- Title
- Creating respectful workplaces for nurses in regional acute care settings
- Creator
- Hawkins, Natasha
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2023
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Background: Negative workplace behaviour among nurses is an internationally recognised problem, and there are various forms of mistreatments and uncaring attitudes experienced by nurses. Generally, the negative workplace behaviours experienced by nurses can be classified into three categories: work-related bullying (e.g., unmanageable workloads or withholding information); person-related bullying (e.g., being humiliated or ignored); and physically intimidating bullying (e.g., being shouted at or threatened with violence). Exposure to these behaviours has been shown to be not only detrimental to individuals but can also have implications for the organisation, the profession and even the safety and quality of care that patients receive. Aim: This study aimed to investigate the self-reported exposure to and experiences of negative workplace behaviours of nursing staff, as well as their ways of coping, in regional acute care hospitals in one Local Health District (LHD) in New South Wales, Australia, before and after an educational intervention was implemented within the organisation. Design: This study employed a mixed-methods sequential explanatory design with an embedded quasi-experimental quantitative component. Post-intervention data also included qualitative interviews, and the theoretical underpinning for the entire study was the Social Worlds Theory. Methods, Setting and Participants: Quantitative data were as collected in 2018. Nurses (N = 230) from 12 wards/units across four hospitals were invited to complete a pre-intervention survey. The structured questionnaire consisted of four parts: demographic questions; the Negative Acts Questionnaire – Revised; questions on exposure to bullying and/or incivility, policy awareness and use of pathways; and, finally, the Ways of Coping Questionnaire. The two hospitals that were assigned as intervention sites then had an educational intervention titled ‘Respectful Workplace Workshops’ delivered by the organisation. The other two hospitals were assigned as control sites, where no intervention was implemented. After the intervention, follow-up surveys were undertaken across all sites using the same questionnaire. Participants were invited to take part in qualitative semi-structured interviews to provide a deeper understanding of nurses’ experiences and perceptions of workplace behaviour. These interviews were undertaken with 13 nurse informants. Results: There were 74 responses (32%) to the pre-intervention survey and 56 responses (24%) in the post-intervention data collection. A total of 111 participants attended the educational intervention, of which 20% (n = 22) completed the follow-up survey for this study. The quantitative data indicated that participants were more likely to be exposed to work-related bullying acts, such as excessive workloads and unrealistic deadlines. Participants also indicated that the negative acts were more likely to be from managers and registered nurse colleagues. When participants were exposed to negative acts, they reported using problem-focused coping strategies to alter their situation and sought social support as a way of coping. The post-intervention survey indicated that overall, there was a decrease in bullying and incivility experienced by participants; however, the findings were unable to establish that a statistically significant difference was made due to the implementation of the intervention. The qualitative interviews explored informants’ views and experiences of workplace behaviours within the nursing social world and identified the core category as A conflicted tribe under pressure, which was comprised of five subcategories: Belonging to the tribe; ‘It’s a living hell’; Zero tolerance – ‘it’s a joke’; Conflicted priorities; and Shifting the cultural norm. The informants spoke about work groups being ‘us versus them’ and depicted a difficult socialisation and authentication process into the nursing social world. They shared their experiences of negative behaviours in their workplace and described the impact on their lives as a living hell. There was also a view by informants that the standard of zero tolerance was unrealistic and suggested that negative behaviours were often not reported or undermanaged. Various components of a struggling health care system, such as heavy workloads and a lack of staff and resources compounded by conflicting care priorities between management and frontline staff, were recognised as negatively affecting workplace interactions. Informants highlighted the need for change at various levels to shift the cultural norms of the profession. Conclusions and Implications: This study highlighted that negative workplace behaviours within the nursing social world are complex and multifaceted. Historically, negative behaviours in nursing have been considered to be the actions of an individual; however, this study has demonstrated that the negative behaviours are largely organisational, work-related negative behaviours. These acts, such as the deprivation of resources and allocation of unachievable workloads, have become commonplace, and nurses are under increasing pressure to provide safe patient care within a broken system. This study has highlighted that these organisational factors feed into and influence the workplace interactions of nurses. Organisations need to consider that a tick-box approach consisting of zero-tolerance policy. implementation and a one-size-fits-all educational program will have a limited impact on the levels of negative workplace behaviours if the influencing organisational factors are not also considered. This was clearly demonstrated in this study, with the educational intervention having a minimal effect on the levels of negative workplace behaviour, mainly work-related negative acts. To truly influence the civility norms of the nursing profession and eliminate negative workplace behaviour, we must first address the organisational factors that allow its continuation and take a zero-tolerance stance to all types of negative behaviours, either personal, physical or work-related acts. Nursing leaders at all levels play a pivotal role in enacting this change and must support nurses to ensure positive workplace change.
- Subject
- nurse; workplace; behaviour; acute care
- Identifier
- http://hdl.handle.net/1959.13/1488881
- Identifier
- uon:52559
- Rights
- Copyright 2023 Natasha Hawkins
- Language
- eng
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