Registered Nurses' Experiences With Incivility During the Early Phase of COVID-19 Pandemic: Results of a Multi-State Survey.

BACKGROUND: Incivility among workers in the health sector is recognized as an occupational hazard. The COVID-19 outbreak brought sudden and profound changes to many health care settings, many of which have been identified as antecedents to workplace incivility. The purpose of this retrospective study was to explore the experiences of registered nurses with workplace incivility, cyber-incivility, and incivility outside of work during the early phase of the COVID-19 pandemic. METHODS: This mixed-methods study used convenience sampling. Data were collected from June to September 2020 via an online survey, which consisted of both closed- and open-ended questions. Participants were recruited from national nursing organizations and unions. Data were analyzed using descriptive statistics and thematic analysis for open-ended responses. FINDINGS: A total of 526 nurses' responses were included in the analysis. More than one third experienced greater incivility at work during the COVID-19 outbreak than before the pandemic (37.4%), and almost half (45.7%) said they witnessed more incivility than before the pandemic. Cyber-incivility and incivility outside of work were also issues. Qualitative results indicated that respondents felt they were on edge during this period. Other themes included leadership failure, fractured co-worker relationships, heightened incivility from patients and families, and hostility and ostracism from the general public. CONCLUSION/APPLICATION TO PRACTICE: Occupational health nurses, nursing leaders, and staff nurses need to work to restore relations that were fractured by incivility during the pandemic. In the future, improved preparedness, including establishing clear channels of communication, may lessen incivility by decreasing role stress and organizational chaos.

An Exploratory Study of Bullying Exposure Among School Nurses: Prevalence and Impact.

The frequency and consequences of bullying directed at school nurses (SNs) are poorly understood. The purpose of this study was to describe the prevalence and impact of bullying directed at school nurses, determine predictors of bullying directed at school nurses, and evaluate the individual and organizational impact of exposure to bullying directed at school nurses. School nurses (n = 334) completed an online survey comprised of the Negative Act Questionnaire-Revised, Perceived Stress Scale, National Institute for Occupational Safety and Health General Social Survey 2010 Quality of Worklife Module, Michigan Organizational Assessment Questionnaire, and open response items to determine their experiences with, and impact of, bullying. Descriptive and inferential statistics were calculated for quantitative data, while content analysis was used to analyze responses to open-ended survey items. One third of participants reported occasional or frequent bullying. Content analysis revealed three themes, including unexpected parent behavior, staff incivility, and formal reporting. Findings support the development of an educational intervention to assist school nurses in the prevention and management of bullying exposure.

An Exploratory Study of Bullying Directed Toward Clinical Nursing Faculty: Prevalence and Impact.

BACKGROUND: Clinical education is an integral component of nursing education and relies heavily on clinical nursing faculty (CNF). However, there are not enough nurses seeking CNF positions to meet the current demand of the nursing workforce. PURPOSE: The purpose of this study was to examine the prevalence and impact of workplace bullying directed toward CNF. METHODS: For this exploratory cross-sectional study, a web-based survey was distributed to CNF working in New England states. RESULTS: A total of 76 participant responses were analyzed. Eighteen percent of the participants met the criteria for being either occasionally or frequently bullied. Nursing staff in the clinical agencies and colleagues and administrators in the nursing program where CNF teach were identified as the most frequent perpetrators. CONCLUSIONS: Understanding the prevalence and impact of bullying of CNF helps inform the development of strategies to support and retain these essential members of the nursing education workforce.

Exploring the bi-directional relationship between sleep and resilience in adolescence.

OBJECTIVE: The study examined whether overall sleep quality and the sleep components comprising the Pittsburgh Sleep Quality Index (PSQI) have a bi-directional relationship with resilience among adolescents, after adjusting for sex, age, depression, and socioeconomic status, and investigated which sleep components have a stronger effect on resilience. METHODS: A total of 1299 students (58% females; mean age, 15.79 years) participated at baseline, with 840 finishing all four study waves over the course of 24 months. Data were collected through questionnaires, including socio-demographics, the Pittsburgh Sleep Quality Index, Patient Health Questionnaire 9-item, and the Connor-Davidson Resilience Scale. Cross-lagged models were used to analyze the relationships between sleep and resilience. RESULTS: Both daytime dysfunction and sleep disturbance had an independent bi-directional relationship with resilience. Higher resilience scores predicted overall better sleep quality and shorter sleep latency, but not vice versa. Sleep disturbance and daytime dysfunction had stronger effects on resilience. CONCLUSIONS: These findings highlight the importance of future school interventions for sleep to improve students' resilience.

Understanding the Impact of Bullying in a Unionized U.S. Public Sector Workforce.

Background: Workplace Bullying (WPB) can have a tremendous, negative impact on the victims and the organization as a whole. The purpose of this study was to examine individual and organizational impact associated with exposure to bullying in a large U.S. unionized public sector workforce. Methods: A cross-sectional Web-based survey was conducted among 16,492 U.S. state government workers. Survey domains included demographics, negative acts (NAs) and bullying, supportiveness of the organizational climate, and individual and organizational impacts of bullying. Multinomial logistic regression was used to assess the impact among respondents who reported exposure to bullying. Findings: A total of 72% participants responded to the survey (n = 11,874), with 43.7% (n = 5,181) reporting exposure to NAs and bullying. A total of 40% (n = 4,711) participants who experienced WPB reported individual impact(s) while 42% (n = 4,969) reported organization impact(s). Regular NA was associated with high individual impact (negatively impacted them personally; odds ratio [OR] = 5.03) when controlling for other covariates including: female gender (OR =1.89) and job tenure of 6 to 10 years (OR = 1.95); working in a supportive organizational climate and membership in a supportive bargaining unit were protective of high impact (OR = 0.04 and OR = 0.59, respectively). High organizational impact (transferring to another position) was associated with regular NA and bullying (OR = 16.26), female gender (OR = 1.55), providing health care and field service (OR = 1.68), and protective effect of organizational climate (OR = 0.39). We found a dose-response relationship between bullying and both individual and organizational-level impact. Conclusion/Application to Practice: Understanding the impacts of WPB should serve to motivate more workplaces and unions to implement effective interventions to ameliorate the problem by enhancing the organizational climate, as well as management and employee training on the nature of WPB and guidance on reporting.

Comparative psychometric review of the Negative Acts Questionnaire-Revised in a unionized U.S. public sector workforce.

BACKGROUND: Workplace violence is a global problem that includes actions collectively defined as bullying as perpetrated by a work colleague. PURPOSE: Two distinct studies were conducted to assess the feasibility of using an abridged 6-item scale within the 21- item Negative Acts Questionnaire-Revised (NAQ-R) designed to assess workplace bullying. METHODS: The pilot study was a psychometric review of the 21-item NAQ-R, and the main study was conducted to determine the reliability and the validity of using a 6-item version. Cronbach's alpha assessed the internal consistency of the two versions of the NAQ-R. Validity was assessed using logistic regression with theoretically related constructs with a pilot study (n = 420) using the 21-item scale, followed by the main study (n = 11,874) using the 6-item version. RESULTS: Both the pilot study (21-item)and the main study (6-item) versions of the NAQ-R demonstrated high internal consistency (Cronbach's alpha 0.93-0.86, respectively). Similar to the 21-item, the 6-item version had a significant impact on the intent to remain on the job, being personally affected, and supported the protective role of the organizational climate against exposure to negative acts. CONCLUSION: This study supports using the 6-item NAQ-R, which can reduce respondent burden and streamline data gathering and analysis.

An exploration of the workplace bullying experience: coping strategies used by nurses.

This qualitative descriptive study explored nurses' experience of being bullied and examined their coping strategies. A purposive sample of 18 registered nurses who self-identified as being targets of bullying behavior was used. The authors found that nurses used a variety of coping strategies. An understanding of these strategies can assist staff development educators to develop interventions to eliminate this pervasive problem.

The percutaneous endoscopic gastrostomy tube: a nurse's guide to PEG tubes.

Nurses are primarily responsible for the care and maintenance of percutaneous endoscopic gastrostomy (PEG) tubes and yet their care is not often included in nursing skills textbooks. Best practice recommendations to care for a person with a PEG tube are described.

Bedside assessment of enteral tube placement: aligning practice with evidence.

Since the flexible Levin tube was introduced in 1921, enteral feeding has become ubiquitous. From the out-set, nurses have been responsible for confirming the correct placement of enteral feeding tubes prior to their use for alimentation or medication administration, but current nursing practice doesn't always reflect the best evidence. Although research has established the inadequacy of auscultation to determine proper tube placement, this method is still commonly practiced. The authors examine the research that's been conducted over the past 25 years and compare the accumulated evidence with current practice, as reflected in a convenience sample of 28 New England hospitals. In addition, they evaluate various methods for assessing enteral feeding tubes and make evidence-based practice recommendations.

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.

Bullying in the workplace--a qualitative study of newly licensed registered nurses.

Bullying in the workplace is associated with negative job satisfaction and retention. It has also been found to have adverse effects on the health of employees. Using a qualitative descriptive design, this study examined the stories of bullying among nurses based on actual or witnessed experiences. One hundred eighty-four newly licensed U.S. nurses responded to an open-ended question on a survey about bullying mailed to their homes. Four major themes emerged that related to varying types of bullying behaviors, perceived causes of bullying, and the impact of bullying behaviors. The themes included structural bullying; nurses "eating their young"; being out of the clique; and leaving the job. Bullying is experienced firsthand and secondhand by nurses, and particularly by vulnerable, newly graduated nurses. Workplace bullying must be explored fully to develop effective strategies to eliminate it.

Workplace bullying experienced by Massachusetts registered nurses and the relationship to intention to leave the organization.

This descriptive study examines bullying behavior among nurses and tests the relationship between bullying and a nurse's intention to leave their organization. Data were collected from 511 randomly selected newly licensed registered nurses by using the Revised Negative Acts Questionnaire, an instrument that measures perceived exposure to bullying at work. Results found that 31% of respondents reported being bullied and that bullying is a significant determinant in predicting intent to leave the organization (B = 3.1, P < .0005). Data suggest that effective interventions are needed to stop workplace bullying that contributes to high rates of nurse turnover.