Rosanna DeMarco

BULLYING OF STAFF REGISTERED NURSES IN THE WORKPLACE :A PRELIMINARY STUDY FOR DEVELOPING PERSONAL AND ORGANIZATIONAL STRATEGIES FOR THE TRANSFORMATION OF HOSTILE TO HEALTHY WORKPLACE ENVIRONMENTS

The primary purpose of this study was to validate the perceptions of frequency and patterns of bullying behavior experienced by registered nurses (RNs) across the United States. This study was completed to develop relevant and sensitive tailored interventions for the future. A 30-item anonymous electronic survey was used to identify the frequency, type, perpetrators, and personal and professional consequences of bullying. Findings from the overall population of 303 RN respondents (mean age of 49 years) indicated that 70% of the bullying was reported by a predominant group of staff RNs (n = 212), and it is this group that is the focus of this report. Of this group, bullying occurred (a) most frequently in medical-surgical (23%), critical care (18%), emergency (12%), operating room/Post Anesthesia Care Unit (9%), and obstetrical (7%) areas of care and (b) within the 5 years or less of employment on a unit (57%). Perpetrators included senior nurses (24%), charge nurses (17%), nurse managers (14%), and physicians (8%) who publicly humiliated, isolated, excluded, or excessively criticized the staff nurses. Subsequent stress levels were reported as moderate or severe, with support found primarily with family, colleagues, and friends and not with an available workplace infrastructure of solution. Many left the workplace completely with or without jobs awaiting them. Bullying among U.S. nurses is a hidden problem with significant patient-directed quality performance and workforce implications. It is critical that innovative strategies be developed and implemented to address the root cause of this problem.

Bullying, Harassment, and Horizontal Violence in the Nursing Workforce The State of the Science

In the complex health care workplace of nurses, intra/interprofessional ideals intersect with the expectations of patients, families, students, and coworkers in a context of managed care environments, academia, and other health care enterprises. Integral to quality assessment, management, and assurance is collegial and respectful communication. Decades of reported descriptive and anecdotal data on intra/inter professional and on client communication, describe the antithesis of these ideals. Specifically, increasing frequency and rates of persistent bullying, harassment, or horizontal violence (BHHV) have shown to yield detrimental effects on workplace satisfaction, workforce retention, and the psychological and physical health of nurses as well as implied effects on quality of patient care and risk of poor health outcomes. Persistent BHHV among nurses is a serious concern. In advancing the science of description and explanation to a level of prevention intervention, explanatory models from biology, developmental psychology, intra/interpersonal interactionism are described along with theoretical explanations for the prevalence of BHHV in nurse workplaces. Making the connection between explanatory models and creative solutions to address BHHV through multiple levels of behavioral influence such as individual, environmental, interpersonal, and cultural contexts is key to advancing the science of the relationship between professional behavior and client/family/community health care outcomes.

Making Things Right: Nurses' Experiences with Workplace Bullying—A Grounded Theory

While bullying in the healthcare workplace has been recognized internationally, there is still a culture of silence in many institutions in the United States, perpetuating underreporting and insufficient and unproven interventions. The deliberate, repetitive, and aggressive behaviors of bullying can cause psychological and/or physical harm among professionals, disrupt nursing care, and threaten patient safety and quality outcomes. Much of the literature focuses on categories of bullying behaviors and nurse responses. This qualitative study reports on the experiences of nurses confronting workplace bullying. We collected data from the narratives of 99 nurses who completed an open-ended question embedded in an online survey in 2007. A constructivist grounded theory approach was used to analyze the data and shape a theory of how nurses make things right when confronted with bullying. In a four-step process, nurses place bullying in context, assess the situation, take action, and judge the outcomes of their actions. While many nurses do engage in a number of effective yet untested strategies, two additional concerns remain: inadequate support among nursing colleagues and silence and inaction by nurse administrators. Qualitative inquiry has the potential to guide researchers to a greater understanding of the complexities of bullying in the workplace.

A new, four‐item instrument to measure workplace bullying

Studies on workplace bullying either in the U.S. or internationally rarely include nurses. We tested the concurrent validity of the Negative Acts Questionnaire-Revised (22 items) with a sample of nurses. Five hundred eleven registered nurses (RNs) responded to a mailed survey. Factor, reliability, and regression analyses tested dimensionality, reliability, and construct and criterion validity. Workplace bullying is best seen as a one-dimensional construct. A subset of four items was found to be both valid and reliable in measuring bullying in this sample. Findings support the use of a one-dimensional, four-item questionnaire to measure perceived bullying in nursing populations. Using a four-item questionnaire decreases participant and researcher burden and makes available an outcome measure for future descriptive and predictive interventional research.

The Undergraduate Research Fellows Program: A Unique Model to Promote Engagement in Research

Well-educated nurses with research expertise are needed to advance evidence-based nursing practice. A primary goal of undergraduate nursing curricula is to create meaningful participatory experiences to help students develop a research skill set that articulates with rapid career advancement of gifted, young graduates interested in nursing research and faculty careers. Three research enrichment models-undergraduate honors programs, research assistant work-for-hire programs, and research work/mentorship programs-to be in conjunction with standard research content are reviewed. The development and implementation of one research work/mentorship program, the Boston College undergraduate research fellows program (UGRF), is explicated. This process included surveying previous UGRFs followed by creating a retreat and seminars to address specific research skill sets. The research skill sets included (a) how to develop a research team, (b) accurate data retrieval, (c) ethical considerations, (d) the research process, (e) data management, (f) successful writing of abstracts, and (g) creating effective poster presentations. Outcomes include evidence of involvement in research productivity and valuing of evidenced-based practice through the UGRF mentorship process with faculty partners.

Primary prevention of skin cancer in children and adolescents: a review of the literature.

Although skin cancer is an easily preventable disease, self-directed prevention behaviors in children are difficult to achieve. The purpose of this article is to evaluate the status of primary prevention interventions and identify gaps in national and international research in order to make suggestions for further intervention design. A comprehensive search of MEDLINE, CINAHL, and PSYCHinfo databases was conducted to collect published research used in this review. The most effective interventions used multicomponent curricula administered over an extended period of time. Younger children were more receptive to interventions than were older children, who had stronger attitudes against sun-protective behaviors. Interventions in Australia have been more successful than interventions in North America and Europe. Further research needs to be conducted to create primary prevention interventions that address informational gaps. Specifically testing the dose and effect of individual educational components and bundling of components with reliable and valid outcome measures would help health care researchers define and measure the most effective way to battle social norms and attitudes of children and sun exposure.

Recommendations and reality: Perceived patient, provider, and policy barriers to implementing routine HIV screening and proposed solutions

In 2006, the Centers for Diseases Control and Prevention (CDC) released recommendations calling for routine HIV testing to be offered to those ages 13 to 64 as a standard of general health care. This recommendation included a plan to conduct HIV testing as part of a general consent. The reasoning and evidence for this recommendation is supported by experts, patients, and sponsored screenings by the CDC. The rationale behind this approach includes that knowledge of ones HIV status helps (1) infected individuals adopt risk-reduction behaviors and access to life-prolonging treatment and (2) uninfected individuals maintain behaviors that reduce their risk of becoming infected. This article discusses the perceived patient, provider, and policy barriers to implementing routine HIV screening and proposed solutions that can be part of a nurse-led contribution to develop and adopt innovative, patient-centered care models that can address the need for screening.

The Use of a Writing Group to Enhance Voice and Connection Among Staff Nurses

The aim of this study was to pilot test a group-writing intervention to decrease negative workplace behaviors. The pilot test demonstrated that cohesive and supportive relationships developed and allowed nurses to talk about important topics. The participants suggested that a writing group would be a forum that could be used by staff development educators to encourage nurses to support each other and develop their voices.

The Effect of Prevention Messages and Self-Efficacy Skill Building With Inner-City Women at Risk for HIV Infection

&NA; The purpose of this study was to examine the effect of gender‐sensitive and culturally relevant HIV prevention film messages combined with self‐efficacy and skill building exercises on self‐reported safe sex behaviors, intentions, attitudes, and self‐advocacy over time. A sample of 131 women of mixed ethnicity from inner‐city Boston who were living in transitional housing participated in a 4‐week pre/postmeasurement design. Results showed that, despite the short duration of the intervention, participants self‐reported significantly more use of safe sex behaviors and being prepared for sexual intimacy after the intervention. The study validated use of an approach originally intended for African American women with other women at risk for HIV.

Caring to confront in the workplace: An ethical perspective for nurses

Because womens sense of integrity appears to be entwined with an ethic of care, so that to see themselves as women is to see themselves in a relationship of connection; the major transitions in womens lives would seem to involve changes in the understanding and activities of care...when the distinction between helping and pleasing frees the activity of taking care from the wish of approval by other, the ethic of responsibility can become a self-chosen anchor of personal integrity and strength)