Workplace bullying among allied health professionals: prevalence, causes and consequences
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Workplace bullying among allied healthprofessionals: prevalence, causes andconsequences
Defne Demir Australian Catholic University, AustraliaJohn Rodwell Australian Catholic University, AustraliaRebecca Flower Australian Catholic University, Australia
Workplace bullying is an occupational hazard in the healthcare industry. Allied health professionals
form an important, yet underresearched, part of this industry. The aim of this study was to investi-
gate the antecedents and consequences of bullying within the allied health context. Data were col-
lected from 166 allied health professionals working in a large Australian healthcare organisation
(response rate = 76%). Logistic regression and analyses of covariance were conducted. Almost aquarter (24%) of respondents reported experiences of workplace bullying. In testing the antecedents
of bullying, low levels of supervisor support and high negative affectivity were associated with bully-
ing. In terms of consequences, bullying, along with tenure, employment type and age, influenced
levels of depression and psychological distress. Findings may assist in informing effective strategies
that aim to reduce and target the occurrence of such negative workplace behaviour.
Keywords: allied health professionals, bullying, depression, negative affect and psychologicaldistress
Negative anti-social behaviour such as workplace bullying is a significant issue foremployees, organisations, unions and government agencies (ODriscoll et al. 2011).Employees working in the healthcare industry are at high risk of workplace bullying
Correspondence: Ms Defne Demir, Research Fellow, Faculty of Business, Australian CatholicUniversity, Locked Bag 4115 Fitzroy, Vic 3065, Australia; e-mail: email@example.com
Accepted for publication 27 February 2013.
Key points1 Workplace bullying is an issue for allied health professionals who appear to be at
risk of exposure.
2 Work and personality characteristics of social support and negative affectivity play
important roles in the development of bullying for these professionals.
3 The negative consequences of bullying are particularly related to the mental health
(depression and psychological distress) of these professionals.
Asia Pacific Journal of Human Resources (2013) 51, 392405 doi:10.1111/1744-7941.12002
2013 Australian Human Resources Institute
(Behar et al. 2008; Hutchinson et al. 2006; Stubbs and Sengupta 2008), particularly withinnursing (Camerino et al. 2008; Farrell, Bobrowski and Bobrowski 2006; Quine 2001).Other healthcare professionals, such as allied health professionals, may also be at risk,especially considering that these professionals often work in multidisciplinary teams thatinclude nurses (Keane et al. 2008). Allied health professionals represent a variety of healthservices, including dieticians, social workers and occupational therapists (Keane et al.2008). Approximately 18% of the Australian healthcare workforce is comprised of alliedhealth professionals (Australian Institute of Health and Welfare 2010). These professionalsare considered an integral component of effective treatment (Keane et al. 2008). However,there has been relatively little research conducted on this group within the Australianworkforce (Keane et al. 2008).
The demandcontrolsupport (DCS) model has been suggested as important to con-sider regarding the antecedents of workplace bullying (e.g. Notelaers et al. 2012; Takakiet al. 2010; Tuckey et al. 2009). Further, research that explores the consequences of work-place bullying has illustrated that bullying not only negatively impacts the work attitudesof the employee, but also their mental health (e.g. Hansen et al. 2006; Kivimki et al. 2003;Quine 2001), which can lead to organisational costs (ODriscoll et al. 2011). Individualand demographic characteristics (e.g. negative affectivity and age) have been shown toplay an important role in these links (e.g. Baillien et al. 2011; Spector et al. 2000). Toenhance our understanding of workplace bullying in the healthcare industry, the aim ofthe study was to examine the antecedents and consequences of bullying for allied healthprofessionals, specifically focusing on these work and individual characteristics thatappear to be influential for other occupational groups.
The definition of workplace bullying continues to be clarified; however the term canbroadly be defined as behaviour that is persistent and repeated, occurring over a period oftime, whereby individuals on the receiving end perceive the behaviour as negative andhave difficulty in defending themselves (Hoel and Cooper 2000). Workplace bullying ismore often psychological in nature, rather than physical, and may include behaviour suchas harassment, social exclusion, threats, or teasing (Einarsen et al. 2011). Over time, bully-ing often increases in frequency, in turn engendering a feeling of inferiority in the victim(Notelaers et al. 2012). Workplace bullying can be the cause of great concern for organisa-tions, particularly within the healthcare system, whereby the performance of staff may benegatively influenced, with effects that flow on to patients (Yildirim 2009). In Australia,workplace bullying is treated as a serious issue, with certain behaviours treated as criminaloffences. Recent reforms to the legislation have included the Victorian Crimes Amendment(Bullying) Bill 2011, which broadened the definition of behaviour considered as bullying,and introduced a potential 10-year jail sentence for convicted offenders. While legislationcurrently varies by state, the introduction of this law may lead to similar nationwidelegislation.
Defne Demir, John Rodwell and Rebecca Flower
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Many existing studies have investigated either the antecedents or consequences ofworkplace bullying, rarely examining both in the same sample. In terms of the character-istics of the antecedents, a model that may be helpful in understanding factors thatincrease the likelihood of bullying is the DCS (Johnson and Hall 1988; Karasek 1979). TheDCS model posits that a combination of different levels of demands, control and socialsupport can lead to particular employee outcomes. Instances where demands are high,while control and social support are low, tend to lead to more negative experiences, suchas distress and depression (Mikkelsen and Einarsen 2002; Quine 2001).
Research that examines a range of occupational groups has illustrated that the DCScomponents may be associated with experiences of workplace bullying. In particular, highjob demands and low job control have been associated with reports of bullying (Notelaerset al. 2012; Takaki et al. 2010; Tuckey et al. 2009). Indirect support for the DCS model hasalso been demonstrated with job control (Agervold and Mikkelsen 2004) and socialsupport (Hansen et al. 2006) being associated with employee reports of bullying.
Researchers have attempted to understand why variations in certain characteristics ofthe work environment (namely demand, control, and support) can foster an environmentwhere bullying is likely to occur. An explanation provided by Baillien et al. (2009) suggeststhat individuals who are under strain and cope in an inefficient, passive manner mayviolate social, work or organisational norms. This violation may result in negative atti-tudes toward the individual and lead to an increased likelihood of becoming a target ofbullying.
In addition to work-related characteristics described as part of the DCS model, thepersonality characteristic of negative affectivity (NA) may be important to consider. Indi-viduals with high NA tend to be more distressed, upset, and hold a negative view of boththemselves and the world (Watson and Clark 1984). Indeed, research investigating therelationship between NA and bullying has found associations between both state and traitNA with workplace bullying (Hansen et al. 2006; Mikkelsen and Einarsen 2002). Individu-als with high NA may be more sensitive to their surrounding environment (Spector et al.2000), and thus may be more likely to magnify negative events and perceive the behaviourof others as bullying (Hansen et al. 2006). Subsequently, this study will consider this traitwhen examining antecedents of workplace bullying, in combination with the work-relatedcharacteristics of the DCS model. To the best of our knowledge, no studies have investi-gated if and how these issues might be important for allied health professionals as ante-cedents to experiences of bullying.
The negative consequences associated with bullying in the workplace for occupationalgroups other than allied health professionals appear to be well documented. Bullying hasbeen associated with both negative changes in job attitudes such as job satisfaction, andthe mental health of employees, such as anxiety and depression (Hansen et al. 2006;Kivimki et al. 2003; Quine 2001).
An understanding of the association between bullying and such negative consequencesmay be gained through attribution processes. Victims of workplace harassment mayattribute the blame to themselves, the perpetrator of the behaviour or the organisation for
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which they work (Bowling and Beehr 2006). Negative consequences such as depression aremore likely to occur when the victim attributes the blame to themselves, while changes inattitudes surrounding ones job are more likely to occur when the victim attributes theblame to the organisation (Bowling and Beehr 2006). These two particular attributionprocesses may explain why changes in work-related and mental health outcomes havebeen observed in other studies.
Further, NA may be important to consider, given that individuals high on the trait mayhave more negative perceptions of experiences, particularly regarding outcomes such asstress and strain (Burke, Brief and George 1993). One potential explanation suggested hasbeen that individuals considered as having high NA might respond to stressors, such asworkplace bullying, in an exaggerated manner. That is, they may experience a greater levelof strain in response to a stressor than individuals with low NA (Spector et al. 2000).
Finally, certain demographic characteristics have been linked with workplace bullyingand may also be important for consideration. For example, Baillien et al. (2011) foundthat younger participants report more bullying than older participants. Similarly, Quine(1999) found that both age and employment type were associated with bullying preva-lence in the healthcare context. Further, coping style has been suggested to change withage (Johannsdottir and Olafsson 2004), whereby the consequences of bullying may differacross age groups. Associations between bullying and tenure have also indicated thatlength of employment may influence outcomes such as job satisfaction and psychologicaldistress (Decker 1997). Therefore, it may be important to consider whether these demo-graphic characteristics play a role in determining the consequences of workplace bullyingfor allied health professionals.
The principal aim of the current study was to add to the sparse amount of literatureregarding allied health professionals and workplace bullying by investigating both theantecedents and consequences of bullying for these professionals. The hypotheses of thestudy are outlined below.
Hypothesis 1a: High levels of job demands, as well as low levels of job control andsocial support will be associated with higher reports of bullying.
Hypothesis 1b: High levels of trait NA will be linked to higher reports of bullying.
Hypothesis 2a: Reports of bullying will be associated with the negative consequencesof lowered job satisfaction, as well as higher psychological distress and depression.
Hypothesis 3a: Trait NA will covary with reports of bullying consequences.
Hypothesis 3b: Demographic variables of age, employment type and tenure willimpact the consequences associated with reports of bullying (i.e. job satisfaction,psychological distress, and depression).
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2013 Australian Human Resources Institute 395
Participants and proceduresThe sample for this study consisted of 166 allied health professionals, employed at a largeAustralian healthcare organisation. Allied health professionals across a number of facilities(e.g. maternity, hospital and residential aged care facilities) were invited to participate inthe study via surveys. The response rate for participation was 76%. The majority ofrespondents were female (86%), and aged 35 years or older (75%). In terms of tenure, theproportions were more evenly spread, with 20% of respondents having worked for theorganisation for less than 1 year, 32% for 14 years, 21% for 59 years, and the remaining27% for 10 years or more.
DemandWorkload was examined using an 11-item scale developed by Caplan et al. (1980). Eachitem asked participants to respond using a 5-point scale. The scale ranged from 1 (veryoften) to 5 (rarely) for four questions, and 1 (a great deal) to 5 (hardly any) for theremaining seven questions. The Cronbachs alpha for this scale in this study was 0.88.
ControlA 9-item scale developed by Karasek (1985) was adopted as a measure of job control. Eachitem asked participants to respond using a 5-point scale ranging from 1 (strongly dis-agree) to 5 (strongly agree). In present study, the Cronbachs alpha for this scale was0.79.
SupportSocial support was assessed using a 4-item scale developed by Caplan et al. (1980). Eachitem sought three responses from participants, one related to the support received fromtheir immediate supervisor, another related to the support received from co-workers, andthe final response related to support received from family and friends. These responseswere rated on a 5-point scale ranging from 4 (very much) to 0 (dont have any suchperson). Three subscales were then formed using the responses (i.e. supervisor,co-workers and family/friends support). The Cronbachs alpha coefficients for the sub-scales of support from supervisors, co-workers, and family/friends were 0.87, 0.84, and0.78 respectively.
Negative affectThe 10-item negative affect subscale from the positive and negative affect schedule(PANAS), developed by Watson, Clark and Tellegen (1988), was utilised as a measure oftrait NA. Each item presented a negative emotion (e.g. distressed, nervous, upset), andasked participants to provide a response related to the degree to which they had felt eachemotion over the past week. Responses were made using a 5-point scale that ranged from1 (very slightly or not at all) to 5 (very much). The Cronbachs alpha of NA for thisstudy was 0.85.
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BullyingBullying was assessed using a single-item scale developed by Hoel and Cooper (2000). Adefinition of bullyin...