Workplace Bullying among Nurses in the Acute Setting

Introduction

This capstone project aimed to create awareness and empower people at my workplace to discuss the bullying-related issues they face daily. Since the onset of the COVID-19 pandemic, the frequency of conflicts between nurses and their colleagues and managers has increased significantly in my workplace. The stressful environment has led some of the least experienced nurses to consider pursuing a different career path. When poorly managed, workplace conflicts become a source of intimidation in the workplace. Therefore, I saw the need to implement organizational change and raise awareness about the problem. As a result of my project- and research-based efforts to study Australian nurses’ mistreatment experiences at the workplace during the COVID-19 pandemic, I developed practical strategies for managing workplace bullying at a job and organizational level. I also acquired an in-depth understanding of bullying, factors that predict workplace bullying, the impact of bullying at the workplace, and bullying prevention strategies.

The justification for the project based on the literature includes the following:

  • Workplace bullying is “repeated and unreasonable behavior directed towards a worker or group of workers that creates a risk to health and safety” (Guide for preventing and responding to workplace bullying, 2016, p. 5).
  • Frontline nurses working in the respiratory, emergency, infectious diseases, and intensive care units are twice more likely to suffer from fear, anxiety, and depression than administrative personnel (Lu et al., 2020).
  • Bullying among nurses threatened patients’ safety (Rutherford et al., 2019).
  • Aggressors are nurses, medical workers, and administrative and support personnel (Birks et al., 2018).
  • Almost 80% of bullying victims eventually decide to leave the profession (Hartin et al., 2020).
  • Managers can influence nurses and prevent bullying (Hartin et al., 2020).
  • There is a demand for hospital-based continuing education programs to raise awareness of the problem (Bambi et al., 2019).
  • Employers worldwide should protect their employees from discrimination and unfair treatment in the workplace (Employee wellbeing in the workplace, 2018).

The project met three learning outcomes, developed considering Bloom’s classifying taxonomy and SMART objectives. A literature review on workplace bullying among nurses in acute settings supported the discussion. The project studied nurses’ understanding and perception of bullying, the most common forms of bullying, factors that predict and impact workplace bullying, and strategies for managing workplace bullying. Gibb’s six-stage critical reflection model was chosen to serve as a framework for self-evaluation. Based on the research, recommendations were developed for employers to manage workplace bullying.

Contents of the Professional Portfolio

  1. Brief background of the investigator
  2. Project plan – completed December 2020
  3. Presentation 1 – completed December 2020
  4. Presentation 2 – completed July-August 2021
  5. Capstone report and critical reflection including references – completed July-August 2021

Self-Assessment Statement

This project will illustrate my skills in integrating the knowledge gained during the Master’s program and the work practice in an acute nursing setting. The project will also prove my capacity to reflect on the learned information and develop new knowledge based on the research and observations. My Master’s program allowed me to apply scientific research and find a practical solution for an urgent and painful workplace bullying issue. For instance, I utilized advice provided in Employee wellbeing in the workplace (2018) to develop strategies for employers that explain how to respond to workplace bullying, regulate employee behavior, and set bullying reporting procedures.

During my work in the acute nursing setting, I noticed that the risks of bullying against new and inexperienced nurses have increased after the COVID-19 pandemic. I decided to study nurses’ experiences and perceptions of bullying after noticing that some of my colleagues speak about bullying but hesitate to report it. In my conversations with new nurses, I found out that they often feel upset because of new rules regarding disinfection and protective equipment and conflicts with colleagues that can occur during every shift. Most nurses experienced bullying, but due to the fear that things will get worse, they failed to speak up. Therefore, I aimed to create awareness and empower people to discuss the bullying-related issues they face daily.

Throughout my nursing practice, I also noticed that the potential causes of emotionally challenging situations are an increased workload on staff members and employees’ fear of making costly mistakes when implementing safety measures. Other reasons include individuals’ emotional stress stemming from the threat of getting an infection or transmitting it to their children and elderly relatives. Additionally, prejudice and bias due to diverse philosophical and cultural values still exist in nursing settings. From what I have witnessed recently, new safety requirements became another reason to express personal hostility towards the care staff. For instance, supervisors and more experienced nurses often ridiculed young nurses’ approaches to hand hygiene and wearing personal protective clothing.

While receiving my education within the Master’s program, I paid particular attention to the research considering workplace bullying. Scientists confirm that medical personnel experienced more stress during a pandemic than administrative personnel (Lu et al., 2020). The researchers emphasized that frontline medical personnel needs effective strategies to improve mental health. Therefore, I have concluded that scientific findings can benefit my nurses’ team if I implement a project aimed at launching a new strategy for managing workplace bullying. As part of the project, I collaborated with my colleague nurses to study their perceptions and understanding of bullying. I also tried to estimate their desire to visit the training sessions and read the handout material for self-education about bullying, which turned out to be reasonably high.

Critical Reflection

In collecting first-hand information and analyzing research, I applied reflective practice to achieve educational and professional goals. I kept a reflective journal to document and discuss the results of each week of work on the project. In 1988, Gibbs proposed a unique six-step approach to reflexive introspection of scientific activity. I used this model to structure journal entries and ensure that each entry contains new knowledge and insights into the context of nursing practice (Squirrell & Hunt, 2018).

This model includes six interrelated steps that reflect the broader application of specific facts. In the description, I focused on the achievements and ideas of the week. The sensations section of the journal entries contained detailed discussions of how the project is progressing and what I think about it. The assessment section focused on good and bad achievements, analyzed what was relevant, and offered conclusions and recommendations on applying this knowledge in future practice.

I also applied the Gibbs model to analyze the overall work done. Luckily, Gibbs’ six stages are best suited for analyzing research practice. These include the Description stage, which answers the question “What happened?”, the Stage of Feelings, showing “What you were thinking and feeling?”, and the Evaluation stage which says “What was good and bad about the experience?”. Then, the fourth stage is Analysis, where I explain “What sense can I make from the situation?”, the fifth stage is the Conclusion saying “What else can be done?”, and the sixth stage is an Action plan describing “If it happens again, what I would do?”.

To sum it up, when I received the requirements for the project plan development, I felt a bit disappointed and thought that this might be a challenging task. The most frustrating part was the volume of the paper and the necessity to fit in it. However, while elaborating on goals and learning outcomes, and then making the literature review and the questionnaires, I felt uplifted and even inspired since the most exciting part – the practical research was still ahead.

To make some sense of the situation, I analyzed the information provided by scholars. Then I got to see the following steps of applying the scientific research to creating the presentation and portfolio and elaborating recommendations. Finally, I realized that I have an action plan for the future, which I will use in similar circumstances. I will most likely repeat all the steps already taken and maybe feel less anxious about the work’s results. Besides, I will develop creative approaches to the practical part of the task more freely in the future.

Individual Learning Outcomes

As a result of the creation of the capstone project, I have fulfilled personal learning outcomes:

  1. Demonstrate a sound understanding of the researched topic by conducting a literature review.
  2. Prove the ability to assess factors that hinder and facilitate workplace bullying by developing and conducting a questionnaire. I have designed an effective questionnaire with 11 questions to identify workplace bullying perceptions and experiences.
  3. Use practical research skills by conducting research based on the presented questionnaire by March 2021. Using the probability sampling technique, I will sample 30 colleagues and analyze bullying-related trends and learning needs by March 2021.
  4. Prove the ability to educate others by creating educational materials about bullying in nursing settings. Using adult learning principles and the identified learning needs, I will design a five-page handout on workplace bullying for nurses and an accompanying ten-slide presentation by July-August 2021.
  5. Evaluate, reflect, and report on the capstone’s findings and recommendations by applying a critical reflection model and creating a professional portfolio.

Critical Analysis and Reflection

Developing the Project Plan

At first, working on the project plan seemed challenging to me. However, later I decided that the most sensitive issues related to my nursing practice should be chosen as the topic of the project and focused on analyzing the situation and collecting theoretical information. It seems important that the project will help solve nurses’ pressing problems since bullying in the workplace often leads to reckless, emotional decisions among young nurses about changing occupations. Besides, I am glad that my research work will help introduce a better, patient-oriented practice. Indeed, in the context of a pandemic crisis, both nurses and patients suffer from workplace conflicts. I am also happy that my experience will help the organization in which I work to overcome some management barriers, improve employees’ work experience, and increase their level of satisfaction. Since I am quite a sociable person, it was not difficult for me to find out what problems my fellow nurses usually face and then draw conclusions about what solutions would be in demand. Besides, since I have witnessed some conflicts, I can more confidently discuss working relations.

In developing the project plan, I experienced some difficulties in my research. I had to analyse different approaches and points of view and compare them with the observed reality. All the scientific sources I used were beneficial as they provided recommendations and conclusions based solely on observations of the real work environment and nurses’ experiences. My commitment to the chosen career path and the desire to improve my colleagues’ experience was the main driving force that helped me work on the project.

Working in the emergency department is a unique experience for me, as it allows me to realize my dream of helping people and alleviating my patients’ suffering. However, since the quality of treatment depends entirely on the nurses’ physical and psychological condition, their needs must be met through the effective work of managers. I recommended strategies that aim at prevention by reporting bullying, educating nurses about bullying, and implementing effective leadership styles. Personal acquaintance with the nurses who faced the problem and the regular observation of the studied environment gave me a unique chance to make a difference.

Developing the Project Rationale and Presentation

According to the requirements, I had to create two presentations, the first presented in December 2020. The second presentation will accompany handouts on workplace bullying, which I will design by July-August 2021. My colleagues’ approval is important to me to continue working on the project, so I was very excited before giving the first presentation. I have studied some public speaking techniques to convey information in the most interesting and accessible way possible. I also wanted to get approval from managers since there is a chance they will be implementing the proposed strategies. The second presentation will be designed to draw attention to handout materials distributed to my fellow nurses.

I am concerned that my arguments may not seem convincing enough to management; therefore, I will include enough factual information in the educational materials. I am also afraid to seem insincere or insufficiently motivated in front of my colleagues since this project is an initiative for which I am personally responsible. Therefore, I will convey the information in my own words, using examples from my nursing practice whenever possible, and describing familiar situations. After the presentation, I hope to involve my colleagues in discussing the presented problem since joint discussion should reduce the frequency of unpleasant and unwanted conflict situations. A few days before the presentation, I plan to present my work to the management, briefly explaining my project’s essence and the importance of the problem.

Demonstrate a sound understanding of the researched topic by conducting a literature review.

Literature Review

As part of project preparation, I made a literature review for the project plan and Presentation 1. The literature selection was successful enough to create an evidence base to justify the project and clarify all intricate aspects. As part of the project plan’s preparation, I was interested in knowing what meaning scientists give to workplace bullying, and I found several suitable definitions. Next, I needed information on how often workplace bullying can be seen in nursing settings to assess the problem’s scale.

After I was convinced that this is indeed a common phenomenon, I tried to find materials that would help me determine the causes and consequences of bullying. Next, I found a selection of studies and guidelines defining workplace bullying as a management issue and providing advice for developing effective bullying prevention strategies. Finally, I spotted official government requirements for nurses regarding handling bullying at the workplace. These materials allowed me to make significant progress in understanding the problem.

As a part of the literature review for Presentation 1, I paid particular attention to concepts of bullying and workplace bullying, types of bullying, statistics on bullying in Australia, factors that predict workplace bullying, the impact of bullying in the workplace, and prevention strategies. The latter included staff education, implementing leadership styles, and reporting bullying. When searching for relevant literature, I used key search terms “workplace bullying in the nursing setting in Australia,” “bullying at the workplace,” “bullying prevention guidelines,” “midwifery standards,” “impact of bullying,” “bullying concept,” “bullying awareness in the nursing settings.” For the most part, I used the university library to find the articles I needed. I had to look through over 100 studies to find the ones that matched my searches. As a result, I selected 18 materials to write the project plan and eight additional sources to complete Presentation 1.

I had to refuse to consider studies not directly related to my specific topic of workplace bullying in nursing settings. Fortunately, I found enough evidence that bullying in the workplace is a threat to nurses and their patients and enough material to suggest ways to address the issue. In particular, Lu et al. (2020) confirmed my observations that medical staff experienced more stress during a pandemic than administrative staff and that nurses in direct contact with infected patients were twice as likely to suffer from anxiety and depression. Most importantly, this study was conducted with workers in the respiratory, emergency, infectious, and intensive care units who scored the highest on the scale of fear, anxiety, and depression. These data allowed me to relate the study to my observed workplace bullying among nurses in the acute setting and conclude that health workers on the frontline need effective strategies to improve mental health.

I also took many ideas from research by Hartin et al. (2018), who noticed that bullying reports’ frequency continues to rise. In the subsequent analysis, the authors emphasized that nursing managers are poorly trained to identify and address this problem (Hartin et al., 2020). Notably, Rutherford et al. (2019) said that the situation threatens patient safety. However, Birks et al. (2018) recognized that nurses, medical workers, and administrative and support personnel act as aggressors, and bullying takes the forms of verbal aggression, racial hatred, physical abuse, and sexual harassment. Researchers also helped me identify the effects of bullying, including increased levels of anxiety, panic attacks, physical symptoms of stress, loss of confidence, and low self-esteem among nursing students (Birks et al., 2018). Most importantly, scholars recognized the need for trained clinical instructors to combat bullying (Birks et al., 2018).

For instance, Bambi et al. (2019) proposed implementing hospital-based continuing education programs to raise awareness of the issue. They suggested implementing an anonymous bullying reporting system and attracting professional psychologists to an environment with high bullying reporting levels (Bambi et al., 2019). Besides, in scholars’ opinion, changes in the staffing of shifts can solve the problem. My attention was particularly drawn to Báez-León et al.’s (2016) observation of witnesses’ roles. Scientists have proposed developing a model that will motivate witnesses to help victims, and I hope to convince managers to implement this strategy at my workplace. Research has shown that helping intentions are usually determined by tension, group identity, peer support, and lack of fear of retaliation. The latter factor turned out to be decisive and directly influenced the provision of assistance.

Another important aspect of the problem is that, according to scientists, bullying in the workplace leads to an increased risk related to patient care. Therefore, in extremely stressful situations, almost 80% of nurses decide to leave the profession (Hartin et al., 2020). It is a glaring statistic, which alone is enough to recognize the need to take immediate action on the part of medical institutions’ leadership. Quite often, employees of hospitals and emergency departments face increased workloads due to a lack of professionals; the situation became especially acute during the pandemic. Therefore, scientists recognize that the optimal number of nurses is an effective measure to prevent bullying in the workplace and contribute to healthy conflict resolution (Bambi et al., 2019; Hartin et al., 2018). A healthy environment will contribute to staff retention, which proves the validity of this requirement.

Finally, the guidelines provided by the Australian Public Service Commission imply that employers worldwide must protect their employees from discrimination and unfair treatment in the workplace (Employee wellbeing in the workplace, 2018). This information has become the most important part of my literature review. The Commission encourages employers to use bullying response strategies in the workplace, regulate employee behavior, and implement bullying reporting procedures. It is also recommended to prevent bullying by offering appropriate training to employees and timely access to updated information on the management of bullying incidents. This prescription creates an evidence base for implementing my project, including the development of educational handout materials for my fellow nurses and implementing changes in job and organizational levels.

Demonstrate the ability to assess factors that hinder and facilitate preventing workplace bullying by developing and conducting a questionnaire

Nurses in emergency departments, including newly hired nurses, recently registered nurses, and nursing students, are the target group for this project. Using an anonymous questionnaire, I plan to explore my colleagues’ experiences concerning mistreatment or conflict in the work environment. The results will shed light on gaps in nursing knowledge about anti-bullying laws in Australia, misconceptions about the actual meaning of bullying, and insufficient understanding of conflict management practices. Adult learning principles will then be used to develop and implement an educational product to raise awareness among nurses on bullying and healthy conflict resolution.

The questionnaire with close-ended questions was designed to understand the scope of the issue and identify the most common forms of bullying. The questionnaire was related to personal learning outcomes 2, 3, and 4 developed using Bloom’s taxonomy and SMART goals. I designed an effective questionnaire with 11 questions to identify nurses’ perceptions of workplace bullying and the experiences they have in this regard. The need to achieve this goal encouraged me to improve my data search, evaluation, synthesis, and critical thinking skills. The creation of the questionnaire was preceded by searching for and evaluating scientific literature on the unique features of workplace bullying in healthcare organizations and misconceptions about the issue among healthcare staff.

Demonstrate practical research skills by conducting research based on the presented questionnaire by March 2021

Using the questionnaire, I will sample 30 colleagues and analyze bullying-related trends and learning needs by March 2021. The staff involvement will be ensured to identify the behaviors and communication practices nurses want to learn to create a shared, safe, and positive workplace. I will encourage enough participants to complete the survey and then use their responses to examine my colleagues’ awareness of workplace bullying and the degree to which misconceptions influence their understandings. This knowledge will enable me to identify the critical knowledge gaps and educational needs to be addressed. Therefore, the results will outline the future educational program and the aspects of the issue that it will have to emphasize.

Demonstrate an ability to educate others by creating educational materials about bullying in the nursing settings for fellow nurses

Using adult learning principles and the identified learning needs, I will design a five-page handout on workplace bullying for nurses by July-August 2021. I will use information from Australian midwifery standards and guidelines provided by the Australian Public Service Commission and will also create an accompanying ten-slide presentation. This goal deals with the sixth domain of knowledge (creating). The goal will be to apply the results of the conducted survey and adult learning principles. For instance, the need for respectful and goal-oriented education is easily translated into practice, to design a final handout/poster. The handout on workplace bullying will be developed with particular attention to some work-related challenges for nurses. An educational presentation for the nursing staff will promote healthy attitudes to conflicts, work in teams, and work culture of respect and responsibility.

Evaluate, reflect, and report on the findings and recommendations of the capstone through applying a critical reflection model and creating a professional portfolio

Conclusion

How has this project benefited its participants – emergency nurses, and what role does the project have in combating workplace bullying? Firstly, I believe that the project confirms the importance of the workplace bullying problem and suggests ways to solve it. The proposed strategies can be implemented for both emergency nurses and other healthcare professionals. Besides, this project allowed me to implement an initiative that will change nurses’ quality of working conditions. It will ensure their safety and well-being in the workplace, guided by the ethical principles of equality and fairness

The participants’ responses inspired me to do further research in this area, convincing me of the need for immediate action. As part of the project, I created an educational product addressing nurses’ knowledge gaps and misconceptions regarding workplace bullying. The questionnaire improved my literacy in workplace bullying, how it affects nurses, and what individual nurses can do to avoid engaging in bullying behaviors or becoming the victims during the COVID-19 pandemic. Keeping a reflective journal supported me in documenting and analyzing my educational journey and progress.

I have developed guidelines for actions aimed at preventing bullying at the workplace:

Education

  1. Explaining the concept and types of workplace bullying, namely physical, cyber, sexual, racial, emotional, and verbal insults.
  2. Creating handout materials for nurses working in the emergency department.
  3. Handouts should include statistics on the prevalence of the problem in Australia, the consequences, impact, and factors that predict workplace bullying.
  4. Explaining strategies aimed at the prevention of workplace bullying.
  5. Organizing in-services to create awareness among nurses.
  6. Handing out printed material on bullying.
  7. Encouraging staff to undertake online training on workplace bullying.

Networking

  1. Encouraging effective and transparent communication between teams.
  2. Encouraging authentic leadership.
  3. Encouraging transformational leadership.
  4. Zero tolerance to any form of abuse.
  5. Informal interviews with work colleagues.
  6. Feedback.

Organizational measures

  1. Implementation of job-level and organizational-level strategies aimed at preventing bullying in the workplace.
  2. Provision of optimal nurse staffing ratios as a prerequisite to patient safety and effective measures to prevent any instances of workplace bullying and promote healthy conflict resolution.
  3. Setting high ethical standards to regulate employees’ workplace behaviors and implementing appropriate and effective bullying reporting procedures.
  4. Providing indebt policies and procedures on bullying during the induction of new employees, including casuals, volunteers, regular visitors, and all other long-term workers.

Job-level strategies

  1. Encourage the reporting of bullying behaviors.
  2. Monitoring the health and safety of the workplace.
  3. Ensure transparency in handling workplace conflicts.
  4. Promote the use of workplace policies on bullying.

Organizational-level strategies

  1. Introduction of a system for evaluation of the level of workplace bullying.
  2. Implementation of a control system for workplace bullying through the development of a system of punishments and rewards.
  3. Development of procedures for reducing the workplace bullying levels through combining all the listed recommendations into clear guidelines.

Evaluation

The assessment of the workplace bullying levels will take the form of:

  1. Anonymous surveys, filled by employees once every two to three months.
  2. Surveys will include questions about verbal and physical offensive behavior and similar online communication situations.
  3. Administration will hold surveys in case of a sharp unmotivated drop in employee productivity.
  4. Administration will hold surveys two weeks after hiring new employees and every month for three months after hiring.
  5. Anonymous surveys will be conducted online.
  6. Surveys will contain open-ended questions.
  7. Based on the answers, the questionnaires will be reformulated.

Control

Development of a system of punishments and rewards:

  1. Employees who are the instigators of aggressive behavior will be subject to a system of penalties, depending on the severity of the consequences of their behavior.
  2. Employees who report that they have become victims of workplace bullying will receive financial compensation for damage and a free opportunity to consult a psychologist.
  3. Employees who have become victims of bullying will receive the organization’s support in the form of the possibility of changing the schedule to avoid contact with the aggressor temporarily.
  4. The aggressors will be reprimanded, and after the second or third reprimand, they will be fired.

Procedures

The procedures will be developed based on the proposed recommendations and will include:

  1. Procedures for conducting an assessment of bullying levels in the organization.
  2. Procedures for the implementation of the system of punishments and rewards.
  3. Procedures of education about workplace bullying.

The capstone project took two semesters to complete, and I believe it achieved its goals. The project allowed me to use the knowledge I gained in the Master’s program to solve practical problems that I witnessed in my workplace. I am glad that the work on the project was progressing following learning outcomes, as it allowed me to develop research skills more purposefully. The objectives and scope of the project were achievable and feasible in the workplace environment.

References

Báez‐León, C., Moreno‐Jiménez, B., Aguirre‐Camacho, A., & Olmos, R. (2016). Factors influencing intention to help and helping behavior in witnesses of bullying in nursing settings. Nursing Inquiry, 23(4), 358-367.

Bambi, S., Guazzini, A., Piredda, M., Lucchini, A., De Marinis, M. G., & Rasero, L. (2019). Negative interactions among nurses: An explorative study on lateral violence and bullying in nursing work settings. Journal of Nursing Management, 27(4), 749-757.

Birks, M., Cant, R. P., Budden, L. M., Russell-Westhead, M., Özçetin, Y. S. Ü., & Tee, S. (2017). Uncovering degrees of workplace bullying: A comparison of baccalaureate nursing students’ experiences during clinical placement in Australia and the UK. Nurse Education in Practice, 25, 14-21.

Birks, M., Budden, L. M., Biedermann, N., Park, T., & Chapman, Y. (2018). A ‘rite of passage?’: Bullying experiences of nursing students in Australia. Collegian, 25(1), 45-50.

Code of conduct for midwives (2018). Web.

Giorgi, G., Perminienė, M., Montani, F., Fiz-Perez, J., Mucci, N., & Arcangeli, G. (2016). Detrimental effects of workplace bullying: Impediment of self-management competence via psychological distress. Frontiers in Psychology, 7, 60.

Employee wellbeing in the workplace. (2018). Web.

Guide for preventing and responding to workplace bullying. (2016). Web.

Hartin, P., Birks, M., & Lindsay, D. (2018). Bullying and the nursing profession in Australia: An integrative review of the literature. Collegian, 25(6), 613-619.

Hartin, P., Birks, M., & Lindsay, D. (2020). Bullying in nursing: How has it changed over 4 decades? Journal of Nursing Management, 1-23.

Lu, W., Wang, H., Lin, Y., & Li, L. (2020). Psychological status of medical workforce during the COVID-19 pandemic: A cross-sectional study. Psychiatry Research, 11, 29-36.

Rutherford, D. E., Gillespie, G. L., & Smith, C. R. (2019). Interventions against bullying of prelicensure students and nursing professionals: An integrative review. Nursing Forum, 54 (1), 84-90.

Sansone, R. A., & Sansone, L. A. (2015). Workplace bullying: A tale of adverse consequences. Innovations in Clinical Neuroscience, 12(1-2), 32-37.

Stanny, C. J. (2016). Re-evaluating Bloom’s taxonomy: What measurable verbs can and cannot say about student learning. Education Sciences, 6(4), 1-12.

Squirrell, B., & Hunt, J. (2018). A nursing student’s reflective account of decision-making in a school nursing setting. Nursing Children and Young People, 30(3), 26-29.

Vanderbilt, D., & Augustyn, M. (2010). The effects of bullying. Pediatrics and Child Health, 20(7), 315-320.

Wilson, J. L. (2016). An exploration of bullying behaviors in nursing: A review of the literature. British Journal of Nursing, 25(6), 303-306.

Wolke, D., & Lereya, S. T. (2015). Long-term effects of bullying. Archives of Disease in Childhood, 100(9), 879-885.

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NerdyRoo. (2022, June 29). Workplace Bullying among Nurses in the Acute Setting. Retrieved from https://nerdyroo.com/workplace-bullying-among-nurses-in-the-acute-setting/

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