-depth, semi structured interviews with 26 nurses who had experienced bullying from two Australian area health services. Content analysis of the verbatim interview transcripts was performed using the nvivo 7 software program. RESULTS The analysis identified six major categories and constituent sub-categories. The typology of bullying behaviours reported here is one of these major categories. CONCLUSION The typology of behaviours developed from the study provides detailed insights into the complexity of bullying experienced by nurses. The behaviours were labelled: personal attack, erosion of professional competence and reputation, and attack through work roles and tasks. These themes provide insight into the construct of bullying by providing a detailed catalogue of bullying behaviours that show that bullying is frequently masked in work tasks or work processes and focused on damaging the reputation and status of targets. RELEVANCE TO CLINICAL PRACTICE The detailed catalogue of bullying behaviours draws attention to the breadth of the bullying experience. It is anticipated the typology will be of use to nurses, managers and other professionals who are interested in responding to the problem of bullying in nursing.

I'm gonna do what i wanna do. Organizational change as a legitimized vehicle for bullies.

Abstract: In-depth interviews with nurses who have been bullied depict bullies masking their bullying behavior behind the cloak of legitimate organizational processes, resulting in extensive harm to targets.

Attributes of clinical leadership in contemporary nursing: An integrative review

Abstract Effective clinical leadership is offered as the key to healthy, functional and supportive work environments for nurses and other health professionals. However, as a concept it lacks a standard definition and is poorly understood. This paper reports on an integrative review undertaken to uncover current understandings of defining attributes of contemporary clinical leadership in nursing. Data collection involved a search of relevant electronic databases for a 10-year period. Keywords for the search were ‘clinical leadership’ and ‘nursing’. Ten research papers met the inclusion criteria for the integrative review. Analysis of these studies indicated clinical leadership attributes had a clinical focus, a follower/team focus or a personal qualities focus; attributes necessary to sustain supportive workplaces and build the capacity and resilience of nursing workforces. The small number of research-based studies yielded for the review indicates the need for further research in the area of clinical leadership.

Trial and retribution: a qualitative study of whistleblowing and workplace relationships in nursing

Abstract This paper reports a study aiming to present and describe the effects of whistleblowing episodes on nurses’ workplace relationships. Eighteen participants with direct experience of whistleblowing were recruited into the study, which was informed by a qualitative narrative inquiry design. Findings were clustered into four main themes, namely: Leaving and returning to work—The staff don’t like you; Spoiled collegial relationships—Barriers between me and my colleagues; Bullying and excluding—They’ve just closed ranks; and, Damaged inter-professional relationships’I did lose trust in doctors after that. Findings suggest a need to facilitate a climate in which it is safe for nurses (and others) to raise concerns about patient care or organisational wrongdoing, and to eliminate the existing belief that whistleblowing is a negative act fuelled by revenge or sedition.

Like Wolves in a Pack: Predatory Alliances of Bullies in Nursing

The findings from the first, qualitative stage of a larger sequential mixed method study of bullying in the Australian nursing workplace are reported. Interviews with twenty-six nurses, recruited from two health care organizations, were analysed using the constant comparative method. Participants described informal organizational networks as the mechanism through which predatory, cooperative, and planned group bullying acts were promulgated. These predatory alliances enabled the co-option of legitimate organizational systems, the concealment of bullying, and the protection and promotion of perpetrators. By identifying the manner in which workplace bullying can be embedded within informal organizational networks, this research has important implications for further research in this field.

Mothering disrupted by illness: a narrative synthesis of qualitative research

AIM This paper is a report of a literature review of qualitative empirical research investigating womens experiences of mothering disrupted by illness. BACKGROUND As a primary identity, motherhood is endangered by illness. Illness can interfere with a womans ability to mother her child/children. Healthcare professionals regularly fail to acknowledge a womans dual identities of mother and patient. DATA SOURCES CINAHL, Medline, PsychInfo, Scopus and Sociological abstracts were searched 1980-2009. METHODS A narrative synthesis was used, with quality appraisal guided by the Critical Appraisal Skills Programme method. Concepts were analysed thematically, explicating common experiences of women disrupted in their mothering by illness. This allowed for both descriptive and narrative synthesis to occur. RESULTS Thirteen papers were included in the final review. Themes identified were: mechanism of disruption; reframing the mother role; protecting the children; experiencing guilt or shame; problems with healthcare professionals; and living to mother, mothering to live. CONCLUSION Women disrupted in their mothering by illness view themselves as a mother first and a patient second. Women found themselves unsupported in their mothering role by healthcare professionals, and this may have left them reluctant to broach difficulties they had relinquishing mothering duties when ill. Nurses are well-positioned to support women in illness by acknowledging the importance of their identity as mothers, offering them opportunities to discuss how illness is disrupting their ability to mother, providing support to help them negotiate the social/emotional distress experienced when mothering is disrupted and, where necessary, referring them to other members of the healthcare team, such as social workers.

Marginalised mothers: Lesbian women negotiating heteronormative healthcare services

Abstract Lesbian mothers share mainstream existence with other mothers by virtue of their motherhood, but remain marginalised by their non-heterosexual identity. This paper will draw on the qualitative findings of a recent Australian study that examined the experiences of lesbian mothers. Using a story-sharing method, data were collected using three methods; a demographic data sheet, in-depth semi-structured interviews and journaling. The findings demonstrated that participants experienced various forms of homophobia when interfacing with healthcare services and providers and included exclusion, heterosexual assumption, inappropriate questioning and refusal of services. Strategies used to avoid homophobia included screening and crusading.