NEW GRADUATE NURSES' PERCEPTION

OF THE WORKPLACE: HAVE THEY

EXPERIENCED BULLYING?
DARLA A. VOGELPOHL, PHD, MSN, CNS, RN, SUSAN K. RICE, PHD, RN, CPNP, NCSN,
MARY ELLEN EDWARDS, PHD, AND CHRISTOPHER E. BORK, PHD

This study investigated the bullying experience in the workplace of newly licensed registered
nurses (RNs). Preventing newly licensed nurses from leaving the profession is important,
especially because there is a nursing shortage. Education of staff and administrators provides
recognition of negative behaviors in the workplace. Participants in this research study included
135 newly licensed RN's from 5 nursing schools in Northwestern Ohio licensed in years
20072010. Quantitative methods and a descriptive design process included chi-square tests
and descriptive statistical methods. Bullying workplace behaviors were identified by
participants utilizing the survey tool, the Negative Acts QuestionnaireRevised, and a
questionnaire on work relationships and bullies recognized in the workplace. Nursing peers,
physicians, or a patient's family were the main sources of bullying, and 29.5% had considered
leaving the nursing profession. Education of staff is imperative for providing recognition of
negative behaviors in the workplace. Bullying occurs in the workplace and is affecting the new
graduates' work performance. Retaining newly graduated nurses is the ultimate goal for
maintaining RN's in the workforce. (Index words: Workplace bullying; Bullying; New graduate
nurses) J Prof Nurs 29:414422, 2013. 2013 Elsevier Inc. All rights reserved.

R EGISTERED NURSES (RNS) ARE increasingly in

high demand in health care organizations to care for
acutely ill patients, yet a signicant numbers of RNs leave
the profession within a few years of graduating. Research
indicates that 30%60% of new graduate nurses actually
leave or intend to leave their nursing jobs after 6 months
to 1 year (Bowles & Candela, 2005; Bartholowmew,
2006; Simons, 2008). Among various reasons for this, it is
suspected that a hostile work environment, more
specically bullying in the workplace, may contribute
to RNs leaving their jobs and profession (Johnson & Rea,
2009; Simons, 2008; Bartholowmew, 2006, Bowles &
Candela, 2005).
Recommendations from professional organizations
(American Nurses Association [ANA], 2003; The Joint
Commission [JCAHO], 2008) call for participation of
Assistant Professor, The University of Toledo, Toledo, OH.
Professor, The University of Toledo, Toledo, OH.
Address correspondence to Dr. Vogelpohl: The University of Toledo,
College of Nursing, Health Science Campus, Mail Stop 1026, 3000
Arlington Ave., 3213 Collier Building, Toledo, OH 43614. E-mail:
darla.vogelpohl@yahoo.com
8755-7223/12/$ - see front matter
414 Journal of Professional Nursing, Vol 29, No. 6 (November/December), 2013: pp 414422
http://dx.doi.org/10.1016/j.profnurs.2012.10.008
leaders/managers in skill-based training to focus on
unprofessional employee behavior and conict resolution.
Workplace bullying has been described as a persistent,
enduring form of abuse that involves negative actions and
interactions at work (Lutgen-Sandvik, Tracy, & Alberts,
2007). There are catastrophic results for both the
organization and the target of bullying of this current
and prevalent workplace dilemma (Einarsen, Hoel, Zapf,
& Cooper, 2003; Rayner & Keashly, 2005). Statistics
project the crisis in health care that is occurring as the
result of the nursing shortage and replacement costs for
the health care organization and consumers. The U.S.
Bureau of Labor Statistics (2007) has projected that more
than 1 million replacement nurses will be needed to
accommodate health care needs in the United States by
2016 (U.S. Department of Health and Services, 2007). A
hospital with a poor nursing retention rate could spend
annually an average of $3.6 million more than a hospital
with a good nursing retention rate (Pricewaterhouse-
Coopers' Health research Institute, 2007).
The victims of workplace bullying can be very costly to
health care organizations (the Workplace Bullying
Institute, 2010). Lawsuits are pursued by some em-
ployees to seek justice against the aggressor or
2013 Elsevier Inc. All rights reserved.
NEW GRADUATE NURSES' PERCEPTION OF THE WORKPLACE
organization, and the litigation and settlements cost up to
$1.4 million. They project that a Fortune 500 Company
could spend up to $24,000,000 annually between staff
turnover and lost productivity. In addition, as a result of
abusive behavior among staff, patients were also found to
be at a 20% more risk of harm from professionals in the
Silence Kills (2005) study. Bullying in the workplace is
costly nancially for the health organization and is a
destructive force in human relationships.
Longo and Sherman (2007) summed the personal
effects of horizontal violence. Nurse victims experience
powerlessness and eventually experience the following
health problems as a result of horizontal violence: (a)
insomnia, (b) low self-esteem, (c) low work morale, (d)
disconnection from others, (e) depression, and (f) usage
of more sick leave than the nurse not involved in
horizontal violence.
The overall purpose of this study was to investigate the
bullying experience of the newly graduated RN. Work-
related bullying, person-related bullying, and physically
intimidating bullying are the three factors identied as
negative work experiences (Einarsen, Hoel, & Notelaers,
2009) using the (Negative Acts QuestionnaireRevised
[NAQ-R]) survey tool. The purposes of this study were
to nd if the newly graduated RN experienced these
types of bullying, determine the relational affects
bullying has on the newly graduated RN, and determine
who does the bullying.
Literature Review
In the 1960s, workplace harassment in the United States
revolved mainly around sexual and racial harassment
cases. The Title VII Civil Rights Act of 1964 provided
legal grounds to stop harassment issues and prevent
discriminatory practices of employers to their em-
ployees. Workplace bullying is a recently identied
form of harassment that is being studied more intensely
in the United States during the past decade. During the
last two decades, most of the workplace research has
been done in European countries, the United Kingdom,
and Australia (Dellesega, 2009). In the United States,
there is one major U.S. workplace study on various
professions (Lutgen-Sandvik et al., 2007) and a few U.S.
studies in the nursing profession (Johnson & Rea, 2009;
Simons, 2008; Bowles & Candela, 2005; Bartholowmew,
2006; Grifn, 2004).
The newly licensed nurse chose to leave the nursing
profession because of problems in the work environ-
ment in one U.S. study. The survey involved 352 RNs
who graduated from a basic nursing program in NV,
USA (Bowles & Candela, 2005). As a result of a negative
work environment, these authors reported that 30% of
new nurses left their job within the rst year, and 57%
left by the second year. In Bartholowmew's (2006)
study, 60% of RNs in the United States were found to
leave their rst position within 6 months because of
horizontal violence. Ninety to 97% of nurses reported
verbal abuse from physicians.
415
Simons (2008) did the rst U.S. study on nurses in the
workplace using the NAQ-R (Einarsen & Hoel, 2001).
The study determined that workplace bullying was
experienced by newly licensed RNs within 6 months of
employment after becoming an RN. Simons' study
determined if RNs intended to leave the organization as
a result of being bullied. Thirty-one percent of the
participants in Simons' study did relate their experience
of being bullied in the workplace, which was interpreted
as a major determinant of their intent to leave the
organization. Using the operational denition of the
NAQ-R survey, bullying consisted of at least two bullying
behaviors on a weekly or daily basis occurring during the
past 6 months. Bullying was found to be higher in this
study than those in other international studies previously
done using the NAQ-R and using this operational
denition of bullying.
The seriousness of disruptive nursing behavior is
summarized by JCAHO (2008) that released Sentinel
Alert 40, requiring health care facilities to ensure that
health care organizations design an organizational
approach to make employees aware of bullying and
disruptive behaviors (The Joint Commission news
release). Harmful behaviors between staff that are rude
and hostile are threatening to the provision of quality
patient care and prompted JCAHO to address them in
accreditations of health organizations. Statistics of the
JCAHO (2008) survey found that 50% of nurses had been
a victim of bullying and/or disruptive behavior in the
workplace, and 90% stated that they witnessed others
being the brunt of abuse within their organization.
Einarsen (1999) is one of the major researchers in the
area of workplace bullying. His group, the Bergen
Bullying Research Group at the University of Norway,
has been studying bullying for years and developed
survey instruments to collect data. Einarsen and Hoel
(2001) explain that workplace bullying is a situation
where a person feels mistreated because they are
persistently exposed to interpersonal aggression over a
long period. Dealing with interpersonal aggression can
have a devastating effect on the person and organization
in which they work.
Concepts and Definitions
Bullying is the persistent act of demeaning and down-
grading another person through cruel words and
negative actions that undermine another's self-con-
dence and self-esteem (Adams, 1997). Bullying, a
growing problem in society, involves maltreatment of
one person, the victim, by another person(s), and the
bully (Einarsen & Hoel, 2001) and includes the
aggressors' tactics of offending behaviors, harassment,
and/or social exclusion. In addition, bullying is
described as repeated incidents (e.g., once/week) and
for a certain amount of time (e.g., 6 months). A single
occurrence with two opposing persons having a single
conict does not constitute bullying (Zapf & Gross,
2001). The bullying conict is difcult to resolve
because there is often a power disparity between the
416
bully and victim. The bullying on the surface appears
nonaggressive, which makes it difcult for a victim to
speak out about the aggression (Lutgen-Sandvik et al.,
2007; Leymann, 1996, Zapf & Gross, 2001).
Workplace bullying is distinct from other denitions
such as incivility or disruptive behaviors because the
behaviors of the bully toward the victim are not random
acts, are intentional, and occur over an extended period.
Workplace incivility is dened as disrespectful deviant
work behaviors of a person to harm another that violates
workplace rules (Andersson & Pearson, 1999. In
addition, uncivil behaviors are generally discourteous
and rude and demonstrate the lack of mutual respect in
the workplace.
Most of the cases of workplace bullying are negative
psychological acts. Issues may involve work issues (e.g.,
withholding information needed in a job) or nonwork
issues (e.g., humiliating and insulting acts), and the
victim has difculty defending himself or herself
(Einarsen, Raknes, & Matthieson, 1994; Leymann,
1996). The perpetrator has no intention to stop the
bullying tactics directed toward the victim in workplace
bullying (Hubert, Furda, & Steensma, 2001).
The intent of this research study using the NAQ-R and
relational questionnaire was to determine if new graduate
nurses recognized bullying tactics, were bullied as a
newly licensed RN, intended to leave nursing, identied
the bullies in the workplace, and received education/
support from employers.
Method
This descriptive research study surveyed a convenience
sample of newly licensed RNs' perception of bullying
occurrence in the workplace. The main characteristics
included the sampling of the newly licensed RN
population, and information was collected through an
electronic survey. Bullying behaviors in the workplace
were identied utilizing the survey tool, the NAQ-R, the
New Graduate Nurses Relational Questionnaire, and
questions identifying the bully in the workplace.
Sample Population
A survey design was implemented to determine the
perceptions of the new graduate nurse RN regarding
bullying in the workplace. This research study was
submitted to the institutional review board for review.
The questionnaire was sent electronically to the target
population, 2,079 newly licensed alumni nurses from
2007 to 2010. Five Northwest Ohio Colleges of Nursing
Alumni Associations were included in the electronic e-
mail survey. Three mailings at 12 weeks after the initial
e-mail were sent to get the maximum return rate. The
single random sample size was set with a condence level
of 95% ( = .5) and the total tolerated reduction error of
no more than plus or minus 5% (Backstrum & Hursh-
Cesar, 1981). Of the 2,079 participants who were sent the
survey, 135 (7%) of newly licensed nurses responded.
Participants were informed that privacy and condenti-
ality were incorporated within the data collection
VOGELPOHL ET AL
process, and only one person at the institutional research
center had access. The survey data submitted were
gathered using Vovici software.
Survey Instrument
The survey instrument, the NAQ-R (Einarsen et al.,
2009), was used to measure bullying behavior in the
workplace and consisted of 22 questions. The NAQ-R
survey questions were analyzed for the frequency of
response to the ve categories of bullying (never,
now and then, monthly, weekly, and daily).
Written permission was obtained from the authors to
use this survey instrument for this research study.
Einarsen et al. reported that the reliability of the NAQ-R
instrument using Cronbach's alpha for the 22 questions
is .90, and validity was reported to be determined using
the analysis of variance (ANOVA) using one-way
ANOVA. Einarsen et al. note that victims of bullying
reported a much higher score on the 22 questions than
nonvictims (p b .001).
The threshold to measure bullying in this research
study was achieved if participants chose a daily or weekly
rating on the NAQ-R. Questions of the instrument were
arranged into three categories, person-related bullying,
work-related bullying, and physically intimidating
bullying (Einarsen et al., 2009).
Einarsen et al. (2009) developed a latent class cluster
approach to compare and analyze participant's responses
to the 22 items on the NAQ-R questionnaire. Three of
seven of Einarsen et al.'s latent clusters were compared as
norms to the new graduate nurses in this research study
for the following categories/questions/percentages: work-
related bullying (1, 3, 14, 16, 18, 19, and 21) at 10%,
person-related bullying (2, 4, 5, 6, 7, 10, 11, 12, 13, 15,
17, and 20) at 13%, and physically intimidating bullying
(8, 9, and 22) at 3%.
Procedure
The new nursing graduate participants in this electronic
survey study provided their informed consent because
they chose to participate and submitted the survey. The
participants received the NAQ-R 22-item survey ques-
tionnaire, including educational, job and career reten-
tion, and demographic questions for completion. The
bullying denition was given to the participants after they
responded to the 22 items to achieve unbiased survey
results (Einarsen et al., 2009).
Data Analysis
The 22 questions on the NAQ-R survey were rst
analyzed for the frequency of new graduates that
responded to ve categories of bullying (never, now
and then, monthly, weekly, and daily). Percentages for
each question indicating weekly and daily occurrences
revealed that serious bullying was occurring in the
workplace. Any frequency of percentages at or more than
10% was considered to be serious.
Table 1 summarizes the percentages of respondents
that claimed the following behaviors that occurred in the
NEW GRADUATE NURSES' PERCEPTION OF THE WORKPLACE 417

Table 1. Comparison of NAQ-R Behaviors of Einarsen and New Graduate Nurses

Einarsen and new graduate nurse
results compared (daily/weekly)
Einarsen New graduate nurse
NAQ-R/Behaviors (n = 135) Expected, % Observed, % (n) 2 p
Work-related bullying
1. Withholding information 10 5.9 (8.0) 1.15 ns
3. Working below one's competence 10 10.5 (14) 0.01 ns
14. Having opinions ignored 10 8.2 (11) 0.02 ns
16. Given tasks with impossible deadline 10 8.2 (11) 0.20 ns
18. Being excessively monitored 10 7.5 (10) 0.39 ns
19. Being pressured to not claim entitlements 10 7.4 (10) 0.43 ns
21. Having unmanageable workload 10 17.1 (23) 2.10 ns

Person-related bullying
2. Being humiliated/ridiculed 13 2.9 (8) 6.87 .0083*
4. Responsibility removed/trivial tasks 13 7.4 (10) 1.71 ns
5. Spreading gossip about you 13 8.1 (11) 1.27 ns
6. Being ignored/secluded 13 11.3 (15) 0.14 ns
7. Insulting remarks 13 5.9 (8) 2.95 ns
10. Hints at quitting job 13 3.7 (5) 5.65 .0174*
11. Being reminded of mistakes 13 2.2 (3) 5.30 .004*
12. Being ignored or hostility 13 7.4 (10) 1.71 ns
13. Persistent criticism 13 1.4 (2) 10.07 .0015*
15. Practical jokes by adversaries 13 2.9 (4) 6.97 .0083*
17. Allegations against you 13 1.4 (2) 10.07 .0015*
20. Excessive teasing/sarcasm 13 4.4 (6) 4.66 .031*

Physically intimidating bullying

8. Being shouted at 3 5.9 (8) .99 ns
9. Intimidating behavior 3 3.7 (5) .08 ns
22. Threats of violence 3 1.4 (2) .59 ns
Tool: NAQ-R (Einarsen et al., 2009).
Note. ns = nonsignificant.
* = significance.

categories work-related bullying, person-related bullying,
and physically intimidating bullying. The respondents in
the new nurse graduate survey selected frequencies for
daily and weekly, were compared with Einarsen et al.
(2009) landmark study, and determined if bullying was
signicant or not signicant using chi-square with one
degree of freedom.
Participant Demographics
The new graduate nurse respondents (135) were
overwhelmingly White, non-Hispanic (92.6%), worked
in the hospital setting (83%), and were staff nurses
(80.3%). The majority had a bachelor's degree (65.1%),
followed by associate degree (20%) and master's degree
(13.3%). Other educational backgrounds were 1.5%.
See Table 2.
Results
NAQ-R/Behavior Survey
Table 1 presents work-related bullying and the frequency
scores on new nurse graduates compared with Einarsen
et al. (2009) population norm for each question. New
nurse graduates reported negative behaviors and work-
place bullying as signicant to all seven questions. Of
importance is noting that new graduate nurses reported
on weekly and daily events, that 10.5% were ordered to
work below their competence, and that 17.1% were
exposed to an unmanageable workload.
Person-related bullying questions were responded to
by the new nurse graduates on a daily and weekly
basis except for Question 11 and Question 15.
Statistically signicant and nonsignicant differences
were found of the specic new graduate's responses.
The reason for statistically different results of this
research compared with Einarsen et al. (2009)
population is that less person-related bullying was
reported by the new nurse graduates. When analyzing
person-related bullying, there was a signicant differ-
ence for questions (2, 10, 11, 13, 15, 17, and 20).
These specic questions were not identied by the
new nurse graduates because they were in Einarsen's
study. New graduate nurses were much like the
population norm for questions (4, 5, 6, 7, and 12).
Of importance are that 11.3% of the new graduates
418 VOGELPOHL ET AL

Table 2. Population Demographics: (n = 135) Any physical threats of violence should be taken very
Variable Frequency % seriously by health care organizations. Employees need
to have a reporting system in the health organization,
Race frequency and the bully should be subject to disciplinary action.
White, non-Hispanic 125 92.6
Questions (8, 9, and 22) were all not statistically
Black or African American 7 5.2
signicant and were similar to Einarsen et al.'s
Hispanic and other 3 2.2
Practice settings population norm.
Ambulatory care 2 1.5 The results for the physically intimidating bullying and
Community/Public health/Home care 2 1.5 work-related bullying subscales were not statistically
Hospital 112 83.0 different when compared with ndings published by
Nursing home or extended care 11 8.1 Einarsen et al. (2009) indicating that the new graduate
Nursing education 2 1.5 nurse encountered similar problems in the workplace.
Unemployed/Other 6 4.5 New nurse graduates reported that they were ignored
Nursing role and secluded (11.3%), were forced to work below their
Staff nurse 106 80.3 competence (10.5%), their opinions were ignored
Charge nurse 10 7.6 (8.2%), and they were assigned tasks with impossible
Nurse manager 1 .8
deadlines (8.2%).
Supervisor 3 2.3
Instructor/Faculty 2 1.5 However, some statistically signicant differences were
CNS 1 .8 found when comparing the new graduate nurses with
Nurse practitioner 8 6.1 Einarsen et al.'s (2009) landmark study. In the person-
Office nurse 1 .8 related bullying subscale, several statistically signicant
Educational background differences were found in the items measured: Being
Associate degree 27 20.0 humiliated/ridiculed (p = .0083), hints at quitting job
Bachelor of science in nursing 82 60.7 (p = .0174), being reminded of mistakes (p = .004),
Bachelor's degree, another area 6 4.4 persistent criticism (p = .0015), practical jokes by
MSN 12 8.9 adversaries (p = .0083), allegations against you (p =
Direct entry, MSN 5 3.7 .0015), and excessive teasing/sarcasm (p = .031). These
Master's degree, another field 1 .7
results are all less than Einarsen et al.'s research and may
Other 2 1.5
be related to the education of the nurse to the
CNS = Clinical nurse specialist; MSN = Master of Science in Nursing. professional nursing role. Cronbach's alpha for the
instrument was .828 in this nursing research study
reported that they were ignored or secluded, 8.1% indicating good internal consistency.
reported that gossip was spread about them, and 7.4%
reported that trivial tasks were given to them because New Graduate Nurse Relational Questionnaire
their responsibility was removed. Table 3, the relational questionnaire, included 20.5% of
For some new graduate nurses, the occurrence of nurse respondents reporting that they had been bullied
negative behaviors were increased up to three times as in the workplace. New graduate nurses (46.7%) reported
often on a monthly basis related to person-related that they had seen others as the subject of bullying
bullying. Monthly meetings may be a situation where during the last 6 months. Thirty-one percent of new
bullying is occurring because 21.1% of new graduates graduates reported that bullying had affected their job
reported that they were ignored and secluded, 15.5% performance. This is a serious issue because patient care
reported that there was gossip spread about them, 14% and job satisfaction could be affected. Nurses deal with
reported that insulting remarks were made about them, critical life and death issues and cannot be distracted
and 12.6% reported that their responsibility was from doing their work by being bullied or working in a
removed and that they were given trivial tasks. This bullying environment.
report may be a hint for those in management or staff New graduate nurses, 29.5%, reported that they had
development that some staff or managers bully during considered leaving nursing because of negative behaviors
the monthly meetings. in the workplace. Of the new graduate nurses that had
Physically intimidating bullying, a very serious form been bullied, 35.4% had changed jobs within the past 2
of bullying, was reported on a weekly or daily basis by years and reported that negative behaviors in the
5.9% of new nurse respondents as being shouted at or workplace did make a difference and affected their
being the target of someone's spontaneous anger (or decision to change jobs. New graduate nurses (82.8%)
rage). Another 3.7% of the respondents reported reported that workplace bullying should be included in
intimidating behavior such as nger pointing, invasion the nursing curricula, but only 22.4% of the nurse
of their personal space, shoving, and blocking/barring respondents reported that the topic of bullying was
the way. A threat of violence or physical abuse or covered in nursing coursework. New graduate nurses
actual abuse was reported by 1.4% of new nurse (59.6%) reported that they had a mentor in the
graduates. It is interesting that on a monthly basis, the workplace. It is important that 35.1% of the group did
intimidating behavior was reported to occur 10.4%. not report that management was supportive of bullied
NEW GRADUATE NURSES' PERCEPTION OF THE WORKPLACE 419

Table 3. New Graduate Nurse Relational Questionnaire (n = 135)

Yes, % (n) No, % (n)
If bullied, has job performance been affected? 31.6 (30) 68.4 (65)
Have you been bullied at work? 20.5 (27) 79.5 (105)
Have you seen others subjected to bullying within the last 6 months? 46.7 (63) 53.3 (72)
Have you changed jobs within the last 2 years? 35.4 (45) 64.6 (82)
Did bullying cause you to change jobs? 13.2 (14) 86.8 (92)
Have negative behaviors at work made you consider leaving nursing? 29.5 (36) 70.5 (86)
Was workplace bullying included in formal nursing education? 22.4 (30) 77.6 (104)
Should workplace bullying be included in formal nursing education? 82.8 (111) 17.2 (23)
Was bullying included in staff education at health care organization? 36.3 (49) 63.7 (86)
Should there be a policy in the health organization to deal with bullying? 95.5 (128) 4.5 (6.0)
Should there be a person to discuss work issues? 59.7 (80) 40.3 (54)
Do you feel confident to handle a bully in the workplace? 62.7 (84) 37.3 (50)
Is management at your workplace supportive of victims? 64.9 (87) 35.1 (47)
Do you feel that the JCAHO is important? 98.5 (131) 1.5 (2.0)

victims. Employees need a supportive management and
reporting system.
New nurse graduates, 98.5%, in this research study did
report overwhelmingly that health care organizations
should launch an organizational approach to provide
information to employees about bullying and disruptive
behaviors as recommended by JCAHO.
Who is the Bully in the Workplace?
Table 4 summarizes the descriptive data of who the new
nurse graduate acknowledged was the likely or most
likely bully in their workplace. The person most likely to
cause a bullying problem in the workplace was the
nursing peer, the physician, or the patient's family, each
at approximately 60%. The patient, nurse supervisor, and
manager administrator were rated at approximately 40%
as the likely bully.
Discussion
The results of this research study parallels the ndings of
Einarsen et al.'s (2009) study, and the data suggest that
bullying is commonly experienced by new graduate nurses.
New graduate nurses (20.5%) reported being bullied more
often than 5,288 (10.6%) of British employees from various
careers reported in Einarsen's landmark study. Focus
groups with nurses in the health care organization may
help uncover that something else is occurring in the
nursing workplace that needs further exploration.
About one third of the new graduate nurses in this
research study reported that they did not feel satised
with their job performance and that either changed jobs
or considered leaving the nursing profession because of
bullying. Of the new nurse graduates, 31.6% reported
that the bullying had affected their job performance,
35.4% had changed jobs in the past 2 years, and the
negative behaviors at work had made 29.5% of the new
nurse graduates consider leaving the nursing profession.
This is comparable to Simons' (2008) study on newly
licensed nurses in Massachusetts where 31% of the
respondents in the survey were leaving the health
organization because of bullying. In the Health Resources
and Services Administration (2010) who released the
National Sample Survey of Registered Nurses (2008),
29.8% of nurses reported that they recently left a nursing
position or planned to leave in the next 3 years (Health
Resources and Services Administration, 2010). New
graduate nurses leaving their job as a result of being
bullied in the workplace is an unneeded expense to the
health care system and to the new graduate that has spent
much time and money to pursue a career in nursing. In
addition, these may be low percentages because new
graduates may be less likely to quit a job after completing
the rigorous nursing education because they have worked
hard to be licensed and many have loans to repay.
The main bullies reported by the new graduate nurses
in the workplace were their peers (63.9%), physician's
(59.8%), and a patient's family (59.2%). The most
damaging bullying psychologically for a new graduate
nurse is from a peer in the same profession. It is troubling
that the peer nurse was not seen as supportive but as a

Table 4. Who is the Bully in the Workplace? (n = 135)

Likely, % (n) Most likely, % (n) Total, % (n)
Peer or fellow nurse 31.1 (39) 32.8 (37) 63.9 (76)
Patient 30.8 (11) 9.2 (37) 40.0 (48)
Patient family 47.5 (14) 11.5 (57) 59.2 (71)
Manager/Administrator 24.4 (14) 11.8 (29) 36.1 (43)
Nursing supervisor 27.1 (14) 11.9 (32) 39.0 (46)
Physician 34.4 (31) 25.4 (42) 59.8 (73)
Other health workers 26.1 (4.0) 3.5 (30) 29.6 (34)
Others 3.6 (3.0) 2.7 (4.0) 6.3 (7.0)
420
bully. It is unclear whether the reported bullying was
hazing as a rite of passage into the professional nurse's
role. Further studies are needed to discover the reasons for
bullying of new graduate nurses by other nurses.
The nding that physicians were perceived as sources
of bullying by new graduate nurses was not unexpected.
Physicians have been noted in the literature of having
power struggles with nursing. The dynamic includes a
gender issue because, historically, physicians have
generally been male and, nurses, female. Nurses also
typically take medical orders from physicians, which
places nurses in the subservient position of following
orders. One potential approach to address bullying by
physicians is through education. Cultural competency
training in medical school needs to include civility,
diversity, and sensitivity training for physicians in their
relationships with other health professionals.
One surprising nding was that the patient's family
was one of the main sources of bullying. This is a topic
that nursing education and health care organizations
should accentuate to help prepare new graduate nurses
for negative patient family interactions. Families are
under a lot of stress and often take out their frustrations
on the nurses. Nurses need knowledge on how to manage
conicts and how to deect some of this negativity in
order to maintain open communication for the patient.
Although one perspective may be to blame the family,
it appears that some family cultures may be uninformed
of the relationship of the nurse as a caregiver for the
patient. Another explanation for the families' behavior
may be related to the lack of control the family
experiences in hospital or health care environments.
Similarly, the family may lack sufcient communication
with the nurse. This is an important issue because
families rely most on nurses for information and
communication. The nurse's increased workload may
not allow for adequate time to communicate with families
about the patient. Qualitative studies on families and
nurses are needed to discover whether the family is acting
out with the nurse to get information, or if the families
who bully live in a culture of bullying, or there are a
combination of factors leading to bullying behaviors.
Of those reporting, 83% of new graduate nurses
worked in a hospital setting, and 80.3% were staff nurses
in this research study. Having an unmanageable
workload (17.1%) was reported at an exceptionally
high rate compared with Einarsen et al.'s (2009) study.
Health care nancial constraints and the nursing shortage
both contribute to excessive workloads and lead to an
environment for bullying to occur.
Practical jokes, teasing, and openly humiliating others
were less reported in this research study than in Einarsen
et al.'s (2009) study. This behavior is less likely projected
in the culture of nursing. Professionalism is taught in
nursing school, and student nurses would not display
overt behaviors such as playing practical jokes, teasing,
and openly humiliating others because they are unprofes-
sional. Persistent criticism may be less of an issue for
many new graduates compared with Einarsen et al.
VOGELPOHL ET AL
because they may not recognize criticism as a form of
bullying and because some may even view it as
constructive. Some new nurse graduates may be desensi-
tized to criticism as a result of their nursing education.
New graduates reported being shouted at (5.9%) in
the workplace and experiencing intimidating behavior
(3.7%), which is physically intrusive and nonprofes-
sional. Physically intimidating bullying, being shouted at
(5.9%), occurred twice as often for new nurse graduates
compared with the employees in Einarsen et al.'s (2009)
study. These types of nonprofessional behaviors could
help explain why new graduate nurses are changing jobs
and considering leaving the profession. Future studies are
needed to nd out why inappropriate behaviors, such as
shouting at fellow employees, are tolerated in a health
care organization and especially when directed at new
graduate nurses.
A minority of new nurse graduates (22.4%) reported
that bullying information was included in their nursing
education, but 82.8% thought it should be included. Of
those reporting, only 36.3% reported that bullying was in
their staff education when hired to a health care
organization. The ndings suggest that new nurse
graduates and all employees need information on how
to handle bullies and stand up for victims.
Some workplace issues for the new graduate nurse could
be resolved, especially if a senior nurse was available to
provide mentorship. In this study, 59.7% of the nurses had
a mentor to discuss workplace issues, and 62.7% felt
condent to handle a bully. It is interesting that
approximately one third of the new nurse graduates had
considered leaving the profession and that approximately
two thirds of the new graduates had a mentor and felt
condent to handle a bully. A supportive mentor who helps
the new graduate feel condence may be a deterrent for the
new nurse graduate's decision to change jobs or leave the
profession. This is another area for future studies.
Employees often do not recognize the patterns of
behavior that constitute bullying. Education during
orientation and staff development in-services within the
health care organization to all employees are crucial.
Conclusion
Bullying is a problem in the workplace. Nurses are being
bullied from three directions: peers who they are working
with, physicians who they take orders from, and patient's
families who they are providing care. The ndings of this
study suggest that further research is needed to learn about
the dynamics of bullying. There is also a need for advocacy
in nursing that provides clear communication with
families, a team approach, and an increased sensitivity to
families' needs. Education is important for the new nurse
graduate to learn to stand up for their self, and sensitivity
training is needed for all members of the health care team.
Health care employers have the responsibility to be
knowledgeable about the occurrence of hostility in the
workplace. Bullying terms should be openly communi-
cated with staff, and education about organizational
NEW GRADUATE NURSES' PERCEPTION OF THE WORKPLACE
policies dealing with negative workplace behaviors is
needed. A reporting system for staff to identify hostile,
negative behaviors in the workplace is suggested, and an
investigation should occur; especially if there is a high
rate of staff turnover, absenteeism, and staff complaints
(Bartholowmew, 2006). Research on the hostile work
environment for nurses in health care recommends that
managers in health care organizations need education
about bullying so that they feel empowered to manage
and educate staff. Bartholowmew states that staff mimics
the leadership style of the manager and will also develop
a sense of empowerment. Assertiveness training for all
staff would improve communication, which is necessary
to identify hostile staff behaviors. Bartholowmew
encourages nursing leaders to decrease hostility by
developing a zero-tolerance policy for hostile behaviors.
JCAHO (2008) provides accreditation to hospitals in
the United States and also issued a directive beginning in
2009 requiring health care organizations to have a
process to deal with bullying and interruptive behavior
in the workplace. Individual states in the United States
are encouraged to tackle bullying through their state
boards of nursing and introduce legislation to address
horizontal violence or bullying behaviors.
In the state of OH, USA, legislation of zero tolerance for
bullying is pending, and education is cited as the key
component to protect against workplace violence (Brunt,
Hoopingarner, Nanna, Nicholson, Smith, & Valentino,
2007). Some of the strategies include the following: (a)
Nurses should be educated in assessing workplace
violence; (b) Each employee should have violence
prevention information in orientation and mandatory
updates; (c) Nurses should be educated about how to
identify and manage agitation; and (d) Regular documen-
ted training sessions on violence are to take place within
organizations. These educational strategies on how to
recognize negative acts in the workplace would help staff
prevent bullying events by dissuading perpetrators.
Health care management has a responsibility to
support those who are victims of bullies and provide
bullies the education and necessary referrals that are
needed. Administrators in health care organizations need
to take bullying seriously and establish an environment
that is supportive to victims and promotes zero tolerance
for bullying.
By initiating education to all staff about the overt and
covert behaviors that constitute bullying, the bullying
experience for many can be prevented. Awareness is
needed by nursing leaders of bullying tactics such as
shouting or ignoring another staff member. Employees
need specic information on bullying language within
their organization and steps to eliminate bullying.
Beginning steps include a formal departmental policy, a
reporting form, counseling sessions for the bully and
victim, and consequences for negative behaviors. Nursing
cannot afford to lose new graduate nurses or any nurse
from the profession in these times of a nursing shortage.
Educators and nurse managers especially need to take a
stand to interrupt bullying behaviors.
421
Respect, civility, assertiveness, and conict manage-
ment need to be professional topics introduced in
undergraduate education and reinforced in workplaces.
Nurse employees need to know the following: Who are
the bullies? What overt and covert bullying behaviors do
bullies exhibit? How do you handle bullies in the
workplace? How can employees prevent bullying? Does
the workplace support efforts to report bullying? The
ultimate goal is to eliminate the power of the bully in the
workplace and create a harmonious work environment.
Educational information helps prevent new graduate
nurses from leaving the profession.
Limitations
This study had a small sample size of newly licensed
nurses from ve nursing schools in Northwest Ohio in
Midwestern United States. One may not be able to
generalize the ndings to newly graduated nurses in
other parts of the United States or internationally. Many
participants from the ve nursing schools in Northwest
Ohio did not check their e-mails on a regular basis after
leaving nursing school. For this reason, it is anticipated
that many newly graduated RNs did not receive the
survey. Another explanation for the low response rate is
that the participants who experienced bullying may have
been more likely to respond to the survey than those who
had not experienced bullying. One wonders about the full
extent of the bullying problem because we do not know
what the nonresponder group was like.
Recommendations for Future Studies
This research study provides the foundation for the need
for nursing leaders and educators to provide information
to students and staff nurses on bullying in the work
environment. Some recommendations for nursing edu-
cators are that undergraduate nursing students need to be
able to recognize bullying behaviors and how to manage
bullying. The nursing curriculum should teach both of
these concepts. Nursing students need to be introduced
to these concepts when they enter the nursing program,
and these concepts need to be reinforced throughout the
entire curriculum. Prior to graduation, special emphasis
needs to be placed on these concepts to prepare
graduating students for entering into nursing practice.
The curriculum for nursing students should include in
their leadership/management course role-playing scenar-
ios of how to handle a bully (peers, other staff, patient,
and family) in the workplace. By practicing how to react
to a bully as a student, the new graduate nurse will be
better prepared to react condently and assuredly.
It is imperative that new nurse graduates recognize and
are prepared to handle bullying in the workplace. Red ags
that should alarm a new graduate nurse that he or she is
being bullied include having an unmanageable workload,
being criticized, humiliated, teased, ignored, isolated,
devalued, blamed, sabotaged, or being shouted at. In
addition, new graduate nurses should be encouraged to ask
for a supportive mentor when newly hired within a health
care organization. As a new graduate nurse, if a bullying
422
situation occurs, the new graduate needs to request the
bully to stop their behavior. If the bullying does not stop,
the new graduate nurse needs to keep a written record and
report any bullying incidences to their supervisor. A sound
health care organization should have antibullying policies,
which includes the statement that the organization has zero
tolerance for bullying.
Future studies may analyze workplace bullying after
new nursing graduates or new employees have been
provided information in staff education and orientation
about the signs of a bullying work environment. Future
studies should also be done on the seasoned nurse's
perception of bullying in the workplace. Studies on new
nurse graduates could include their knowledge of conict
management techniques and strategies to diffuse bully-
ing. Physicians also need bullying information in their
medical training and in staff development sessions within
health care organizations.
Bullying is a serious problem and may have serious
consequences for the victim, patients, and the organization.
Nurses must promote the ANA Code of Ethics (2003)
where patients and staff are treated with respect and dignity.
A civil workplace should be the right of all employees.
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