Prevalence of bullying at work and its association with self-esteem scores in a Spanish nurse sample
Marta Elena Losa Iglesias
Department of Nursing, Health Sciences School, King Juan Carlos University, Madrid, Spain
Ricardo Becerro de Bengoa Vallejo
School of Nursing, Physiotherapy and Podiatry, Medical School, Compultense University of Madrid, Spain
Abstract
Background: Bullying has been recognized as an important and increasing problem for nurses, who are faced with different kinds of bullying. Recent research has suggested a possible association between bullying and low self-esteem.
Objective: To determine the prevalence of bullying at work in a sample of Spanish nurses; to examine the association between bullying and self-esteem; and to investigate the prognostic factors that determine bullying at work.
Design: A descriptive survey study was developed to represent the population of Spanish nurses.
Participants: The sample consisted of 538 nurses who met the inclusion criteria of having worked for a minimum of one year in adult or paediatric services in the public or private heath care system of Principado de Asturias-Spain.
Methods: The Rosenberg Self-Esteem Scale (RSE) and the Negative Acts Questionnaire (NAQ) standardized for Spain were used to measure self-esteem and bullying behaviours respectively.
Results: Our results show that about one in five nurses (17%) experienced subjective bullying, and 8% of these cases reported weekly or daily bullying. The negative acts reported most frequently in bullied and non-bullied nurses were work-related bullying behaviours, such as 'Being given tasks with unreasonable or impossible targets or deadlines' (2.71 SD 1.33). However, bullied nurses reported significantly higher rates in all questions of the NAQ, and self-reported bullying was significantly related to low self-esteem (χ2=109; p<0.001).
Conclusion: Prevalence of self-reported bullying is high among Spanish nurses and is clearly associated with higher exposure to bullying behaviours at work and lower levels of self-esteem.
Keywords
bullying, nurses, self-esteem, workplace, self-reporting, unreasonable tasks, deadlines, harassment, psychosocial
Article Text
Workplace bullying has become an increasingly important area of debate in the last 15 years, particularly among researchers adopting a psychological perspective on work (Hoel & Beale, 2006). Leymann (1990) appears to be the first researcher to use the term 'workplace bullying' in research undertaken in Sweden. The term is largely recognised as referring to hostile actions and psychological assault by work groups against a colleague or colleagues (Cusack, 2000; Di Martino, Hoel & Cooper, 2003; Leymann, 1996). Workplace bullying is similarly used in the United States (Davenport, Schwartz & Elliott, 1999) and Canada (Westhues, 2002). However, in Spain, based on the studies of Piñuel and Zabala (2001), who draws on Leymann's research, the term 'mobbing' is used to refer to 'bullying at work' and to 'harassment'. Although several reports have graphically illustrated the pain, distress, physical illness, and damage suffered by victims of mobbing, research in this area is, nonetheless, relatively recent (Crawford, 1997; Rayner & Hoel, 1997; UNISON, 1995; 1996).
This increased attention to workplace bullying reflects a growing realization of the breadth and depth of its consequences, particularly in the context of the global shortage of nurses. There is growing evidence that bullying contributes to a range of stress symptoms among health workers (Brodsky, 1976; Einarsen, Raknes & Matthiesen, 1994, Mikkelsen & Einarsen, 2001), a high rate of psychosomatic symptoms, physical disease, and low job satisfaction (Groeblinghoff & Becker, 1996; Zapf, Knorz & Kulla,1996). At the organizational level, there is evidence that bullying is associated with high rates of absenteeism and employee turnover (Leymann, 1996; Rayner, 1997; Simons, 2008). The wider implications of psychological harassment have made bullying a matter of great public interest; it is now considered one of the most severe forms of psychosocial stress at work (Niedl, 1995).
In addition, victims of bullying at work have been shown to have low self-esteem and to be anxious in social settings (Einarsen et al., 1994). In one study, however, the victims also felt that their own lack of coping resources and self-efficacy, such as low self-esteem, shyness, and lack of conflict management skills, contributed to the problem. Only a few of the victims in this study blamed external factors, such as a stressful work situation and the social climate at work (Einarsen et al., 1999).
Bullying in the nursing profession is frequently described in terms of 'oppressed group' behaviour or 'horizontal violence' (Hutchinson et al., 2006). These concepts have been used to explain bullying between colleagues who are on the same level within the organisation's hierarchy (Duffy, 1995; Dunn, 2003; Randle, 2003), and who, as a result of their (supposed) low personal self-esteem and poor group identity (Roberts, 2000), direct abusive behaviour toward each other (Hutchinson, 2006). Psychosocial working conditions and violence have an independent negative impact upon nurses' commitment to their organization (Camerino et al., 2008). For instance, a study by Matthiesen et al. (1989) of 99 nurses and assistant nurses in a Norwegian psychiatric ward showed that 10% of this group was exposed to bullying at work. The same study showed that such bullying correlated significantly with burnout, psychological complaints, and poor somatic health (Matthiesen et al., 1989). Similarly, a Royal College of Nursing (RCN) survey found female nurses were the main victims of workplace bullying (Alderman, 1997), and another RCN survey 'Working well' (Ball et al. 2002) found that 30% of nurses on long-term sick leave reported harassment and intimidation arising from sex/gender, age, race, sexuality or personal clashes as the main cause of their absence.
Self-esteem is defined as a positive or negative orientation toward oneself, as an overall evaluation of one's worth or value. Self-esteem is considered a major predictor of behaviour and, for that nurses with healthy self-esteem are likely to deliver therapeutic patient care, while those with low self-esteem are less likely to do so (Randle, 2003).
Aims
While there is one study of the prevalence of bullying among all types of workers in Spain, there is, as yet, little research on the prevalence of bulling at work among Spanish nurses (Carnero et al., 2008). Therefore, the aims of the present study were to determine the prevalence of bullying at work in a sample of Spanish nurses; to examine the association between bullying and self-esteem scores; and to investigate the prognostic factors to determine bullying at work in staff nurses.
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