Journal of Nursing Management, 2016, 24, 327–335
Factors affecting workplace bullying and lateral violence among clinical nurses in Korea: descriptive study HYUNJIN OH
RN, PhD
1
, DONG CHOON UHM
RN, PhD
2
and YOUNG JOO YOON
PhD
3
Assistant Professor, School of Nursing, Gachon University, Incheon, South Korea, 2Associate Professor, Department of Emergency Medical Technology, Daejeon University, Daejeon, South Korea and 3Assistant Professor, Department of Business Information Statistics, Daejeon University, Daejeon, South Korea 1
Correspondence Dong Choon Uhm 62 Daehak-ro Dong-gu Daejeon 300-716 Korea E-mail: [email protected]
OH H., UHM D. C. & YOON Y. J.
(2016) Journal of Nursing Management 24, 327–335. Factors affecting workplace bullying and lateral violence among clinical nurses in Korea: descriptive study Background & aim Workplace bullying and lateral violence are serious issues affecting the work life of hospital nurses. The purpose of this study was to identify the selected individual and institutional characteristics for workplace bullying and lateral violence using a conceptual framework. Methods A descriptive survey design was used. A convenience sample of 255 nurses in tertiary hospitals, who had a minimum of 6 months clinical experience, completed the survey. Regression analysis was used to determine factors significantly associated with workplace bullying and lateral violence. The Negative Acts Questionnaire-Revised and the Lateral Violence scale were used to measure workplace bullying and lateral violence. Results A negative affect, individualism and working in hospital specialty units predicted workplace bullying. Individualism, a negative affect, affiliated hospital and working hours predicted verbal abuse whereas the place of employment was significantly associated with lateral violence. Conclusion The results of this study identified factors that are associated with bullying and violence but did not fully support the conceptual framework. The individual characteristic negative affect was significantly associated with most types of workplace bullying and lateral violence bully whereas the place of employment was an important factor in lateral violence. Implications for Nursing Management Nurse managers need to be aware that both individual and institutional factors may impact levels of workplace bullying and lateral violence in their hospitals and need to prepare specific strategies to address these multiple factors. Keywords: hospital nurses, workplace bullying, workplace violence
Accepted for publication: 26 May 2015
Introduction Workplace bullying (WPB) and lateral violence (LV) are serious issues affecting clinical nurses and the hospital work environment. Bullying includes negative acts such as hostile remarks, persistent criticism, physical abuse, threats and social exclusion (Einarsen et al. DOI: 10.1111/jonm.12324 ª 2015 John Wiley & Sons Ltd
2003, Samnani & Singh 2012). WPB refers to repeated and persistent attacks or acts of bullying someone for more than 6 months in the workplace (Samnani & Singh 2012). Another important concern negatively impacting the work environment is lateral violence (LV). LV refers to nurse-on-nurse aggression and has various concepts, 327
H. Oh et al.
including horizontal violence, horizontal hostility, bullying and workplace incivility (Farrell 1997, Stanley et al. 2007, Embree & White 2010, Einarsen et al. 2011). WPB and LV overlap, and a recent report outlined the need for differentiating types and sources of LV. It is recommended that the focus for LV be reserved for actual abuse that includes perceived or actual harm (Farrell 1997, Hesketh et al. 2003, Rodwell & Demir 2012). In general, both WPB and LV are defined as negative events occurring in the workplace (Farrell 1997, Embree & White 2010, Einarsen et al. 2011). However, researchers have noted that WPB is work-related and psychological in nature whereas LV focuses on various instances of actual physical harm (Einarsen et al. 2011, Rodwell & Demir 2012). Cultural differences could influence perceptions of mistreatment (Nisbett et al. 2001), implying that people from different cultures can interpret behaviours differently. If understanding LV is different, definitions and experiences of WPB may also be different (Seo et al. 2012). Contrary to the low rate of physical violence reported in Western studies (Farrell 1997, Hesketh et al. 2003), actual physical harm among Korean nurses has often occurred and has been featured in the media (Kim 2006, Park 2014). WPB and LV have been defined and studied mainly in Western countries, but little is known about the characteristics and differences of perceptions of WPB and LV in other cultures. To bring clarity to an analysis of many factors associated with WPB and LV for hospital nurses, we employed a conceptual framework stressing the impact of both individual and institutional characteristics. Our conceptual framework integrated Rodwell and Demir’s (2012) notion of WPB and violence, and Samnani and Singh’s model (2012) to exam factors influencing WPB and LV. Samnani and Singh (2012) developed a conceptual framework based on an extensive review of over 20 years of extant literature focusing on the antecedents and consequences of WPB. In their framework, individual characteristics of victims and organisational characteristics were delineated. Regarding individual level antecedents, there is some evidence suggesting that victims of WPB presented individual characteristics of low self-esteem (Losa Iglesias & De Bengoa Vallejo 2012), introverted tendencies and a negative affect (Einarsen et al. 2003, Rodwell & Demir 2012, Samnani & Singh 2012). A negative affect – described as a tendency to experience negative emotions such as anxiety, fear, sadness and anger (Watson et al. 1988) – could be an important factor to a victim of WPB. Persons with low self-worth, introversion and a negative affect may be easily vulnerable to becoming 328
victims as they may appear scared, sad or anxious (Rodwell & Demir 2012, Samnani & Singh 2012). According to Rodwell and Demir (2012), workrelated characteristics are important in identifying antecedents of bullying and violence. WPB has been found to be associated with a more senior nurse resorting to the use of rude language targeted at newly employed nurses (Johnson & Rea 2009, Seo et al. 2012). Vessey et al. (2009) reported that nurses with 1–5 years of clinical experience are exposed to twice as much workplace violence as are those with 6–15 years of experience (Vessey et al. 2009). Previous studies have also reported that excessive workloads introduce the likelihood of bullying behaviours among nurses (Quine 2001, Yıldırım 2009) Although meaning and conceptual ideas differ, WPB is a worldwide phenomenon in the nursing profession. In Western studies, ‘Nurses eat their young’ (Simons & Mawn 2010) is a concept appearing in recent research literature, and can be considered comparable to the Korean expression ‘tae wum’ and the Japanese concept of ‘Ijime’ (Abe & Henly 2010). Collectivist traditions in Asian countries, such as Japan and South Korea, value harmony and group norms (Abe & Henly 2010), an individualistic personal characteristic that can influence WPB and LV. ‘Tae wum’, the Korean equivalent to WPB, which translates to ‘burn something up’, could be considered in the cultural aspect of WPB and LV in South Korea (Kim 2006, Lee 2007, Seo et al. 2012). Literature suggests that various antecedents can explain the occurrence of WPB (Samnani & Singh 2012), but, thus far, cultural factors have been of little interest to nursing researchers. Studies of clinical nurses in South Korea have been few. Nam et al. (2010) reported the prevalence of WPB in one South Korean hospital; however, no research has explored potential predictors of either WPB or LV. We attempt to fill this gap by exploring the impact of both individual and work-related characteristics using a respected and tested scientific framework (Figure 1). The purpose of this study was to explore the individual and institutional factors associated with WPB and LV using a conceptual framework.
Methods Design This is a descriptive study. This study is part of a larger study investigating WPB and patient safety for nurses working in one city’s hospitals. ª 2015 John Wiley & Sons Ltd Journal of Nursing Management, 2016, 24, 327–335
Bullying and violence among clinical nurses in Korea
Figure 1 Potential predictors of workplace bullying and lateral violence: conceptual framework. Table 1 Demographic and Work-related Characteristics (N = 255) Characteristics
Category
Demographic characteristics Gender Male Female Age (years) Religion Yes No Education level Junior college BSN Graduate school Work-related characteristics Years working in 0.5≤ to
Factors affecting workplace bullying and lateral violence among clinical nurses in Korea: descriptive study HYUNJIN OH
RN, PhD
1
, DONG CHOON UHM
RN, PhD
2
and YOUNG JOO YOON
PhD
3
Assistant Professor, School of Nursing, Gachon University, Incheon, South Korea, 2Associate Professor, Department of Emergency Medical Technology, Daejeon University, Daejeon, South Korea and 3Assistant Professor, Department of Business Information Statistics, Daejeon University, Daejeon, South Korea 1
Correspondence Dong Choon Uhm 62 Daehak-ro Dong-gu Daejeon 300-716 Korea E-mail: [email protected]
OH H., UHM D. C. & YOON Y. J.
(2016) Journal of Nursing Management 24, 327–335. Factors affecting workplace bullying and lateral violence among clinical nurses in Korea: descriptive study Background & aim Workplace bullying and lateral violence are serious issues affecting the work life of hospital nurses. The purpose of this study was to identify the selected individual and institutional characteristics for workplace bullying and lateral violence using a conceptual framework. Methods A descriptive survey design was used. A convenience sample of 255 nurses in tertiary hospitals, who had a minimum of 6 months clinical experience, completed the survey. Regression analysis was used to determine factors significantly associated with workplace bullying and lateral violence. The Negative Acts Questionnaire-Revised and the Lateral Violence scale were used to measure workplace bullying and lateral violence. Results A negative affect, individualism and working in hospital specialty units predicted workplace bullying. Individualism, a negative affect, affiliated hospital and working hours predicted verbal abuse whereas the place of employment was significantly associated with lateral violence. Conclusion The results of this study identified factors that are associated with bullying and violence but did not fully support the conceptual framework. The individual characteristic negative affect was significantly associated with most types of workplace bullying and lateral violence bully whereas the place of employment was an important factor in lateral violence. Implications for Nursing Management Nurse managers need to be aware that both individual and institutional factors may impact levels of workplace bullying and lateral violence in their hospitals and need to prepare specific strategies to address these multiple factors. Keywords: hospital nurses, workplace bullying, workplace violence
Accepted for publication: 26 May 2015
Introduction Workplace bullying (WPB) and lateral violence (LV) are serious issues affecting clinical nurses and the hospital work environment. Bullying includes negative acts such as hostile remarks, persistent criticism, physical abuse, threats and social exclusion (Einarsen et al. DOI: 10.1111/jonm.12324 ª 2015 John Wiley & Sons Ltd
2003, Samnani & Singh 2012). WPB refers to repeated and persistent attacks or acts of bullying someone for more than 6 months in the workplace (Samnani & Singh 2012). Another important concern negatively impacting the work environment is lateral violence (LV). LV refers to nurse-on-nurse aggression and has various concepts, 327
H. Oh et al.
including horizontal violence, horizontal hostility, bullying and workplace incivility (Farrell 1997, Stanley et al. 2007, Embree & White 2010, Einarsen et al. 2011). WPB and LV overlap, and a recent report outlined the need for differentiating types and sources of LV. It is recommended that the focus for LV be reserved for actual abuse that includes perceived or actual harm (Farrell 1997, Hesketh et al. 2003, Rodwell & Demir 2012). In general, both WPB and LV are defined as negative events occurring in the workplace (Farrell 1997, Embree & White 2010, Einarsen et al. 2011). However, researchers have noted that WPB is work-related and psychological in nature whereas LV focuses on various instances of actual physical harm (Einarsen et al. 2011, Rodwell & Demir 2012). Cultural differences could influence perceptions of mistreatment (Nisbett et al. 2001), implying that people from different cultures can interpret behaviours differently. If understanding LV is different, definitions and experiences of WPB may also be different (Seo et al. 2012). Contrary to the low rate of physical violence reported in Western studies (Farrell 1997, Hesketh et al. 2003), actual physical harm among Korean nurses has often occurred and has been featured in the media (Kim 2006, Park 2014). WPB and LV have been defined and studied mainly in Western countries, but little is known about the characteristics and differences of perceptions of WPB and LV in other cultures. To bring clarity to an analysis of many factors associated with WPB and LV for hospital nurses, we employed a conceptual framework stressing the impact of both individual and institutional characteristics. Our conceptual framework integrated Rodwell and Demir’s (2012) notion of WPB and violence, and Samnani and Singh’s model (2012) to exam factors influencing WPB and LV. Samnani and Singh (2012) developed a conceptual framework based on an extensive review of over 20 years of extant literature focusing on the antecedents and consequences of WPB. In their framework, individual characteristics of victims and organisational characteristics were delineated. Regarding individual level antecedents, there is some evidence suggesting that victims of WPB presented individual characteristics of low self-esteem (Losa Iglesias & De Bengoa Vallejo 2012), introverted tendencies and a negative affect (Einarsen et al. 2003, Rodwell & Demir 2012, Samnani & Singh 2012). A negative affect – described as a tendency to experience negative emotions such as anxiety, fear, sadness and anger (Watson et al. 1988) – could be an important factor to a victim of WPB. Persons with low self-worth, introversion and a negative affect may be easily vulnerable to becoming 328
victims as they may appear scared, sad or anxious (Rodwell & Demir 2012, Samnani & Singh 2012). According to Rodwell and Demir (2012), workrelated characteristics are important in identifying antecedents of bullying and violence. WPB has been found to be associated with a more senior nurse resorting to the use of rude language targeted at newly employed nurses (Johnson & Rea 2009, Seo et al. 2012). Vessey et al. (2009) reported that nurses with 1–5 years of clinical experience are exposed to twice as much workplace violence as are those with 6–15 years of experience (Vessey et al. 2009). Previous studies have also reported that excessive workloads introduce the likelihood of bullying behaviours among nurses (Quine 2001, Yıldırım 2009) Although meaning and conceptual ideas differ, WPB is a worldwide phenomenon in the nursing profession. In Western studies, ‘Nurses eat their young’ (Simons & Mawn 2010) is a concept appearing in recent research literature, and can be considered comparable to the Korean expression ‘tae wum’ and the Japanese concept of ‘Ijime’ (Abe & Henly 2010). Collectivist traditions in Asian countries, such as Japan and South Korea, value harmony and group norms (Abe & Henly 2010), an individualistic personal characteristic that can influence WPB and LV. ‘Tae wum’, the Korean equivalent to WPB, which translates to ‘burn something up’, could be considered in the cultural aspect of WPB and LV in South Korea (Kim 2006, Lee 2007, Seo et al. 2012). Literature suggests that various antecedents can explain the occurrence of WPB (Samnani & Singh 2012), but, thus far, cultural factors have been of little interest to nursing researchers. Studies of clinical nurses in South Korea have been few. Nam et al. (2010) reported the prevalence of WPB in one South Korean hospital; however, no research has explored potential predictors of either WPB or LV. We attempt to fill this gap by exploring the impact of both individual and work-related characteristics using a respected and tested scientific framework (Figure 1). The purpose of this study was to explore the individual and institutional factors associated with WPB and LV using a conceptual framework.
Methods Design This is a descriptive study. This study is part of a larger study investigating WPB and patient safety for nurses working in one city’s hospitals. ª 2015 John Wiley & Sons Ltd Journal of Nursing Management, 2016, 24, 327–335
Bullying and violence among clinical nurses in Korea
Figure 1 Potential predictors of workplace bullying and lateral violence: conceptual framework. Table 1 Demographic and Work-related Characteristics (N = 255) Characteristics
Category
Demographic characteristics Gender Male Female Age (years) Religion Yes No Education level Junior college BSN Graduate school Work-related characteristics Years working in 0.5≤ to
