CHAPTER ONE

INTRODUCTION

1.1 Background of The Study

Bullying refers to repetitive and intentional harmful behavior aimed at an individual

or group, often involving a power imbalance. This behavior can take various forms,

like physical attacks, hurtful words, damaging relationships, or online harassment.

Bullying is characterized by its intention to cause harm, a pattern of recurrence, a

power dynamic, and negative effects on the victim's well-being.

There are different types of bullying: physical, verbal, relational (social), and

cyberbullying. These actions can lead to serious emotional, mental, and physical

consequences for the victims. Roles in bullying include the bully, victim, bystanders

who witness but may not act, and up standers who intervene positively.

Preventing bullying requires efforts from individuals, communities, and institutions

like schools and workplaces. Strategies include raising awareness, promoting

empathy, establishing anti-bullying policies, creating inclusive environments,

addressing incidents promptly, educating about cyberbullying, and encouraging

supporti3ve bystander behavior. If you encounter bullying, seeking help from trusted

sources is crucial.

Workplace bullying is the repetitive mistreatment, harassment, or negative conduct

that a worker or a group of workers endure from one or more colleagues or superiors

within a professional setting. This behavior takes various forms, such as verbal

insults, humiliation, intimidation, exclusion, or deliberate harm to one's work. The

outcome is an unwelcoming atmosphere for the targeted employees, impacting their

job satisfaction, performance, and overall well-being.

Key aspects of workplace bullying

Workplace bullying is a persistent and destructive problem that can erode the

psychological well-being of employees and harm the organizational culture. The

negative actions associated with bullying are ongoing, frequent, and take many forms,

including verbal abuse, isolation, and undermining of a victim's reputation. These

actions can have serious consequences for victims, such as anxiety, stress, reduced

productivity, and even physical health issues. Bullying is often perpetrated by

individuals in positions of power or authority, and can negatively impact the entire

workplace, resulting in decreased morale, increased turnover rates, and a toxic work

environment.

Workplace bullying is a complex and multifaceted issue that requires comprehensive

solutions. Employees, managers, and the organization must work together to raise

awareness, educate individuals about bullying and its consequences, establish clear

policies, create channels for reporting, and provide support mechanisms. In addition,

managers should receive training in identifying and addressing bullying, and

organizations should conduct thorough investigations into reported incidents and take

appropriate actions based on their findings. Cultivating a positive culture of respect

and collaboration can go a long way in preventing and mitigating bullying behaviors.

Ultimately, eliminating workplace bullying is essential for the overall health and
productivity of both individuals and organizations (Michetti, M.A. 2020)

Bullies have always been a part of any group development, from the earliest

civilizations, and in religions, militaries, schools, neighborhood cliques, teams,

families, and companies. The workplace bullying phenomenon, as we know it today,

first entered the public consciousness on the heels of the workplace sexual harassment

issue in the early 1980s. During that decade, Swedish psychologist Heinz Leymann

was among the first to conceptualize and analyze the act of workplace bullying. In the

early 1990s, British journalist Andrea Adams popularized the term “workplace

bullying” through a series of BBC radio documentaries.

In the United States, bullying first became a major issue in the public sector, with

some schools and government agencies taking an avid interest in safeguarding against

it. Later, this interest spilled over into private sector workplaces. During the early to

mid-1990s, more American researchers began studying the problem of

psychologically abusive behaviors at work and the harm they create. Another driver of

interest in the private sector was the growing concern about the costs of workplace

bullying to a company’s bottom line. Today, workplace bullying incidents are four

times more common in all U.S. organizations than sexual harassment episodes, and

the related costs to businesses are also four times higher. In behavioral studies,

bullying is now often closely linked to suicide and violence. The seriousness of the

problem warrants that employers implement a sensible duty of care program in

response (Mark Tarallo, 2017).

Workplace bullying exists in today’s healthcare system and often targets newly
licensed nurses. Experiences of workplace bullying behavior may negatively affect

the nurses’ physical and psychological health and impact job satisfaction and staff

turnover rates at an organizational level. The purpose of study is to assess nurse’s

perception on work place bullying. Some people consider nurse bullying a rite of

passage — a regrettable yet unavoidable mark of the profession. The American

Nurses Association (ANA) reports that 18% to 31% of nurses have been bullied by

colleagues. It’s so common that nurses in the profession refer to it as “eating our

young.”

Clearly, nurse bullying takes its toll. The fallout from bullying includes decreased

productivity, absenteeism, and medical and legal expenditures as healthcare

organizations lose staff and experience diminished morale among employees. Reports

from Nursing Administration Quarterly show that up to 34% of nurses leave or

consider leaving the profession because of bullying. Nurse leaders can overcome

abusive work cultures by understanding why nurse bullying happens and how to

prevent it. The foundation lies in fostering a supportive, collaborative workplace

where nurses can work as a team rather than compete.

Workplace Bullying (WB) in healthcare remains a persistent problem, particularly

against newly licensed nurses. Among healthcare workers, frequently experienced

workplace bullying behaviors included being assigned an unmanageable workload

(62%, n = 149), being ignored by others (35%, n = 85), coworkers withholding

information need for clinical care (28%, n=68), and being humiliated or ridiculed

(22%, n = 54). In nurses, negative outcomes of workplace bullying behaviors include

burnout and lack of engagement, decreased work productivity, organizational [

mistrust, turnover intention, sleep difficulties, and general physical and mental health

complaints (Traynor et at., 2016)

Debate still exists surrounding what label best reflects bullying behaviors experienced

by nurses in the workplace (e.g., lateral violence, horizontal violence, mobbing).

Despite the debate, most researchers agree that bullying in nursing workplaces consist

of “repeated, cumulative, and patterned form of negative behaviors of a perpetrator

abusing his or her power over time toward the victim, resulting in the profound

negative impact on the bully victim and organization.

Several strategies have been recommended by {Carolyn [Link] 2020} to address the

persistence of workplace bullying in healthcare. First, the work culture needs to be

redesigned to foster collegiality and a violence free workplace. Several researchers

encourage the adoption of a “no tolerance policy”. While this policy is a good start

towards creating a safe work culture, the implementation of such a policy is typically

not described, does not account for one-time behaviors atypical for the offender, and

focused on how to respond after the event has already occurred. This necessitates the

need for further interventions to be considered which are prevention-focused.

Hospitals should Provide bystander training by training staff to recognize the signs of

bullying and how to intervene effectively, encouraging staff to speak up and report

bullying behavior, creating a culture of support and respect where bullying is not

tolerated and many more like creating a Report mechanism, offer employee support as

an assessment and public reporting process related to workplace bullying (National

Academy of Medicine, 2021). Workplace bullying is unfortunately not uncommon in

teaching hospital, where high levels of stress, hierarchy, and competition can

contribute to a toxic work environment. Research has identified several forms of

workplace bullying that can occur in teaching hospitals, including verbal abuse,

public humiliation, isolation, and withholding of information.

The consequences of workplace bullying can be particularly detrimental in teaching

hospital, as it can impact the quality of care provided to patients and undermine the

educational mission of the institution. For example, workplace bullying can lead to

increased turnover among staff, which can disrupt continuity of care and reduce

opportunities for professional development and mentorship. It can also create a

culture of fear and mistrust, which can discourage reporting of errors or concerns and

undermine efforts to promote a culture of safety and accountability.

To address workplace bullying in teaching hospital, it is essential to create a culture

of respect, communication, and collaboration. This requires leadership commitment

and engagement, effective policies and procedures for reporting and addressing

bullying behaviors, and ongoing education and training for all staff. It is also

important to create an environment that promotes work-life balance and supports the

mental and emotional well-being of staff, which can help reduce stress and mitigate

the risk of workplace bullying. More so provide training and awareness by educating

the employees on bullying behaviors and how to respond appropriately. However,

providing support to victims by offering counselling, legal advice and other resources

to support victims of bullying (Nursing journal, 2021)

According to the study conducted in Lagos Nigeria by Osarenoma Ujo-Eziyi,

Jacqueline Visser, and Stella Chiemeka-Ezeh {2023} the prevalence of workplace

bullying was 28.8%. victims of bullying experienced various negative outcomes

including psychological distress (69.4%), job dissatisfaction (67.5%), and decreased

productivity (56.3%). Women and younger employees were more likely to experience

bullying. Hospitality and finance staff reported higher levels of bullying. workplace

bullying is a significant issue in Nigeria healthcare sector, with detrimental effects on

employee wellbeing and organizational performance. Intervention are needed to

address this problem and create a respectful and inclusive work environment.

(Osarenoma Ujo-Eziyi et al, 2023) another study conducted in Ogun State Abeokuta

North, Ijebu-ode,sagamu,and ota and in Osun state Oshogbo, Iiesha,ile-ife,Iwo and

Ejigbo by A.O. Adebayo,A.O. Okoro, and S.O. Oluwasola { January 2021} High

prevalence of workplace bullying among nurses, with 49.2% experiencing it in the

past 12 months. Bullying behaviors included verbal abuse, physical intimidation,

social isolation, and overloading with work, Nurses in leadership position and those

working government hospitals were more likely to experience to experience

workplace bullying. most common perpetrators wee colleagues(62.2%), supervisors

(29.8) and patients/relatives (7.9%) (international journal of nursing, 2021.)

1.2 Statement of the Study

The nursing organization workplace has been identified as one in which workplace

bullying occurs quite frequently. Workplace bullying among Nurses has been

identified as a major contributor to poor attitude toward duties and reduction in

overall productivity. Workplace bullying was associated with reduced patient

satisfaction and increased medical errors. Bullied nurses were more likely to

experience medication errors, falls and pressure ulcers in patients. The study

highlighted the detrimental impact of bullying on patient safety (Haruna A., Bello

M.M., & Sani L.U.2022)

A recent study conducted in 2023 by researchers from Ahmadu bello teaching hospital

found that workplace bullying among Nurses remained a significant problem. The

study reported that 42.7% of nurses reported experiencing bullying in the past year.

Bullying was associated with increased increases absenteeism, decreased productivity,

and intention to leave the profession. The hospital implemented anti-bullying

measures but their effectiveness was limited.

A systematic review by Laschinger et al. (2014) found that the prevalence of

workplace bullying among nurses ranged from 12.2% to 50%, with an average

prevalence of 37.7% globally.

A meta-analysis by Perales-Martinez et al. (2019) reported an overall prevalence of

workplace bullying among nurses at 38.1%, with higher rates in countries outside

Europe.

A study by Emedosi et al. (2018) in Nigeria found that the prevalence of workplace

bullying among nurses was 57.8%.A systematic review by Okonkwo et al. (2019)

reported that the prevalence of workplace bullying among nurses in Africa ranged

from 19.8% to 69.9%, with an average prevalence of 41.6%.A study by Chigunta et al.

(2019) in Malawi found that the prevalence of workplace bullying among nurses was
42.3%.A study by Mbabazi et al. (2019) in Uganda found that the prevalence of

workplace bullying among nurses was 37.0%.A study by Jimba et al. (2022) found

that the prevalence of workplace bullying among nurses in Nigeria was 68.6%.

A study by Nnaji and Nwosu (2020) reported a prevalence of workplace bullying

among nurses in Nigeria at 72.3% (Okonkwo et al,2019). International Council of

Nurses (ICN): Developed the "Guidelines on Ethical Nursing: Respectful

Workplaces" in 2019, emphasizing the importance of creating safe and respectful

work environments for nurses. World Health Organization (WHO): Launched the

"Health Workforce 2030" strategy in 2016, which includes measures to address

violence and bullying in healthcare settings. International Labor Organization (ILO):

Adopted the "Convention Concerning Violence and Harassment" in 2019, requiring

employers to prevent, address, and respond to bullying in the workplace. African

Nurses and Midwives Organization (ANMAO): Established the "Committee on

Violence and Bullying" in 2015 to develop strategies for addressing workplace

bullying in African [Link] Health Professionals Council (RHPC):

Developed a "Code of Conduct for Health Professionals" in 2018, which prohibits

workplace bullying and [Link] Nurses and Midwives Association

(GNMA): Established a "Workplace Bullying Prevention and Intervention Taskforce"

in 2018 to implement strategies for reducing workplace bullying among [Link]

Africa Nursing Council (SANC): Developed a "Code of Conduct for Nurses" in 2015,

which includes measures to prevent and address workplace bullying. Nigerian Nurses

Association (NNA): Established a "National Working Group on Workplace Bullying"

in 2016 to develop strategies for reducing bullying in nursing practice. Nursing and

Midwifery Council of Nigeria (NMCN): Developed a "Code of Ethics and Standards

of Practice" in 2016, which prohibits workplace bullying and harassment

(International Labour, 2019)

Why Workplace Bullying Still Happens

Despite these initiatives, workplace bullying among nurses continues to be a

persistent issue due to several factors, including:

Culture of acceptance: In some workplaces, bullying may be tolerated as a normal

part of the profession.

Leadership failures: Managers may lack the training or skills to effectively address

bullying behaviors.

Limited resources: Hospitals and healthcare organizations may not have adequate

resources to implement effective anti-bullying programs.

Fear of retaliation: Nurses may fear being targeted for bullying if they report

inappropriate behavior.

Power imbalances: Differences in seniority, experience, or authority can create power

imbalances that contribute to bullying (international council of Nurses,2019).

1.3 Objective of the Study

[Link] assess the knowledge of workplace bullying among nurses in Ahmadu bello

university teaching hospital.

[Link] identify types of bullying behavior among nurse in Ahmadu bello university

teaching hospital.
[Link] identify factors that influence bullying behavior among nurses in Ahmadu bello

university teaching hospital.

[Link] identify the effect of work place bulling on nurses performance in Ahmadu bello

university teaching hospital.

1.4 Research Questions

[Link] are nurse’s perceptions of the causes and consequences of work place bullying

and how do these perceptions differ base on individual, organization and

environmental factor.

[Link] are the common work place bullying behavior nurses are exposed to?

[Link] are the factors that influence work place bullying behavior?

[Link] are the perception of work place bullying on nurse’s job satisfaction, burnout,

mental health and quality of patient care and how can intervention be designed to

mitigate these effect?

1.5 Significance of the Study

Workplace bullying is a prevalent issue in health care, affecting a significant number

of nurses. Studies estimate that up to 50% of nurses have experienced workplace

bullying at some point in their careers (National Nurses United, 2021).

Impact on Nurses' Well-being:

Workplace bullying can have detrimental effects on nurses' well-being, including:

Increased psychological distress (anxiety, depression), Reduced job satisfaction and

organizational commitment, Burnout, Physical health problems (headaches,

insomnia).

Impact on Patient Care:

Workplace bullying can also negatively impact patient care by: Distracting nurses

from providing optimal care, Creating a hostile work environment that affects patient

outcomes, Reducing nurse retention and recruitment, leading to staffing shortages.

Critical Issues Affecting Nurses' Well-being and Patient Care:

Underreporting and Stigma:

Many nurses do not report incidences of bullying due to fear of retaliation or

judgment.

Stigma associated with being a bullying victim can further discourage nurses from

seeking support.

Lack of Effective Policies and Enforcement:

Many health care organizations lack clear policies and procedures to address

workplace bullying.

Enforcement of existing policies is often weak, resulting in a lack of accountability

for perpetrators.

Limited Support Systems:

Nurses often experience limited support from supervisors and colleagues when facing

bullying, Fear of retaliation may prevent nurses from seeking help or speaking out

against the behavior.

Hospital management: Workplace bullying can create a toxic work environment that
undermines the hospital's goals and values. It can lead to high staff turnover, increased

absenteeism, and decreased productivity, all of which can have a negative impact on

the hospital's financial bottom line. It can also damage the hospital's reputation and

lead to decreased patient satisfaction and lower quality of care.

Family: Workplace bullying can cause significant emotional distress for nurses and

their families. Family members may notice changes in their loved ones' behavior,

mood, and physical health, which can be distressing and cause strain on the family

unit.

Community at large: Workplace bullying can have a ripple effect beyond the hospital

walls, impacting the broader community. It can reduce the quality of care provided to

patients, lead to higher healthcare costs, and erode public trust in the healthcare

system.

In summary, workplace bullying is never beneficial and can have significant negative

consequences for nurses, their patients, hospital management, family, and the

community at large. It is essential for organizations to prioritize the prevention and

elimination of workplace bullying to ensure a healthy and safe work environment for

all employees (National Nurses United,2021).

Creating a safe, supportive, and respectful work environment in healthcare can

significantly reduce turnover rates, absenteeism, and burnout among nurses. Here are

several strategies to achieve this: Promote Open Communication, encourage

transparent communication channels where nurses feel safe to voice concerns, provide

feedback, and suggest improvements without fear of retaliation, Provide Adequate

Resources, ensure that nurses have access to the necessary tools, equipment, and

support to perform their duties efficiently and safely, Implement Strong Support

Systems, Establish mentorship and peer support programs to offer guidance, reduce

isolation, and foster professional growth. Focus on Work-Life Balance: Offer flexible

scheduling options, adequate breaks, and policies that support work-life balance to

help nurses manage their personal and professional responsibilities. Offer Competitive

Compensation: Provide fair and competitive salaries along with benefits like health

insurance, retirement plans, and bonuses to reflect the value of nurses' contributions.

Invest in Professional Development: Support continuous education and training

opportunities to help nurses advance their skills and careers. Recognize and Reward

Contributions: Regularly acknowledge and celebrate the achievements and hard work

of nurses to boost morale and job satisfaction. Foster a Respectful Culture: Promote

respect and inclusivity in the workplace, and address any instances of bullying,

harassment, or discrimination promptly and effectively. Monitor Workload and

Staffing Levels: Ensure that staffing levels are adequate to prevent excessive

workloads and reduce the risk of burnout. Implement measures to manage and

balance workloads. Provide Mental Health Support: Offer access to mental health

resources, such as counseling services and stress management programs, to help

nurses cope with the emotional demands of their roles. By integrating these strategies

into workplace policies and culture, healthcare organizations can create a more

positive environment that supports nurse well-being and enhances overall job

satisfaction (Pagnin et al. 2020).

1.6. Scope of the Study

This study is delimited to nurses in Ahmadu Bello University Teaching Hospital,

Zaria Kaduna State.

1.7 Operational Definition of Terms

BULLY: A person who is intentionally, physically, or emotionally cruel to others;

especially to those who are weaker or have a less power or privilege.

WORKPLACE BULLYING: This is a verbal, physical, social, or psychological abuse

by your employer or [manager], another person or group of people at work.

PERCEPTION: this refers to the process by which individuals interpret and organize

sensory information from their environment.

WORKPLACE: this refers to the physical or virtual environment where employees

perform their job tasks and duties.

NURSES: this refers to health care professionals who play a vital role in the medical

field.