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Workplace bullying is common among nurses and negatively affects several work-related variables, such as job burnout and job satisfaction. However, no study until now has examined the impact of workplace bullying on quiet quitting among nurses. Thus, our aim was to examine the direct effect of workplace bullying on quiet quitting and to investigate the mediating effect of coping strategies on the relationship between workplace bullying and quiet quitting in nurses. We conducted a cross-sectional study with a convenience sample of 650 nurses in Greece. We collected our data in February 2024. We used the Negative Acts Questionnaire-Revised, the Quiet Quitting Scale, and the Brief COPE to measure workplace bullying, quiet quitting, and coping strategies, respectively. We found that workplace bullying and negative coping strategies were positive predictors of quiet quitting, while positive coping strategies were negative predictors of quiet quitting. Our mediation analysis showed that positive and negative coping strategies partially mediated the relationship between workplace bullying and quiet quitting. In particular, positive coping strategies caused competitive mediation, while negative coping strategies caused complimentary mediation. Nurses' managers and policy makers should improve working conditions by reducing workplace bullying and strengthening positive coping strategies among nurses.
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Citation: Galanis, P.; Moisoglou, I.;
Katsiroumpa, A.; Malliarou, M.;
Vraka, I.; Gallos, P.; Kalogeropoulou,
M.; Papathanasiou, I.V. Impact of
Workplace Bullying on Quiet Quitting
in Nurses: The Mediating Effect of
Coping Strategies. Healthcare 2024,12,
797. https://doi.org/10.3390/
healthcare12070797
Academic Editor: Maura MacPhee
Received: 9 March 2024
Revised: 3 April 2024
Accepted: 4 April 2024
Published: 6 April 2024
Copyright: © 2024 by the authors.
Licensee MDPI, Basel, Switzerland.
This article is an open access article
distributed under the terms and
conditions of the Creative Commons
Attribution (CC BY) license (https://
creativecommons.org/licenses/by/
4.0/).
healthcare
Article
Impact of Workplace Bullying on Quiet Quitting in Nurses: The
Mediating Effect of Coping Strategies
Petros Galanis 1, * , Ioannis Moisoglou 2, Aglaia Katsiroumpa 1, Maria Malliarou 2, Irene Vraka 3,
Parisis Gallos 1, Maria Kalogeropoulou 1and Ioanna V. Papathanasiou 2
1Clinical Epidemiology Laboratory, Faculty of Nursing, National and Kapodistrian University of Athens,
11527 Athens, Greece; aglaiakat@nurs.uoa.gr (A.K.); parisgallos@nurs.uoa.gr (P.G.);
mariakalo@nurs.uoa.gr (M.K.)
2Faculty of Nursing, University of Thessaly, 41500 Larissa, Greece; iomoysoglou@uth.gr (I.M.);
malliarou@uth.gr (M.M.); iopapathanasiou@uth.gr (I.V.P.)
3
Department of Radiology, P. & A. Kyriakou Children’s Hospital, 11527 Athens, Greece; irenevraka@yahoo.gr
*Correspondence: pegalan@nurs.uoa.gr
Abstract: Workplace bullying is common among nurses and negatively affects several work-related
variables, such as job burnout and job satisfaction. However, no study until now has examined the
impact of workplace bullying on quiet quitting among nurses. Thus, our aim was to examine the
direct effect of workplace bullying on quiet quitting and to investigate the mediating effect of coping
strategies on the relationship between workplace bullying and quiet quitting in nurses. We conducted
a cross-sectional study with a convenience sample of 650 nurses in Greece. We collected our data in
February 2024. We used the Negative Acts Questionnaire—Revised, the Quiet Quitting Scale, and
the Brief COPE to measure workplace bullying, quiet quitting, and coping strategies, respectively.
We found that workplace bullying and negative coping strategies were positive predictors of quiet
quitting, while positive coping strategies were negative predictors of quiet quitting. Our mediation
analysis showed that positive and negative coping strategies partially mediated the relationship
between workplace bullying and quiet quitting. In particular, positive coping strategies caused
competitive mediation, while negative coping strategies caused complimentary mediation. Nurses’
managers and policy makers should improve working conditions by reducing workplace bullying
and strengthening positive coping strategies among nurses.
Keywords: bullying; quiet quitting; nurses; workplace; coping strategies; mediation analysis
1. Introduction
Incidents of violence are a frequently occurring phenomenon in the working life of
nurses. Workplace bullying is a type of violence, which can take the form of persistent
negative mistreatment, consisting of frequent and constant criticism and person-related
physical, verbal, or psychological violence [
1
,
2
]. Any conflict or confrontation in the
workplace does not constitute bullying, which has certain defining characteristics. These
include the fact that the employee is systematically targeted (by peers, superiors, or even
subordinates) by becoming the subject of negative and unwanted social behavior in the
workplace; this targeting lasts for a long period of time and the victim of this behavior can
neither easily escape the situation nor stop the unwanted treatment [
3
]. It is estimated that
at least one in ten healthcare professionals is a victim of workplace bullying [
4
,
5
], while
the prevalence among nurses varies between 2.4% and 94% [
6
,
7
]. A systematic review of
qualitative studies highlighted the “faces” of nurses’ bullying, where they indicated that
they experienced being excluded and isolated, facing verbal abuse and hostility, and being
excessively scrutinized, silenced, oppressed, and threatened by those in power. They also
reported being trapped in a system of intimidation, being provided with limited career
opportunities, and having their reputation damaged [8].
Healthcare 2024,12, 797. https://doi.org/10.3390/healthcare12070797 https://www.mdpi.com/journal/healthcare
Healthcare 2024,12, 797 2 of 12
The factors that trigger the occurrence of bullying in the working environment of
nurses are mostly related to organizational issues. In particular, the work characteristics
of the nursing profession, such as work overload, shift work, job demands, severe staff
shortages, and stress, were found to be associated with the development of bullying behav-
ior [
9
,
10
]. Also, supervisors lack adequate skills to manage bullying incidents and support
victims; in addition, lack of organizational support and support from colleagues, disruptive
working relationships, tolerance of bullying incidents, lack of policies on bullying, and lack
of prevention measures are some of the most important antecedents for the occurrence
of bullying incidents among nursing staff [
9
,
10
]. The effects of bullying are multidimen-
sional and affect nurses, patients, and the functioning of the organization. Nurses who
are bullied are more likely to experience stress, burnout, job dissatisfaction, depression,
anxiety, post-traumatic stress disorder, low self-esteem, physical health symptoms, and
deterioration in the quality of their work life [
9
,
11
,
12
]. Patients who are hospitalized in
departments where nursing staff experience bullying may experience errors and adverse
events and may not receive comprehensive nursing care [
13
15
]. At the organizational
level, nurses’ relationships are disrupted as barriers to teamwork and communication
develop due to bullying incidents [
13
]. Also, high rates of absenteeism of nurses from
work are recorded; they have a reduced commitment to the organization and report their
turnover intention [6,16,17].
In the case of bullying incidents, the reaction of the victim is crucial, especially the
reaction of their management. Studies show that nurses use both positive and negative
management strategies [
18
20
]. The positive ones include being problem-focused, seeking
social support, and having crucial conversations. The negative ones, which are often the
most common reactions, include wishful thinking, detachment, evasion, substance use,
and leaving the organization. By choosing avoidance and wishful thinking, no reduction
in bullying incidents is achieved; the problem remains and will continue to manifest. The
other negative strategies actually harm the nurses (substance use) and have negative con-
sequences for the functioning of the healthcare organization (leaving the organization).
The above makes it imperative to train nursing staff in the optimal management of bully-
ing incidents, as well as to establish organizational policies of zero tolerance to violence
regardless of where it comes from.
During the COVID-19 pandemic, a new phenomenon emerged among employees,
that of quiet quitting, which was presented on the video creation and sharing platform,
TikTok [
21
]. Employees who opt for quiet quitting do not resign from their job or their
professions but reduce their performance. Specifically, they perform the minimum require-
ments of their job, barely enough to avoid being fired, do not express new ideas, do not
stay overtime, and do not arrive at work earlier than the designated arrival time [
21
,
22
].
Although some argue that this is an old phenomenon [
23
], until recently there was no
literature on the extent of the issue, the factors that cause it, and its impact. A large study in
the business sector in the US during the COVID-19 pandemic by Gallup showed that half
of the employees are quiet quitters [
24
]. In the same period, a study of the phenomenon
was also initiated in the healthcare sector, with the development of a reliable and valid tool
for measuring quiet quitting [
25
], which revealed that in this sector too, more than 50%
of employees opt for quiet quitting, highlighting the urgency of the issue [
26
]. In partic-
ular, nurses had the highest rates of quiet quitting (67.4%) compared to other healthcare
professionals [
26
]. Studies have shown that burnout is a predictor of quiet quitting [
27
],
which in turn increases the likelihood of turnover intention among nurses [
28
], while moral
resilience negatively influences the occurrence of quiet quitting [
29
]. To the best of our
knowledge, no study until now has examined the impact of workplace bullying on quiet
quitting in nurses. Thus, our first hypothesis was the following:
H1. Workplace bullying would have a direct effect on quiet quitting in nurses. In other words, we
hypothesized that the higher the levels of workplace bullying, the higher the quiet quitting in nurses.
Healthcare 2024,12, 797 3 of 12
The highly demanding nursing profession often confronts nurses with stressful situa-
tions that affect their physical and mental health. Faced with these situations, regardless
of the degree of organizational support, nurses are required to cope with them in order
to reduce their negative impact. Coping with a stressful situation is the third part of a
procedure, where the primary appraisal is the process of perceiving a threat to oneself, the
secondary appraisal is the process of bringing to mind a potential response to the threat,
and coping is the process of executing that response [
30
]. Studies have shown the bene-
ficial effect of coping strategies on nurses in reducing their levels of stress, burnout, and
compassion fatigue and enhancing their psychological well-being [
31
34
]. Considering the
essential role of coping strategies as mediators in studies including nurses, we examined
the following second hypothesis:
H2. Coping strategies would be a mediator in the relationship between workplace bullying and
quiet quitting in nurses. In other words, we hypothesized that nurses who received more workplace
bullying may employ more maladaptive (or negative) coping strategies (e.g., self-blame) and less
adaptive (or positive) coping strategies (e.g., active coping), and therefore experience higher levels of
quiet quitting.
In short, our aim was to examine the direct effect of workplace bullying on quiet
quitting and to investigate the mediating effect of coping strategies on the relationship
between workplace bullying and quiet quitting in nurses (Figure 1).
Healthcare 2024, 12, x 3 of 13
H1. Workplace bullying would have a direct effect on quiet quitting in nurses. In other words, we
hypothesized that the higher the levels of workplace bullying, the higher the quiet quitting in nurses.
The highly demanding nursing profession often confronts nurses with stressful
situations that affect their physical and mental health. Faced with these situations,
regardless of the degree of organizational support, nurses are required to cope with them
in order to reduce their negative impact. Coping with a stressful situation is the third part
of a procedure, where the primary appraisal is the process of perceiving a threat to oneself,
the secondary appraisal is the process of bringing to mind a potential response to the
threat, and coping is the process of executing that response [30]. Studies have shown the
beneficial effect of coping strategies on nurses in reducing their levels of stress, burnout,
and compassion fatigue and enhancing their psychological well-being [3134].
Considering the essential role of coping strategies as mediators in studies including
nurses, we examined the following second hypothesis:
H2. Coping strategies would be a mediator in the relationship between workplace bullying and
quiet quitting in nurses. In other words, we hypothesized that nurses who received more workplace
bullying may employ more maladaptive (or negative) coping strategies (e.g., self-blame) and less
adaptive (or positive) coping strategies (e.g., active coping), and therefore experience higher levels
of quiet quitting.
In short, our aim was to examine the direct effect of workplace bullying on quiet
quitting and to investigate the mediating effect of coping strategies on the relationship
between workplace bullying and quiet quitting in nurses (Figure 1).
Figure 1. Structural model depicting the relationships between workplace bullying, coping
strategies, and quiet quitting.
2. Materials and Methods
2.1. Study Design
We conducted a web-based cross-sectional study with nurses in Greece. We used
Google forms to create an online version of the study questionnaire. Then, we distributed
the questionnaire through nursing groups on Facebook, LinkedIn, Viber, and WhatsApp.
Thus, a convenience sample was obtained. Our inclusion criteria were the following: (a)
nurses who have been working in clinical settings, such as hospitals and healthcare
centers, (b) nurses who have been working for at least two years in order to experience
workplace bullying, and (c) nurses who understand the Greek language. We collected our
data in February 2024.
Workplace bullying Quiet quitting
Coping strategies
Figure 1. Structural model depicting the relationships between workplace bullying, coping strategies,
and quiet quitting.
2. Materials and Methods
2.1. Study Design
We conducted a web-based cross-sectional study with nurses in Greece. We used
Google forms to create an online version of the study questionnaire. Then, we distributed
the questionnaire through nursing groups on Facebook, LinkedIn, Viber, and WhatsApp.
Thus, a convenience sample was obtained. Our inclusion criteria were the following:
(a) nurses
who have been working in clinical settings, such as hospitals and healthcare
centers, (b) nurses who have been working for at least two years in order to experience
workplace bullying, and (c) nurses who understand the Greek language. We collected our
data in February 2024.
2.2. Measures
We used the Negative Acts Questionnaire—Revised (NAQ-R) to measure workplace
bullying among nurses [
35
]. The NAQ-R consists of 22 items measuring work-related
bullying, person-related bullying, and physically intimidating bullying during the last
Healthcare 2024,12, 797 4 of 12
six months. Answers are on a 5-point Likert scale: never (1), now and then (2), monthly
(3), weekly (4), and daily (5). A total score from 22 to 110 is obtained by summing up all
answers. Higher scores on NAQ-R indicate higher levels of workplace bullying. We used
the valid Greek version of the NAQ-R [
36
]. In particular, Kakoulakis et al. [
36
] validated
the Greek version of the NAQ-R in a sample of teachers by investigating the reliability
and validity of the tool. In that study, Cronbach’s alpha for the NAQ-R was 0.83, while
the concurrent validity of the tool was high since scholars found statistically significant
correlations between NAQ-R and self-esteem (r =
0.364), stress (r = 0.406), and depression
(r = 0.389). In our study, Cronbach’s alpha for the NAQ-R was 0.963.
We used the Quiet Quitting Scale (QQS) to measure the levels of quiet quitting among
our nurses [
25
]. The Greek version of the QQS has been validated in a sample of nurses
in Greece [
26
]. The QQS consists of nine items measuring detachment, lack of initiative,
and lack of motivation. Answers are on a 5-point Likert scale: strongly disagree/never (1),
disagree/rarely (2), neither disagree or agree/sometimes (3), agree/often (4), and strongly
agree/always (5). Answers to nine items are averaged to compose an overall score on
QQS. Overall QQS score takes values from 1 (low levels of quiet quitting) to 5 (high levels
of quiet quitting). Developers of the QQS suggest a cut-off point of 2.06 to discriminate
quiet quitters from non-quiet quitters [
37
]. In that study, researchers used a sample of
workers from every job sector to identify a cut-off point for the QQS. In particular, they
used several external criteria (i.e., the “Job Satisfaction Survey”, the “Copenhagen Burnout
Inventory”, and the “Single Item Burnout Measure”) and they performed the Receiver
Operating Characteristic analysis to estimate the best cut-off point for the scale. In our
study, Cronbach’s alpha for the QQS was 0.816.
We used the Brief COPE to measure coping strategies in our sample [
38
]. The Brief
COPE consists of 28 items measuring the following 14 dimensions: self-distraction, active
coping, denial, substance use, use of emotional support, use of instrumental support,
behavioral disengagement, venting, positive reframing, planning, humor, acceptance,
religion, and self-blame. Answers are on a 4-point Likert scale: I have not been doing
this at all (1), I have been doing this a little bit (2), I have been doing this a medium
amount (3), and I have been doing this a lot (4). The score ranges from 1 to 4. Higher
values indicate a higher adaptation of coping strategy. We used the valid Greek version of
the Brief COPE [
39
]. In this study, scholars used a sample of Greek-speaking adults and
found adequate psychometric properties for the Greek version of the scale. In particular,
scholars performed exploratory and confirmatory factor analysis, and they calculated
Cronbach’s alpha for the factors. In our study, all Cronbach’s alphas for the 14 dimensions
were above 0.60. A recent systematic review revealed that most studies used the Brief
COPE have identified a two-factor structure: approach or positive coping strategies (active
coping, use of emotional support, use of instrumental support, positive reframing, planning,
acceptance, religion, venting, and humor) and avoidance or negative coping strategies
(self-distraction, denial, self-blame, behavioral disengagement, and substance use) [
40
].
Thus, we followed this two-factor structure in our study. In other words, approach coping is
considered a positive/adaptive/engaged/active/direct strategy, while avoidance coping is
considered a negative/maladaptive/disengaged/indirect strategy. Scores on positive and
negative coping strategies range from 1 (low adaptation of strategy) to 4 (high adaptation
of strategy).
We considered gender (females/males), age (continuous variable), understaffed de-
partment (no/yes), clinical experience (continuous variable), and shift work (no/yes) as
covariates in the mediation models.
2.3. Ethical Issues
We informed nurses about the aim and the design of the study and obtained their
informed consent to participate. We did not collect personal data. We followed the
guidelines of the Declaration of Helsinki in our study. The study protocol was approved by
Healthcare 2024,12, 797 5 of 12
the Ethics Committee of the Faculty of Nursing, National and Kapodistrian University of
Athens (approval number; 479, 10 January 2024).
2.4. Statistical Analysis
As we explained above, we considered positive (approach) coping and negative
(avoidance) coping as potential mediators in the relationship between workplace bullying
(independent variable) and quiet quitting (dependent variable). Hair et al. suggest that
the number of participants should be at least 10 times that of the study variables in the
mediation analysis [
41
]. Since the NAQ-R (predictor variable) consists of 22 items, the Brief
COPE (mediator variable) consists of 28 items, and the number of covariates was five; the
required sample size was 550 nurses (=55 variables ×10 = 550).
We present categorical variables with numbers and percentages. Moreover, we present
continuous variables with mean, standard deviation, median, minimum value, maximum
value, and range. We calculated Pearson’s correlation coefficient to determine the correla-
tion between workplace bullying, quiet quitting, positive coping strategies, and negative
coping strategies. We constructed a multivariable linear regression model to determine the
independent effect of workplace bullying on quiet quitting. In that case, we eliminated
the confounding caused by demographic and job characteristics of nurses. The correlation
between age and clinical experience was very high (r = 0.912, p< 0.001). Thus, to avoid
collinearity in the multivariable linear regression model, we decided to include one variable
(age) in our model. We present adjusted coefficients beta, 95% confidence intervals (CI),
and p-values for variables in the multivariable linear regression model.
We used the PROCESS macro (Model 4) [
42
] to test the mediating effect of positive
and negative coping strategies in the relationship between workplace bullying and quiet
quitting. We based our mediation analysis on 5000 bootstrap samples [
43
]. We calculated
the 95% Cis, regression coefficients (b), and standard errors. The p-values less than 0.05
were considered statistically significant. We used IBM SPSS 21.0 (IBM Corp. Released
2012; IBM SPSS Statistics for Windows, Version 21.0.: IBM Corp., Armonk, NY, USA) for
statistical analysis.
3. Results
3.1. Demographic and Job Characteristics
Our sample included 665 nurses. The mean age of nurses was 38.9 years (SD = 10.1),
while the median and range were 39 and 42 years, respectively. The majority of nurses
were females (87.7%). Among our nurses, 80.2% stated that they have been working
in understaffed departments and 74.4% were shift workers. The mean years of clinical
experience were 14.1 (SD = 10.2), the median value was 14 years, and the range was 39
years. Table 1shows the detailed demographic and job characteristics of our nurses.
Table 1. Demographic and job characteristics of nurses (N = 665).
Variables N %
Gender
Males 82 12.3
Females 583 87.7
Age (years) a38.9 10.1
Understaffed department
No 132 19.8
Yes 533 80.2
Clinical experience (years) a14.1 10.2
Shift work
No 170 25.6
Yes 495 74.4
amean, standard deviation.
Healthcare 2024,12, 797 6 of 12
3.2. Study Scales
Descriptive statistics for the study scales are shown in Table 2. The mean value of the
NAQ-R was 51.3 (SD = 20.6), while the mean value of the QQS was 2.5 (SD = 0.6). Applying
the cut-off point (2.06) for the QQS, we found that 77.3% (n= 514) of our nurses were
quiet quitters, while 22.7% (n= 151) were non-quiet quitters. Nurses employed positive
coping strategies more often than negative coping strategies, since the mean scores were
2.6 (SD = 0.5) and 2.0 (SD = 0.5), respectively.
Table 2. Descriptive statistics for the study scales (N = 665).
Scale Mean Standard
Deviation
Median
Minimum
Value
Maximum
Value Range
Negative Acts Questionnaire—Revised 51.3 20.6 46.0 22 108 86
Quiet Quitting Scale 2.5 0.6 2.4 1 5 4
Brief COPE
Positive coping strategies 2.6 0.5 2.6 1 4 3
Negative coping strategies 2.0 0.5 2.0 1 4 3
3.3. Correlation Analysis
Table 3shows Pearson’s correlation analysis of workplace bullying, quiet quitting,
positive coping strategies, and negative coping strategies. We found a positive correlation
between workplace bullying and quiet quitting (r = 0.453, p< 0.001), positive coping strate-
gies (r = 0.244, p< 0.001), and negative coping strategies (r = 0.423, p< 0.001). Moreover,
we found a positive correlation between negative coping strategies and quiet quitting
(r = 0.395, p< 0.001).
Table 3. Pearson’s correlation analysis among workplace bullying, quiet quitting, positive coping
strategies, and negative coping strategies.
Variables Quiet Quitting Positive Coping
Strategies
Negative Coping
Strategies
Workplace bullying 0.453 *** 0.244 *** 0.423 ***
Quiet quitting 0.060 0.395 ***
*** p< 0.001.
3.4. Regression Analysis
We conducted a multivariable linear regression analysis to examine Hypothesis 1.
We found that workplace bullying had an independent positive effect on quiet quitting
(adjusted beta = 0.010, 95% CI = 0.008 to 0.012, p< 0.001). Workplace bullying explained
20.4% of the variance of quiet quitting. Therefore, Hypothesis 1 was proved. Gender,
positive coping strategies, and negative coping strategies were also associated with quiet
quitting. These three independent variables explained 7.7% of the variance of quiet quitting.
Analysis of variance for the multivariable model was statistically significant (p< 0.001).
Table 4shows the detailed results from the multivariable linear regression analysis.
Table 4. Multivariable linear regression analysis with quiet quitting as the dependent variable.
Independent Variables Coefficient
Beta
95% Confidence
Interval p-Value
Males vs. females 0.156 0.041 to 0.271 0.008
Age 0.001 0.005 to 0.003 0.511
Understaffed department (yes vs. no) 0.033 0.064 to 0.130 0.508
Shift work (yes vs. no) 0.076 0.014 to 0.165 0.096
Workplace bullying 0.010 0.008 to 0.012 <0.001
Positive coping strategies 0.169 0.251 to 0.087 <0.001
Negative coping strategies 0.382 0.285 to 0.479 <0.001
Healthcare 2024,12, 797 7 of 12
3.5. Mediation Analysis
Table 5shows the indirect impact of workplace bullying on quiet quitting through
positive and negative coping strategies. Our mediation analysis showed that the indirect
mediated effect of workplace bullying on quiet quitting through positive coping strategies
was significant (b =
0.0011, 95% CI =
0.0017 to
0.0005, p< 0.0001). Workplace bullying
was a significantly positive predictor of quiet quitting (b = 0.0128, 95% CI = 0.0109 to 0.0147,
p< 0.0001). Workplace bullying was a significantly positive predictor of positive coping
strategies (b = 0.0060, 95% CI = 0.0042 to 0.0078, p< 0.0001), while positive coping strategies
were a significantly negative predictor of quiet quitting (b =
0.1754,
95% CI = 0.2574
to
0.0933, p< 0.0001). Additionally, workplace bullying was a significantly positive predictor
of negative coping strategies (b = 0.0094, 95% CI = 0.0079 to 0.0110, p< 0.0001), while nega-
tive coping strategies were a significantly positive predictor of quiet quitting (
b = 0.3864
,
95% CI = 0.2891 to 0.4837, p< 0.0001). Moreover, the direct effect of workplace bullying on
quiet quitting was still significant (b = 0.0103, 95% CI = 0.0082 to 0.0122,
p< 0.0001
) even
after the mediating effect of positive and negative coping strategies. Positive and negative
coping strategies partially mediated the relationship between workplace bullying and quiet
quitting since the direct and indirect effects of workplace bullying were significant. Positive
coping strategies caused partial competitive mediation, while negative coping strategies
caused partial complementary mediation. In conclusion, our mediation analysis supported
Hypothesis 2. Figure 2presents the final mediation model.
Healthcare 2024, 12, x 8 of 13
Figure 2. Structural mediation model using PROCESS macro with path coefficients and p-values of
positive and negative coping strategies as the mediators in the relationship between workplace
bullying and quiet quitting.
4. Discussion
The present study revealed that workplace bullying and negative coping strategies
were positive predictors of quiet quitting, while positive coping strategies were negative
predictors of quiet quitting. The mediation analysis showed that positive and negative
coping strategies partially mediated the relationship between workplace bullying and quiet
quitting.
The present study is the first to highlight the association between bullying and quiet
quitting among nurses. We found that 77.3% of our participants can be considered quiet
quitters. The high incidence of bullying in healthcare organizations may exacerbate the
phenomenon of quiet quitting, which in any case seems to be widespread. Nurses who
opt for quiet quitting are actually giving an image of adequate staffing, where underneath
the numerical staffing lies reduced performance, lack of creativity, and innovative
behavior. Nurses are caught in the middle of a constant tug-of-war, where on one side are
the high job demands and requirements to improve the outcomes of healthcare
organizations, and on the other side is the long-standing inability of healthcare
organizations to ensure adequate resources and organizational support needed in the
challenging task of providing healthcare by nurses. As a result of the above, nurses
experience high rates of burnout, dissatisfaction, stress, and depression. Bullying is
another burdening factor in the work environment of nurses, as it becomes a source of
burnout, depression, psycho-physical consequences, turnover, and leaving the nursing
profession [44–46]. By opting for quiet quitting, employees are essentially trying to
balance their personal and work lives [21]. A study by the Harvard Business Review in
the field of business showed that as a managers ability to balance between achieving
results and caring about others increases, quiet quitting decreases and employees
willingness to put in more effort increases [47]. Similar findings were observed in the
Workplace bullying Quiet quitting
Positive coping
strategies
c΄ = 0.0103 (p<0.0001)
Negative coping
strategies
Figure 2. Structural mediation model using PROCESS macro with path coefficients and p-values
of positive and negative coping strategies as the mediators in the relationship between workplace
bullying and quiet quitting.
Healthcare 2024,12, 797 8 of 12
Table 5. Mediation effect of coping strategies on the relationship between workplace bullying and
quiet quitting.
Outcome Mediation Analysis Paths Regression
Coefficient SE 95% Bias-Corrected CI
p-Value
LLCI ULCI
Quiet quitting Total effect 0.0128 0.0010 0.0109 0.0147 <0.0001
Direct effect 0.0103 0.0010 0.0082 0.0122 <0.0001
Indirect effect of positive coping strategies 0.0011 0.0003 0.0017 0.0005 <0.0001
Indirect effect of negative coping strategies 0.0036 0.0006 0.0084 0.0049 <0.0001
Workplace bullying Positive coping strategies 0.0060 0.0090 0.0042 0.0078 <0.0001
Positive coping strategies Quiet quitting 0.1754 0.0418 0.2574 0.0933 <0.0001
Workplace bullying Negative coping strategies 0.0094 0.0008 0.0079 0.0110 <0.0001
Negative coping strategies Quiet quitting 0.3864 0.0496 0.2891 0.4837 <0.0001
LLCI: lower limit of confidence interval; SE: standard error; ULCI: upper limit of confidence interval.
4. Discussion
The present study revealed that workplace bullying and negative coping strategies
were positive predictors of quiet quitting, while positive coping strategies were negative
predictors of quiet quitting. The mediation analysis showed that positive and negative
coping strategies partially mediated the relationship between workplace bullying and quiet
quitting.
The present study is the first to highlight the association between bullying and quiet
quitting among nurses. We found that 77.3% of our participants can be considered quiet
quitters. The high incidence of bullying in healthcare organizations may exacerbate the
phenomenon of quiet quitting, which in any case seems to be widespread. Nurses who opt
for quiet quitting are actually giving an image of adequate staffing, where underneath the
numerical staffing lies reduced performance, lack of creativity, and innovative behavior.
Nurses are caught in the middle of a constant tug-of-war, where on one side are the
high job demands and requirements to improve the outcomes of healthcare organizations,
and on the other side is the long-standing inability of healthcare organizations to ensure
adequate resources and organizational support needed in the challenging task of providing
healthcare by nurses. As a result of the above, nurses experience high rates of burnout,
dissatisfaction, stress, and depression. Bullying is another burdening factor in the work
environment of nurses, as it becomes a source of burnout, depression, psycho-physical
consequences, turnover, and leaving the nursing profession [
44
46
]. By opting for quiet
quitting, employees are essentially trying to balance their personal and work lives [
21
]. A
study by the Harvard Business Review in the field of business showed that as a manager’s
ability to balance between achieving results and caring about others increases, quiet quitting
decreases and employees’ willingness to put in more effort increases [
47
]. Similar findings
were observed in the health sector regarding bullying, where nurse managers with a low
relationship-oriented leadership style are associated with the occurrence of bullying and
turnover intention [
48
]. When the nurse manager chooses caring leadership, it reduces the
likelihood of their staff being exposed to bullying behavior [
49
]. Also, when the victims of
bullying receive organizational support, their satisfaction increases and absenteeism from
work decreases [50].
Regardless of the manager’s response to the bullying and the degree of organizational
support, the nurse is also required to cope with the stressful situation of the bullying
episode in which they are involved. The results of the present study showed that nurses
choose more positive bullying management strategies compared to negative ones. These
findings are consistent with those of other studies, where positive strategies also scored
higher [
19
,
20
]. However, studies show that there is great diversity in the bullying coping
strategies chosen by nurses. A cross-cultural scoping review showed that nurses used
emotion-focused coping strategies more frequently almost in all clusters [
9
]. In a study
involving nurses from Portugal, negative bullying coping strategies including substance
use and resorting to evasion predominated, and in their majority, nurses did not receive
training on bullying management [
20
]. In contrast, nurses in Australia seem to choose
Healthcare 2024,12, 797 9 of 12
positive coping strategies such as being problem-focused and seeking social support [
51
].
In another study, the nurses were more likely to report distraction, substance use, emotional
support, disengagement, venting, positive reframing, humor, and religion [52]. Therefore,
an effective attempt to address the problem is to provide nurses with the skills and guidance
needed to deal with bullying, using positive coping strategies such as conflict management
and assertiveness [53].
As bullying is a negative and stressful incident in the workplace, the choice of positive
coping strategies by the victim is an effective factor in mitigating the negative effects of the
incident and contributing to the well-being of the victim [
54
]. When nurses apply positive
bullying coping strategies, such as more approach-oriented strategies and fewer avoidance-
oriented strategies, these strategies are found to be associated with greater psychological
well-being and fewer mood disturbances [
33
,
55
]. Psychological well-being in turn was
directly related to the quality of nurses’ practice environment and safety attitudes [
33
]. As
bullying deteriorates the quality of nurses’ working lives, the adoption of positive bullying
coping strategies moderates this negative effect [
56
]. Another effective bullying coping
strategy that can be utilized is resilience and mental resilience. Studies have shown their
beneficial effect on nurses in terms of reducing COVID-19 pandemic burnout, job burnout,
quiet quitting, and turnover intention [
29
,
57
]. In the case of workplace bullying, nurses
with a high degree of resilience succeed in reducing the negative impact of bullying on the
quality of their work life, as resilience acts as a mediating factor [
58
]. Although bullying
negatively affects nurses’ self-efficacy, when it is cultivated and employed as the coping
strategy for bullying, it serves as a mediating factor for the negative impact of bullying on
both nurses’ mental health and on their intention to leave [59].
Limitations
Our study had several limitations. First, we cannot infer a causal relationship be-
tween workplace bullying and quiet quitting since we employed a cross-sectional design.
Longitudinal studies that prospectively measure workplace bullying, quiet quitting, and
coping strategies among nurses will add significant information. Second, we conducted
a web-based study and, therefore, we cannot calculate the response rate. Future studies
should employ a paper–pencil survey method that allows scholars to calculate the response
rate. Third, we used a convenience sample of nurses in Greece. There is no nurses’ registry
in Greece and, thus, a random sample cannot be achieved. For instance, the majority
of our nurses were females and have been working in understaffed departments. Thus,
we cannot generalize our results although we achieved the minimum sample size for
our study. Further studies with random and more representative samples would add
invaluable knowledge. Additionally, studies in other countries with different clinical and
cultural settings will offer the ability to make comparisons. Fourth, we examined the
mediating effect of coping strategies on the relationship between workplace bullying and
quiet quitting. Other variables can also act as mediators and should be investigated in the
future. For instance, personality characteristics, organizational variables, and managers’
characteristics such as transformational leadership and organizational support can be con-
sidered as mediators in future studies. Fifth, we considered several socio-demographic
characteristics as covariates in the mediation models. However, scholars should include
more socio-demographic variables in the mediation models to further increase the validity
of the results. Finally, we used self-reported scales to collect our data. Although our scales
are valid and reliable, information bias is still possible.
5. Conclusions
Bullying is a negative aspect of the nurses’ work environment, with a significant
prevalence. The present study highlighted its impact on nurses’ quiet quitting and the
crucial role of bullying coping strategies in mediating its impact on quiet quitting. As quiet
quitting is becoming increasingly prevalent across a wide range of businesses, including the
healthcare sector, reducing the phenomenon of bullying should be an important priority
Healthcare 2024,12, 797 10 of 12
for the management of healthcare organizations, with the objective of addressing the
phenomenon of quiet quitting as well. The participants of the present study were found to
apply positive bullying coping strategies, which is an effective attitude towards bullying
and contributes to the reduction of its negative effects. Studies in the existing literature
show that nurses often choose negative coping strategies, which have an adverse effect on
both the work environment and on themselves personally (e.g., substance use and mental
health). Therefore, it has become imperative to implement educational interventions to
train nurses in the adoption of positive bullying management strategies. At the same time,
the administrators of healthcare organizations should carry out a diagnostic audit in the
working environment of nurses, in order to identify the existence of factors that favor the
development of bullying behavior and to proceed immediately to the implementation of
necessary interventions.
Author Contributions: Conceptualization, P.G. (Petros Galanis); methodology, P.G. (Petros Galanis),
I.M., A.K., M.M. and I.V.P.; software, P.G. (Petros Galanis) and P.G. (Parisis Gallos); validation, A.K.,
I.V., M.M., P.G. (Parisis Gallos), M.K. and I.M.; formal analysis, P.G. (Petros Galanis), A.K. and I.V.;
investigation, P.G. (Parisis Gallos), M.K., A.K. and I.V.; resources, P.G. (Petros Galanis), M.M., I.V.P.,
A.K., I.V., I.M., M.K. and P.G. (Parisis Gallos); data curation, I.M., M.M., I.V.P., A.K., I.V., M.K. and P.G.
(Parisis Gallos); writing—original draft preparation, P.G. (Petros Galanis), I.M., A.K., M.M., I.V., P.G.
(Parisis Gallos) and I.V.P.; writing—review and editing, P.G. (Petros Galanis), I.M., A.K., M.M., I.V.,
P.G. (Parisis Gallos) and I.V.P.; supervision, P.G. (Petros Galanis); project administration, P.G. (Petros
Galanis) and I.V.P. All authors have read and agreed to the published version of the manuscript.
Funding: This research received no external funding.
Institutional Review Board Statement: The study was conducted in accordance with the Declara-
tion of Helsinki and approved by The Ethics Committee of the Faculty of Nursing, National and
Kapodistrian University of Athens (approval number; 479, 10 January 2024).
Informed Consent Statement: Informed consent was obtained from all subjects involved in the
study.
Data Availability Statement: The data presented in this study are available upon request from the
corresponding author.
Acknowledgments: We acknowledge all the participants who made this study possible.
Conflicts of Interest: The authors declare no conflicts of interest.
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... The prevalence of this newly defined phenomenon in the business world has increased interest in investigating the causes and consequences of quiet quitting. Researches indicate that burnout as an individual cause (Galanis, Moisoglou, Katsiroumpa, et al. 2024;Moon, O'Brien, and Mann 2023) and managerial organisational support (Gabelaia and Bagociunaite 2023) are important reasons for quiet quitting behaviour. Studies conducted in various sectors have identified a lack of appreciation from management and the absence of adequate career opportunities as significant factors contributing to the emergence of quiet quitting behaviour (Pevec 2023). ...
... Therefore, it is believed that the prevalence of quiet quitting behaviour exceeds the currently detected rates. Additionally, it has been reported that quiet quitting is expected to become more widespread among nurses in the future (Galanis, Moisoglou, Katsiroumpa, et al. 2024). The growing prevalence of quiet quitting among nurses poses a significant threat to the nursing workforce and, consequently, the healthcare system. ...
... The literature highlights that the rate of quiet quitting among nurses is quite high, at approximately 60.9%, and this rate is expected to increase even further in the future (Galanis, Moisoglou, Malliarou, et al. 2024). In studies conducted among nurses, the effects of turnover intention (Galanis, Moisoglou, Malliarou, et al. 2024), burnout and job satisfaction (Galanis et al. 2023) and the influence of bullying and negative coping strategies on quiet quitting were assessed (Galanis, Moisoglou, Katsiroumpa, et al. 2024). However, to date, no research has explored the impact of perceived organisational support on quiet quitting among nurses, nor has the mediating role of burnout been examined. ...
Article
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Aim The main purpose of this study was to investigate the potential mediating role of job burnout in the relationship between organisational support and quiet quitting among nurses. Additionally, this study aimed to determine the associations between organisational support, job burnout and quiet quitting. Design This study was a descriptive, cross‐sectional study. Methods This descriptive and cross‐sectional study included a total of 383 nurses. The convenience sampling method was used, and the study was conducted in Türkiye. Self‐reported measures, which included organisational support, job burnout and the quiet quitting scale, were completed by using an online version of the scale. Results Statistically significant associations were found between organisational support, job burnout and quiet quitting. Organisational support had a significant negative effect on quiet quitting. Additionally, job burnout had a positive effect on quiet quitting behaviour. Moreover, job burnout partially mediated the relationship between organisational support and quiet quitting. Conclusion The findings highlight the importance of considering job burnout as a critical factor in mitigating the positive effect of organisational support on quiet quitting. Prioritising the job burnout of healthcare workers plays a significant role in reducing quiet quitting behaviour through organisational support. Impact This study focused on how organisational support and burnout interact with quiet quitting, which is a current issue among nurses, and explained the mediating role of job burnout in the relationship between organisational support and quiet quitting. The main findings of this research provide evidence that organisational support influences quiet quitting behaviour. Similarly, job burnout affects quiet quitting behaviour. Moreover, job burnout plays a mediating role in the relationship between organisational support and quiet quitting behaviour. It has been proven that job burnout is a significant barrier to the impact of organisational support in reducing quiet quitting behaviour. This research will have an impact on the management and strategic planning of healthcare organisations. Reporting Method STROBE reporting method has been followed. Patient or Public Contribution No patient or public contribution.
... The higher scores for 'Lack of motivation' and 'Lack of initiative' suggest that quiet quitting in health care settings may manifest differently than other domains where disengagement is typically more evident, highlighting the role of intrinsic motivation in caring professions, where the work is deeply personal and emotionally demanding [15,24]. A recent observational study by Moisoglou et al. examined the impact of innovation support on quiet quitting, innovation behavior and innovation outcomes in 328 nurses [25]. ...
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Background/Objectives: Quiet quitting, defined as employees fulfilling only the minimal requirements of their roles without extra effort or engagement, poses unique challenges in high-stress environments like hospitals where commitment directly impacts patient care. This study investigates the phenomenon of “quiet quitting” within the healthcare sector, with a specific focus on hospital staff in Greece. Methods: A cross-sectional design was employed, surveying 186 healthcare professionals from the General Hospital of Argos using the Questionnaire for Conflicts in Healthcare Organizations and the Quiet Quitting Scale (QQS). Results: Descriptive and inferential statistical analyses revealed that 62% of participants exhibited characteristics of quiet quitting, with “lack of motivation” scoring highest (M = 2.80, SD = 0.987) among QQS subscales. Significant correlations were observed between perceived reward fairness and motivation levels (r = −0.194, p < 0.01) and between management awareness of contributions and both motivation (r = −0.313, p < 0.01) and initiative (r = −0.192, p < 0.01). Logistic regression identified perceptions of management awareness as a key predictor of quiet quitting (p < 0.05). Conclusions: The findings emphasize the critical role of equitable reward systems and managerial recognition in reducing disengagement. Strategies to enhance employee engagement and resolve workplace conflicts are essential for fostering a resilient healthcare workforce.
... Early studies in the healthcare sector showed the extent of the phenomenon, with nurses compared to other healthcare professionals choosing quiet quitting at a rate of over 60% [22]. Burnout and bullying have been identified as contributing factors to the occurrence of quiet quitting, while emotional intelligence and moral resilience reduce the likelihood of this work-related behavior [23][24][25][26]. ...
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Introduction High workloads among nurses affect critical workplace outcomes, such as turnover intention, job burnout, and job satisfaction. However, there are no studies that measure the relationships between workload and these variables in the post-COVID-19 era. Objective To evaluate the effect of workload on quiet quitting, turnover intention, and job burnout. Methods We conducted a cross-sectional study using a sample of nurses in Greece. The NASA task load index was used to measure workloads among nurses. Also, we used valid scales to measure quiet quitting (quiet quitting scale), job burnout (single item burnout measure), and turnover intention (a six-point Likert scale). Results The mean workload score was 80.7, indicating high workloads in our sample. Moreover, most of the nurses belonged to the group of quiet quitters (74.3%). About half of the nurses reported a high level of turnover intention (50.2%). After controlling for confounders, data analysis showed that higher workloads were associated with higher levels of quiet quitting [beta = 0.009, 95% confidence interval (CI) = 0.006 to 0.012, p-value < 0.001], turnover intention (odds ratio = 1.046, 95% CI = 1.035 to 1.056, p-value < 0.001), and job burnout (beta = 0.072, 95% CI = 0.065 to 0.079, p-value < 0.001). Conclusion We found that workload was associated with quiet quitting, turnover intention, and job burnout in nurses. Thus, appropriate interventions should be applied to reduce nursing workloads to improve productivity and the healthcare provided to patients.
... The phenomenon is very novel, and a reliable and valid measurement tool has just lately been created, resulting in restricted studies within the health sector [9]. Factors contributing to the quiet quitting among nursing personnel include burnout and bullying at work [10,11], whereas moral resilience, emotional intelligence, and support for innovation serve as protective elements [12][13][14]. Nurses who engage in quiet quitting are more prone to express turnover intentions [15]. ...
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Background/Objectives: The nursing work environment, encompassing accessible resources and established processes, might affect nurses' professional behavior. Our aim was to examine the effect of nurse work environment on quiet quitting and work engagement among nurses. Methods: We performed a cross-sectional study with nurses in Greece. We used the “Practice Environment Scale-5” to measure nurse work environment, the “Quiet Quitting Scale” to measure quiet quitting, and the “Utrecht Work Engagement Scale-3” to measure work engagement among nurses. We developed multivariable regression models adjusted for gender, age, understaffed ward, shift work, and work experience. Results: After controlling for confounders, we found that lower nurse participation in hospital affairs, worse collegial nurse‐physician relationships, worse nursing foundations for quality of care, and lower levels of nurse manager ability, leadership, and support were associated with higher levels of quiet quitting among nurses. Moreover, our multivariable analysis identified a positive association between nurse manager ability, leadership, and support, collegial nurse‐physician relationships, nursing foundations for quality of care and work engagement among nurses. Conclusion: We found that poor nurses’ work environment was associated with higher levels of quiet quitting. Moreover, our findings showed that nurses work environment had a positive impact on work engagement.
... We can also take action to develop positive coping strategies to mediate the effects (including quiet quitting) of bullying and other negative workplace events. According to Galanis et al. (2024), such strategies include emotional and instrumental support, positive reframing, problem-focused planning, acceptance, venting or having crucial conversations and humour. ...
... A work environment where bullying occurs is a stressful environment where employees feel intimidated, abused, or insulted, resulting in a stressful work experience [32]. Workplace bullying among nurses can lead to a number of psychological and mental health outcomes and work behaviors such as quiet quitting [67], depression, suicidal ideation, post-traumatic stress disorder, deterioration in the quality of their work life [68], job dissatisfaction [51], and burnout [69]. Physical health symptoms experienced by bullied nurses include headaches, eating disorders, onset of chronic diseases, and sleep disturbances [40]. ...
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The bullying of nurses by patients, doctors, and employees is common in the healthcare industry. Nurses who are bullied are more likely to experience burnout, and nurses who experience burnout are more likely to intend to quit. However, few studies investigate how leadership can mitigate workplace incivility and nurse bullying as a way to improve nurse retention. A cross-sectional study was conducted using a sample of 216 nurses recruited from various regions across the United States from different specialties. A moderated mediation model using path analysis was used to examine the relationships between bullying, burnout, and ethical leadership in predicting intentions to stay. Bullying significantly and positively related to burnout (β = 0.22, p=0.02), and burnout significantly and negatively related to intent to stay (β = −0.18,p=0.01). Perceived ethical leadership predicted intentions to stay (β = 0.62, p=0.00), and ethical leadership moderated the effect of bullying on burnout (β = 0.20, p=0.03). The results of our study also suggest that nurses are less likely to quit when ethical leadership is present, and ethical leadership weakens the effect of bullying on burnout.
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Objetivo: analizar la ansiedad desde la perspectiva de la enfermería. Método: Descriptiva documental. Resultados y conclusión: La fuente de estrés en el personal de enfermería comúnmente citada en los diferentes estudios ha sido, con diferencia, la carga del trabajo, seguida de las relaciones con los pacientes, el contacto con la muerte, los problemas con los compañeros y los conflictos con los superiores, y en menor medida también se hace referencia a los conflictos con los médicos, sentir que se tiene una preparación inadecuada y la incertidumbre relativa al tratamiento.
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OBJECTIVE To identify an appropriate cutoff point for the "Quiet Quitting" Scale (QQS), in order to discriminate quiet quitters from those with a low level of quiet quitting. METHOD A cross-sectional study in Greece during June 2023 was conducted. We recruited adult employees from every job sector and achieved to obtain a convenience sample. The Receiver Operating Characteristic analysis was used to calculate the best cutoff point for the QQS. In that case, "Job Satisfaction Survey" (JSS), "Copenhagen Burnout Inventory" (CBI), "Single Item Burnout" (SIB) measure, and turnover intention score as external criterions were used. For each criterion, a dichotomous variable was created with the use of medians or suggested values from the literature as cutoff points. RESULTS A significant predictive power of QQS for job satisfaction assessed by JSS, and for job burnout assessed by CBI and SIB measure were found. The best cutoff point for the QQS was found to be 2.06. In that case, the highest values for Youden's index (0.34) and AUC (0.73) were found, while the 95% confidence interval for the AUC ranged from 0.70 to 0.76. Sensitivity and specificity of QQS were 0.68 and 0.66, respectively (p<0.001). Therefore, employees with QQS score ≥2.06 as quiet quitters, and those with QQS score <2.06 as non-quiet quitters were considered. CONCLUSIONS The best cutoff point for the QQS was 2.06. Employees with QQS score ≥2.06 as quiet quitters can be described as quiet quitters. Further research should be conducted to validate the present results.
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Nurses have experienced several psychological and work-related issues during the COVID-19 pandemic, including pandemic burnout and job burnout. The aim of this study was to examine the impact of social support and resilience on COVID-19 pandemic burnout and job burnout among nurses. We conducted a cross-sectional study in Greece. The study population included 963 nurses. We measured social support, resilience, COVID-19 pandemic burnout, and job burnout with the Multidimensional Scale of Perceived Social Support, Brief Resilience Scale, COVID-19 Burnout Scale, and Single-Item Burnout Measure, respectively. Nurses received high levels of social support, while their resilience was moderate. Additionally, nurses experienced moderate levels of COVID-19 burnout and job burnout. Increased social support and increased resilience were associated with reduced COVID-19 pandemic burnout. We found a negative relationship between social support and job burnout. A similar negative relationship was found between resilience and job burnout. Social support and resilience can act as protective factors against COVID-19 pandemic burnout and job burnout among nurses. Policy makers should develop and implement appropriate strategies to improve nurses’ social support and resilience since they are the backbone of healthcare systems worldwide.
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Workplace bullying affects workers’ lives, causing several mental and physical health problems and job-related issues. Therefore, a summary of the evidence on the consequences of workplace bullying on workers’ lives is essential to improve working conditions. The literature lacks systematic reviews and meta-analyses on the association between workplace bullying and job stress and the professional quality of life of nurses. Thus, we aimed to quantitatively summarize the data on the association between workplace bullying, job stress, and professional quality of life. We performed our study in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The review protocol was registered with PROSPERO (CRD42024495948). We searched PubMed, Medline, Scopus, Cinahl, and Web of Science up to 4 January 2024. We calculated pooled correlation coefficients and 95% confidence intervals [CI]. We identified nine studies with a total of 3730 nurses. We found a moderate positive correlation between workplace bullying and job stress (pooled correlation coefficient = 0.34, 95% CI = 0.29 to 0.39). Moreover, a small negative correlation between workplace bullying and compassion satisfaction (pooled correlation coefficient = −0.28, 95% CI = −0.41 to −0.15) was identified. Additionally, our findings suggested a moderate positive correlation between workplace bullying and job burnout (pooled correlation coefficient = 0.43, 95% CI = 0.32 to 0.53) and secondary traumatic stress (pooled correlation coefficient = 0.36, 95% CI = 0.11 to 0.57). Our findings can help nursing managers and policy-makers to draw attention to workplace bullying by implementing effective interventions, so as to reduce the bullying of nurses.
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Aim The aim of this study was to analyze the well-being and coping strategies of nurses working in an organizational setting perceived as characterized by workplace bullying. The innovative aspect of this study is that we considered only those who perceive to work in an organizational environment characterized by workplace bullying, and not those who see themselves as victims and those who perceive they work in an organizational environment not characterized by workplace bullying. Method A questionnaire with the NAQ-R, PGWBI, Val.Mob. and Brief COPE scales was administered to nurses. To better understand this phenomenon, a comparison was made between 331 nurses and 166 workers in other professions who also work in an organizational environment perceived to be characterized by workplace bullying. Results In both groups (nurses and workers), the results were approximately the same in terms of personal bullying and workplace bullying episodes and the number of physical and emotive symptoms. The PGWBI score was lower for nurses than for workers in other fields. Among the individual symptoms, nurses and registered nurses were more likely to report gastritis, insomnia and heartburn than workers in other contexts. Workers in other contexts were more likely than nurses to report symptoms of anxiety, fear, feelings of insecurity, inferiority and guilt. In terms of coping strategies, nurses were more likely than other workers to report distraction, substance use, emotional support, disengagement, venting, positive reframing, humor, and religion. Workers in other professional context were more likely than nurses to report active coping, denial, instrumental support, planning, acceptance, and self-blame. Conclusion Results suggest that the consequences of working in a perceived organizational environment characterized by workplace bullying are similar for both groups of workers, with nonstatistical differences in perceived workplace bullying episodes and sum of physical and emotive symptoms. Implication Overall, findings suggest that workplace bullying prevention is a fundamental element in training workers in all types of workplaces and should be an integral part of curriculum activities.
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Nurses have experienced several psychological and work-related issues during the COVID-19 pandemic including pandemic burnout and job burnout. The aim of the study was to examine the impact of social support and resilience on COVID-19 pandemic burnout and job burnout among nurses. We conducted a cross-sectional study in Greece. Study population included 963 nurses. We measured social support, resilience, COVID-19 pandemic burnout, and job burnout with the Multidimensional Scale of Perceived Social Support, Brief Resilience Scale, COVID-19 burnout scale, and single item burnout measure respectively. Nurses received high levels of social support, while their resilience was moderate. Additionally, nurses experienced moderate levels of COVID-19 burnout and job burnout. Increased social support (adjusted beta = -0.075, 95% CI = -0.125 to -0.024) and increased resilience (adjusted beta = -0.399, 95% CI = -0.491 to -0.308) were associated with reduced COVID-19 pandemic burnout. We found a negative relationship between social support and job burnout (adjusted beta = -0.263, 95% CI = -0.405 to -0.121). A similar negative relationship was found between resilience and job burnout (adjusted beta = -0.529, 95% CI = -0.785 to -0.272). Social support and resilience can act as protective factors against COVID-19 pandemic burnout and job burnout among nurses. Policy makers should develop and implement appropriate strategies to improve nurses’ social support and resilience since they are the backbone of healthcare systems worldwide.
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The aim of the study was to examine the impact of moral resilience on quiet quitting, job burnout, and turnover intention among nurses. A cross-sectional study was implemented in Greece in November 2023. The revised Rushton Moral Resilience Scale was used to measure moral resilience among nurses, the Quiet Quitting Scale to measure levels of quiet quitting, and the single-item burnout measure to measure job burnout. Moreover, a valid six-point Likert scale was used to measure turnover intention. All multivariable models were adjusted for the following confounders: gender, age, understaffed department, shift work, and work experience. The multivariable analysis identified a negative relationship between moral resilience and quiet quitting, job burnout, and turnover intention. In particular, we found that increased response to moral adversity and increased moral efficacy were associated with decreased detachment score, lack of initiative score, and lack of motivation score. Additionally, personal integrity was associated with reduced detachment score, while relational integrity was associated with reduced detachment score, and lack of initiative score. Moreover, response to moral adversity was associated with reduced job burnout. Also, increased levels of response to moral adversity were associated with lower probability of turnover intention. Moral resilience can be an essential protective factor against high levels of quiet quitting, job burnout, and turnover intention among nurses. This study was not registered.
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As turnover intention is a strong determinant of actual turnover behavior, scholars should identify the determinants of turnover intention. In this context, the aim of this study was to assess the effect of quiet quitting on nurses' turnover intentions. Additionally, this study examined the impact of several demographic and job characteristics on turnover intention. A cross-sectional study with 629 nurses in Greece was conducted. The data were collected in September 2023. Quiet quitting was measured with the "Quiet Quitting" scale. In this study, 60.9% of nurses were considered quiet quitters, while 40.9% experienced high levels of turnover intention. Multivariable regression analysis showed that higher levels of quiet quitting increased turnover intention. Moreover, this study found that turnover intention was higher among females, shift workers, nurses in the private sector, and those who considered their workplace understaffed. Also, clinical experience was associated positively with turnover intention. Since quiet quitting affects turnover intention, organizations, policymakers, and managers should address this issue to improve nurses' intentions to stay at their jobs.
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Aims This study aimed to explore the relationship between workplace bullying among nurses and their professional quality of life, as well as the mediating role of coping styles between the two factors. Background In China, the overall status of nurses' professional quality of life is not optimistic, and the problems of low compassion satisfaction and high compassion fatigue persist. Workplace bullying, which is a serious global issue, can negatively impact the mental health and professional quality of nurses. However, it has still not attracted enough attention from managers. Methods The study used a cross-sectional research design and surveyed 297 clinical nurses from two tertiary grade A hospitals in Wuhan, China. Data were collected through an online questionnaire survey from March to May 2022. The data were analyzed using descriptive statistical methods, including Pearson correlation analysis and structural equation modeling. Results The score for nurses' workplace bullying was 38.72 ± 12.30. The scores for the three dimensions of professional quality of life were 27.56 ± 4.79 for compassion satisfaction, 30.51 ± 4.33 for burnout, and 28.47 ± 4.65 for secondary trauma stress. The scores for positive coping style and negative coping style were 34.59 ± 5.72 and 20.34 ± 5.08 points, respectively. Workplace bullying had a direct negative effect on compassion satisfaction, as well as positive direct effects on burnout and secondary traumatic stress. Coping styles played a mediating effect between workplace bullying and the pairwise relationships of compassion satisfaction, burnout, and secondary trauma stress. Conclusion Workplace bullying hurts nurses' professional quality of life while coping styles plays an mediating role between workplace bullying and professional quality of life. Nursing managers can improve nurses' professional quality of life by reducing workplace bullying and enhancing positive coping style. Implications for nursing management Nursing managers can employ management wisdom and techniques to mitigate the presence and detrimental effects of workplace bullying. This, in turn, promotes a positive work environment and enhances the professional quality of life for nurses.
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Introduction COVID-19 pandemic causes drastic changes in workplaces that are likely to increase quite quitting among employees. Although quiet quitting is not a new phenomenon, there is no instrument to measure it. Objective To develop and validate an instrument assessing quiet quitting among employees. Methods We identified and generated items through an extensive literature review and interviews with employees. We carried out the content validity by content experts and we calculated the content validity ratio. We checked face validity by conducting cognitive interviews with employees and calculating the item-level face validity index. We conducted exploratory and confirmatory factor analysis to investigate the quiet quitting scale (QQS) factorial structure. We checked the concurrent validity of the QQS using four other scales, i.e., Copenhagen burnout inventory (CBI), single item burnout (SIB) measure, job satisfaction survey (JSS) and a single item to measure turnover intention. We estimated the reliability of the QQS measuring Cronbach's alpha, McDonald's omega, Cohen's kappa and intraclass correlation coefficient. Results After expert panel review and item analysis, nine items with acceptable corrected item-total correlations, inter-item correlations, floor and ceiling effects, skewness and kurtosis were retained. Exploratory factor analysis extracted three factors, namely detachment, lack of initiative and lack of motivation, with a total of nine items. Confirmatory factor analysis confirmed this factorial structure for QQS. We found statistically significant correlations between QQS and CBI, SIB, JSS and turnover intention confirming that the concurrent validity of the QQS was great. Cronbach's alpha and McDonald's omega of the QQS were 0.803 and 0.806 respectively. Conclusion QQS, a three-factor nine-item scale, has robust psychometric properties. QQS is an easy-to-administer, brief, reliable and valid tool to measure employees' quiet quitting. We recommend the use of the QQS in different societies and cultures to assess the validity of the instrument.
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Aim To assess the level of quiet quitting among healthcare workers (HCWs) and identify possible differences between nurses, physicians, and other HCWs. We investigated the impact of sociodemographic variables, job burnout, and job satisfaction on quiet quitting levels. Background The quiet‐quitting phenomenon is not new but has been frequently discussed during the COVID‐19 pandemic. Interestingly, the level of quiet quitting among HCWs has not been measured yet. Methods We conducted a cross‐sectional study with a convenience sample. We measured sociodemographic variables, job burnout, job satisfaction, and quiet quitting. We adhered to STROBE guidelines for cross‐sectional studies. Findings Among our sample, 67.4% of nurses were quiet quitters, while the prevalence of quiet quitting for physicians and other HCWs was 53.8% and 40.3%, respectively. Multivariable linear regression analysis identified that the levels of quiet quitting were higher among nurses than physicians and other HCWs. Moreover, greater job burnout contributed more to quiet quitting, while less satisfaction implied more quiet quitting. HCWs who work in shifts and those working in the private sector experienced higher levels of quiet quitting. Discussion More than half of our HCWs were described as quit quitters. Levels of quiet quitting were higher among nurses. Job burnout and job dissatisfaction were associated with higher levels of quiet quitting. Implications for nursing practice and nursing policy Measurement of quiet quitting and identification of risk factors are essential to prevent or reduce quiet quitting levels among HCWs. Our study provides information on this field helping managers and organizations to identify quiet quitters within HCWs. Policymakers and managers should develop and implement interventions both at an organizational level and at an individual level.