Antecedents of Workplace Aggression for Hospital Nurses. Defne Demir

Transcription

1 Page 1 of 14 ANZAM 2012 Antecedents of Workplace Aggression for Hospital Nurses Defne Demir Faculty of Business Australian Catholic University, Melbourne, Australia Defne.Demir@acu.edu.au Prof. John Rodwell Faculty of Business Australian Catholic University, Melbourne, Australia John.Rodwell@acu.edu.au

2 ANZAM 2012 Page 2 of 14 Antecedents of Workplace Aggression for Hospital Nurses ABSTRACT This study tests characteristics of work as predictors of workplace aggression for hospital nursing staff. The study adopted a survey design. Two hundred and seven nurses/midwives from an Australian hospital participated. Results revealed bullying was linked to high negative affectivity (NA), as well as low supervisor and co-worker support. Internal emotional abuse was associated with low levels of these support variables, as well as high outside work support and low job control. External threat of assault was related to high job demands and NA. Different combinations of work conditions (job demandsresources) and individual levels of NA predicted certain types of aggression. This study therefore extends previous research on antecedents of workplace bullying to other types of workplace aggression for nurses. Keywords: Employment Relations (HRM), EEO (HRM), Job design (HRM), Job satisfaction (HRM), and Commitment (HRM) 1

3 Page 3 of 14 ANZAM 2012 Nurses are at high risk for workplace aggression, with reports of exposure ranging as high as 63.5% to 95% (Farrell, Bobrowski & Bobrowski 2006; O Connell, Young, Brooks, Hutchings & Lofthouse 2000). Previous research however has focused on workplace bullying, often neglecting other types of aggression, such as violence. In terms of antecedents, the research focused on workplace bullying suggests that the job demands-resources (JD-R) model and the individual trait of negative affectivity (NA) may be useful in understanding how psychosocial factors lead to other forms of workplace aggression (e.g., Baillien, Rodríguez-Muñoz, de Witte, Notelaers & Moreno-Jiménez 2011). Similarly, previous research highlights that workplace bullying negatively impacts psychological and organisationally-related employee outcomes (e.g., Hoel & Cooper 2000; Mikkelsen & Einarsen 2002; Quine 2001; Simons 2008) and that NA may play an important role in these relationships (Mikkelsen & Einarsen, 2002; Zapf, 1999). Thus, this study aims to test a model of the antecedents to workplace aggression, considering work and dispositional characteristics, among nursing staff. The conceptualisation of workplace aggression can include a range of behaviours, namely those that are bullying or violence related. Although there are issues surrounding a consensus of exact definitions, several key features appear to be emphasised in the literature. Specifically, from the victim s perspective, workplace bullying is primarily repeated perceived and/or actual psychological harm and tends to come from fellow co-workers or supervisors (Einarsen, Hoel, Zapf & Cooper 2011; Hoel & Cooper 2000). In contrast, workplace violence, again from the victim s standpoint, can be single or repeated act(s) that are mostly perceived and/or physical harm (Einarsen et al. 2011; Hesketh et al. 2003). Several types of violence are discussed in the literature, for example, emotional abuse, physical assault, threat of assault and verbal sexual harrassment (Hesketh et al. 2003). The sources of such violence may be either internal (co-workers or supervisors) or external (pateints or patient family and friends) to the organisation (Hesketh et al. 2003). Given these differences in the constructs that make up workplace aggression, it is important to consider both bullying and violence when attempting to understand and 2

4 ANZAM 2012 Page 4 of 14 investigate the antecedents to workplace aggression among nurses. Antecedents of Aggression A framework that may be useful in examining the antecedents of workplace aggression for nurses is the JD-R model (Demerouti, Bakker, Nachreiner & Schaufeli 2001). The JD-R model originates from occupational stress research and is a leading model within this area. The model proposes that relationships between an employee s job demands and resources such as job control and social support can affect particular employee-level outcomes. According to the JD-R model, the most stressful or high strain jobs are those that involve high job demands and low job resources (e.g., job control and/or social support; Demerouti et al. 2001). Job demands refer to aspects of a job that require sustained physical or psychological effort. Job control refers to levels of decision latitude and autonomy relating to how and when tasks are undertaken. In terms of social support, this may come from a range of sources, including supervisors, co-workers or family/friends of employees outside the workplace. Research exploring a range of contexts has found that these job characteristics have been linked to a number of negative employee outcomes (e.g., De Witte, Verhofstadt & Omey 2007; Van Der Doef & Maes 1999). In turn, studies have attempted to extend these applications of the components of the JD-R model to social behavioural outcomes, including workplace bullying. More specifically, Baillien et al. (2011) tested a two-component job demands and job control version of the model with workplace bullying and found links between high job demands, low job control, and reports of bullying. Additionally, Tuckey, Dollard, Hosking and Winefield (2009) examined the JD-R model within the context of workplace bullying and found similar results to Baillien et al. (2011) in regards to demands and control, also finding that low social support was significantly linked to bullying. Both studies support the notion that stressful work characteristics presage workplace bullying. 3

5 Page 5 of 14 ANZAM 2012 Baillien, Neyens, De Witte and De Cuyper (2009) and Baillien et al. (2011) attempted to explain why such relationships occur between job conditions and bullying by drawing on previous literature. These researchers discuss how work-related stressors, such as increased demands and low levels of control may lead to violations of existing social, organisational and work-related norms, which may then increase the likelihood of being/becoming? a target of bullying. Violations may occur for two potential reasons: (1) stressed workers are more likely to make errors, which then leads to co-workers having negative attitudes and retaliating with acts of bullying, (2) stressed workers lack the job resources needed to resist bullying and therefore are more vulnerable. Thus, it appears that stressful psychosocial factors, such as those proposed as part of the JD-R model, not only lead to negative employee outcomes, but also potential social behavioural outcomes such as workplace bullying. Little research has investigated these relationships with workplace bullying among nursing staff. Further, similar links may exist for other forms of workplace aggression, including violence. However, these too are rarely explored. In addition to workplace factors, different levels of NA have also been shown to play an important role in investigating workplace stress and bullying (e.g., Mikkelsen & Einarsen 2002; Zapf 1999). NA reflects degrees of pervasive negative emotionality and varies from individual to individual (Watson & Clark 1984; Watson, Clark & Tellegen 1988). Those with high NA levels are likely to experience negative emotions more often, with the opposite occuring for those with low NA levels. Several possible explanations for the relationship between NA and workplace bullying have been proposed, including the possibility that NA works in a self-reinforcing negative cycle (Mikkelsen & Einarsen 2002). That is, NA may initially be involved in an antecedent relationship with workplace bullying, whereby NA leads to a vulnerability to interpersonal conflict. The occurrence of conflict leads to heightened distress levels, which then result in appraisals of the conflict as more personal and negative. In turn, negative emotions are experienced at heightened levels, and therein the cycle repeats. Given the support from the literature that such links exist between NA and workplace bullying, it may be worthwhile extending this type of 4

6 ANZAM 2012 Page 6 of 14 investigation to other forms of workplace aggression and its role as an antecedent and a potential correlate of the consequences. The overall aim of this study was to test a model of the antecedents of workplace aggression among nurses. More specifically, the aims of the study are to: (1) test the antecedent relationships of the JD-R variables for various forms of workplace aggression and (2) understand the role of NA as a potential antecedent to workplace aggression. METHOD Sample The study sample comprised 207 nurses and midwives (26.9% response rate) from a large Australian hospital. Almost all of the sample were females (n=204, 99.5%), with a majority aged 40 years or older (n=139, 67.7%). In terms of tenure, over half the respondents had worked for the organisation for less than 10 years (n=115, 58.1%), and most worked on a part-time basis (n=133, 64.6%). Procedures Seven hundred and seventy seven survey packs were sent to the work addresses of all nurses and midwives working for the hospital. Participation in the study was voluntary and anonymous. Completed surveys were returned to the university research team using a reply paid envelope also provided in the pack. Measures Aggression types were measured using two separate scales, one that measured bullying and another that measured violence. The bullying scale was a single item developed by Hoel and Cooper (2000). The item included a comprehensive definition of bullying, requesting that respondents use this definition in rating their frequency of exposure to workplace bullying. Response options were: 1 = no, 2 = 5

7 Page 7 of 14 ANZAM 2012 yes, very rarely, 3 = yes, now and then, 4 = yes, several times a month, 5 = yes, several times a week, and 6 = yes, almost daily. The violence scale was an adapted version of a scale developed by Hesketh et al. (2003). Respondents rated the number of times they had experienced particular types of violence using the following options: 0 = never, 1 = 1 time, 2 = 2 times, and 3 = 3 or more times. The four violence types included physical assault, threat of assault, emotional abuse and verbal sexual harassment. Short examples and definitions of each were also provided as part of the scale. For each of the items, respondents indicated the source as being their supervisor, a co-worker, patient, or patient visitor/family member. The sources were collapsed into two subscales comprising those internal to the organisation (i.e., co-worker and supervisor) and those external to the organisation (i.e., patient and visitor/family member) for each of the violence types.. Work conditions were measured using the three scales of job demands, job control and social support. The job demands scale was developed by Caplan, Cobb, French, Harrison and Pinneau (1980) and respondents rated their level of perceived physical and psychological job demands. There were 11 items on this scale, with response options ranging from 1 = very often/a great deal to 5 = rarely/hardly any. The job control scale was developed by Karasek (1985) and assessed the level of perceived control of job demands. The scale had nine items, with response options ranging from 1 = strongly disagree to 5 = strongly agree. The social support scale was developed by Caplan et al. (1980) and involved four items assessing levels of perceived support.. Each item required participants to provide a response regarding the level of support available to them from three sources, a) their supervisor, b) their co-workers, and c) their family and friends. Responses were rated from 0 = don t have any such person to 4 = very much. Individual levels of NA were measured using the NA scale from the Positive and Negative Affect Schedule (PANAS) developed by Watson et al. (1988). The scale had 10 items asking respondents to 6

8 ANZAM 2012 Page 8 of 14 indicate the extent to which certain negative emotions were experienced in the past week. Response options for items were rated from 1 = very slightly or not at all to 5 = very much. RESULTS Data were analysed using Predictive Analytics SoftWare (PASW) 18.0 (SPSS Inc. 2009). Descriptive statistics were performed to examine frequencies of reported workplace aggression. Ordinal regression analyses were performed to test antecedent relationships of aggression. JD-R and NA variables were explored for each of the aggression types in these analyses. For all analyses, appropriate checks regarding outliers, missing values and normality were conducted to ensure no violations of assumptions. To ensure adequate sample sizes for statistical analyses, the workplace aggression responses were collapsed into smaller groups. There were three groups formed for the ordinal regression analyses, that is, those responding no, yes, rarely and the remaining categories were grouped as yes, frequently. The majority of respondents reported no occurrences of workplace bullying (n = 127, 62.3%), 38 (18.6%) indicated yes, very rarely, 27 (13.2%) indicated yes, now and then, 2 (1.0%) indicated yes, several times a month, none indicated yes, several times a week and 3 (1.5%) indicated yes, almost daily, giving a combined frequency of those indicating some form of yes to bullying of 34.3%. The frequencies of workplace violence are presented in Table 1 with the majority of respondents reporting never to violence for each type ranging from 77.0% to 98.1%. High frequencies were reported for internal and external emotional abuse. Specifically, 14.5% responded 1 time (yes, rarely) and 8.5% indicated either 2 times or 3 or more times (yes frequently) to internal emotional abuse. For external emotional abuse, 7.5% indicated 1 time (yes, rarely) and 10.1% indicated either 2 times or 3 or more times (yes frequently) Insert Table 1 about here

9 Page 9 of 14 ANZAM 2012 Ordinal regression analyses could only be performed on four of the nine aggression types (namely, bullying, internal emotional abuse, external emotional abuse and external threat of assault), because the number of reports of incidents were only large enough to be statistically stable for these types. Tests of the model were significant for bullying [χ² (6, n =199) =16.28, p<.05], internal emotional abuse [χ² (6, n =201) =37.54, p<.05], and external threat of assault [χ² (6, n =201) =15.10, p<.05]. There were several significant results for these analyses that are presented in Table Insert Table 2 about here DISCUSSION This study examined the antecedents to workplace aggression for hospital nursing staff. Although the majority of nurses who participated in the study reported that they had not been exposed to workplace aggression, high rates were still evident for bullying, internal emotional abuse and external emotional abuse (17.6% to 34.3%), particularly relative to the zero tolerance policies toward aggression often adopted in hospital settings. Our findings therefore provide support for the work of previous studies, such as that by Farrell et al. (2006), illustrating that nurses are at high risk for workplace aggression reporting high rates of exposure. The antecedent relationships of the JD-R and NA variables with workplace aggression were somewhat consistent with previous research surrounding workplace bullying as an occupational stressor. Different combinations of the JD-R components and NA were significant for bullying, internal emotional abuse and external threat of assault. Social support was most influential on bullying and internal emotional abuse, whereby low levels of supervisor support and co-worker support were related to these aggression types, respectively. These results are in line with Tuckey et al. (2009) and may be explained by the process whereby a lack of such resources leads an individual to be more vulnerable and less 8

10 ANZAM 2012 Page 10 of 14 resistant to workplace aggression (Baillien et al. 2009; Baillien et al. 2011). Low levels of job control were linked to internal emotional abuse and may also be explained by this process. However, the results of the study revealed another type of relationship between a resource and aggression type. High levels of outside work support were linked to increased reports of internal emotional abuse, suggesting that even when support of this sort is high, one is not resistant and can be more vulnerable to internal emotional abuse. Alternatively, the high levels of outside work support associated with experience of internal emotional abuse may be due to a mechanism where nurses seek support from outside the organisation, such as support given by family and friends that is, from sources clearly separate from the source of aggression. In terms of the JD-R components, increased job demands were associated with external threat of assault. This finding was consistent with the job demand results by Baillien et al. (2011) and Tuckey et al. (2009). Stressed workers under pressure may therefore be more likely to make mistakes, possibly triggering a negative response (Baillien et al. 2009; Baillien et al. 2011). Although Baillien et al. (2009) and Baillien et al. (2011) discussed this potential process as relevant to aggression from co-workers, the pressure mechanism appears to be extendable, in that it may apply to those external to the organisation/hospital, such that a patient s visiting family and friends may threaten assault when errors by nurses occurring due to heavy workloads are observed. In considering NA as an antecedent of workplace aggression, this individual factor was influential for workplace bullying, supporting previous work by Mikkelsen and Einarsen (2002) and Zapf (1999), supporting the role of NA in the perceptual cycle whereby NA influences perceptions of interpersonal conflict and bullying at work. This relationship can now be extended to another type of workplace aggression, given that high NA was also linked to reports of external threat of assault. These findings combined suggest that heightened NA levels may lead to increased perceptions of particular types of workplace aggression beyond the more thoroughly tested role of NA in the field of bullying. 9

11 Page 11 of 14 ANZAM 2012 Several limitations of the present study need to be considered. The study is cross-sectional affecting the types of conclusions that can be drawn. Longitudinal studies are needed to draw inferences about causality between the variables analysed. Similarly, the sample examined were Australian hospital nurses who all work for the same healthcare organisation and the generalisability of the results may therefore be limited. Future research is encouraged to investigate similar variables surrounding workplace aggression in samples of nurses from different organisations and countries. Another possible limitation of the present study is the use of self-report survey data leading to concerns of common-method variance. However, the study is focused on the subjective measure of bullying from the victim s perspective and therefore this method of data collection is appropriate. Finally, the bullying measure adopted in this study is a single-item measure by Hoel and Cooper (2000) assessing self-identified perceptions of bullying. However, this measure is strongly correlated with the Negative Acts Questionnaire-Revised (NAQ-R; Einarsen, Hoel & Notelaers 2009) a 22 item measure that assesses behaviourally defined bullying, confirming the appropriateness of using the perceptual item. In conclusion, this study extends previous research on workplace bullying as a stressor to other types of workplace aggression for nurses. The findings highlight factors that are important in considering effective prevention and intervention of workplace aggression among hospital nursing staff. That is, different combinations of work conditions (demands, control and support) and consideration of the role of the individual s level of NA were associated with certain types of aggression. Additional research is necessary to replicate these findings and provide comparative data from nurses working in other healthcare organisations and countries to develop a more comprehensive understanding of workplace aggression in nursing. This type of research is of particular importance given the high risk of workplace aggression often reported by nurses. 10

12 ANZAM 2012 Page 12 of 14 REFERENCES Baillien E, Neyens I, De Witte H & De Cuyper N (2009) A qualitative study on the development of workplace bullying: Towards a three way model, Journal of Community & Applied Social Psychology 19(1): Baillien E, Rodríguez-Muñoz A, de Witte H, Notelaers G & Moreno-Jiménez B (2011) The Demand Control model and target's reports of bullying at work: A test within Spanish and Belgian bluecollar workers, European Journal of Work and Organizational Psychology 20(2): Caplan R, Cobb S, French Jr J, Harrison R and Pinneau S (1980) Job demands and worker health: Main effects and occupational differences, MI: The Institute for Social Research, Ann Arbour. De Witte H, Verhofstadt E & Omey E (2007) Testing Karasek's learning and strain hypotheses on young workers in their first job, Work & Stress 21(2): Demerouti E, Bakker AB, Nachreiner F & Schaufeli WB (2001) The job demands-resources model of burnout, Journal of Applied Psychology 86(3): Einarsen S, Hoel H & Notelaers G (2009) Measuring exposure to bullying and harassment at work: Validity, factor structure and psychometric properties of the negative acts questionnaire-revised, Work & Stress 23(1): Einarsen S, Hoel H, Zapf D and Cooper CL (2011) The concept of bullying and harrassment at work: The European tradition, in Einarsen S, Hoel H, Zapf D and Cooper CL (Eds) Bullying and harrassment in the workplace: Developments in theory, research and practice (2nd edn) pp3-39, CRC Press, Boca Raton. Farrell G, Bobrowski C & Bobrowski P (2006) Scoping workplace aggression in nursing: Findings from an Australian study, Journal of Advanced Nursing 55(6): Hesketh KL, Duncan SM, Estabrooks CA, Reimer MA, Giovannetti P, Hyndman K & Acorn S (2003) Workplace violence in Alberta and British Columbia hospitals, Health Policy 63(3): Hoel H & Cooper CL (2000) Destructive conflict and bullying at work. Unpublished report, University of 11

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14 ANZAM 2012 Page 14 of 14 TABLE 1: PERCENTAGE OF RESPONDENTS BY TYPE OF WORKPLACE VIOLENCE Internal External Internal External Internal External Internal External Violence emotional emotional threat of threat of physical physical verbal sexual verbal sexual response abuse abuse assault assault assault assault harassment harassment Never time times ,+ times TABLE 2: VARIABLE WEIGHTS (b) FOR ORDINAL REGRESSIONS FOR THE ANTECEDENTS OF WORKPLACE AGGRESSION Internal External External Workplace Bullying emotional emotional threat of aggression: abuse abuse assault Job control * Demand *.11* Supervisor support -.09* Co-worker support * Outside work support.06.16* Negative affect.06* * * p<.05 13