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Workplace Bullying, Psychological Distress, and Job Satisfaction in Junior Doctors

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Workplace bullying has been recognized as a major occupational stressor since the mid 1980s. A number of different terms have been used to describe it, including employee abuse, emotional abuse, mistreatment and neglect at work, mobbing, and harassment. In the United Kingdom, a number of reports from trades unions illustrating the pain, psychological distress, physical illness, and career damage suffered by the victims of bullying first drew attention to the issue. However, academic interest in the issue began only recently, and there are still few empirical studies. The most systematic research comes from Scandinavia, where there is strong public awareness and antibullying legislation.
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Special Section:
Praxis: Ethical Issues in Medical Education and Training
Workplace Bullying, Psychological Distress,
and Job Satisfaction in Junior Doctors
LYN QUINE
Workplace bullying has been recognized as a major occupational stressor since
the mid 1980s.
1,2,3
A number of different terms have been used to describe it,
including employee abuse,
4
emotional abuse,
5
mistreatment and neglect at
work,
6
mobbing,
7,8
and harassment.
9
In the United Kingdom, a number of
reports from trades unions illustrating the pain, psychological distress, physical
illness, and career damage suffered by the victims of bullying first drew
attention to the issue.
10,11,12
However, academic interest in the issue began only
recently, and there are still few empirical studies. The most systematic research
comes from Scandinavia, where there is strong public awareness and antibul-
lying legislation.
13,14
In the school-based literature, bullying is defined as a subset of aggressive
behaviors involving three criteria: it is intentional harm-doing, involves an
imbalance of power between the victim and the bully, and is carried out
repeatedly and over time.
15
Three main types are identified: direct physical
bullying, verbal bullying, and indirect bullying. Definition of workplace bully-
ing presents the researcher with significantly more difficulties, for there is no
clear agreement on what constitutes adult bullying, whether it refers to a range
of behaviors or can be expressed in a single definition. Physical bullying is
rarely reported,
16
but the workplace presents unique opportunities for a wide
range of aggressive and intimidating behaviors. Most existing definitions incor-
porate three elements. First, in line with case-law definitions in the related
areas of racial and sexual harassment, the perceptions of the behavior by the
victim, not the intention of the perpetrator, determines whether bullying has
occurred. Thus it is subject to differences in personal perceptions. Second, there
must be a negative effect on the victim.
17
See for example, one of the most
widely used definitions, that of the U.K. Manufacturing, Science, and Finance
Union (MSF):
persistent, offensive, abusive, intimidating, malicious or insulting behav-
iour, abuse of power or unfair penal sanctions, which makes the
recipient feel upset, threatened, humiliated or vulnerable, which under-
mines their self-confidence and which may cause them to suffer stress.
(p. 3)
18
Thirdly, the bullying must be persistent. The rule of thumb used in Sweden, for
example, is one occurrence per week over the last six months.
19
Five categories of bullying behavior have been identified in the literature:
20
Cambridge Quarterly of Healthcare Ethics (2003), 12,91
101. Printed in the USA.
Copyright © 2003 Cambridge University Press 0963-1801/03 $12.50
91
threat to professional status
belittling you in public, professional humil-
iation, accusation of lack of effort
threat to personal standing
spreading rumors, gossiping about you, name
calling, and teasing
isolation
ignoring you, withholding information from you, preventing
access to opportunities such as leave or training
enforced overwork
undue pressure to produce work, setting impossible
deadlines, unnecessary disruptions
destabilization
failure to give credit when due, being given meaningless
tasks, removal of responsibility, shifting of goalposts, repeated reminders
of error
Bullying is most frequently associated with an abuse of power, by a line
manager or supervisor over junior staff. However, other power relationships
may lead to bullying by colleagues or a group of people who may target one
individual.
In the United States, a parallel literature has indicated that medical students
and trainee doctors also report experiencing high levels of mistreatment or
bullying behaviors. In 1982, a U.S. physician, Henry Silver, drew attention to a
transformation in attitude and behavior that took place among students over
the course of medical school training, from “eager and enthusiastic” to “cyni-
cal, depressed, and filled with frustration,” and suggested that these changes
could be the result of abuse or mistreatment that was unrecognized or ignored.
In a later paper, Silver and Glicken reported the results of the first empirical
study of the incidence and severity of abuse in one medical school.
21
A number
of other studies quickly followed describing the types of mistreatment suf-
fered.
22,23,24,25,26,27,28,29,30,31,32
A survey of ten U.S. medical schools in 1991, for
example, found that 96% of medical students had suffered abuse: 87% reported
public belittlement and humiliation, 81% being shouted or yelled at, 55% sexual
harassment, 36% being given extra tasks for punishment, 34% being threatened
with unfair grades, 19% racial harassment, and 18% being hit or pushed.
33
It is
now recognized that high levels of mistreatment occur, which increase with
progression through medical school, continue during the early postgraduate
years,
34
are a significant source of stress, and may be an important cause of
dropout.
35,36
The literature suggests that such treatment is often justified in
terms of its “educational” value. Kassebaum and Cutler observe that the most
common forms of mistreatment
public belittlement and humiliation
appear
to be “misguided attempts to reinforce learning.”
37
Both mistreatment of medical students and workplace bullying have been
linked to a host of adverse effects on the health and well-being of those who
experience it, including depression, anxiety, lowered job satisfaction, greater
sickness absence, higher propensity to leave, and reduced effectiveness at
work.
38,39,40,41,42,43
Increased smoking and escape drinking have also been
reported.
44,45,46,47
One issue that makes the study of bullying difficult is inherent in the way it
is defined. Because bullying or mistreatment are normally assessed by self-
report, the question inevitably arises as to whether some people’s perceptions
may be biased due to dispositional traits, leading them to be more likely to
report benign behavior as bullying. In previous work, I drew attention to a
likely source of bias
negative affectivity
48
defined by Watson and Clarke as
Lyn Quine
92
a mood dispositional dimension that reflects stable and pervasive individual
differences in negative emotionality and self-concept. In an influential review,
these authors concluded that individuals high in negative affectivity “are more
likely to report distress, discomfort, and dissatisfaction over time and regard-
less of the situation.” Such individuals also tend to dwell on their failures and
shortcomings and to focus more on the negative aspects of other people and
the world in general. “Consequently they have a less favourable view of self
and other people and are less satisfied with themselves and life” (p. 483).
49
Findings from this and further reviews
50,51
suggest that it would be appropriate
to take account of negative affectivity when investigating reports of bullying.
Though there has been considerable research on the mistreatment or abuse of
medical students in the United States, there is little research on trainee doctors
either in the United States or the United Kingdom. Additionally, the influence
of negative affectivity on reports of bullying and on relationships between
bullying and occupational health outcomes has not been investigated. This
study aimed to bridge that gap. The study arose after the issue of bullying was
raised with the author by a Dean Director of Postgraduate Medical Training in
the United Kingdom, following publication of a paper in the British Medical
Journal on bullying among health professionals.
52
The aims were to investigate
the prevalence of bullying among junior doctors, to determine the association
between workplace bullying and demographic variables such as age, gender,
and ethnic group, and to examine the relationship between bullying and two
occupational health outcomes, job satisfaction and psychological distress after
partialing out the effects of negative affectivity.
Methods
An anonymous questionnaire was sent out with the BMA News Review to a
sample of 1,000 junior hospital doctors with job grades from house officer to
senior registrar, randomly generated electronically from the British Medical
Association members’ mailing list. The News Review is sent out regularly to all
registered doctors. Because of the method of contacting participants, it was not
possible to send reminders. After 2 months, the data were entered onto
computer and analyzed using SPSS for UNIX.
Questionnaire
The questionnaire was in three sections. The first collected information about
the participant’s age, gender, job grade (house officer, registrar, etc), and ethnic
group. The second section contained two widely used scales to measure
occupational health outcomes, psychological distress (GHQ-12),
53
job satisfac-
tion,
54
and a measure of negative affectivity.
55
The GHQ-12 is a self-
administered questionnaire for detecting psychiatric disorder in a British
population. It is a shortened 12-item version of the General Health Question-
naire designed by Goldberg.
56
The job satisfaction scale is an 18-item measure
produced by Brayfield and Rothe to measure facet-free job satisfaction.
57
The
Negative Affectivity Scale provides a 21-item measure of negative affectivity.
All three scales are widely reported to have satisfactory reliability and validity.
The third section of the questionnaire contained questions about junior
doctors’ experiences of bullying. The Lyons et al. definition of bullying, which
Workplace Bullying in Junior Doctors
93
has been endorsed by trades unions, was presented.
58
Participants were then
asked to indicate whether they had been subjected to workplace bullying in the
last 12 months and whether they had witnessed others being bullied. Partici-
pants also completed a 21-item bullying scale developed for our earlier work,
which asked about experience of 21 bullying behaviors from peers, senior staff,
or managers in the past 12 months.
59
Results
We received 594 completed questionnaires, and 48 were returned undelivered
by the postal service, which represented a response rate of 62%. As a first step,
scores were computed for job satisfaction, GHQ-12, and negative affectivity.
Each scale was found to have good internal reliability, with Cronbach’s alphas
of 0.92 for job satisfaction, 0.90 for GHQ-12, and 0.81 for negative affectivity.
Table 1 shows the participants’ job grade, gender, and ethnic group. Fifty-five
percent of the respondents were house officers or senior house officers, whereas
39% were registrars, 3% were senior registrars, and 3% held other junior
grades. The sample was equally divided between men and women. Seventy
percent were white, and 30% were from other ethnic groups.
Prevalence of Bullying
Overall, 37% (220) junior doctors reported having been bullied in the past 12
months. Sixty-nine percent (407) had witnessed the bullying of others. Fifty-
three percent (107/211) reported being bullied by colleagues in their own work
group, 46% (91/199) by people outside their own work group, 60% (123/205)
by their immediate team leader, 34% (66/194) by a senior manager, and 30%
(46/154) by some other person. Ninety-six percent (212/220) of doctors reported
being bullied by more than one person.
Associations between Bullying and Demographic Variables
To investigate differences in reports of bullying by gender, ethnic group, job
grade, and age, analyses by chi-square test were conducted. The results showed
that doctors from minority ethnic groups were more likely to report being
Table 1. Profile of Participants
Job grade (n 5 589)
House officer/senior house officer 321 (55%)
Registrar/specialist registrar 230 (39%)
Senior registrar 18 (3%)
Other 20 (3%)
Gender (n 5 590)
Male 294 (50%)
Female 296 (50%)
Ethnic group (n 5 587)
White 413 (70%)
Other ethnic group 174 (30%)
Lyn Quine
94
bullied than white doctors (45% [78] compared to 34% [139]; df 1, x
2
5 5.9, p ,
0.05; CI 1.11
2.28), and women were more likely to report being bullied than
men (43% [126] compared to 32% [92] of male doctors; df 1, x
2
5 7.2, p , 0.01;
CI 1.14
2.26). There were no differences in reports of bullying by age or job
grade. There were no significant differences in negative affectivity between
men and women or between white doctors and those from minority ethnic
groups, showing that variations in negative affectivity could not account for the
significant findings. Overall, negative affectivity accounted for only 6% of the
variance in reports of bullying (R2 5 0.059, F(1,556) 5 36.0; p , 0.001).
Prevalence of Bullying Behaviors
Table 2 shows the proportion of junior doctors reporting each type and
frequency of bullying behavior and the proportion of doctors from minority
ethnic groups compared to white doctors. Eighty-four percent of doctors (486)
had experienced at least one type of mistreatment. Table 3 presents the differ-
ences in gender between those who reported each type of bullying behavior
and those who did not.
Associations between Bullying and Occupational Health Variables
To examine whether doctors who reported being bullied suffered lower levels
of job satisfaction and greater psychological distress than other doctors and to
ensure that these relationships were unrelated to negative affectivity, analyses
of covariance were conducted. Two separate analyses, one for job satisfaction
and one for psychological distress, were conducted using negative affectivity as
a covariate. The results showed that even when negative affectivity was
partialed out, doctors who reported being bullied had significantly lower levels
of job satisfaction (adjusted mean 61.5 versus 64.9, t(1, 523) 5 8.1, p , 0.001;
95% CI 20.23
0.38) and higher levels of psychological distress (adjusted mean
4.0 versus 2.7, t(1, 551) 5 10.6, p , 0.001; 95% CI 0.15
0.10) than those who did
not report it.
Discussion
Thirty-seven percent (220) of junior doctors in this study reported being bullied
in the previous year. Negative affectivity accounted for only 6% of the variation
in such reports. These rates compare with 18% reporting being bullied in the
last 6 months in a recent UNISON survey of trade union members and 38% in
the previous 12 months in a study of 1,100 staff in a community National
Health Service Trust.
60,61
Both of these studies were carried out in the United
Kingdom. Though a little over a third of doctors identified themselves as
having been bullied, 84% of doctors had actually experienced at least one type
of bullying behavior. These most often took the form of destructive innuendo
and sarcasm (43%), persistent attempts to belittle and undermine an individu-
al’s work (40%), or undue pressure to produce work (39%), although persistent
and unjustified criticism of work (37%), public humiliation (34%), and shifting
the goalposts (32%) were frequently reported.
Estimates of harassment, abuse, and discrimination among both medical
students and junior doctors in the United States are generally somewhat higher,
Workplace Bullying in Junior Doctors
95
Table 2. Overall Rates of Bullying Behaviors and Differences by Ethnic Group
All White
Other
ethnic groups x
2
Threat to professional status
Persistent attempts to belittle and undermine your work 232 (40%) 149 (37%) 78 (45%) 3.5*
Persistent unjustified criticism and monitoring of your work 213 (37%) 151 (38%) 57 (33%) 1.1 NS
Persistent attempts to humiliate you in front of colleagues 198 (34%) 131 (33%) 63 (37%) 0.8 NS
Intimidatory use of discipline/competence procedures 101 (17%) 66 (16%) 33 (19%) 0.7 NS
Threat to personal standing
Undermining your personal integrity 174 (30%) 120 (30%) 51 (30%) 0.0 NS
Destructive innuendo and sarcasm 250 (43%) 170 (42%) 77 (45%) 0.3 NS
Verbal and nonverbal threats 107 (18%) 66 (16%) 39 (23%) 3.2 NS
Making inappropriate jokes about you 166 (28%) 99 (25%) 59 (34%) 5.7 **
Persistent teasing 122 (21%) 89 (22%) 31 (18%) 1.2 NS
Physical violence 2 (0%) 0 (0%) 0 (0%)
——
Violence to property 10 (2%) 6 (2%) 4 (2%) 0.5 NS
Discrimination on grounds of race or gender 88 (15%) 35 (9%) 50 (29%) 39.4 ***
Isolation
Withholding necessary information from you 114 (20%) 71 (18%) 42 (24%) 3.4 NS
Freezing out/ignoring/excluding 179 (31%) 115 (29%) 61 (36%) 2.7 NS
Unreasonable refusal of applications for leave, training, or promotion 142 (24%) 83 (21%) 56 (33%) 9.4 **
Overwork
Undue pressure to produce work 356 (39%) 138 (34%) 81 (47%) 8.2 **
Setting of impossible deadlines 179 (31%) 119 (30%) 58 (34%) 0.9 NS
Destabilization
Shifting goalposts without telling you 188 (32%) 131 (33%) 53 (31%) 0.2 NS
Constant undervaluing of your efforts 164 (28%) 110 (27%) 49 (29%) 0.1 NS
Persistent attempts to demoralize you 96 (17%) 61 (15%) 33 (19%) 1.4 NS
Removal of areas of responsibility without consultation 73 (13%) 54 (13%) 19 (11. ) 0.5 NS
NS 5 Not significant
*p , 0.05
**p , 0.01
***p , 0.001
96
Table 3. Differences in Reported Bullying Behaviors by Gender
Males Females x
2
Threat to professional status
Persistent attempts to belittle and undermine your work 100 (32%) 128 (44%) 5.4 *
Persistent unjustified criticism and monitoring of your work 95 (33%) 114 (40%) 2.7 NS
Persistent attempts to humiliate you in front of colleagues 79 (27%) 115 (40%) 10.0 ***
Intimidatory use of discipline/competence procedures 42 (15%) 57 (20%) 2.6 NS
Threat to personal standing
Undermining your personal integrity 63 (22%) 109 (38%) 17.1 ***
Destructive innuendo and sarcasm 107 (37%) 141 (49%) 7.6 **
Verbal and nonverbal threats 47 (16%) 58 (20%) 1.3 NS
Making inappropriate jokes about you 66 (23%) 92 (32%) 5.6 **
Persistent teasing 60 (21%) 60 (21%) 0.0 NS
Physical violence 2 (1%) 0 (0%) 2.0 NS
Violence to property 8 (3%) 2 (1%) 3.7 NS
Discrimination on grounds of race or gender 44 (15%) 40 (14%) 0.1 NS
Isolation
Withholding necessary information from you 60 (21%) 54 (19%) 0.4 NS
Freezing out/ignoring/excluding 86 (30%) 91 (32%) 0.8 NS
Unreasonable refusal of applications for leave, training, or promotion 72 (25%) 68 (23%) 0.2 NS
Overwork
Undue pressure to produce work 111 (39%) 109 (38%) 0.0 NS
Setting of impossible deadlines 86 (30%) 91 (31%) 0.1 NS
Destabilization
Shifting goalposts without telling you 89 (31%) 95 (33%) 0.2 NS
Constant undervaluing of your efforts 64 (22%) 96 (33%) 8.5 **
Persistent attempts to demoralize you 34 (12%) 60 (21%) 8.2 **
Removal of areas of responsibility without consultation 40 (14%) 33 (12%) 0.8 NS
NS 5 Not significant
*p , 0.05
**p , 0.01
***p , 0.001
97
though measured over a longer time period. For example, Richman et al. found
that 89% of graduates reported experiencing some form of harassment during
their time at medical school, whereas Baldwin et al. reported a figure of 96%,
and Wolf et al. 99%.
62,63,64
Daugherty et al., in a survey of bullying in the first
postgraduate year, found a figure of 93%.
65
Junior doctors from minority ethnic
groups were more likely to be bullied and reported five bullying behaviors
significantly more frequently than white doctors. These findings are consistent
with findings in the United States.
66,67
Although this should be a cause for
concern, it should not come as a surprise. Racial discrimination has been shown
to occur at all levels in the U.K. medical profession, from application to medical
school
68,69,70
to examination success,
71
job application,
72,73,74,75
and even the
allocation of distinction awards to consultants.
76
Women doctors were more
likely than men to be bullied and reported seven of the 21 bullying behaviors
significantly more frequently. These findings are in accord with those from a
study of university employees, which found that women experience work
harassment more often and more severely than men.
77
Junior doctors were
most likely to have been bullied by their immediate team leader, which is
consistent with the idea that it is an ill-conceived attempt to reinforce learning.
78
Those who had experienced bullying reported decreased job satisfaction and
increased psychological distress, even when negative affectivity had been
covaried out, which suggests that negative affectivity does not play any
significant role in these relationships and should not be used as an explanation
by those seeking to deny the existence of bullying. The reports of other doctors
who have witnessed bullying, though have not themselves been bullied, also
suggests that bullying is not simply in the eye of the beholder. The notion that
those who report bullying are simply those who view the world through
gloomier spectacles places the victims in double jeopardy, because it both
denies their own perceptions of their experience and precludes any discussion
of the health consequences that bullying may have.
The interpretation of these findings should be guarded. Like all the U.S.
studies, this one relied on self-reports of bullying, which are by definition
subjective and may not entirely correspond to the actual occurrence of mis-
treatment. People’s perceptions about what constitutes bullying or their per-
sonal sensitivity and vulnerability to mistreatment or abuse may differ.
Nevertheless, the literature on stress emphasises that it is people’s appraisals of
stressful events that are important rather than the events per se (pp. 22
94).
79
We have tried to minimize the effects of bias by providing a clear definition of
bullying, asking about individual bullying behaviors and controlling for neg-
ative affectivity in some analyses. A second reason for caution is that the data
are cross-sectional, which limits the conclusions that can be drawn about cause
and effect relationships. Prospective longitudinal data that would monitor
reports of bullying and subsequent negative effects are now needed. A final
limitation is the nonresponse rate. Although a higher rate would have been
desirable, the study achieved an acceptable response rate of 62%, which is
similar to many other studies of mistreatment (Baldwin et al. 59%; Wolf et al.
61%; Mangus et al. 55%; Komaromy et al. 62%).
80,81,82,83
Despite these limitations, the data presented here strongly suggest that
disturbingly high levels of bullying and mistreatment during training are a part
of many junior doctors’ perceptions and experience. The price of ignoring it
may be dropout from medical school, high levels of anxiety and depression
Lyn Quine
98
among trainee doctors, ignoring the needs of patients, and future mistreatment
of others by those who have been mistreated
the so-called transgenerational
legacy.
84,85,86
The development and implementation of antibullying policies that
include a statement on expected standards of behavior, education to raise
awareness of bullying, the introduction of procedures for dealing with allega-
tions of bullying, and protection of the accusers from retaliation would seem to
be important steps forward. These are beginning to be implemented in the
United Kingdom,
87
although they seem to have had little effect in the United
States, where, after two articles had aroused national attention,
88,89
the Amer-
ican Medical Association recommended that all medical schools should imple-
ment measures to combat bullying.
90
According to Kassebaum and Cutler,
however, despite these measures, the pattern of student abuse is largely
unabated.
91
It appears that alongside changes in policy, what is required is a
change in attitudes and in the mistaken conviction that negative rather than
positive reinforcement best promotes learning.
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... Research by Kivimäki et al. (2003) and Kivimäki et al. (2000) also showed that direct recipients of workplace bullying are more likely to suffer a range of chronic diseases such as asthma, rheumatoid arthritis, osteoarthritis, sciatica, diabetes, and/or cardiovascular disease (although the direction of causality was not explored). The recipients of bullying also often exhibit workplace dysfunctions including self-doubt, low mood/ self-confidence, emotional control loss, low self-esteem, and relatively more negative emotions (O'Driscoll et al. 2011;Mikkelsen & Einarsen 2002;Moayed, Daraiseh, Shell & Salem 2006;Quine 2003;Vartia 2001). But the impact types may vary with personal characteristics e.g. ...
... Bullying has also been shown to adversely impact organisational performance, including diminished individual job performance and morale; and increases in absenteeism, workrelated stress and medically certified sick leave, plus employee turnover, decreased job satisfaction and productivity issues (Bentley et al. 2012;Carter et al. 2013;Duffy & Yamada 2018;Kivimäki et al. 2000;Quine 2003;Vartia 2001). Through the combination of direct and indirect costs, it is estimated that the impact of bullying on workplaces is significant, for example, one study in 2008 estimated that the annual cost of bullying to organisations in the United Kingdom was £13.75 billion (Giga, Hoel & Lewis 2008). ...
...  Gender: in a small number of studies women are found to be slightly more likely to be bullied than men (Quine 2003;Salin 2001;WBI 2014), and Moayed, Daraiseh, Shell and Salem (2006) note that this finding is not universally the case in related studies, with a number of studies finding no statistically significant difference in rates of bullying based on gender. However, an interesting aspect of these studies that may require further consideration is that women were more likely to be bullied by other women than by men, whereas men are equally likely to be bullied by both men and women (WBI 2014; WBI 2017). ...
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There is no universal definition of bullying, but it is increasingly pervasive and is recognised as a ‘psychosocial hazard’ with associated wellbeing and organisational dysfunctions. Literature identifies antecedents associated with bullying, including leadership style, role autonomy, etc, but some overarching characteristics may also add to understanding of the organisational profiles which give rise to bullying, e.g. organisational size, public/ private, industry, predominant gender and diversity etc. These are worthy of consideration because they may help identify where risk of bullying is likely to be greatest. To aid in understanding this under-researched area, this paper uses the New Zealand Diversity Survey to look at bullying through themes of perceived importance, policy implementation, organisational size and sector. The aim of this paper is exploratory: it establishes a preliminary understanding of the relationship between organisational characteristics and bullying prevalence to identify areas for further research in the next phase of the investigation.
... The hierarchical structure of education in healthcare is a known risk factor for workplace bullying. [1][2][3][4][5][6][7] Workplace bullying is defined as "harassing, offending, socially excluding someone, or negatively affecting someone's work…occur [ing] repeatedly and regularly (weekly) and over a period of time (eg, about six months)." 8 Horizontal violence (HV), "persistent exposure to interpersonal aggression and mistreatment from colleagues," 9 has predominately been researched within the nursing field [10][11] with interest in resident-directed HV intern year, 62.9% of residents had experienced mistreatment from any source (eg, medical student, resident, attending, nurse, patient). ...
... 1 Workplace bullying of resident physicians is associated with increased psychological distress, increased depressive symptoms, and a positive post-traumatic stress disorder screening. 3,[18][19] Overall, there is a paucity of data regarding HV specifically and its adverse effects on residents, especially residents in EM -a specialty that depends on frequent interactions with staff and residents from different services. In this pilot study we hypothesized that women residents in their first year of residency training would experience more HV, specifically from other residents and support staff, as measured by a tailored healthcare version of the 22-item NAQ-R. ...
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Introduction: Horizontal violence (HV) is defined as "persistent exposure to interpersonal aggression and mistreatment from colleagues." Our objective in this pilot, single-site study was to identify sources of HV toward emergency medicine (EM) residents, using the Negative Acts Questionnaire-Revised (NAQ-R). Methods: In this investigation we used a descriptive cross-sectional survey design to categorize HV. All voluntary participants were residents in an Accreditation Council for Graduate Medical Education-approved, three-year academic EM residency. Data were collected via electronic survey and occurred six months into an academic year. We collected demographic information and responses to the NAQ-R in 2020. Horizontal violence is subdivided into three categories: work-related; person-related; and physical intimidation. Emergency medicine residents answered questions as they related to their interactions with residents and support staff, which included nursing. Results: A total of 23 of 26 residents responded (89%). Participants were 56% women, 78% white, 11% Hispanic, and 89% heterosexual. Participant clinical year was 39% first-, 39% second-, and 22% third-year residents. Women reported a higher frequency of HV compared to men (1.3 vs 1.1, P =.01). By category, women indicated higher incidence of work-related violence from other residents (P = .05) and staff (P =.02). There was no difference in reported frequency of violence for interns compared to senior residents. Conclusion: Our pilot study demonstrated horizontal violence toward EM residents exists and is more prevalent in women.
... Abundant research studies have examined the relationship between PJI and PD (De Witte et al., 2016). Seemingly, PD (Quine, 2003), well-being (Witte, 1999), and psychological health (Ferrie, Shipley, Stansfeld, & Marmot, 2002) are highly researched topics in the domain of occupational health (Sverke & Hellgren, 2002) and organizational psychology (Wang et al., 2014). Empirically, the relationship has been investigated in several articles and books' chapters (Conway & Briner, 2005;Keim et al., 2014;Witte, 1999). ...
... The notion is that PJI leads to the frustration of the fundamental needs associated with jobs such as powerlessness, the threat of losing a job or other key features, lack of certainty. Thus, frustration serves as a stress factor and leaves a person with the feeling of deprivation (De Witte et al., 2016) consequently, resulting in increased PD (Quine, 2003). Therefore, it is hypothesized that high/low PJI leads to high/low PD. ...
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Drawing on uncertainty management theory and social exchange theory, this research examined the interaction effect of organizational justice with perceived job insecurity in organizational citizenship behaviour. A hypothesised model was developed and tested using PLS-SEM (v 3.2.7) on a sample of 210 employees in the banking sector in Pakistan. The study found that at a high level of organizational justice, perceived job insecurity has a weak negative relationship with organizational citizenship behaviour, while at a low level of organizational justice; perceived job insecurity has a strong negative correlation with organizational citizenship behaviour. Results also support the interaction effect of perceived job insecurity and organizational justice on affective organizational commitment and psychological distress. This research highlights the significance of contextual variable which may help the practical community in managing their intellectual capital through casting an appropriate concern in organizational justice.
... A number of studies have established a relationship between workplace bullying and psychological and physical health problems (Bowling and Beehr 2009;Niedhammer, Chastang and David 2008). For instance, cross sectional evidence has shown that exposure to bullying is associated with mental and psychosomatic complaints (Quine 2003;Mikkelsen and Einarsen 2001;Vie, Glaso and Einarsen 2011), such as musculoskeletal problems, and in particular, depression and anxiety (Mikkelsen and Einarsen 2001;Hansen, Hogh, Persson, Garde and Orbaek 2006;Zapf, Knorz and Kulla 1996). ...
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The classic elitists were „anti-democratic” because they were skeptical regarding the concrete possibilities of implementing democracy. Pareto, Mosca and Michels have properly noticed the inadequacy of the democratic ideals to the political reality of the time when they wrote their works. The fact that the society cannot be governed directly by the people is a reality that cannot be contested not even today. The radical elitists (Th. Veblen, C. Wright-Mills, and W.G. Domhoff) will reaffirm the leading potential of elites based on empiric proofs provided by the way the American society was 0perating; a society dominated by corporatism and conservatism in the second half of the 20th century. Unlike the monism of the classical and radical elitist theories, the pluralist elitism represents a theoretical and methodological „jump”, meaning that the elites are analyzed as social groups in a fierce competition for power. The first successful attempt of bringing together the elite theory and the democracy theory will belong to the pluralists (R. Aron, R.A. Dahl, J.A. Schumpeter), who see the „democratic game” as a competition between a plurality of elites. If the pluralist elitism has tried and succeeded to give an answer to the question how is it possible for a „dominant minority” to govern when the electoral majority decides who will govern, the democratic elitism faces the problem of the „commitment” of the political elites towards the democratic values, norms and rules. According to John Higley and Heinrich Best, „the democratic elitism describes the elites as being guardians of democracy”.
... ‫ر‬ (Jaussi and Dionne, 2003) (Bartlett and Bartlett, 2011;Glambek et al., 2014;vadi, 2011, 2012;Gholamzaden and Khazaneh, 2012;Berry et al., 2012;Palaz, 2013;Nielsen et al., 2016;Pitney et al., 2016;Oh et al., 2016;Gardner et al., 2016;Einarsen et al., 2016;Glambek et al., 2016;Eriksen et al., 2016;Berry et al., 2016;Drüge et al., 2016;Ritzman, 2016;Dussault and Frenette, 2015;Olsen et al., 2017) (Leymann, 1990(Leymann, , 1996Einarsen and Raknes, 1997;Rayner and Hoel, 1997;Quine, 1999Quine, , 2003Ollafson and Johannsdottir, 2004;Djurkovic et al., 2008;Dilek and Aytolan, 2008;Oade, 2009;5;Tambur and vadi, 2009;Gholamzaden and Khazaneh, 2012;Berry et al., 2012;Palaz, 2013) . ...
... Intern's welfare not met was seen as the first challenge echoed by the interns whereby they have expressed the need for accommodation, delay employment contracts and work without pay. The findings of this study were convenient to the other studies whom have reported that lacking the right support and having poor infrastructure that is not conducive for the wellbeing of the IDs brings disturbance to their learning [23,26,27]. Likewise, other studies have stated that when there is poor support in; hospital management, medical intern doctor's welfare, hospital staff, and academic opportunities, it greatly impacts an ID's transitional phase from being a medical student to becoming a registered doctor [24,28]. ...
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The transition from being a medical student to a fully qualified registered doctor is a challenging time in the lives of intern doctors (IDs). Throughout those challenging times they face many challenges which significantly impact their professional lives as well as their transitional experience. This study aimed to identify the transitional challenges experienced by IDs in Vanuatu. This qualitative study was conducted using a phenomenological approach whereby data collection is done through semi-structured in-depth interviews. Ethical approval was obtained before the commencement of this study. Twenty-seven participants were IDs of Vila Central Hospital and Northern Provincial Hospital in Vanuatu who were either current IDs and had worked for more than 6 months or had completed internship within the past 2 years. The willing IDs were consented on paper before they participated in the interview. The interview data was then transcribed verbatim and interpreted thematically. The participating IDs in the study were between the ages of 27 and 36 years old. Twenty two were current interns while the remaining five had recently completed their internship and now working as registered doctors. Three subthemes were identified as challenges through thematic analysis in this study; intern’s welfare not met; different medical training institution; and transitional shock. Those subthemes were later categorized. The study findings have identified that intern’s welfare needs improvement along with diverse training medical schools, and the transitional internship encounters were significant challenges experienced by IDs. There is indeed a need for healthcare providers, medical leaders, and relevant stakeholders to recognize and address these challenges.
... Workplace bullying has been regarded as a significant source of social stress at work (Zapf, 1999;Vartia, 2001), and causes serious distress and damage to employees compared with other types of work stress (Wilson, 2016). Numerous studies have remarked that workplace bullying has a considerable impact on the physical health, psychological health, and quality of life of the victims, triggering severe depression and anxiety (Zapf et al., 1996;Mikkelsen & Einarsen, 2001;Quine, 2003;Vie et al., 2011). Moreover, Hsu (2010) revealed that as a form of social pressure, workplace bullying causes a psychological burden on employees and adversely affects their physical health, causing physical discomfort such as tingling in certain body parts, inexplicable exhaustion, and headaches. ...
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Employee assistance programs required resources and manpower of various natures across different types of public sector organization. However, the current evaluation indexes and proportions of employee assistance programs in public sectors stipulated by the Directorate-General of Personnel Administration of the Taiwan’s Executive Yuan did not follow the rules, leading to a decreased efficiency in the subsequent execution of these assistance programs. Data analysis indicated that the weight and priorities associated with elements of evaluation criteria for employee assistance programs implemented by four types of public sector organization were not fully identical. For example, the aspect of health was prioritized in the group for the “Executive Yuan” organization type, and anxiety was the top element among these criteria. The group for the “municipal governments” and “county and city governments” organization type prioritized evaluation criteria for the aspect of work, and employee guidance was prioritized among the criteria. The organization type “others (mainly Assemblies)” also—as for the “municipal governments” and “county and city governments” groups—prioritized the evaluation criteria for the aspect of work; crisis management was deemed the most important element of the criteria. The results of this study suggested that, in terms of employee assistance programs, the Directorate-General of Personnel Administration of the Executive Yuan should provide an adequate system of service: This should be pursuant to appropriate employee assistance programs provided by various public sector organizations according to the needs of their employees as well as the diverse objective conditions in which these organizations operate.
... The past research has established the ill-effects of exposure to WB (Rai and Agarwal, 2016;Samnani and Singh, 2012). There is considerable research on the outcomes of WB such as negative emotions (Brotheridge and Lee, 2010;Ciby and Raya, 2018;Glasø and Notelaers, 2012), affective commitment (McCormack et al., 2009;Steele et al., 2020), job satisfaction (Giorgi et al., 2015;Nielsen and Einarsen, 2012;Quine, 2003;Steele et al., 2020), turnover intention (Berthelsen et al., 2011;Coetzee and van Dyk, 2018;Djurkovic et al., 2003;Rosario-Hernández and Millán, 2018), work engagement (Glasø et al., 2011;Rodríguez-Muñoz et al., 2009), burnout (Giorgi et al., 2016;Laschinger et al., 2010;Srivastava and Dey, 2020) and physical and mental health (Ciby and Raya, 2018;Hallberg and Strandmark, 2006;Nielsen and Einarsen, 2012;Steele et al., 2020). ...
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Workplace bullying involves repeated exposure to negative behaviors that need serious attention at the workplaces. Extant research shows that workplace bullying affects turnover intention of the employees. However, there have been limited research efforts towards understanding the multiple mediating mechanisms in the workplace bullying-turnover intention relationship. Drawing from Affective Events Theory, we posit negative emotions and affective commitment as serial multiple mediators in the relationship between workplace bullying and turnover intention. The study was conducted among employees in Information Technology companies in India. The results indicate that workplace bullying influences turnover intention through serial multiple mediators. This study found that workplace bullying evokes negative emotions, which in turn influences affective commitment and subsequently impacts turnover intention. Negative emotions are the proximal effect of a negative work event like bullying that can provoke employees attitudes and behaviors. Managing these negative emotions can reduce the deleterious effects of bullying. Future research directions and implications are also discussed.
Chapter
This chapter chronicles the legislative and jurisprudential history of workplace bullying and analyzes new frameworks for applying employee harassment laws to the digital era. Part I considers the sociolegal underpinnings of workplace harassment found in Title VII of the 1964 Civil Rights Act. The authors discuss how Title VII and its legal progeny gave way to “hostile work environment” claims. Part II discusses leading U.S. Supreme Court precedent, the creation of an affirmative defense for employers, and the limitations of that defense, including those developing in state and local jurisdictions. Part III discusses prevailing solutions and raises questions not yet addressed in the legal literature. Findings reveal that American jurisprudence is ill-set to protect or compensate workers injured by bullying—either cyber or physical.
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Objective. —To assess the prevalence, correlates, and mental health consequences of reported medical training—related abuses.Design. —A longitudinal cohort study of 137 students surveyed from medical school entrance (time 1) through the winter of the fourth training year (time 4).Setting. —A state college of medicine.Outcome Measures. —Reported training-related abuses (measured at time 4) and mental health status measured at times 1 and 4 (depressive and anxiety symptoms, hostility, problem drinking, escapist drinking, alcohol consumption levels, and gender role orientations).Results. —Seventy-two percent of students reported at least one abusive experience during medical training. Females were significantly more likely than males to report gender discrimination, exclusion from informal settings, discomfort from sexual humor, and unwanted sexual advances. Abuse was significantly related to most psychopathological outcomes, controlling for pre-existing psychopathology. Males low in masculinity and females low in femininity were most likely to report abuse.Conclusions. —The data provide further support for the assumption that a high proportion of medical students not only experience the training process as abusive in nature but also suffer measurable psychopathological consequences. Efforts should be made to reform medical education, with a prominent focus on gender role—related issues.(JAMA. 1992;267:692-694)
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In this article the concept of mobbing is introduced. Mobbing means harassing, ganging up on someone, or psychologically terrorizing others at work. Although mobbing is a very old phenomenon, it was not described and systematically researched until the early 1980s. The article begins with a case example, some historical notes, and a definition of mobbing, and then regards mobbing in the context of medical and psychological stress research. Several stages in the development of mobbing are described, based on about 800 case studies. Some epidemiological findings from a representative sample of the Swedish work population are reported. Causes and consequences of mobbing are discussed, and conclusions for prevention and intervention are drawn.