Workplace Bullying among Nurses and Patient Outcomes – An Exploratory Bayesian Analysis
J. Arnetz, S. Sudan, B. Arnetz, T. Maiti, F. Viens, L. Neufcourt, Michigan State University, USA
Background: The health and safety of hospital patients is largely dependent on the skills, safety and well-being of the nurses who care for them. Workplace bullying is a commonly recognized aspect of the nursing culture that presents a significant challenge to nurse safety. Bullying entails repeated negative behavior directed towards a particular individual with the intention of offending, abusing, or intimidating them. Nurse bullying has been inversely associated with nurses’ physical and psychological health, job satisfaction, work productivity, and job turnover. However, the possible impact of bullying on patient outcomes has not been explored. The aim of this study was to examine the association between self-reported nurse bullying and documented patient quality indicators in a single hospital. Methods: An anonymous survey on workplace bullying was administered in 2017 via email to all registered nurses (n=1780) in a regional hospital in Michigan. A total of 432 nurses (24.3% response rate) from 37 units responded. The proportion of nurses that reported being bullied and/or witnessing bullying, respectively, in the last six months was calculated at the unit level. Unit-level de-identified nursing-sensitive patient adverse event data from the last two quarters from the National Database of Nursing Quality Indicators (NDNQI®) were used as dependent variables: (1) hospital-acquired pressure ulcers; (2) patient falls; (3) central line associated blood stream infections (CLABSI); (4) catheter associated urinary tract infections (CAUTI); and (5) ventilator associated events (VAEs). A collaborative team of Family Medicine researchers and statisticians utilized the subject-area knowledge of the Family Medicine team to identify unit-level priors, including for nurse qualification (highest nursing degree completed), nurse staffing (ratio of the number of nurse days to patient days), and failure to report work unit due to the sensitivity of the questionnaire subject. Bayesian methodology was used to investigate whether self-reported and witnessing bullying, respectively, predicted patient adverse events after taking nurse qualification and staffing into account. Results: 139 nurses (36.9%) reported having personally experienced bullying and 191 (51.5%) reported having witnessed someone else being bullied in the past 6 months. Participants’ personal experiences of bullying were directly related to CLABSI (95% credible interval, CI [0.017, 0.212] but not to the other patient adverse events. Witnessing bullying was not significantly related to any patient adverse events at a 95% credibility level. However, both forms of bullying approached significance (posterior probability >0.81) in association with VAEs. Nurse qualification was positively and significantly associated with patient falls and unassisted falls at the 10% level (posterior probability >0.9). Nurse staffing associated positively with CLABSI CI [-0.086, 1.3] and CAUTI CI [0.14, 1.53] for those who experienced bullying and those that witnessed bullying CI [CLABSI -0.106, 1.45]; CI [CAUTI 0.14, 1.53]. Conclusions: Results suggest that efforts to reduce bullying among hospital nurses could result in corresponding moderate but likely significant reductions in rates of patient adverse events, specifically CLABSI, CAUTI, and VAEs.