The Problem of Bullying in Nursing

Abstract

Horizontal violence among nurses is an issue that leads to high rates of turnover, mental health problems for impacted individuals, lowered quality of healthcare, and significant financial losses for the healthcare industry research considers two views points, scientific, and mathematical, and each of them poses two research questions. The first ones are concerned with the psychological effects of bullying for nurses and the link between horizontal violence and nurses’ development of mental health issues.

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Mathematical inquiries include the potential economic consequences such as loss of profit as well as nurse’s turnover rates. Data gathering is the foundation of the research process, and it is performed with the help of academic studies. The collected information confirms that nurses are significantly affected by bullying. They become less confident in their competency, afraid of physical and emotional abuse and can develop anxiety-, sleep-, and stress-related disorders.

The connection between horizontal violence and such conditions as anxiety, depression, bipolar personality disorder, borderline personality disorders is strong. There are many economic issues related to bullying, including nurses’ shortage, costs of education, hiring spendings, and others. High rates of turnover are directly impacted by bullying and also lead to financial problems. Finally, emotional abuse leads to a decrease in care quality, adverse patient outcomes, and low ranks of involved medical facilities. Anti-bullying policies designed and enforced by the government should assist in reducing the rates of bullying among nurses. They should encourage the creation of a respectful and supportive environment and prevent horizontal violence.

Introduction

Even though such values as equality, trust-based relationships, mutual understanding, and togetherness are constantly promoted in the United States, the problem of aggression still exists in various institutions. The cases of bullying or the use of force, social/job position, or threats in order to influence the behavior of certain individuals are extremely common, which makes the national community concerned about the ways to reduce it. Individuals who bully others can pursue a variety of goals, ranging from the expression of their personal attitudes toward other people to the use of others’ sense of fear for benefits or emotional intimidation.

Speaking about the age groups with the highest levels of aggression, many people typically focus on teenagers, and this is why bullying is traditionally perceived as a problem peculiar to educational institutions. However, the cases of bullying that involve adult people working in healthcare organizations are not uncommon, and this is why workplace bullying in nursing is a problem that deserves close attention.

The problem of workplace bullying is especially common in the nursing environment. To explain the causes of this tendency, it can be supposed that these specialists are socialized to neglect their own problems to ensure the psychological and physical comfort of other people.

With that in mind, the given research paper focuses on this issue to help society better understand the long-term consequences of aggressiveness toward nurses in the context of its psychological effects and economic issues. The paper approaches the problem of bullying in nursing from mathematical and scientific perspectives in order to analyze the existing statistical data. Therefore, it discusses the presence of links between nurse bullying, mental disorder rates, decreases in profits, and other economic consequences for the healthcare industry.

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The Significance of Research

The term horizontal violence refers to the aggressive behavior of one or several members of the group to another member of the same group, also includes provoking conflicts, and personal bullying. Unfortunately, this problem is widespread in the nursing environment, and it leaves a negative impact on care quality and efficiency. I would like to understand why this happens in groups of like-minded individuals with shared values and goals. Research of this question should provide a deeper understanding of the causes and facilitate the creation of anti-bullying policies for nurses. I think that this goal is realistic because even if we fail to eradicate horizontal violence, we can try to make this phenomenon less frequent in this particular field.

Bullying significantly affects every individual suffering from it, the clinical environment, and the profession of nurses. Research shows that there is a direct correlation between horizontal violence and job satisfaction among nurses, which affects the efforts of individuals who choose this profession and the public health sector in general (Purpora & Blegen, 2015). It is necessary to research the reasons behind these statistics and find ways of changing the current unacceptable state of affairs.

A friendly and supportive environment is key for any workspace, and especially for nurses, who devote all of their energy and empathy to patients. The current level of bullying, affects their efficiency and satisfaction with their job; this is why the level of horizontal violence should be reduced. It would be beneficial for the victims of bullying in the first place and for all the community of nurses, as every one of them is under the threat of being bullied. Secondly, it is supposed to decrease the dissatisfaction of nurses with their working environment, and, as a result, raise the quality of care. This change should also cut the shortage of specialists, make it more appealing to the general public, and attract specialists to the profession.

Scientific and Mathematical Perspectives

Bullying in the workplace is a nationwide problem in the US. According to the statistics, around 75% of workers experience workplace bullying at least once a year. At the same time, over 80% of bullying is conducted by less than 6% of the total workforce (Wright & Khatri, 2015). Workplace bullying affects nearly every domain of labor activity, including the healthcare system. Despite being an industry founded on holistic principles of kindness, compassion, and care, the healthcare industry shows a persistent dynamic in workplace bullying across all specialties and designations (Blackstock, Harlos, Macleod, & Hardy, 2014).

Bullying in nursing has very strong connections to the turnover rate, effectively increasing it. The costs of turnover in medicine are among the highest in the world, ranging from 22,000 to 65,000 dollars per employee, excluding the associated expenses for university studies (Blackstock et al., 2014). Overall, the healthcare industry loses more than 300 billion dollars worldwide because of turnover based on mundane slights (Wright & Khatri, 2015). In addition to making people lose their jobs and causing additional expenses, nurse turnover is associated with various psycho-emotional issues and an overall decrease in the quality of care. The purpose of this paper is to analyze the issue of workplace bullying in healthcare through the lens of mathematical and scientific analysis.

Research Questions

The research questions for this paper are as follows:

  • Scientific:
    • What are the psychological effects of nurse bullying in the workplace?
    • What is the connection between nurse bullying and the development of psychological diseases in the workplace?
  • Mathematical:
    • What are the economic consequences of bullying in healthcare institutions?
    • What is the connection between nurse bullying, turnover rates, and loss of profit?

The Psychological Effects of Nurse Bullying

Nurse bullying has profound psychological effects both on the victims and the perpetrators. For the victims, bullying is one of the primary sources of stress and anxiety. They do not feel safe, threatened, and fearful of both physical and emotional bullying. Their self-esteem decreases and they start feeling less competent than they actually are. Attempts to stand up to organized groups of perpetrators often result in failure, which only magnifies the impact of further bullying attempts.

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According to Wright and Khatri (2015), many bullied nurses acquire bullying as a coping mechanism and learned behavior, exuding it on those who have even less power than they have. Thus, to summarize, the psychological effects of nurse bullying include a negative outlook on oneself, stress and anxiety, uneven sleeping patterns, and a plethora of unhealthy coping behaviors, some of which are learned (Wright & Khatri, 2015).

As for the nurses who participate in bullying or witness it as bystanders, they are more likely to develop emotional detachment from their job and antisocial behavior tendencies. They are typically desensitized towards patients and their suffering and are more likely to be fired for the poor quality of care (Wright & Khatri, 2015). They are aware of this fact, which leads to stress and a desire to supplant others to make themselves look competent.

Nurse Bullying and the Development of Psychological Disorders

Some of the most common psychological disorders found among victims of bullying in the workplace are depression, anxiety, and borderline personality disorder. Depression is a common psychological illness that can have severe consequences on a person’s life. It causes sadness and a lack of pleasure in activities that used to bring enjoyment and satisfaction. This is directly related to nursing turnover. When faced with constant abuse from workplace colleagues while suffering from depression, nurses are far more likely to drop out of the job. Anxiety is often accompanied by depression and has a person suffering from panic attacks, jitteriness, and a loss of confidence (Chang et al., 2017).

Low self-esteem is connected with bipolar personality disorder, which is often represented by mood swings, bouts of indecisiveness, apathy, and fear as well as the polar opposites of these symptoms, such as hyperactivity, desire for conflict, and violence. Bullies, on the other hand, tend to suffer from the development of antisocial personality disorder, which is characterized by a complete disregard for conventions, morals, and feelings of others (Wright & Khatri, 2015). It leads to social isolation and ostracizing, making them more likely to quit.

Economic Consequences of Bullying in Healthcare

As it was already mentioned, mundane slights cause over 300 billion dollars of deficit in healthcare institutions worldwide. The majority of these expenses arise from the need to recruit and train new staff. As it stands, the US hospital system experiences a shortage of nurses. According to Duffield, Roche, Homer, Buchan, and Dimitrelis, (2014), the US healthcare market will require additional 1.1 million nurses by 2022, increasing the overall body of nurses in the country by about 20-25%. Because of shortages, time, and effort required to educate professional doctors and nurses, the costs of healthcare for the end-users are increased.

US healthcare department reports that an average family of four (mother, father, two children) spend roughly 20% of their yearly income (Duffield et al., 2014), which is around 10,000 dollars, assuming the family receives government aid, which covers for half of the expenses. Otherwise, the expenses may rise to 20,000-25,000 dollars a year, depending on the insurance plan. Since bullying directly affects nurse turnover rates, it also sends a ripple effect throughout the entire system, affecting the economic well-being of all individuals and stakeholders involved, including the nurses, the hospitals, the patients, and the governments, who are forced to pay for these expenses.

Nurse Bullying, Turnover Rates, and Loss of Profit

Nurse bullying is directly related to the profitability of healthcare ventures. Duffield et al. (2014) highlight the three important ways how harassment creates a budget deficit in hospitals. First, it creates a shortage of nurses, doctors, and employees. US hospitals on average have a job vacancy rate of about 14-16%. It means that the majority of healthcare facilities are, on average, understaffed. Seeking out, hiring, and training nurses costs around 20,000-60,000 dollars (Blackstock et al., 2014). Every time a nurse quits because of workplace harassment, the hospital suffers a direct loss of investment equal to half of a nurse’s yearly pay.

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Loss of profit is exacerbated by the fact that most hospitals cannot deal with the imposed workload during seasonal peaks. Chang et al. (2017) report that hospitals are forced to hire temporary staff to be able to manage their patients at a basic level. Hospitals that cannot deal with extra patients simply lose them, which results in a loss of profit and reputation, as the patients the hospitals failed to serve are unlikely to recommend the facility to their friends and family.

Lastly, fewer nurses mean higher chances of clinical mistakes. Wright and Khatri mention that patients in understaffed nursing settings are more likely to contract hospital-related diseases, which would result in long, expensive, and potentially dangerous treatments. Ulcers, blood contamination, as well as bacterial and viral infections contracted by patients are usually paid for by the hospitals.

Ethical and Cultural Perspectives of Inquiry

Despite the fact that nursing practice is guided by various ethical principles and standards, the issue of bullying is still observed in nurses’ workplace, affecting their psychological state and provoking decreases in facilities’ profit. Focusing on the ethical perspective of inquiry, it is important to discuss the issue from the point of moral obstacles that can affect the ways of how the medical community responds to the issue.

The research question related to this inquiry is the following one: How does the medical community address the psychological effects of nurse bullying in the workplace in the context of faced ethical obstacles? The cultural perspective selected for the research is related to determining what cultures or societies can be most affected by the discussed issue. The research question associated with this perspective of inquiry is the following: What is the connection between nurse bullying, turnover rates, and decreased profits in the context of different cultures represented in the workplace? The purpose of this paper is to address the formulated research questions for each perspective with reference to the existing literature in the field and conclude regarding possible insights.

The Ethical Perspective of Inquiry: Research Question One

The first question to discuss in detail is how the medical community usually addresses certain psychological effects of nurse bullying in the workplace with reference to experienced ethical obstacles. According to Berry, Gillespie, Fisher, Gormley, and Haynes (2016), the key ethical obstacle in this area is the unwillingness of authorities to accept the fact that nurse bullying exists in the healthcare system. This aspect influences the response of the medical community to the controversial issue of workplace violence.

From the ethical perspective, medical authorities often make a wrong choice when avoiding the accentuation of the problem of nurse bullying because this issue affects both nurses and patients. Thus, Koh (2016) states that nurses as victims of bullying can suffer from such psychological problems as stress, anxiety, sleeping disorders, and mood disorders among others while remaining unaddressed and untreated. In addition, the effect of nurse bullying on patients is also significantly negative due to the decreased quality of care, and it represents another ethical barrier (Berry et al., 2016; Koh, 2016). Those nurses who regularly become victims of workplace violence and suffer from stress cannot provide effective care.

Nursing practice is regulated by the code of ethics, but the medical community often fails to prevent nurse bullying because of ignoring different forms it can take: discrimination, verbal abuse, physical abuse, and psychological pressure. This avoidance of accepting the presence of workplace violence and bullying in healthcare facilities is also considered among ethical obstacles medical providers face when discussing this issue (Berry et al., 2016; Koh, 2016).

As a result, the problem is that the psychological effects of bullying on nurses become ignored, causing more difficulties for healthcare professionals who can suffer from different mental conditions, disorders, and syndromes (Berry et al., 2016). The situation creates the grounds for discussing the ethical dilemma of how to overcome the issue of avoiding the necessity of resolving the problem of nurse bullying. The reason for the medical community to address the issue of nurse bullying is to prevent negative psychological effects on nurses that usually lead to decreasing the quality of their work (Koh, 2016). The research literature indicates that more efforts are required to address workplace violence for nurses to decrease their psychological and social pressure.

The Cultural Perspective of Inquiry: Research Question Two

In the context of the cultural perspective, the research question is associated with determining the connection between the problem of nurse bullying, turnover rates in healthcare facilities, and decreased profits with reference to different cultures. Thus, researchers have found that representatives of some ethnicities and races suffer from bullying in the nursing workplace more than others (Sabri et al., 2015; Schilgen, Nienhaus, Handtke, Schulz, & Mösko, 2017).

African Americans and Hispanics, as well as migrant workers from different countries, are reported to be most affected by workplace violence and bullying in facilities in comparison to the majority population (Schilgen et al., 2017). The researchers explain the trend with reference to the ideas of racial discrimination and prejudice that are often observed in healthcare workplaces.

The available research on nurse bullying supports the opinion that nurses as representatives of minority groups more often become victims of workplace violence than their colleagues. Thus, the percentage of bullied migrant nurses is higher when comparing it to the percentage of bullied representatives of the majority (Schilgen et al., 2017). This aspect is also explained with reference to bias and discriminatory practices that can be observed in the workplace of different medical facilities (Sabri et al., 2015).

However, researchers also state that bullying is even more typical among White nurses than among Asian and Black nurses, and this aspect also allows for discussing the cultural factor with reference to the analyzed issue. The reason is that the organizational culture significantly affects the cases of bullying in medical facilities.

As a result of nurse bullying, those nurses who belong to minority groups or who are migrants are more likely to leave their position. From this perspective, workplace violence and bullying associated with the cultural issue can affect increases in turnover rates (Koh, 2016; Sabri et al., 2015; Schilgen et al., 2017). In addition, the literature on the topic indicates that the situation of discriminating and bullying nurses as representatives of minorities can negatively affect healthcare profits (Koh, 2016; Sabri et al., 2015).

The reason is that healthcare authorities are interested in attracting high-qualified migrant nurses, and they usually set lower salaries for them (Schilgen et al., 2017). As a result, hospitals become able to address the problem of nurse shortages and increase patient outcomes, as well as overall revenues.

Research Questions

The research questions for this paper are as follows:

  • Scientific:
    • What are the psychological effects of nurse bullying in the workplace?
    • What is the connection between nurse bullying and the development of psychological diseases in the workplace?
  • Mathematical:
    • What are the economic consequences of bullying in healthcare institutions?
    • What is the connection between nurse bullying, turnover rates, and loss of profit?

The Psychological Effects of Nurse Bullying

Nurse bullying has profound psychological effects both on the victims and the perpetrators. For the victims, bullying is one of the primary sources of stress and anxiety. They do not feel safe, threatened, and fearful of both physical and emotional bullying. Their self-esteem decreases and they start feeling less competent than they actually are. Attempts to stand up to organized groups of perpetrators often result in failure, which only magnifies the impact of further bullying attempts.

According to Wright and Khatri (2015), many bullied nurses acquire bullying as a coping mechanism and learned behavior, exuding it on those who have even less power than they have. Thus, to summarize, the psychological effects of nurse bullying include a negative outlook on oneself, stress and anxiety, uneven sleeping patterns, and a plethora of unhealthy coping behaviors, some of which are learned (Wright & Khatri, 2015).

As for the nurses who participate in bullying or witness it as bystanders, they are more likely to develop emotional detachment from their job and antisocial behavior tendencies. They are typically desensitized towards patients and their suffering and are more likely to be fired for the poor quality of care (Wright & Khatri, 2015). They are aware of this fact, which leads to stress and a desire to supplant others to make themselves look competent.

Nurse Bullying and the Development of Psychological Disorders

Some of the most common psychological disorders found among victims of bullying in the workplace are depression, anxiety, and borderline personality disorder. Depression is a common psychological illness that can have severe consequences on a person’s life. It causes sadness and a lack of pleasure in activities that used to bring enjoyment and satisfaction. This is directly related to nursing turnover.

When faced with constant abuse from workplace colleagues while suffering from depression, nurses are far more likely to drop out of the job. Anxiety is often accompanied by depression and has a person suffering from panic attacks, jitteriness, and a loss of confidence (Chang et al., 2017).

Low self-esteem is connected with bipolar personality disorder, which is often represented by mood swings, bouts of indecisiveness, apathy, and fear as well as the polar opposites of these symptoms, such as hyperactivity, desire for conflict, and violence. Bullies, on the other hand, tend to suffer from the development of antisocial personality disorder, which is characterized by a complete disregard for conventions, morals, and feelings of others (Wright & Khatri, 2015). It leads to social isolation and ostracizing, making them more likely to quit.

Economic Consequences of Bullying in Healthcare

As it was already mentioned, mundane slights cause over 300 billion dollars of deficit in healthcare institutions worldwide. The majority of these expenses arise from the need to recruit and train new staff. As it stands, the US hospital system experiences a shortage of nurses. According to Duffield, Roche, Homer, Buchan, and Dimitrelis, (2014), the US healthcare market will require additional 1.1 million nurses by 2022, increasing the overall body of nurses in the country by about 20-25%. Because of shortages, time, and effort required to educate professional doctors and nurses, the costs of healthcare for the end-users are increased.

US healthcare department reports that an average family of four (mother, father, two children) spend roughly 20% of their yearly income (Duffield et al., 2014), which is around 10,000 dollars, assuming the family receives government aid, which covers for half of the expenses. Otherwise, the expenses may rise to 20,000-25,000 dollars a year, depending on the insurance plan. Since bullying directly affects nurse turnover rates, it also sends a ripple effect throughout the entire system, affecting the economic well-being of all individuals and stakeholders involved, including the nurses, the hospitals, the patients, and the governments, who are forced to pay for these expenses.

Nurse Bullying, Turnover Rates, and Loss of Profit

Nurse bullying is directly related to the profitability of healthcare ventures. Duffield et al. (2014) highlight the three important ways how harassment creates a budget deficit in hospitals. First, it creates a shortage of nurses, doctors, and employees. US hospitals on average have a job vacancy rate of about 14-16%. It means that the majority of healthcare facilities are, on average, understaffed. Seeking out, hiring, and training nurses costs around 20,000-60,000 dollars (Blackstock et al., 2014). Every time a nurse quits because of workplace harassment, the hospital suffers a direct loss of investment equal to half of a nurse’s yearly pay.

Loss of profit is exacerbated by the fact that most hospitals cannot deal with the imposed workload during seasonal peaks. Chang et al. (2017) report that hospitals are forced to hire temporary staff to be able to manage their patients at a basic level. Hospitals that cannot deal with extra patients simply lose them, which results in a loss of profit and reputation, as the patients the hospitals failed to serve are unlikely to recommend the facility to their friends and family.

Lastly, fewer nurses mean higher chances of clinical mistakes. Wright and Khatri mention that patients in understaffed nursing settings are more likely to contract hospital-related diseases, which would result in long, expensive, and potentially dangerous treatments. Ulcers, blood contamination, as well as bacterial and viral infections contracted by patients are usually paid for by the hospitals.

Ethical and Cultural Perspectives of Inquiry

Despite the fact that nursing practice is guided by various ethical principles and standards, the issue of bullying is still observed in nurses’ workplace, affecting their psychological state and provoking decreases in facilities’ profit. Focusing on the ethical perspective of inquiry, it is important to discuss the issue from the point of moral obstacles that can affect the ways of how the medical community responds to the issue. The research question related to this inquiry is the following one: How does the medical community address the psychological effects of nurse bullying in the workplace in the context of faced ethical obstacles?

The cultural perspective selected for the research is related to determining what cultures or societies can be most affected by the discussed issue. The research question associated with this perspective of inquiry is the following: What is the connection between nurse bullying, turnover rates, and decreased profits in the context of different cultures represented in the workplace? The purpose of this paper is to address the formulated research questions for each perspective with reference to the existing literature in the field and conclude regarding possible insights.

The Ethical Perspective of Inquiry: Research Question One

The first question to discuss in detail is how the medical community usually addresses certain psychological effects of nurse bullying in the workplace with reference to experienced ethical obstacles. According to Berry, Gillespie, Fisher, Gormley, and Haynes (2016), the key ethical obstacle in this area is the unwillingness of authorities to accept the fact that nurse bullying exists in the healthcare system. This aspect influences the response of the medical community to the controversial issue of workplace violence.

From the ethical perspective, medical authorities often make a wrong choice when avoiding the accentuation of the problem of nurse bullying because this issue affects both nurses and patients. Thus, Koh (2016) states that nurses as victims of bullying can suffer from such psychological problems as stress, anxiety, sleeping disorders, and mood disorders among others while remaining unaddressed and untreated. In addition, the effect of nurse bullying on patients is also significantly negative due to the decreased quality of care, and it represents another ethical barrier (Berry et al., 2016; Koh, 2016). Those nurses who regularly become victims of workplace violence and suffer from stress cannot provide effective care.

Nursing practice is regulated by the code of ethics, but the medical community often fails to prevent nurse bullying because of ignoring different forms it can take: discrimination, verbal abuse, physical abuse, and psychological pressure. This avoidance of accepting the presence of workplace violence and bullying in healthcare facilities is also considered among ethical obstacles medical providers face when discussing this issue (Berry et al., 2016; Koh, 2016).

As a result, the problem is that the psychological effects of bullying on nurses become ignored, causing more difficulties for healthcare professionals who can suffer from different mental conditions, disorders, and syndromes (Berry et al., 2016). The situation creates the grounds for discussing the ethical dilemma of how to overcome the issue of avoiding the necessity of resolving the problem of nurse bullying. The reason for the medical community to address the issue of nurse bullying is to prevent negative psychological effects on nurses that usually lead to decreasing the quality of their work (Koh, 2016). The research literature indicates that more efforts are required to address workplace violence for nurses to decrease their psychological and social pressure.

The Cultural Perspective of Inquiry: Research Question Two

In the context of the cultural perspective, the research question is associated with determining the connection between the problem of nurse bullying, turnover rates in healthcare facilities, and decreased profits with reference to different cultures. Thus, researchers have found that representatives of some ethnicities and races suffer from bullying in the nursing workplace more than others (Sabri et al., 2015; Schilgen, Nienhaus, Handtke, Schulz, & Mösko, 2017).

African Americans and Hispanics, as well as migrant workers from different countries, are reported to be most affected by workplace violence and bullying in facilities in comparison to the majority population (Schilgen et al., 2017). The researchers explain the trend with reference to the ideas of racial discrimination and prejudice that are often observed in healthcare workplaces.

The available research on nurse bullying supports the opinion that nurses as representatives of minority groups more often become victims of workplace violence than their colleagues. Thus, the percentage of bullied migrant nurses is higher when comparing it to the percentage of bullied representatives of the majority (Schilgen et al., 2017). This aspect is also explained with reference to bias and discriminatory practices that can be observed in the workplace of different medical facilities (Sabri et al., 2015).

However, researchers also state that bullying is even more typical among White nurses than among Asian and Black nurses, and this aspect also allows for discussing the cultural factor with reference to the analyzed issue. The reason is that the organizational culture significantly affects the cases of bullying in medical facilities.

As a result of nurse bullying, those nurses who belong to minority groups or who are migrants are more likely to leave their position. From this perspective, workplace violence and bullying associated with the cultural issue can affect increases in turnover rates (Koh, 2016; Sabri et al., 2015; Schilgen et al., 2017). In addition, the literature on the topic indicates that the situation of discriminating and bullying nurses as representatives of minorities can negatively affect healthcare profits (Koh, 2016; Sabri et al., 2015).

The reason is that healthcare authorities are interested in attracting high-qualified migrant nurses, and they usually set lower salaries for them (Schilgen et al., 2017). As a result, hospitals become able to address the problem of nurse shortages and increase patient outcomes, as well as overall revenues.

Conclusion

In the end, the results of the research indicate that nurse bullying causes a variety of problems that manifest themselves both at the personal and national levels. Using a range of credible sources, the paper proves that exposure to bullying is strongly associated with the increased risks of anxiety, borderline disorder, panic attacks, depression, and self-esteem problems. Interestingly, the experience of being a perpetrator also has negative consequences, making people less sensitive to others’ problems.

Moreover, some bullies use this model of behavior to cope with the traumatic experience of being a victim of bullying in the past. People exposed to bullying can experience a variety of problems, ranging from sleeping difficulties to the need to use unhealthy coping mechanisms to reduce stress.

From the economical point of view, nurse bullying can be detrimental to financial stability due to its impact on healthcare deficits, nurse-to-patient ratios, and rapid changes in healthcare costs. The psychological effects of bullying mentioned above are responsible for an increase in turnover intentions, thus contributing to a catastrophic situation in the nursing labor market. Nurse bullying can create budget deficits in healthcare institutions in a variety of ways since it contributes to understaffing and causes an increase in hiring and training costs.

Finally, bullying in nursing gives rise to problems at the confluence of ethics and patient interests. The paper concludes that staff shortages are inextricably connected to higher hospital-acquired disease rates and clinical mistakes. From the perspective of cultural diversity, the research indicates that the issues of bullying and discrimination on the basis of race and ethnicity are closely interconnected. With that in mind, the components of national strategies aimed at the prevention of nurse bullying should focus on various pretexts to hate, including cultural differences.

References

Berry, P., Gillespie, G., Fisher, B. S., Gormley, D., & Haynes, J. (2016). Psychological distress and workplace bullying among registered nurses. The Online Journal of Issues in Nursing, 21(3), 1-4.

Blackstock, S., Harlos, K., Macleod, M. L. P., & Hardy, C. L. (2014). The impact of organisational factors on horizontal bullying and turnover intentions in the nursing workplace. Journal of Nursing Management, 23(8), 1106-1114.

Chang, H. Y., Shyu, Y. I. L., Wong, M. K., Chu, T. L., Lo, Y. Y., & Teng, C. I. (2017). How does burnout impact the three components of nursing professional commitment? Scandinavian Journal of Caring Sciences, 31(4), 1003-1011.

Duffield, C. M., Roche, M. A., Homer, C., Buchan, J., & Dimitrelis, S. (2014). A comparative review of nurse turnover rates and costs across countries. Journal of Advanced Nursing, 70(12), 2703-2712.

Koh, W. M. S. (2016). Management of work place bullying in hospital: A review of the use of cognitive rehearsal as an alternative management strategy. International Journal of Nursing Sciences, 3(2), 213-222.

Sabri, B., Vil, N. M., Campbell, J. C., Fitzgerald, S., Kub, J., & Agnew, J. (2015). Racial and ethnic differences in factors related to workplace violence victimization. Western Journal of Nursing Research, 37(2), 180-196.

Schilgen, B., Nienhaus, A., Handtke, O., Schulz, H., & Mösko, M. (2017). Health situation of migrant and minority nurses: A systematic review. PloS One, 12(6), 1-7.

Purpora, C., & Blegen, M. A. (2015). Job satisfaction and horizontal violence in hospital staff registered nurses: The mediating role of peer relationships. Journal of Clinical Nursing, 24(15-16), 2286-2294.

Wright, W., & Khatri, N. (2015). Bullying among nursing staff. Health Care Management Review, 40(2), 139-147.

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