Journal Review Paper 700-900 words


Workplace Violence/ Bullying

Format: APA style (includes title pg, work cited, reference pg)

Word Count:



Read two articles and  S
ummarize the article.
  Identify forms of bullying that may lead to violence in the workplace and w
hat strategies may be implemented to manage the impact of violence in the workplace?


Identify sources of violence in the workplace. Explain strategies to manage the impact of violence.


– APA format is to include: an opening paragraph (thesis statement) before body of the paper and closing paragraph is summarizing what the paper discussed. Inlcude at least 3-references.


Articles Attached 

This is the assignment


Cyberbullying: The New Face of Workplace Bullying?

Carmel Privitera, MPsych and Marilyn Anne Campbell, Ph.D.


While the subject of cyberbullying of children and adolescents has begun to be addressed, less attention and
research have focused on cyberbullying in the workplace. Male-dominated workplaces such as manufacturing
settings are found to have an increased risk of workplace bullying, but the prevalence of cyberbullying in this
sector is not known. This exploratory study investigated the prevalence and methods of face-to-face bullying and
cyberbullying of males at work. One hundred three surveys (a modified version of the revised Negative Acts
Questionnaire [NAQ-R]) were returned from randomly selected members of the Australian Manufacturing
Workers’ Union (AMWU). The results showed that 34% of respondents were bullied face-to-face, and 10.7%
were cyberbullied. All victims of cyberbullying also experienced face-to-face bullying. The implications for
organizations’ ‘‘duty of care’’ in regard to this new form of bullying are indicated.


The information and communication technology(ICT) revolution over the last decade has heralded a rapid
growth in the number of people interacting using modern
technologies such as the Internet and mobile phones. In 2005,
there were over 1 billion Internet users and 2 billion mobile
phone users worldwide.2 This widespread access to modern
communication devices has provided an alternative medium
for bullies to target their victims.3 Various terms are used to
describe this new phenomenon, including cyberbullying, elec-
tronic bullying, e-bullying, SMS bullying, mobile bullying, online
bullying, digital bullying, and Internet bullying.4 As in the case of
face-to-face bullying, this relatively new field of study has
initially focused on children and adolescents, with investiga-
tions of cyberbullying in the workplace slow to commence.


Workplace bullying is repeated behavior that offends,
humiliates, sabotages, intimidates, or negatively affects some-
one’s work when there is an imbalance of power.5,6 Both face-
to-face bullying and cyberbullying are about relationships,
power, and control.7 Workplace bullying is considered to
occur when one or more individuals perceive themselves to
be the target of repeated and systematic negative acts on at
least a weekly basis8 over a period of 6 months or longer.8,9

There is also an imbalance of power between the perpetra-
tor and the target of bullying in addition to the victim’s at-
tribution of the perpetrator’s intent to cause harm.10 Because
of this imbalance of power, victims’ ability to cope with the
exposure to systematic negative acts becomes severely im-

paired11 because they may not perceive themselves to be in a
position to effectively protect themselves or to be able to re-
move themselves from the negative situation.11


Research in Scandinavian countries has reported work-
place bullying prevalence rates from 3.5% to 16%.9,12 How-
ever, studies conducted in the United Kingdom have found
higher prevalence rates. Incidence rates have been estimated
from international studies13 to be between 400,000 and 2 mil-
lion employees.

Large organizations with a higher ratio of male-to-female
employees in the manufacturing sector have also been shown
to have an increased risk of exposure to workplace bully-
ing.9,12 Furthermore, male workers and supervisors have
been found to be exposed to higher frequencies of negative
behavior14 due to the often hostile and authoritarian culture
of male-dominated work environments.


The experience of workplace bullying can have negative
consequences on victims physical health and emotional well-
being.15–18 The impact of workplace bullying can also extend
into the victim’s social and family relationships.16,19–22 In
addition, future career advancements such as job promotion
can be threatened or damaged21 because of victims taking
long-term or recurring sick leave as a result of ill health from
being bullied at work.22

The psychological well-being of employees who witness
bullying in the workplace can also be compromised,16,23–26

School of Learning and Professional Studies, Queensland University of Technology, Brisbane, Queensland, Australia.

Volume 12, Number 4, 2009
ª Mary Ann Liebert, Inc.
DOI: 10.1089=cpb.2009.0025


producing low staff morale,21,27 reduced commitment,21,27,29

lowered job satisfaction,21,28 and the breakdown of work re-
lationships and teams.25

The impact at the organizational level is an increased rate
of absenteeism,16,21,30,31 which in turn negatively impacts ef-
ficiency, productivity, and profitability.21,27,32 High staff
turnover due to low workplace morale and the resignation of
staff is costly and time consuming, requiring recruitment
and the retraining of new staff.16,21,27 The reputation of the
organization may also suffer because of a poor public image
as a difficult place to work.16 These consequences could
be exacerbated even more by the new form of workplace


Cyberbullying techniques use modern communication
technology to send derogatory or threatening messages di-
rectly to the victim or indirectly to others, to forward personal
and confidential communication or images of the victim for
others to see, and to publicly post denigrating messages.7,33,34

The two main electronic devices through which bullying from
a distance occurs are online computers, providing access to
e-mail and Web sites, and mobile phones, including calls and
Short Message Service (SMS).

The emerging literature on research with children and
adolescents indicates that cyberbullying is a serious and es-
calating concern at a global level.10,33–36 Cases have also
emerged of bullying at work via e-mail.16,37 While cyberbul-
lying in school and at work has become a recent topic in the
media,39 research into workplace cyberbullying is still in

Research aims

The primary aim of this exploratory study was to ascertain
the prevalence of face-to-face bullying and cyberbullying in
the manufacturing workplace. In addition, organizational
size (small, medium, large), type of organization (private or
public sector), and hierarchical job status (worker or super-
visor) were investigated to ascertain whether there were any
differences in types of negative acts used to bully. Both a
behavioral inventory and a self-report measure of workplace
bullying were used.



Participants were male employees belonging to the Aus-
tralian Manufacturing Workers’ Union (AMWU), Queens-
land, Australia. A total of 145 questionnaires were returned,
of which 84 (57.9%) were from the mail-out and 61 (42.1%)
were from the online survey, an overall response rate of 7.3%.

However, 42 (29%) of these respondents were excluded from
the analysis on the basis of missing data. The total sample for
analysis consisted of 103 individuals, of whom 63.1% were
recruited via mail-out and 36.9% via e-mail.

The average age for the sample was 43.2 (SD¼ 9.81),
ranging from 20 to 60 years. All respondents were employed
on a full-time basis. Two respondents did not indicate the
type of organization for which they worked. Table 1 presents
the main characteristics of the respondents included in the

Although there was a significant difference in age between
the sample obtained from mail-out and the online survey
(t¼ 2.55, df¼ 101, p¼ 0.012), with the Internet responders
being younger, on average, than the mail responders, there
were no significant differences in regard to size of orga-
nization (w2¼ 1.03, df¼ 2, p¼ 0.599), employment sector
(w2¼ 0.43, df¼ 1, p¼ 0.510), or hierarchical status at work
(w2¼ 0.07, df¼ 1, p¼ 0.797). It was therefore decided to com-
bine the data of the two groups.


Participants were randomly selected by computer from the
AMWU Queensland members’ register comprising of ap-
proximately 13,000 individuals from within four divisions
(Metal & Engineering; Technical, Supervisory and Adminis-
trative (TSA); Printing; and Vehicle). Initially, a paper version
of the questionnaire was posted to the home address of 1,000
participants. Included with the questionnaire was a letter
from the Union endorsing the research, an information sheet
informing voluntary participation and confidentiality of re-
sponses, and a self-addressed stamped envelope to facilitate
the return of the questionnaire. Due to a low response rate,
another 1000 members, selected on the basis of having an
e-mail address on the AMWU Queensland member’s register,
were e-mailed. The e-mail contained the hyperlink to an on-
line version of the survey, an electronic version of the Union-
endorsed letter, and the information sheet.

Measure of workplace bullying

The Negative Acts Questionnaire-Revised (NAQ-R)1 com-
prises 22 items referring to particular behaviors in the
workplace that may be perceived as bullying as well as a self-
report item on victimization. The behaviors or negative acts
are descriptive without labeling the actions as bullying. The
behaviors include being shouted at, being humiliated, having
opinions ignored, being excluded, repeated reminders of er-
rors, intimidating behavior, excessive monitoring of work,
and persistent criticism of work and effort. The researchers
modified the NAQ-R to also incorporate cyberbullying mo-
dalities of e-mail, SMS, and mobile or landline telephone calls
in addition to the original face-to-face modality.

Table 1. Main Characteristics of the Respondents Included in the Sample (N¼ 103)

Job tenure (%) Organizational size (number of employees) Sector (%) Hierarchical status1 (%)*

< 5 yrs > 5 yrs Small Medium Large Private Public Worker Supervisory

43.69 56.31 < 101 101–500 > 500 58.25 39.81 62.14 37.86

*The last two categories were aggregated to form one supervisory role category for the purposes of analysis.


Participants were asked to complete a 5-point Likert scale
on how often they had been subjected to these behaviors
over the last 6 months: 1, never; 2, now and then; 3, monthly;
4, weekly; and 5, daily. To estimate the frequency of exposure
to both face-to-face and cyberbullying, Leymann’s8 opera-
tional definition of workplace bullying of one incident per
week over a period of at least 6 months was employed.

In addition to indicating the frequency of any negative act
experienced in the workplace face to face, by e-mail, by SMS,
and=or by phone over the previous 6 months, respondents
were asked to report if they had been bullied, according to the
following definition of workplace bullying, modified from
the NAQ-R, to include both face-to-face bullying and cyber-

We define bullying as: a situation where one or several indi-
viduals persistently over a period of time perceive themselves
to be on the receiving end of negative actions (whether in
person, by email, by SMS and=or by phone), from one or
several persons, in a situation where the target of bullying has
difficulty in defending him or herself against these actions. We
will not refer to a one-off incident as bullying.

Participants indicated, according to this definition, if they
had been subjected to bullying over the past 6 months. The six
possible responses were (a) no; (b) yes, very rarely; (c) yes, now
and then; (d) yes, several times per month; (e) yes, several times per
week; and (f ) yes, almost daily.

In this study, the internal consistency of the NAQ-R, as
measured by Cronbach’s a, was found to be 0.94 overall.


Perceived exposure to negative behaviors
in the workplace

Of the 103 respondents, 89.3% (n¼ 92) reported experi-
encing at least one negative act either face-to-face or by

e-mail, SMS, or telephone on at least a ‘‘now-and-then’’ basis
over the previous 6 months. Of these respondents, 5.8%
(n¼ 6) reported experiencing a single type of negative act,
while 83.5% (n¼ 86) reported two or more types of nega-
tive acts. On average, participants reported exposure to
8.9 (SD¼ 6.6) different types of negative acts on an now-
and-then or more frequent basis. The incidence of negative
acts on a now-and-then basis via modern technology was
8.7% (n¼ 9) by e-mail, 8.7% (n¼ 9) by SMS, and 34% (n¼ 35)
by telephone.

In accordance with Leymann’s8 criterion of bullying, 34%
(n¼ 35) of all respondents could be classified as victims of
bullying behavior because they reported experiencing at least
one negative behavior on at least a weekly basis in the last
6 months. Furthermore, 25.2% (n¼ 26) of these respondents
reported weekly exposure to multiple negative acts. Of all the
respondents who experienced negatives acts via modern
technology (10.7% [n¼ 11]), 7 participants were from the
online survey sample and 4 were from the mail-out sample.
All respondents who perceived themselves as having been
exposed to negative behaviors via modern technology also
perceived that they were exposed to face-to-face victimiza-
tion. This consisted of 8.7% (n¼ 9) by e-mail, 7.8% (n¼ 8) by
telephone, and 5.8% (n¼ 6) by both e-mail and telephone. No
respondents had experienced at least one negative act on a
weekly basis by SMS.

Bullying and type of negative acts

Table 2 presents the prevalence of perceived exposure to
negative acts, bullying, and victimization for each negative
act as per Leymann’s8 operational definition.

Using Leymann’s8 operational definition of workplace
bullying of one negative behavior on at least a weekly
basis in the last 6 months, all 22 acts were reported by one
or more respondents, who could identify then as victims of

Table 2. Prevalence of Perceived Exposure to Negative Acts, Bullying, and Victimization
for Each Negative Act as per Leymann’s (1996) Operational Definition

Negative act Face-to-face (N¼ 35) Via modern technology (N¼ 11)

Ordered to do work below your level of competence. 17 (48.6%) 4 (36.4%)
Information withheld affecting your performance. 14 (40.0%) 6 (54.5%)
Opinions and views ignored. 14 (40.0%) 2 (18.2%)
Being ignored, excluded, or being ‘‘sent to Coventry.’’ 11 (31.4%) 2 (18.2%)
Key areas of responsibility removed. 10 (28.6%) 2 (18.2%)
Excessive monitoring of your work. 10 (28.6%) 2 (18.2%)
Insulting=offensive remarks. 10 (28.6%) 1 (9.1%)
Exposed to an unmanageable workload. 9 (25.7%) 3 (27.3%)
Given tasks with unreasonable targets=deadlines. 9 (25.7%) 1 (9.1%)
Spreading of gossip and rumors about you. 8 (22.9%) 3 (27.3%)
Humiliated=ridiculed in connection with your work. 6 (17.1%) 1 (9.1%)
Being shouted at=the target of anger or rage. 6 (17.1%) 1 (9.1%)
Ignored=facing a hostile reaction when you approach. 6 (17.1%) 0
Persistent criticism of your work and effort. 6 (17.1%) 0
Repeated reminders of your errors or mistakes. 5 (14.3%) 1 (9.1%)
Pressure not to claim your entitlements. 5 (14.3%) 1 (9.1%)
Intimidating behavior. 5 (14.3%) 0
Allegations made against you. 4 (11.4%) 3 (27.3%)
Hints=signals from others to quit your job. 3 (8.6%) 1 (9.1%)
Practical jokes from people you don’t get on with. 3 (8.6%) 0
Threats of violence or physical abuse. 2 (5.7%) 0
Excessive teasing and sarcasm. 1 (2.9%) 0


face-to-face bullying. However, only 16 of the 22 items
presented in the NAQ-R were reported by victims of cyber-

The most frequently reported negative act via modern
technology was ‘‘someone withholding information’’ by
e-mail 55.6% (n¼ 5) and=or by telephone 37.5% (n¼ 3) (this
included 2 respondents reporting both methods). The
spreading of gossip by telephone was reported by 37.5%
(n¼ 3) of respondents cyberbullied. Being subjected to alle-
gations made against them by e-mail and being exposed to an
unmanageable workload by e-mail were each reported by an
equal number of cyberbullied respondents, 37.5% (n¼ 3). As
mentioned earlier, no respondents indicated experiencing
cyberbullying by SMS as per Leymann’s criteria.

Bullying and organizational demographics

To analyze whether the size (small, medium, or large), type
of organization (public or private), and hierarchical status of
the employee (worker or supervisory role) impacted bullying
(bullied or not bullied), Chi-square tests were applied. There
were no significant relationships found between the size or
type of organization and being a victim of workplace bully-
ing: w2¼ 0.688, df¼ 2, p¼ 0.709 and w2¼ 1.413, df¼ 1, p¼ 0.234
respectively. This suggests that there exists an equal chance of
being bullied regardless of whether respondents were em-
ployed in small, medium, or large organizations or within the
private or public sectors. Similarly, there were no statistically
significant relationships found between the employees’ hier-
archical status in the organization and the reporting of face-
to-face bullying (w2¼ 1.946, df¼ 1, p¼ 0.163). Therefore, those
in supervisory roles as general workers were as likely to re-
port perceived exposure to face-to-face bullying.

Due to the small sample size, it was not possible to sta-
tistically test whether an association existed for the same
variables and cyberbullying.

Comparing reported perceived negative acts
and self-reported bullying

After indicating the frequency of negative acts experienced
in the workplace on the behavior inventory section of the
NAQ-R, respondents were asked to report, according to the
given definition, if they considered themselves to have been
subjected to face-to-face bullying and=or cyberbullying. The
frequency of respondents reporting experiencing victimiza-
tion in the workplace in the total sample is shown in Table 3.

By combining the frequencies in the ‘‘Yes, several times per
week’’ with the ‘‘Yes, almost daily’’ categories, 18.7% (6) re-
spondents could be classified as victims of workplace bully-
ing according to Leymann’s8 criteria.

Of the 35 respondents who reported being subjected to
negative acts on a daily or weekly basis on the behavior
inventory section of the NAQ-R, only 17.1% (n¼ 6) self-

reported being subjected to victimization according to the
given definition. However, all of the respondents who self-
reported experiencing victimization also indicated via the
NAQ-R that they had experienced bullying. Therefore, all
respondents who identified themselves as being victimized fit
Leymann’s8 criteria used in the operational definition.


The aim of the present study was to ascertain the preva-
lence of face-to-face bullying and cyberbullying in the man-
ufacturing workplace. The results suggest that negative acts
via technology are emerging alongside those enacted face-to-
face in the workplace and may represent the new form of
bullying, though to a much more limited extent.

Overall, the results revealed that one third of the respon-
dents reported being recipients of at least one negative act
weekly over the previous 6 months. Using Leymann’s8 op-
erational definition of workplace bullying, these respondents
could be considered to have experienced workplace bullying.
A quarter of these respondents reported having experienced
more than one negative act toward them weekly with the
average number of negative acts experienced weekly being
nearly nine. Furthermore, the majority of respondents re-
ported experiencing some form of negative act on a now-and-
then basis over the same period.

All 34% of victims of workplace bullying had been sub-
jected to face-to-face bullying. Nearly one third of these re-
spondents also experienced negative acts via modern
technologies, by e-mail, telephone, or both, on at least a
weekly basis. This represented 1 in 10 of all respondents,
suggesting that when applying Leymann’s8 operational def-
inition of workplace bullying, 11% of all respondents could be
considered to have experienced some form of cyberbullying.
This figure increased to over half of all respondents when the
criteria for cyberbullying were relaxed to include respondents
who were subjected to a negative act on a now-and-then
basis. Every respondent who reported negative acts by e-mail
had been subjected to cyberbullying as per Leymann’s criteria
of workplace bullying. The negative acts reported by SMS
were not experienced frequently enough to fit Leymann’s
criteria of workplace bullying. It is interesting to note that at
this time, victims who were considered to have experienced
cyberbullying were also bullied face-to-face, contrary to re-
cent preliminary findings with children who reported expe-
riencing cyberbullying without face-to-face bullying.37

There were no significant differences found when the
prevalence of face-to-face bullying was compared across
several organizational types. This demonstrated an equal risk
of exposure to face-to-face bullying regardless of the size
and type of organization and the hierarchical status held
within the workplace by the respondent. Because cyberbul-
lying could not be statistically analyzed in this sample, it was

Table 3. Frequency of Respondents’ Self-Reporting Having Experienced Bullying in the Workplace

Yes, very

Yes, now and

Yes, several

times per month
Yes, several times

per week
Yes, almost

daily Total bullied

N 71 12 10 4 5 1 32
% 68.9% 37.5 31.3% 12.5% 15.6% 3.1% 31.1%


not possible to determine whether this held true for cyber-

The self-report question on the NAQ-R asking participants
to respond to the given definition of bullying provides an
opportunity to capture respondents who identify themselves
as victims of workplace bullying even though they were
not identified as such due to the limits of the operational
definition in the behavior inventory section of the NAQ-R.
Nonetheless, all respondents who self-reported as victims of
workplace bullying were also identified in the behavioral
inventory. Of the 35 workers who reported being subjected to
negative acts on a daily or weekly basis, 29 did not self-report
as victims of bullying.

The higher prevalence rates found using the behavioral
inventory compared with the self-report of being a victim of
workplace bullying confirms the findings of previous stud-
ies.12 This disparity may be explained by factors relating to
culture. Shopfloor culture, especially in male-dominated or-
ganizations, may impact on self-reporting of workplace bul-
lying if negative behaviors are accepted as the norm.38

Awareness that negative acts may constitute bullying be-
haviors may therefore be low among respondents who were
subjected to negative acts, and=or men may be reticent to
label themselves as victims. This may be due to male ste-
reotypes within the wider culture.

This exploratory study was limited by several factors. The
sample size was small with a response rate of only 7.3%, and
it was Queensland based, which prevents the findings being
generalized to the overall experience of members of the
AMWU or extended to include all employees working in
manufacturing as a whole. Additionally, only males partici-
pated, which also limits these results. It is also possible that
individuals who had experienced negative acts in the work-
place may have been more motivated to respond and were
subsequently overrepresented.

In addition, the survey did not include information about
the respondents’ levels of access to e-mail or to fixed-line or
mobile telephones. Workers in manufacturing may not have
continual access to modern technologies, which may have
impacted on the frequency of cyberbullying. Subsequently, it
could not be verified that every respondent was at equal risk
of exposure to cyberbullying or whether cyberbullying by
telephone was on a fixed-line telephone or a mobile tele-
phone. It remains for future research to undertake further
study with a different population. Another limitation could
be that some negative acts are easier to imagine happening
face-to-face than by technology.

There are significant benefits, however, in incorporating
online surveys into future research on workplace cyberbul-
lying, such as the potential to improve response rates, elimi-
nate missing data, minimize human data-input error, and
maximize cost effectiveness.


The present study contributes to the literature of workplace
bullying through the exploration of prevalence rates of both
face-to-face bullying and cyberbullying in the workplace,
particularly in the manufacturing sector in Queensland,
Australia. The results suggest that the ICT revolution has
the potential to change the face of bullying, which now in-
cludes victims being subjected to negative behaviors via

modern communication technologies such as e-mail and

As many countries impose a duty of care to protect the
health, safety, and welfare of employees, organizational
management need to be aware that cyberbullying exists in the
workplace. Codes of practice need to be updated to ensure
that workplaces implement policies and procedures to ad-
dress this issue. Future research into this relatively new field
of study, cyberbullying, is essential in order to further un-
derstand the extent of the phenomenon and impact on em-
ployees, organizations, and society, as well as to establish
preventative measures for cyberbullying in the workplace.

Disclosure Statement

No competing financial interests exist.


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McCarthy P, Sheehan M, Wilkie W, et al. eds. Bullying:
causes, costs and cures. Nathan, Australia: Beyond Bullying
Association, pp. 115–31.

38. Salin D. Prevalence and forms of bullying among business
professionals: a comparison of two different strategies for
measuring bullying. European Journal of Work & Organi-
zational Psychology 2001; 10:425–41.

39. Meadows B, Bergal J, Helling S, et al. The Web: the bully’s
new playground. People 2005; 63:152.

Address correspondence to:
Dr. Marilyn Anne Campbell

School of Learning and Professional Studies
Queensland University of Technology

Kelvin Grove
Brisbane, Queensland 4059





Business and Leadership

Dr. Simons is Assistant Professor and Dr. Mawn
is Professor and PhD Program Director, Depart-
ment of Nursing, University of Massachusetts
The authors disclose that they have no signifi-
cant financial interests in any product or class of
products discussed directly or indirectly in this
activity, including research support.
Address correspondence to Shellie R. Simons,
PhD, RN, 8 Marie Avenue, Sharon, MA 02067.

Bullying in the Workplace—A Qualitative Study of
Newly Licensed Registered Nurses

by Shellie R. Simons, PhD, RN, and Barbara Mawn, PhD, RN

Bullying in the workplace is associated with negative job satisfaction and
retention. It has also been found to have adverse effects on the health of
employees. Using a qualitative descriptive design, this study examined the
stories of bullying among nurses based on actual or witnessed experiences.
One hundred eighty-four newly licensed U.S. nurses responded to an open-
ended question on a survey about bullying mailed to their homes. Four major
themes emerged that related to varying types of bullying behaviors, perceived
causes of bullying, and the impact of bullying behaviors. The themes included
structural bullying; nurses “eating their young”; being out of the clique; and
leaving the job. Bullying is experienced firsthand and secondhand by nurses,
and particularly by vulnerable, newly graduated nurses. Workplace bullying
must be explored fully to develop effective strategies to eliminate it.

t has long been acknowledged
that some nurses engage in
hostile behaviors toward other

nurses, as evidenced by the often re-
peated expression, “Nurses eat their
young” (Bartholomew, 2006; Meiss-
ner, 1999; Rowe & Sherlock, 2005).
This behavior has been reported pre-
dominately through anecdotal stories
among nurses and has only recently
appeared in the research literature.

Bullying in health care workplaces
has been identified in U.S. and inter-
national research reports.

Various terms have been used to
describe the interpersonal hostility
that can occur in the nursing work-
place, including bullying (Quine,
2001), horizontal violence (Duffy,
1995; McKenna, Smith, Poole, &
Coverdale, 2003), and verbal abuse
(Ferns & Meerabeau, 2008; Johnson,
Martin, & Markle-Elder, 2007). Al-
though the terms are often confused,
subtle differences distinguish these

Cox (1991) defines verbal abuse
as any form of communication that
nurses perceive to be harsh, con-
demnatory attacks on them, pro-
fessionally or personally. Bullying
behavior in the workplace is a form
of aggression that occurs when em-

ployees perceive negative actions
directed at them from one or several
individuals over time; employees
have difficulty defending themselves
against these actions (Matthiesen &
Einarsen, 2001). An incident cannot
be categorized as bullying unless
there is a power gradient, perceived
or actual, between the individuals
involved (Zapf & Gross, 2001). Bul-
lying is distinct from harassment in
that it is not distinguished by sexual
or racial motives (Pryor & Fitzger-
ald, 2003).

Bullying differs from horizontal
or lateral violence in several ways.
Horizontal or lateral violence can
occur as a single isolated incident,
without power gradients between
the individuals involved (i.e., the
interaction occurs between peers
in a culture that they share) (Duffy,
1995). In contrast, bullying is repeat-
ed over at least 6 months. Horizontal
or lateral violence and bullying do,
however, share behaviors such as
sabotage, infighting, scapegoating,
and excessive criticism.

This descriptive study originated
from a survey study that explored
workplace bullying among U.S.
nurses and the relationship of bul-
lying to nurses’ intent to leave the
workplace (Simons, 2008). These
nurses had compelling stories to tell
that exemplified the phenomenon of
bullying in the workplace and its im-
pact on nurses.

AAOHN JOURNAl • VOl. 58, NO. 7, 2010

306 Copyright © American Association of Occupational Health Nurses, Inc.

Business and Leadership

Workplace bullying has signifi-

cant implications for nurses work-
ing in the occupational health set-
ting because workplace bullying
has profound negative health effects
on individuals. Research has also
demonstrated that bullying results
in considerable economic conse-
quences for organizations (Einarsen
& Mikkelsen, 2003; Hoel, Faragher,
& Cooper, 2004). In a 2001 study of
nurses in the United Kingdom, Quine
reported that 8% of those experienc-
ing bullying had used their sick time
to deal with the problem. The direct
costs to the employer included a low-
er quality of work, higher turnover
rates, and increased absenteeism.
Indirect costs include those opportu-
nity costs related to lowered employ-
ee commitment, lack of individual
discretionary effort, and time spent
talking about the problem rather than
working. Kivimaki, Elovainio, and
Vahtera (2000) attempted to quantify
the cost of bullying to the organiza-
tion. They studied two Finnish hos-
pitals and estimated that the annual
cost of increased absenteeism as a
consequence of bullying was close to
£125,000 (approximately $191,489
U.S. dollars).

Recent studies have found that
targets of bullying showed a variety
of symptoms indicative of posttrau-
matic stress disorder (Balducci, Al-
fano, & Fraccaroli, 2009; Tehrani,
2004). Kivimaki et al. (2000) found
that workplace bullying was associ-
ated with a significant increase in
sickness absenteeism. A 2003 study
found a strong association between
workplace bullying and subsequent
depression, suggesting that bullying
is an antecedent factor for mental
health issues (Kivimaki et al.).

In 1976, Brodsky published
the seminal work on bullying in the
workplace, but it was not until 1990
that Swedish researcher Heinz Ley-
mann (1990) began the systematic
study of workplace bullying, con-
ceptualizing it as “psychological
terrorization.” Recently, published
studies have explored workplace bul-
lying from an international perspec-
tive, including studies from Australia

(Hutchison, Jackson, Vickers, & Wil-
kes, 2006), New Zealand (McKenna
et al., 2003), Norway (Nielsen, Mat-
thiesen, & Einarsen, 2008), and the
United Kingdom (Lewis & Orford,

In the United States, Lutgen-
Sandvik, Tracy, and Alberts (2007)
studied the prevalence of workplace
bullying among workers in several
industries, including health and so-
cial services, education, and finance.
Only a few of the international stud-
ies examined the effects of workplace
bullying on nurses (McKenna et al.,
2003; Quine, 2001). More recently,
researchers have examined bullying
among nurses in the United States
(Felblinger, 2008), but a paucity of
research related to bullying among
nurses in this country exists (Fox &
Stallworth, 2005; Lewis, 2006; Lut-
gen-Sandvik et al., 2007).

Simons (2008) surveyed newly
licensed U.S. nurses to measure the
frequency and intensity of workplace
bullying. The theory of oppressed
group behavior served as the theoret-
ical framework for the study (Fanon,
1963; Freire, 2000). One thousand
surveys were mailed to a random list
of U.S. nurses licensed in the state of
Massachusetts. Five hundred eleven
nurses responded. Although some
studies using postal questionnaires
have reported a response rate as low
as 10% to 20% (Curtis & Redmond,
2009), this response rate of 54.4%
was higher than the reported average
response rate of 49.6% in a recent
meta-analysis (Van Horn, Green, &
Martinussen, 2010). The survey used
the Negative Acts Questionnaire-Re-
vised (NAQ-R) (Einarsen & Hoel,
2001), which contained 22 items re-
lated to bullying and a 3-item scale
that measured intention to leave the
job from the Michigan Organiza-
tional Assessment Questionnaire
(Cammann, Fichman, Jenkins, &
Klesh, 1981). In addition, the survey
included the definition of bullying
and then asked if the respondent had
experienced or witnessed bullying at
work during the past 6 months.

The results of the Simons
(2008) survey revealed that 31% of
the sample had experienced at least

two bullying behaviors on a weekly
or daily basis from another nurse
during a 6-month period based on
the criteria of the NAQ-R bully-
ing scale. The data revealed that as
bullying scores increased, so did
nurses’ intention to leave the orga-
nization (Simons, 2008). However,
the survey questions could not as-
certain how bullying impacted their
intention to leave. At the end of that
survey, respondents were offered an
open-ended section to add any com-
ments related to the topic of bully-
ing. One hundred eighty-four nurses
shared their stories of bullying in
their workplaces, which provided
the qualitative data for this article.

This article presents the quali-

tative findings from a survey study
(Simons, 2008) examining work-
place bullying among newly li-
censed nurses. The analysis of the
open-ended responses in the sur-
vey followed the methods used in
qualitative description to examine
previously undescribed aspects of
an experience (Kearny, 2001). The
Institutional Review Board at the
University of Massachusetts Boston
approved this study. No names or
other identifiers were used in ana-
lyzing the results. In appreciation
for participation, respondents who
completed the survey were eligible
to win one of five $50 raffle prizes.

The population of interest was

newly licensed nurses in the United
States. In accordance with Benner’s
(2001) model of novice to expert,
which indicates that 3 years is need-
ed for a nurse to attain competence,
the population included registered
nurses licensed from 2001 to 2003
in the state of Massachusetts who
had graduated from a diploma, asso-
ciate degree, baccalaureate, or direct
entry master’s program. Nurse man-
agers and supervisors were excluded
from the study. One hundred eighty-
four of 511 registered nurses who
responded to the mail survey wrote
narratives at the end of the survey.
One hundred thirty-nine wrote of


Business and Leadership

being bullied at work and 14 oth-
ers wrote of witnessing other nurses
being bullied. The remaining par-
ticipants wrote narratives that were
not related to bullying. Respondents
were predominately female (92%),
with ages ranging from 22 to 61
years (M = 35.8 years). Forty-three
percent of respondents had an asso-
ciate degree and 37% had a bacca-
laureate degree in nursing. The re-
maining 20% had earned a diploma,
a baccalaureate or a master’s degree
in another field, or a direct entry
master’s degree. The majority (85%)
were staff nurses. The Table reveals
similar demographics between the
subsample who responded to the
open-ended comment section and
the entire sample of survey respon-
dents. Seventy-one percent of the
nurses who wrote of being bullied
reported that they worked in hos-
pitals and 12% worked in nursing

Data Collection
Data were collected via a

mailed survey during 6 weeks using
the Tailored Design Method (Dill-
man, 2000). This method consists of
specified preparation and distribu-
tion of survey materials to increase
response rate. As noted, 36% (n =
184) of the original 511 survey par-
ticipants shared their stories related
to their personal and witnessed ex-
periences of bullying.

The written narratives at the

end of the survey were transcribed
verbatim and analyzed using con-
tent analysis (Sandelowski, 2000).
Content analysis “refers to the set of
techniques that are used to identify
patterns, categories and themes in
recorded language” (Waltz, Strick-
land, & Lenz, 2005, p. 239). After
reading and rereading the narra-
tives, the transcripts were entered
into NVivo 7, a software package
for qualitative research. Data reduc-
tion was completed by writing in the
margins and counting the frequency
of similar comments. Two research-
ers trained in qualitative research,
one of whom is an expert in bully-

ing among nurses, independently re-
viewed the comments to ensure that
the stories fit the defining criteria of
bullying. They then conducted a the-
matic content analysis making com-
parisons, noting patterns and expla-
nations. The data were then coded
according to themes and patterns
that were found. Data saturation was
noted by both researchers after ana-
lyzing the first 100 responses; how-
ever, all responses were included in
the analysis.

Four themes describing different

aspects of bullying were identified
from the analysis of the transcripts:
structural bullying, nurses eating
their young, feeling out of the clique,
and leaving the job.

Structural Bullying
The term structural bullying was

developed by the researchers to rep-
resent perceived unfair and punitive
actions taken by supervisors. These
actions included scheduling, patient
assignments and workload, or use

of sick and vacation time. Seventeen
nurses wrote of consistently being
given an unmanageable workload.
For example, one respondent com-
mented, “The only factor that may
cause me to seek another job while
still practicing as a registered nurse
would be the unsafe staffing situation
that exists consistently. Any time the
acuity and patient load is so high that
patients may be at risk, it creates strife
among me and my coworkers.”

Others wrote of unfairness relat-
ed to use of earned time. One wrote,
“My manager yelled at me about my
sick time in front of six other nurses.”
Another wrote, “Being single with
no children, I’m expected to take
a holiday and mandatory shifts.” A
23-year-old nurse wrote, “My hos-
pital is understaffed and I’m usually
the first to be asked to work extra
hours or overnight double because
‘I’m young’ and ‘I don’t need a lot
of sleep.’”

Nurses Eating Their Young
Nineteen nurses wrote com-

ments that included the phrase

AAOHN JOURNAl • VOl. 58, NO. 7, 2010


comparison of Study Participants
Original Survey


Number of participants 511 184


Female 93.3% 92%

Male 6.7% 8%

Mean age (years) 33.1 35.8

Age range (years) 22-64 22-61

Educational background

Associate degree 38% 43%

Bachelor’s degree 45.2% 37%

Other 16.8% 20%

Primary practice role of staff nurse 93% 85%

Primary practice setting

Hospital 76% 71%

Nursing home 10% 12%

Other 13% 17%

Not reported 1%

308 Copyright © American Association of Occupational Health Nurses, Inc.

Business and Leadership

“nurses eat their young.” For exam-
ple, one respondent commented, “In
my first job as a registered nurse, I
experienced such extreme hostility;
it was like working in a pool with
a pack of barracudas that ate their
young.” Others shared similar sto-
ries without using the actual phrase.
A new graduate wrote, “Working as
a new nurse is scary on its own. Add
to this being afraid to ask questions
for fear of being ridiculed and now
you get one very unhappy nurse.”
Similarly, another wrote, “In my
first year as a nurse, I saw the major-
ity of senior nurses were much too
happy to keep information to them-
selves and would rather see a new
registered nurse fall flat on her face
rather than give him or her the infor-
mation to prevent it.”

The concept of nurses eating
their young was noted by several
nurses to begin in the formative years
of the respondents’ education as a
nurse. Several nurses wrote of their
negative experiences as student nurs-
es. One commented, “When I was in
nursing school, we spent most of our
time doing clinical work in a small
community hospital. I found so much
negativity in this environment that I
considered quitting nursing school.”
Another wrote, “Nursing school was
a very different experience. I wit-
nessed many registered nurses treat
my classmates horribly, and that al-
most prevented me from practicing.”

Feeling Out of the Clique
Some of the respondents re-

lated bullying experiences to their
feelings of alienation and not feel-
ing part of the group. These nurses
wrote of having difficulty fitting in
when they perceived that they were
different in any way. Differences
may have been related to ethnic-
ity, education, or the nurse not be-
ing part of that group (i.e., being a
per diem float or travel nurse). One
nurse commented, “During my first
pregnancy, because the charge nurse
did not like me, I was assigned the
most infectious patients (HIV, tu-
berculosis, and hepatitis). When
I complained, I was ridiculed and
told, ‘Sorry, this is your assignment.’

When pregnancy complications de-
veloped, I was put on light duty but
nobody would help me. I was told,
‘Do your job or leave.’”

A 50-year-old new graduate
wrote, “There were negative behav-
iors in my first nursing experience,
which was at a long-term care center:
clique groups, rumors, sarcasm, and
nurses not helping me with things I
hadn’t encountered before. I was left
alone with 40 patients constantly.”
A 27-year-old Asian nurse wrote,
“My pronunciation and English often
gets ridiculed. I am one of the nurses
from the Philippines who were hired
3 years ago.”

Leaving the Job
Nurses wrote of leaving their

jobs as a result of being targets of
bullying behaviors. Some talked of
leaving their jobs and others wrote
of leaving the profession. The ori-
entation period seems to be a time
when newly graduated nurses are
particularly vulnerable to bullying.
Thirty-eight nurses wrote of nega-
tive experiences during the orien-
tation period. A 24-year-old staff
nurse in the operating room lament-
ed, “During my 3 months of orienta-
tion, I was bullied quite often. It was
seen as proving yourself to your fel-
low employees. I was often set up to
fail purposely. I considered leaving
almost daily.”

Another wrote, “This survey al-
lowed me to share my experiences of
my first years in the work force as a
registered nurse. I worked in a hos-
pital for 10 months. After that expe-
rience, I seriously considered never
working as a nurse again.”

A 28-year-old nurse wrote of
her first year, “I currently work in an
emergency room but recently left a
cardiac floor in the same hospital be-
cause of most of the nurses I worked
with. The gossip and bullying made
me leave. Many other new graduates
have left this particular unit as well.
The nurse manager was fully aware
of the actions and attitudes on her
unit but chose not to do much about
them. It is a shame that new nurses
are treated so badly. Every nurse was
a new nurse once!”

The qualitative findings in this

study served as a method of trian-
gulation for the survey data in the
original study. The original study
design did not aim to use a mixed-
methods approach to examine bul-
lying. At the outset of the study, it
was not anticipated that 36% of the
survey respondents would provide
such rich narratives. However, de-
spite these limitations in the original
study design, the researchers chose
to analyze the rich narratives us-
ing qualitative methods, sharing the
profound stories of experienced and
witnessed bullying among nurses.
The four major themes identified
from the narratives clarified some of
the suffering experienced and wit-
nessed by nurses.

Simons (2008) reported an inter-
esting finding in the original quan-
titative analysis of the survey: 31%
of the respondents met the criteria
for experiencing bullying based on
the responses to the NAQ-R scale,
whereas only 21% responded that
they had been bullied when asked
and given the definition. This sug-
gested a discrepancy in nurses’ un-
derstanding of the construct of bul-
lying and its impact on their work
lives. Perhaps some of the nurses
had the common perception of bully-
ing as involving verbal taunts as op-
posed to negative actions by those in
positions of power over time. Many
of those who shared their stories,
however, reflected an awareness of
this aspect of the definition. One of
the four major themes captured the
essence of these stories—structural
bullying. Nurses wrote of unfair and
punitive scheduling and pressure
placed on them not to use earned
sick or holiday time.

The theme of structural bully-
ing has significant implications for
nurses in general and occupational
health nurses in particular. Nurses
need to be aware that this type of
subtle bullying (i.e., inequitable pa-
tient assignments, shift allocations,
or vacation allotments) needs to be
prevented, identified, and dealt with
fairly. Nurses who feel powerless
in the workplace need to find their


Business and Leadership

voice and recognize how to identify
and resolve this issue. Occupational
health nurses can provide nursing
staff with the knowledge and actions
to stop the perpetuation of this nega-
tive culture.

The survey questions focused on
a descriptive analysis of the preva-
lence of bullying and its impact
on leaving the profession. The two
themes identified in the narratives—
nurses eating their young and feeling
out of the clique—helped to clarify
how bullying can emerge in the work
setting. The former is unfortunate
and was expressed by many of the re-
spondents. They experienced and wit-
nessed this phenomenon as nursing
students and as newly licensed nurs-
es. In addition, many attributed their
experience of bullying to not quite
fitting in with the perceived clique.
Racial and ethnic differences were
identified within this theme, as were
factors such as being pregnant or a
float nurse. Implications for nurses in
the educational setting as well as for
nurses in the occupational health set-
ting are evident in terms of preparing
new nurses to address and deal with
this potential form of workplace bul-
lying and educating those in positions
of power to prevent bullying and be
aware of its potential impact.

The fourth theme identified in
these narratives was related to the
perceived impact of bullying on job
retention. Although the survey tool
measured bullying and intention to
leave the job, it could not capture the
direct impact of bullying and could
not control for other factors that
would impact leaving the job. Those
participants who chose to write their
stories commonly discussed the im-
pact of bullying on their choice to
leave a job and, in some cases, the
profession. Occupational health
nurses must be aware of the direct
impact that bullying can have on job
retention, in both the nursing pro-
fession and other job sectors. When
faced with such powerlessness, many
employees choose to resign the posi-
tion. Occupational health nurses can
provide a vehicle to educate and sup-
port those who are oppressed in the

None of the nurses wrote of
actions that they employed to ame-
liorate or eliminate the bullying be-
havior. With the exception of one
study (Griffin, 2004) that tested
cognitive rehearsal as a strategy to
deal with the negative effects of lat-
eral violence, a paucity of research
is available to assist administrators
and nurses in occupational health
with this problem that affects all as-
pects of nursing. Both nursing staff
and administrators need to be better
educated about bullying so that they
can more clearly identify the behav-
ior both in themselves and in oth-
ers. Future qualitative study designs
need to specifically address this as-
pect of the bullying cycle.

Although these qualitative find-
ings shed light on a poorly understood
phenomenon, several limitations of
this study were identified. The major
limitation of this study is that it was
not designed originally with the rigor
of a qualitative study that includes
prolonged engagement in the field,
in-depth personal interviews, or an
avenue for member checking (Cre-
swell, 2007). The authors acknowl-
edge that the analysis of these data
relied on qualitative methods, but the
study was not designed with the stan-
dards of a rigorous qualitative study.

Creswell (2007) suggests that at least
two means of validation be incorpo-
rated into qualitative analysis. Two
measures used for this analysis in-
cluded peer review or debriefing by
the two authors of this report and the
inclusion of data that provided a writ-
ten rich description that could allow
the reader to evaluate whether the
findings are transferable to nurses in
other settings.

A second limitation is that the
open-ended section of the survey
did not define bullying or ask for
responses related to this definition.
However, two researchers indepen-
dently analyzed the data to ensure
that the narratives included in the
analysis did meet the criteria. Al-
though the 184 respondents to the
open-ended section of the survey
had demographics similar to those of
the entire survey respondent group,
it cannot be implied that this group
represented all of the survey partici-
pants. In addition, another limitation
is that the sample was drawn solely
from nurses licensed in one state;
it is unknown whether these results
are typical of nurses in other parts
of the country. Self-selection bias
is a possible limitation to this study
as well. Those with bullying expe-
riences may have been more likely

AAOHN JOURNAl • VOl. 58, NO. 7, 2010

Bullying in the Workplace
A Qualitative Study of Newly licensed Registered Nurses

Simons, S. R., & Mawn, B.

AAOHN Journal 2010; 58(7), 305-311.

1 Substantial research has shown that workplace bullying has profound negative effects on the health and well-being of individuals. These
effects translate into considerable economic consequences for the

2 Occupational health nurses can intervene directly to affect the health of employees and the profitability of the company. Through educa-
tion and counseling, occupational health nurses develop programs to
prevent bullying and provide support to those who experience it.

3 Occupational health nurses promote healthy working environments and positive organizational changes to ensure that bullying is not an
accepted part of the culture.

i n S U M M A R Y

310 Copyright © American Association of Occupational Health Nurses, Inc.

Business and Leadership

to respond to the survey in the first
place and may not represent all new-
ly licensed registered nurses in the
United States.

Although additional future sur-
veys can well serve to document the
prevalence and incidence of bullying
in varying settings among nurses with
diverse levels of experience and edu-
cation, rigorous qualitative research
needs to be conducted to understand
the roots of the phenomenon and its
impact on nurses. In addition, inter-
vention studies need to be designed
to evaluate best practices and poli-
cies to improve reporting and reduce
the impact and existence of bullying
among nurses.

This survey provided these

nurses an opportunity to share their
personal stories about workplace bul-
lying. The four themes identified put
a new lens on the survey findings and
expanded the understanding of bul-
lying among the nursing work force.
Several recent studies have validated
that bullying exists in nurses’ work-
places. These studies have shown
that bullying is associated with job
satisfaction, performance, and reten-
tion, but little has been documented
to examine these relationships in-
depth. Additional research is needed
to expand the knowledge about the
factors that precipitate this noxious
behavior and how to effectively treat
and eradicate it.

Occupational health nurses can
intervene in these issues that direct-
ly affect the health of employees.
Through research, educational pro-
grams, and counseling, occupational
health nurses can support and assist
targets of bullying through difficult
conflict situations. Bullying has
been part of workplace culture since
the beginning of professional nurs-
ing and has been tacitly accepted by
nurses for too long. Nurses are only
just beginning to understand the root
of this unfortunate phenomenon.
Although this study adds to the un-
derstanding of workplace bullying
among nurses, additional research
is needed to fully understand the
phenomenon and develop effective

interventions to ultimately eliminate
the behavior.

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