The number of attacks and acts of violence workers direct at each other in the workplace is alarmingly high. It is clear from various statistical studies and analyses that this situation is alarming for the workers and damaging for the facility. The point of agreement in the international studies is that there are more victims of workplace psychological violence than other types of violence and harassment (Chappell & Di Martino 2000). As a result of legal regulations, the significant sanctions for physical violence in public facilities in particular have led to an increase in psychological violence. The number of research studies on psychological violence in the workplace, which has a damaging effect on the victim's well-being and facility, are increasing, and there is also increasing awareness and actions being taken on the issue in many countries (Bilgel et al. 2006; Hansen et al. 2006; Jackson et al. 2002; Quine 1999, 2001; Yildirim & Yildirim 2007).
Bullying behaviours involved
Heinz Leymann first defined psychological violence that has been a part of working life for centuries but has often been ignored in 1984 (Davenport et al. 1999). Leymann stated that the psychologically violent behaviours he saw in workplaces in Sweden were a kind of ‘workplace terror’, and defined it as ‘a type of psychological terror that arises in the form of systematic, directed, unethical communication and antagonistic behaviour by one or more individuals towards one individual’ (Leymann 1990). Workplace bullying constitutes repeated offensive behaviour through vindictive, cruel, malicious or humiliating attempts to undermine an individual or group of employees (Chappell & Di Martino 2006, p. 20). Leymann (1996) also identified five different negative effects of terrorizing behaviours. Victims routinely struggle with communicating, maintaining social contacts, maintaining their personal reputation, poor occupational situation and physical health problems. Similarly, Rayner & Höel (1997) grouped workplace bullying into five categories: threats to professional status (e.g. belittling, public or professional humiliation, and accusations of lack of effort); threats to personal standing (e.g. name-calling, insults, intimidation and devaluing regarding age); isolation (e.g. preventing access to opportunities, physical or social isolation, and withholding information); overwork (e.g. undue pressure, impossible deadlines and unnecessary disruptions); and destabilization (e.g. failure to give credit when due, assigning meaningless tasks, removal of responsibility, repeated reminders of blunders and setting one up to fail). The major difference between ‘experienced’ bullying and ‘intentional’ bullying is the frequency and longevity of the negative behaviours. In order for the bullying label to be applied to a particular activity, interaction or process, it has to occur repeatedly and regularly (e.g. weekly) and over a period of time (e.g. about 12 months) (Björqvist et al. 1994; Dilek & Aytolan 2008; Fox & Stallworth 2003). These behaviours can be inflicted on the individual by facility administrators, supervisors, co-workers at the same level or subordinates (Einarsen 2000; Fox & Stallworth 2003). The individual or individuals who are psychologically abusive mount an organized front against the individual with systematic, long-term and frequently occurring bullying behaviours that also affect others. Others who work in the facility often act oblivious to these behaviours or even provoke them. The victim feels helpless facing so many powerful people when mobbing occurs (Cowie et al. 2002; Einarsen 2000; Leymann 1990).
Reactions to bullying behaviours
The effects of deliberate and systematically repetitive psychological oppression become evident as a collection of injuries that develop gradually in the individual. They experience a variety of physiological, psychological and social problems that are related to the intense stress and anxiety of bullying (Björkqvist 2001; Cowie et al. 2002; Einarsen 2000; Fox & Stallworth 2003; Leymann 1990, 1996). The literature reports that the victims of long-term and continuous workplace bullying have decreased self-esteem and self-confidence (Einarsen 2000; Randle 2003), and experience social isolation, social stigmatization, social maladaptation (Leymann 1996), anxiety, aggression, depression and symptoms related to depression (Bilgel et al. 2006; Quine 1999, 2001). Many victims of mobbing experience symptoms of post-traumatic stress disorder (Bilgel et al. 2006; Fox & Stallworth 2003; Leymann 1996) and some have even attempted suicide (Leymann 1990, 1996).
Exposure to bullying behaviours such as verbal abuse has been known to have negative effects on nurses' self-esteem, job satisfaction, morale, patient care, work productivity and professional error rates (Braun et al. 1991; Cox 1991). In addition, the victims of workplace psychological violence have decreased job satisfaction, work performance, motivation and productivity, and disturbances in social relationships inside and outside the institution (Björkqvist 2001; Cowie et al. 2002; Einarsen 2000; Niedl 1996). Individuals exposed to workplace psychological violence become unable to do their work because of the damage that has been inflicted. Individuals exposed to bullying begin to use sick time to alleviate the pressure and torture, resign under pressure or willingly, or are fired or forced to retire early because of psychological violence (Davenport et al. 1999; Jackson et al. 2002; Tınaz 2006). Employees experiencing bullying have a higher propensity to leave the organization (Quine 2002), and links have been drawn between bullying and the current recruitment and retention crisis in the nursing workforce (Jackson et al. 2002).
Studies of violence suggest that a valid means of resolving the problem of violence is still being sought today (Jackson et al. 2002; Leymann 1996; Salin 2003). In addition, in studies conducted about nurses who are victims of violence, it has been shown that nurses are at a higher risk of being exposed to violence than other healthcare personnel (Ferrinho et al. 2003; Mayhew & Chappell 2001; Quine 1999; Rutherford & Rissel 2004). The fact that there are more female healthcare personnel and that the overwhelming majority of nurses are women also has an effect on this frequency (Mayhew & Chappell 2001). Ferrinho et al. (2003) determined that compared with men, women experience more of every type of violent behaviour in healthcare facilities. On the other hand, because people in high-level positions in the nursing profession consider psychologically violent behaviours in the workplace to be a part of their position within the hierarchical structure and professional practices (Lewis 2001), there is a lack of sensitivity to these types of behaviours, and in many healthcare facilities, incidents of bullying go unreported (Jackson et al. 2002; Quine 1999). Cox (1987) determined that 97% of nurses have been exposed to verbal violence, while Yildirim & Yildirim (2007) determined that 86% of nurses have faced one or more bullying behaviours within the last 12 months and that the source of a large percentage of these behaviours stemmed from their managers. In a survey of 1100 employees from the National Health Service (NHS), including nurses, 70% of respondents reported that they had experienced bullying in the previous year (Quine 1999).
In a further study of the NHS nursing workforce by the same author, 44% of respondents reported being bullied (Quine 2001). Niedl (1996) determined that 26.6% of nurses face hostile actions in the workplace once or more a week. A Norwegian study concluded that 20% of nurses were exposed to bullying behaviours and that these behaviours were frequently inflicted by nurses, assistant nurses and head nurses in their own department (Einarsen et al. 1998). Previous studies have determined that the most common type of violence that healthcare personnel face is verbal violence, followed by bullying/mobbing (Cox 1991; Ferrinho et al. 2003; Lewis 2001; Yildirim & Yildirim 2007). These behaviours frequently include shouting, reprimanding and belittling in front of patients and/or other employees in the ward by people in high-level positions (Lewis 2001).
Aim of the study
Workplace bullying became a topic of discussion at the beginning of the 2000s in Turkey. Because this is a relatively new topic in Turkey, there have been a limited number of research studies on bullying to which nurses are exposed. For this reason, this study was conducted as a cross-sectional and descriptive study for the purpose of determining the rate and nature of workplace bullying experienced by nurses who work in healthcare facilities in Turkey and the effects on nurses' practice and depression status. The research questions were as follows:
- 1What are the most common workplace bullying behaviours nurses are exposed to and by whom are these being inflicted?
- 2Are there any relationships between bullying behaviours and the nurses' age, educational level, total years of experience, years of employment at current facility, or current position and workload?
- 3What are the effects of nurses' exposure to bullying behaviours on nursing practice?
- 4Are the nurses who are victims of bullying depressed? Is there a correlation between depression and having been exposed to bullying behaviours?