Making It Right: How Nurses Resolve Workplace Aggression and Bullying

Purpose:
The purpose of this study was to gain a deeper understanding of the experiences, motivations & consequences of nurses who have encountered aggressive behaviors in the workplace. It was proposed that the nurses' narratives would yield detailed, in depth information about their bullying experiences.

Background/Significance:
Bullying in the healthcare setting has been long-recognized internationally. However, in the US, workplace aggression is underreported which keeps it from emerging as the problem that it is. The fallout is disastrous; compromised work performance, absenteeism, and ultimately, increased job turnover and there may be a relationship between job satisfaction and negative patient outcomes. Newly graduates are at significant risk with resignation rates higher during the first year of practice.

Methods:
A constructivist grounded theory approach was used in this study. A convenience sample of 303 US RNs responded to an online survey identifying the frequency, type, perpetrators, and personal and professional consequences of bullying and aggressive behavior. The results of the main study have been reported elsewhere. Ninety-nine of the 303 respondents answered an open ended question in the online survey asking them to describe a bullying situation. Respondents who did not describe specific situations, e.g. opinion or commentary, were excluded from analysis. A preliminary reading of 81 narratives was followed by line by line and focused coding guided by the constant comparative method.

Results:
The findings of this qualitative study shape a grounded theory of how nurses "make things right" when confronted with bullying in their professional lives. The elements of "making things right" are "placing" bullying in a context, "assessing" the event, "taking action" and "judging outcomes". Time, milieu and interpersonal dynamics influence the actions of the nurse. A minority of respondents wrote about bullying events early in their careers. A majority of respondents wrote about how patient care is threatened, the humiliation of bullying and the more subtle acts of social aggression. Nurses also described how they assessed the situation and the actions they took to "make things right."

Conclusions and Implications for Practice:
The findings of this study reveal that nurses are not helpless victims of bullying. They are keenly aware that bullying compromises patient care and know it is their obligation to change a potentially harmful situation. New collaborative models between staff and administration are proposed.