More support needed for nurses facing mistreatment at work

New research suggests that nurses need more help dealing with disrespectful behaviour from colleagues if patient care is to be maintained.

The study, led by Dr Roberta Fida from the University of East Anglia (UEA), argues that in order to retain high quality nurses it is important to understand what factors might protect them from the negative effects of workplace mistreatment. It comes at a time when many countries are facing nursing shortages which are expected to worsen as the workforce and population ages.

The ability to cope with the high levels of stress that nurses face in the workplace is important to their health and wellbeing. Incivility - defined as rude and discourteous comments and actions, and a general lack of concern for others - can come from colleagues, managers or patients. It remains a widespread issue and has previously been linked to nurse burnout - in terms of emotional exhaustion and cynicism - and, in turn, to poor mental health and staff leaving their jobs.

This new study, conducted with Dr Heather Laschinger from the University of Western Ontario in Canada, investigated whether individuals' beliefs about their ability to deal with workplace-specific stressful events can protect nurses from these negative effects. It is part of a wider research project on nursing work environments led by Dr Laschinger.

Published in the journal Health Care Management Review, the results show that self-efficacy - the belief in one's capabilities to achieve a goal or an outcome - does have a protective role. The more nurses believed in their capability to cope with stressful interpersonal situations at work the less they perceived incivility from co-workers and supervisors.

Nurses with higher levels of self-efficacy also experienced less emotional exhaustion and cynicism a year after they were first surveyed and reported fewer mental health issues. However, self-efficacy was not significantly related to later intentions to leave the job.

Dr Fida, a lecturer in organisational behaviour at UEA's Norwich Business School, said: "These results are encouraging because self-efficacy is something that can be supported and promoted by proactive hospital management. Every effort must be made to ensure that incivility is not tolerated and to create working conditions that prevent subsequent burnout to ensure both employee and organisational health.

"Developing strategies to strengthen nurses' ability to deal with negative behaviour from different sources is also critical to ensuring high-quality patient care, while training and retaining highly qualified nurses is vital for addressing the supply and demand imbalance facing the profession."

The study involved 596 registered nurses in Canada who were surveyed at the start and again a year later. They were assessed on their levels of self-efficacy, their perception and experience of workplace incivility and burnout (emotional exhaustion and cynicism), their mental health and intention to leave their job.

Physician and co-worker incivility significantly affected nurses' emotional exhaustion and cynicism a year later, while supervisor incivility did not have a significant effect on either.

Nurses who reported greater emotional exhaustion and cynicism at the start of the study reported poorer mental health a year later. Although cynicism was significantly related to job intentions, emotional exhaustion was not.

Dr Fida said: "Nurses' confidence in their ability to handle incivility from team members is a crucial factor in maintaining a unified work group necessary for high-quality patient care. Confidence in their ability to deal with incivility from supervisors is also important in this respect. If managers are dismissive of concerns or ideas from frontline co-workers, patient care is threatened."

The researchers recommend providing nurses with opportunities to build their coping strategies for managing job demands and difficult personal interactions. For example, providing exposure to effective role models, such as colleagues and supervisors who are able to deal with these stressful situations and in this way show nurses a way of managing the possible difficulties experienced when interacting with their colleagues. Providing meaningful verbal encouragement from managers and co-workers is also recommended.