Nurses who are the victims of violence and bullying at work may be more likely to behave badly towards others, according to a new study looking at the impact of aggression in the workplace.
The study led by the University of East Anglia (UEA) saw 855 nurses complete anonymous questionnaires about their experiences of violence and abuse at work, including physical assaults, threats and verbal abuse by patients and relatives and bullying by colleagues and managers.
“Victims experience anger that may prompt a ‘hot’ and impulsive aggressive response”
Nurses were also asked about their own misconduct such as insulting colleagues, stealing items from work and “clinical misbehaviour”, including not updating a patient’s notes properly, turning off call bells at night and making unauthorised changes to treatment or prescriptions.
The research, published in the journal Frontiers in Psychology, suggested that being bullied or abused at work not only affects nurses’ health but feelings of anger and fear may make them more likely to cross the line themselves leading to a “vicious circle” of misconduct.
The study was led by Roberta Fida, lecturer in organisational behaviour at UEA’s Norwich Business School, who worked with colleagues from Coventry University and universities in Italy and the US.
She said the findings were important for those responsible for designing programmes to boost staff wellbeing and when it came to improving the quality of patient care.
“Our findings provide further evidence that being a target of aggression represents a frustrating situation in which victims experience anger that may prompt a ‘hot’ and impulsive aggressive response, with likely impact on the quality of care provided to patients,” she said.
“Being the target of aggression at work could lead some nurses to translate their emotional activation into misconduct”
The research suggests working in an environment where abuse and bullying is the norm not only has an impact on individual nurses but also risks creating an unhealthy and unpleasant culture across a hospital or care setting.
“There are consequences, not only for the direct victim, but also for the entire organisational system, in which it is possible to envision the trigger of vicious circles leading to broader and more diffuse forms of workplace aggression,” said Ms Fida.
The researchers – who carried out two separate studies each involving more than 400 nurses – say they are the first to unpick the links between mistreatment at work and misconduct by looking in detail at the role of three negative emotions generated by nasty incidents – anger, fear and sadness.
They also looked at the role of “moral disengagement”, a frame of mind that can allow someone to do things they know are wrong.
They found sadness was linked to health symptoms such as headaches and difficulty in concentrating but was not associated with misconduct.
Fear and anger were also linked to health problems, which confirms that being a victim of aggression harms nurses’ overall wellbeing, and associated with misconduct.
“In particular, findings suggest that the experience of anger and fear associated with being the target of aggression at work could lead some nurses to translate their emotional activation into misconduct possibly disregarding professional and ethical codes,” said the study.
In particular, Ms Fida said the research provided the first evidence that fear was an important emotion linked to misconduct.
“Since individuals experiencing fear are more alert and attentive to picking up potential external threats, and tend to perceive the environment as highly dangerous and threatening, they are more likely to engage in any form of behaviour, including aggression, which may potentially help them to defend themselves and comply with their need for protection,” she said.
The researchers says their studies highlight the need to focus on emotions in training for nurses and others including exploring the different types of emotional response to aggression at work and the development of “emotional regulation” and anger management skills.