OBJECTIVE: The aim of this study was to investigate
the impact of subtle forms of workplace mistreatment
(bullying and incivility) on Canadian nurses’ perceptions
of patient safety risk and, ultimately, nurse-assessed
quality and prevalence of adverse events.
BACKGROUND:Workplacemistreatment is known
to have detrimental effects on job performance and in
nursing may threaten patient care quality.
METHODS: A total of 336 nurses from acute care
settings across Ontario responded to a questionnaire
that was mailed to their home address in early 2013,
with a response rate of 52%.
RESULTS: Bullying and incivility fromnurses, physicians,
and supervisors have significant direct and indirect
effects on nurse-assessed adverse events (R2 =
0.03-0.06) and perceptions of patient care quality
(R2 = 0.04-0.07), primarily through perceptions of
increased patient safety risk.
CONCLUSIONS: Bullying and workplace incivility have
unfavorable effects on nurse-assessed patient quality
through their effect on perceptions of patient safety risk.
High-quality patient care is a fundamental expectation
of an effective healthcare system, and nurses, representing
almost one-half of all healthcare workers in
Canada,1 play a critical role in ensuring that patients
are provided with comprehensive nursing care. An extensive
body of research has shown that nursing work
environments that support professional nursing practice
and foster high-quality relationships among employees
are associated with high-quality nurse and
patient outcomes.2 However, recent studies have shown
that nurses are reporting frequent exposure to workplace
bullying and incivility,3-5 which are associated
with higher levels of burnout and job turnover intentions.
6 However, little research has linked these subtle
forms of workplace violence to patient care quality.
Workplace aggression appears to be on the rise.7
The World Health Organization8 recently identified
workplace bullying as a serious public health threat in
light of evidence that workplace bullying is reaching
epidemic levels worldwide. Workplace mistreatment
is known to have detrimental effects on job performance
and workplace well-being.9 In the nursing profession,
poor performance has serious implications for
patient care quality and patient safety.10,11 However,
there are few large-scale studies that have systematically
examined the effects ofworkplacemistreatment
on patient safety outcomes