negative workplace behaviors

Negative workplace behaviours: an ethical dilemma for nursemanagers

CHERYL LINDY P h D , R N , B C , N E A - B C 1 and FLORENCE SCHAEFER M S , R N , A C N S - B C 2

1Director of Nursing and Patient Education and Research and 2Education Specialiist, St Lukes Epsicopal Hospital,Houston, TX, USA

Introduction

Negative workplace behaviour has been studied

worldwide with most of the information available

coming from Europe and Australia (Simons 2006). The

focus of the research regarding this phenomenon has

been in the business and corporate realms rather than in

healthcare settings. As recently as 3 years ago, research

studies investigating negative workplace behaviour and

nursing practice in the United States were few in num-

ber (Simons 2006). Studies reporting nurse managersperspectives regarding the occurrence of negative

workplace behaviours on their units, how it affects the

staff and teamwork and how they address these situa-

tions are absent from the literature. This realization led

us to complete this study.

Background

Researchers have used many different descriptors for

negative workplace behaviour. Common terms

researchers use to describe this phenomenon are aggres-

sion in the clinical setting (Farrell 1997), emotional abuse

(Einarsen 1999), interpersonal harassment (Thomas-

Correspondence

Cheryl Lindy

Director of Nursing & Patient

Education & Research

St Lukes Epsicopal Hospital6720 Bertner Avenue

Houston

TX 77030

USA

E-mail: [email protected]

or

Florence Schaefer

Education Specialist

St Lukes Episcopal Hospital6720 Bertner Avenue

Houston

TX 77030

USA

E-mail: [email protected]

L I N D Y C. & S C H A E F E R F. (2010) Journal of Nursing Management 18, 285292

Negative workplace behaviours: an ethical dilemma for nurse managers

Aims To discover nurse managers perception of negative workplace behaviours(bullying) encountered by staff on their unit.

Background Negative workplace behaviour is a worldwide phenomenon happening

in all types of work settings. Absent from the literature were studies specific to the

nurse managers perception on this topic.Methods A phenomenological qualitative research methodology was used to gain

insight into the perceptions of nurse managers about negative workplace behaviours

that they have observed or addressed.

Results Nurse Managers described their perceptions of, and experiences pertaining

to, instances of negative workplace behaviour. Six themes emerged from the data

analysis: thats just how she is, they just take it, a lot of things going on,old baggage, three sides to a story and a management perspective.Conclusion Nurse Managers had observed, experienced and/or had received reports

of negative workplace behaviours. While some felt comfortable addressing the

behaviour, others experienced ethical dilemmas when trying to treat all fairly.

Implications The results of the present study provide guidance for nurse managers

to address negative workplace behaviours occurring on their units.

Keywords: bullying, negative workplace behaviour, nurse manager, perception

Accepted for publication: 4 February 2010

Journal of Nursing Management, 2010, 18, 285292

DOI: 10.1111/j.1365-2834.2010.01080.x 2010 The Authors. Journal compilation 2010 Blackwell Publishing Ltd 285

Peter 1997), horizontal violence (Farrell 1997, Einarsen

1999, McKenna et al. 2003, Randle 2003, Rowell 2005,

Simons 2006), bullying (Farrell 1997, Einarsen 1999,

McKenna et al. 2003, Randle 2003, Rowell 2005,

Simons 2006) and mobbing (Einarsen 1999), with the

most recent being incivility (Einarsen et al. 2009). The

terms, bullying and negative workplace behaviour, will

be used interchangeable throughout the remainder of the

present study.

Staale Einarsen, associated with the University of

Bergen, Norway, is world renowned as a pioneer in

researching bullying behaviours. He defines bullying as

the

unwelcome repeated hostile aggressive behav-iours (physical or non-physical) of one colleague

towards another (Einarsen 1999). Einarsen et al.(2009) reported that bullying is a common prob-

lem affecting contemporary working life.

Bullying is not specific to nursing and can be found in

almost every profession and workplace. A study con-

ducted by the Workplace Bullying Institute and Zogby

International, found that 54 million people or 37% of

American workers reported being bullied at work. An

additional 17.5 million people have witnessed this

negative behaviour at work (Namie 2007).

Daniel (2006) described bullying as a repeated mis-treatment including humiliation, and intimidation that

interferes with job performance. According to Longowith the Center for American Nurses (2007), victims of

abuse may exhibit physical and psychological illness

and effects, decreased self-esteem and increased job-

related stress. Simons (2006) reports that bullying inthe workplace affects the way nurses feel about their

jobs, the ability to do their jobs and whether they stay in

their jobs. AbuAlRub (2004) stated that increased job-related stress is shown to decrease job satisfaction.

Dissatisfaction with colleagues is ranked 4th as a source

of workplace difficulties (Simons 2006).

There is a relationship between work stress and bul-

lying (Hauge et al. 2007). Studies have demonstrated

that those who are the victims of bullying have less job

satisfaction. Job dissatisfaction is widely regarded as the

primary contributor to turnover among nurses. In-

creased turnover exacerbates understaffing, decreasing

productivity and compromises standards of patient

care. The nurses who are left feel increased pressure and

in response either leave themselves or exhibit decreased

participation in the organization (Simons 2006).

Up to 40% of nurses surveyed in hospitals in the

United States, responded that they were dissatisfied

with their jobs (Aiken et al. 2001). Factors contributing

to their dissatisfaction were inadequate staffing, in-

creased patient load, decreased quality of care and

verbal abuse (Murray 2002). Simons (2006) reports

that negative workplace behaviour is a job dissatisfierand it interferes with positive workplace relationships.Murray (2002) states that one in three nurses

the philosophy is embodiment meaning the body is vital

for perception, thought and interaction with the world

(Thomas 2005). Time is another tenet of the philosophy

with a focus on the present (Thomas 2005). Subjective

experiences make one aware of time.

Merleau-Ponty viewed the human experience as

sacred (Thomas 2005). This directs the investigator be a

learner with interest in understanding the human

experience when approaching a study participant. The

investigator seeks to understand the complex relation-

ship between the body and the world. The philosophy

of Merleau-Ponty guided the investigators as they

explored the nurse managers experiences and percep-tions of negative workplace behaviours experienced by

nursing personnel.

Methods

Setting and sample

Nurse managers of a tertiary hospital in South Central

United States of America employing approximately

4500 people were recruited as study participants. An

e-mail was sent to nurse managers inviting them to

participate in this study. There were approximately 40

nurse managers who supervise approximately 1400

registered nurses and 600 unlicensed assistive person-

nel. Of those, 20 participated in the study.

Instruments

A demographic information form was developed to

collect data regarding participant age, education level,

years as a registered nurse, years as a nurse manager,

years in current position, ethnicity and clinical area of

practice. The investigators developed semi-structured

interview questions. Each participant was asked to

describe what they have experienced or observed as

related to negative workplace behaviours using the

following questions:

How would you describe the characteristics of hori-zontal violence, workplace bullying or mobbing?

Have you observed or experienced horizontal vio-lence?

Have staff reported incidences to you? What were the factors contributing to the horizontal

violence (people, situation, communication and

environment)?

Describe the communication involved in the incident. How would you describe the bully? How would you describe the victim? What have been the effects of workplace bullying?

How are incidences handled? What do you see your role is in managing horizontal

violence?

In the literature and the study conducted here, staffindicated the manager ignores workplace violence.

What is your response to this?

What support do you need to address horizontalviolence in your unit(s)?

Data collection

Prior to data collection, approval was granted by the

organizations Investigational Review Board. An e-mailcommunication was sent out to the 40 nurse managers

employed by the organization. Twenty nurse managers

agreed to participate in the study. One-on-one inter-

views were held with the participants.

A private setting was used to conduct the personal

interview. The interview began with the investigator

providing information regarding the study. Each par-

ticipant signed an informed consent to participate in the

study. After signing the consent form, the participant

was asked the demographic and interview questions. All

interviews were audio taped. Each audio tape was

transcribed verbatim that resulted in over 250 pages of

text. The investigator recorded written field notes of

observations made during the interview. Some of these

notes were made during the interview, but most nota-

tions were made immediately after the interviews.

Data analysis

The recordings were transcribed verbatim of the

interview. The phenomenological analytic method

described by Colaizzi (1978) was used for data anal-

ysis. This method requires seven steps of the investi-

gator. The first step is to read each transcript to begin

to understand the meaning. The second step is to re-

turn to each transcript and extract significant sen-

tences or statements that are reflective of the

phenomenon being studied. Each transcript was re-

viewed to identify statements participants used to

depict their experiences with negative workplace

behaviours. In the third step, the investigators began

to formulate a meaning for each statement identified.

Similar statements by participants were grouped to-

gether into themes or common experiences between

the participants as the fourth step (Morse 1994). The

investigators carefully re-examined the data to assure

data were not excluded or erroneously aligned with a

theme. In the fifth step, an exhaustive description of

the phenomenon is prepared. To assure clarity,

Negative workplace behaviours

2010 The Authors. Journal compilation 2010 Blackwell Publishing Ltd, Journal of Nursing Management, 18, 285292 287

an unequivocal description of the phenomenon is

developed in the sixth step of the method. The seventh

step is to take actions to demonstrate the trustwor-

thiness of the data. The themes identified were vali-

dated with the participants. This ensured that the

themes were consistent with their experience and

helped to establish credibility of the findings (Colaizzi

1978, Polit & Beck 2008).

To assure confirmability, records and field notes were

retained. Notes were made that describe the analysis of

the data and the development of the themes. Comments

made during the validation review by the participants

were documented. No changes were made to the iden-

tified themes based on the validation.

Results

Interviews were conducted with 20 participants, 18

females and two males. Demographic characteristics

of the sample are provided in Table 1. The average

age of the study participants was 46.9 years. Forty-

five per cent held masters degrees in nursing and an

additional 35% were prepared at the baccalaureate

level. The average number of years of experience as a

manager was 14.8 years, with 8.5 years in the current

position.

Although all nurse managers reported observing

bullying behaviours when they were staff nurses, few

reported observing negative workplace behaviours in

their manager role. All managers indicated staff

reported situations to them.

Open-ended questions enabled the participants to

share their experiences when confronted with bullying

behaviours. Six common themes emerged from the data

provided by the nurse managers.

Themes

Just how she is

Each participant described verbal and non-verbal acts

of the bully that were attributed to the personality ofthe individual. One manager stated, Its just how she is(interview 1, Manager 7 years). Descriptions of the

bully included being loud and inappropriate with a

tendency to snap at people, be abrupt, demanding and

self-centered. Although the bullying nurses demon-

strated negative behaviours, they were viewed as good

clinicians. Several managers indicated the staff nurses

with negative behaviours were good clinicians with

many years of experience.

Another participant with 10 years management

experience described the bully on the unit as:

The best nurse in the world, having the best skillsyou know hands on, but when it comes to inter-

personal skills, she doesnt have it. She is respectedby her peers for her nursing skills, her nursing

judgment, and her critical thinking skills. She

shows up to work on time every time (interview13).

They just take it

The characteristics of the victim were described asaccommodating and passive. The victims tended not to

react to the behaviour, but rather tolerated it. Often the

victims looked to others to help or provide support to

them. One manager with 14 years of management

experience responded:

Theyre trying to stay professional. They try toappease her (the bully). They want professional

courtesy, peace, and respect. They dont want toconfront and deal with all of that (Interview 19).

A lot of things going on

Participants explained one of the triggers resulting in

bullying behaviour was related to the personality of the

individual or that the individual is very stressed.

Increased bullying is observed when the census is high

or critical events are occurring on the unit.

There are a lot of things going on and people(bully) expect people (victim) to just jump in(Interview14, Manager 25 years).

Table 1Demographic characteristics of sample (n = 20)

GenderMale n (%) 2 (10%)Female n (%) 18 (90%)Age range (mean) 3458 years (46.9 years)Years as RN range (mean) 1135 years (23.5 years)Years as Manger range (mean) 2.529 years (14.8 years)Years in Current Position range (mean)

0.527 years (8.5 years)

Race n (%)Asian 1 (5%)African American 5 (25%)Hispanic 1 (5%)White 13 (65%)

Education n (%)Diploma/Associate 4 (10%)Baccalaureate 7 (35%)Masters 9 (45%)

Clinical area n (%)Acute care 9 (45%)Critical care 5 (25%)Other areas 6 (30%)

C. Lindy and F. Schaefer

288 2010 The Authors. Journal compilation 2010 Blackwell Publishing Ltd, Journal of Nursing Management, 18, 285292

When shes very busy and behind in her work, shecant tolerate a lot and says things that she shouldnot have (Interview 10, Manager 27 years).

Some managers attributed the negative behaviours to

generational differences, personality differences or

work ethic differences.

Generational differences, personality differences,or work ethic differences contribute to bullying. If

you are a strong person and you dont likeanybody pointing out your mistakes, you hide the

behaviour by bullying other people (Interview 15,Manager 7 years).

Old baggage

Participants described the decreased teamwork as one

of the long-term effects of bullying. This was attributed

to the inability of the individuals involved to resolve

conflict.

People carry a lot of old baggage and sometimesbecause they carry those feelings. Theres ani-mosity. It does interfere with their working rela-

tionship (Interview 12, Manager 5 years).

Managers reported an increased turnover and

absenteeism among the victims of negative workplace

behaviour.

Turnover is high. Thats the biggest impact ofbullying. If youre not happy at work or a part ofthe team, you dont want to come to work(Interview 2, Manager 14 years).

Three sides to a story

Managers explained the actions they take to investigate

and address the negative work behaviours. All the

managers reported they will meet with the individuals

involved to determine what happened.

I tell the staff there are always three sides to thestoryyour story, their story, and somewhere inbetween lays the truth. You sit them down and

talk about whatever happened, give each one time

to sort it out and talk it out (Interview 17,Manager 15 years).

Managers indicated that when they became aware of

bullying, they had the obligation to address the

behaviour and correct the inappropriate behaviour

using the organizations established processes.

I think people dont want to report it (bullying),but when they do, you have to act on it (Interview5, Manager 25 years).

A management perspective

Participants described ethical dilemmas they experi-

enced when they addressed negative workplace behav-

iours. One new manager discussed how her point of

view regarding the behaviour had changed:

The perception is that the person might be able toget away with more stuff because they know a lot

and they seem like an asset to the unit. As a staff

nurse, I was How could that person get awaywith that? But from a management perspective, Isee it differently now (Interview 11, Manager3 years).

Another ethical dilemma for managers often is that

the bully is an expert clinician with several years

experience. This nurse is often viewed as the informal

leader of the staff. The managers question if the

behaviour is actually bullying or if the nurse has con-

fronted someone for not doing something correctly.

Shes an excellent clinician. Other staff say thatsjust the way she is and we cant do that justbecause thats the way she wants it done (inter-view 10, Manager 27 years).

When responding to the question regarding managers

ignoring negative behaviours, managers described

frustration with staff perceptions that the manager is

aware of the negative behaviour of other staff members.

It was noted that managers may ignore the behaviour in

some cases because its human nature not to want tohave conflict with people. However, staff will not know

if the manager has addressed the issue.

We dont announce corrective action. We donthave public floggings (Interview 10, Manager27 years).

Managers indicated it was important to have support

from their immediate supervisor and the Human

Resources Department when addressing negative

behaviour.

In a previous position, I didnt have support thatI needed to address the behaviour and staff may

have thought the behaviour was being ignored(Interview 13, Manager 9 years).

All managers reported that when they were made

aware of the negative behaviour, they addressed the

behaviour. However, new managers expressed frustra-

tion when questioned by peers regarding the decision to

address the bullying. Their perception was that the

bullying had been happening for some time and no one

had attempted to correct it. Managers reported that



victims have requested them not to talk to the bully

because they were fearful of retaliation.

Managers indicated that once they address the issue,

they are not always aware if the behaviour continues.

When people (victims) report it (bullying behav-iour) to the manager, the manager has to follow

up with the staff. Please let me know if thebehaviour continues. You cant assume justbecause you did corrective action that it has

changed (Interview 2, Manager 14 years).

Discussion

Incidences of verbal and non-verbal bullying behaviours

described by the nurse managers in this study were

consistent with behaviours described in the literature.

According to Einarsen (1999), verbal abuse is the most

common form of negative acts. Of the 551 participants

in a study conducted by McKenna et al. (2003), 34% of

the participants experienced verbal attacks. Namie

(2007) found non-verbal negative acts were experienced

by 53% (n = 7740) of participants. Farrell (1999) found

that 72% of respondents (n = 270) had experienced

coworkers refusal to help and 68% experiencedintimidating behaviours. Nurse Managers in this study

identified the bully as being clinically competent and

often the best nurse on the unit. No evidence in the

literature was found regarding the clinical competency

of the bully.

The victim in this study was described as being pas-

sive and willing to tolerate the negative workplace

behaviours of the bully. No descriptions of the victim

were found in the literature. In reporting the reaction of

victims, McKenna et al. (2003) found 50% (n = 1169)

of the victims would take no action and Namie (2007)

reported 40% (n = 7740) of the victims would not

report the incident. This may be viewed as being passive

and tolerant.

The participants in this study identified bullying

triggers that were related to increased workload which

is consistent with the literature (Hauge et al. 2007).

However, unlike findings from this study, in the previ-

ous literature, the triggers are attributed to the per-

sonality of the bully (Farrell 1997, Einarsen 1999).

Namie (2007) reported 56% (n = 7740) of bullying was

due to the personality of the bully and only 14%

(n = 7740) was related to the work environment.

Rowell (2005) described the long-term effects of

negative workplace behaviours on the victim including

diagnosable mental illness such as depression, anxiety

and Post Traumatic Stress Syndrome. In addition,

physical impacts described included hypertension,

weight gain/loss, cardiac palpitations and irritable bo-

wel. None of these long-term effects were reported by

the participants in this study.

In the present study, nurse manager participants re-

ported decreased teamwork, increased turnover and

increased absenteeism. This is consistent with previous

research findings (McKenna et al. 2003, Simons 2006,

Yamada 2008).

Nurse managers are reported to have tolerated bul-

lying behaviours (Einarsen 1999, Liefooghe & Olafsson

1999, Farrell 2001, Namie 2007), suggested the

behaviours (Namie 2007) or approved the behaviours

(Einarsen 1999). In this study, participants indicated

that when they were made aware of the behaviour, they

took action. However, managers indicated staff were

not informed about when or what action was taken to

address the bullying behaviours. This may contribute to

the perception that the behaviour was ignored or tol-

erated.

As the nurse managers revealed during their inter-

views, there are instances when they had experienced

ethical dilemmas in the management of bullying

behaviours. Respect for individual dignity is funda-

mental in nursing practice. As stated in the American

Nurses Association(ANA) (2001) Code of Ethics, nur-ses must take into account the needs and values of all

persons in all professional relationships. Yamada(2008) writes that the right to be left alone goes to thevery core of individual dignity. There are times when

the nurse manager is not aware of the bullying behav-

iours that occur on their units. They reported that they

have not witnessed the behaviour and unless it is

brought to their attention, they remain unaware. In one

such report of bullying to the nurse manager a staff

member said, How can you not see it?While resolving conflict, the Code of Ethics (2001)

states that this must be done in a manner that preserves

a nurses professional integrity. When an incident ofbullying is reported to the nurse manager, the involved

staff will be interviewed individually and then together

if warranted. All conversation is kept confidential. At

times staff have asked the manager for the outcomes of

the disciplinary action. The manager is bound by con-

fidentiality and again placed in a situation where the

staff at times feel they (the manager) have not addressed

the issue adequately.

The Code of Ethics (2001) states that the viewpoint

of one person should not be considered the truth over

that of another. Some of the nurse managers described

the person who is frequently reported to be the bully as

one of their best clinicians. The nurse mangers listen to



all involved prior to deciding which course of action

should be taken to rectify the problem. Nursing

administration is responsible for ensuring that the out-

come of similar situations is consistent and that all

personal are treated fairly.

One of the limitations of this study was that the

sample of 20 nurse managers was limited to one study

site. Another limitation was that the participants in the

study self-selected to participate.

Implications for nursing management

The ANA (2001) Code of Ethics for Nurses should be

enforced and utilized as a guide for the type of workplace

behaviour that is acceptable. The ANA is a professional

organization that represents the interests of the 2.9 mil-

lion nurses in the United States. The organizationsresponsibilities include developing standards of practice,

promoting nurses rights, safeguarding the portrayal of

nursing in media and working with the government

and agencies on issues affecting nurses and the public.

The Code of Ethics (2001) was developed to serve as

a statement of the ethical obligations and duties ofevery individual who enters the nursing profession andis an expression of nursings own understanding ofits commitment to society. The Code of Ethics pro-vides guidelines for nurses to provide the best care for

the patients and the community while supporting each

other.

Individual institutions should develop and enforce

Standards of Behaviour for all staff (Longo 2007).

Staff should know which behaviours at work are

acceptable and which are not. They need to be aware

of the consequences of behaviour that violates the

standards. Then there are no surprises when the staff

are held responsible for bullying behaviour. The

institution has an obligation to put into place clear

expectations regarding communication, teamwork,

professionalism, respect and responsiveness to requests

(Rowell 2005, Randle 2007). The nurse managers need

to have the support of Human Resources, Employee

Relations and upper management as they enforce these

standards when dealing with a bullying situation

(Longo 2007).

To better prepare staff to deal with bullying behav-

iour and to help decrease the incidents of bullying, it is

recommended to offer the staff training (McKenna et al.

2003, Rowell 2005). Assertiveness training will aid staff

to better defend themselves against, and diffuse, bully-

ing behaviours. Workshops geared towards team

building will foster a sense of camaraderie which in turn

may decrease the bullying behaviour (Randle 2007).

Implications for further research

This research opens the field for further research. Studies

to further understand the causes and effects of negative

workplace behaviour will provide additional insight into

the phenomenon. Studies of negative workplace behav-

iour, specific to nursing, will help determine how we can

better manage this phenomenon. Replicating this study

in another facility with similar demographics will help to

determine if other nurse managers have similar experi-

ences. Further research focusing on nurse managersperceptions of interventions to decrease bullying will

help provide direction for the nurse manager as they

continue to address this matter with their staff. Longo

(2007) and Randle (2007) report that effective manag-

ing of bullying will lead to a decrease of its negative

effects on the patients, staff and organization.

Conclusion

All nurse managers reported that they observed, had the

phenomenon reported to them and/or personally expe-

rienced bullying workplace behaviours. While some felt

comfortable in addressing the behaviour, others expe-

rienced an ethical dilemma in trying to treat all indi-

viduals involved fairly. Bullying is a universal issue and

there are resources available for nurse managers to use

as guidelines in dealing with these occurrences. It is

important for senior leadership and front-line managers

to promote a healthy work environment, one that does

not tolerate workplace bullying by having enforceable

employee policies. In addition to providing education

to nurse managers on addressing negative behaviours,

all personnel need training and guidance to recognize

and diffuse bullying behaviours.

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