The prevalence of workplace bullying, job burnout, and turnover intention among nursing staff increased during the COVID-19 pandemic. However, to the best of our knowledge, there are no studies that have measured the relationships among variables of interest after the pandemic.
Our intention is to investigate the effect of workplace bullying on job burnout and turnover intention in nursing staff.
We conducted a cross-sectional study during January–February 2024 in Greece. We obtained a convenience sample of 450 nurses. We used the 22-item Negative Acts Questionnaire-Revised to assess workplace bullying. We measured job burnout with the single-item burnout measure. We measured nurses' turnover intention with a valid 6-point Likert scale.
The study sample included 450 nurses with the mean age of 39.1 years (standard deviation [SD] = 10.2). The mean workplace bullying score was 7.7 (SD = 2.0), while the mean job burnout score was 7.7 (SD = 2.0). Among our nurses, 57.3% showed a high level of turnover intention. After eliminating confounders, we found that increased workplace bullying (adjusted beta = 0.031, 95% confidence interval [CI] = 0.023 to 0.039, p < 0.001) was associated with increased job burnout. Moreover, multivariable logistic regression analysis showed that increased turnover intention was more common among nurses who experienced higher levels of workplace bullying (adjusted odds ratio = 1.057, 95% CI = 1.043 to 1.071, p < 0.001).
We found a positive relationship between workplace bullying, job burnout, and turnover intention. Nurse managers, organizations, and policy-makers ought to consider such findings to intervene and decrease workplace bullying by improving working conditions.
Citation: Petros Galanis, Ioannis Moisoglou, Aglaia Katsiroumpa, Panayota Sourtzi. Impact of workplace bullying on job burnout and turnover intention among nursing staff in Greece: Evidence after the COVID-19 pandemic[J]. AIMS Public Health, 2024, 11(2): 614-627. doi: 10.3934/publichealth.2024031
The prevalence of workplace bullying, job burnout, and turnover intention among nursing staff increased during the COVID-19 pandemic. However, to the best of our knowledge, there are no studies that have measured the relationships among variables of interest after the pandemic.
Our intention is to investigate the effect of workplace bullying on job burnout and turnover intention in nursing staff.
We conducted a cross-sectional study during January–February 2024 in Greece. We obtained a convenience sample of 450 nurses. We used the 22-item Negative Acts Questionnaire-Revised to assess workplace bullying. We measured job burnout with the single-item burnout measure. We measured nurses' turnover intention with a valid 6-point Likert scale.
The study sample included 450 nurses with the mean age of 39.1 years (standard deviation [SD] = 10.2). The mean workplace bullying score was 7.7 (SD = 2.0), while the mean job burnout score was 7.7 (SD = 2.0). Among our nurses, 57.3% showed a high level of turnover intention. After eliminating confounders, we found that increased workplace bullying (adjusted beta = 0.031, 95% confidence interval [CI] = 0.023 to 0.039, p < 0.001) was associated with increased job burnout. Moreover, multivariable logistic regression analysis showed that increased turnover intention was more common among nurses who experienced higher levels of workplace bullying (adjusted odds ratio = 1.057, 95% CI = 1.043 to 1.071, p < 0.001).
We found a positive relationship between workplace bullying, job burnout, and turnover intention. Nurse managers, organizations, and policy-makers ought to consider such findings to intervene and decrease workplace bullying by improving working conditions.
| [1] |
Purpora C, Cooper A, Sharifi C, et al. (2019) Workplace bullying and risk of burnout in nurses: A systematic review protocol. JBI Database System Rev Implement Rep 17: 2532-2540. https://doi.org/10.11124/JBISRIR-D-19-00019 
|
| [2] |
Einarsen S (2000) Harassment and bullying at work: A review of the scandinavian approach. Aggress Violent Behav 5: 379-401. https://doi.org/10.1016/S1359-1789(98)00043-3
|
| [3] |
Nielsen MB, Einarsen SV (2018) What we know, what we do not know, and what we should and could have known about workplace bullying: An overview of the literature and agenda for future research. Aggress Violent Behav 42: 71-83. https://doi.org/10.1016/j.avb.2018.06.007
|
| [4] |
Álvarez Villalobos NA, De León Gutiérrez H, Ruiz Hernandez FG, et al. (2023) Prevalence and associated factors of bullying in medical residents: A systematic review and meta-analysis. J Occup Health 65: e12418. https://doi.org/10.1002/1348-9585.12418
|
| [5] |
La Torre G, Firenze A, Colaprico C, et al. (2022) Prevalence and risk factors of bullying and sexual and racial harassment in healthcare workers: A cross-sectional study in Italy. Int J Environ Res Public Health 19: 6938. https://doi.org/10.3390/ijerph19116938
|
| [6] | Bambi S, Foà C, De Felippis C, et al. (2018) Workplace incivility, lateral violence and bullying among nurses. A review about their prevalence and related factors. Acta Bio Medica 89: 79. |
| [7] |
Karatuna I, Jönsson S, Muhonen T (2020) Workplace bullying in the nursing profession: A cross-cultural scoping review. Int J Nurs Stud 111: 103628. https://doi.org/10.1016/j.ijnurstu.2020.103628
|
| [8] |
Shorey S, Wong PZE (2021) A qualitative systematic review on nurses' experiences of workplace bullying and implications for nursing practice. J Adv Nurs 77: 4306-4320. https://doi.org/10.1111/jan.14912
|
| [9] |
Wolf LA, Perhats C, Clark PR, et al. (2018) Workplace bullying in emergency nursing: Development of a grounded theory using situational analysis. Int Emerg Nurs 39: 33-39. https://doi.org/10.1016/j.ienj.2017.09.002
|
| [10] |
Serafin L, Kusiak A, Czarkowska-Pączek B (2022) The COVID-19 Pandemic increased burnout and bullying among newly graduated nurses but did not impact the relationship between burnout and bullying and self-labelled subjective feeling of being bullied: A cross-sectional, comparative study. Int J Environ Res Public Health 19: 1730. https://doi.org/10.3390/ijerph19031730
|
| [11] |
Maslach C, Schaufeli WB, Leiter MP (2003) Job burnout. Annu Rev Psychol 52: 397-422. https://doi.org/10.1146/annurev.psych.52.1.397
|
| [12] |
Woo T, Ho R, Tang A, et al. (2020) Global prevalence of burnout symptoms among nurses: A systematic review and meta-analysis. J Psychiatr Res 123: 9-20. https://doi.org/10.1016/j.jpsychires.2019.12.015
|
| [13] |
Shah MK, Gandrakota N, Cimiotti JP, et al. (2021) Prevalence of and factors associated with nurse burnout in the US. JAMA Netw Open 4: e2036469-e2036469. https://doi.org/10.1001/jamanetworkopen.2020.36469
|
| [14] |
Gómez-Urquiza JL, De la Fuente-Solana EI, Albendín-García L, et al. (2017) Prevalence of burnout syndrome in emergency nurses: A meta-analysis. Crit Care Nurse 37: e1-e9. https://doi.org/10.4037/ccn2017508
|
| [15] |
Pradas-Hernández L, Ariza T, Gómez-Urquiza JL, et al. (2018) Prevalence of burnout in paediatric nurses: A systematic review and meta-analysis. PLoS One 13: e0195039. https://doi.org/10.1371/journal.pone.0195039
|
| [16] |
Montgomery A, Panagopoulou E, Esmail A, et al. (2019) Burnout in healthcare: The case for organisational change. BMJ 366: l4774. https://doi.org/10.1136/bmj.l4774
|
| [17] |
Macphee M, Dahinten VS, Havaei F (2017) The impact of heavy perceived nurse workloads on patient and nurse outcomes. Adm Sci 7: 1-17. https://doi.org/10.3390/admsci7010007
|
| [18] | Ghavidel F, Fallahi-Khoshknab M, Molavynejad S, et al. (2019) The role of organizational factors in nurse burnout: Experiences from Iranian nurses working in psychiatric wards. J Family Med Prim Care 8: 3899. https://doi.org/10.4103/jfmpc.jfmpc_615_19 |
| [19] |
Bae SH (2021) Intensive care nurse staffing and nurse outcomes: A systematic review. Nurs Crit Care 26: 457-466. https://doi.org/10.1111/nicc.12588
|
| [20] |
Lang M, Jones L, Harvey C, et al. (2022) Workplace bullying, burnout and resilience amongst perioperative nurses in Australia: A descriptive correlational study. J Nurs Manag 30: 1502-1513. https://doi.org/10.1111/jonm.13437
|
| [21] |
Johnson J, Cameron L, Mitchinson L, et al. (2019) An investigation into the relationships between bullying, discrimination, burnout and patient safety in nurses and midwives: Is burnout a mediator?. Journal of Research in Nursing 24: 604-619. https://doi.org/10.1177/1744987119880329
|
| [22] |
Amini K, Miyanaji H, Din Mohamadi M (2023) Bullying and burnout in critical care nurses: A cross-sectional descriptive study. Nurs Crit Care 28: 202-210. https://doi.org/10.1111/nicc.12744
|
| [23] |
Matziari A, Montgomery AJ, Georganta K, et al. (2017) The relationship between organizational practices and values with burnout and engagement. Current Psychology 36: 276-285. https://doi.org/10.1007/s12144-016-9413-7
|
| [24] |
Moisoglou I, Yfantis A, Tsiouma E, et al. (2021) The work environment of haemodialysis nurses and its mediating role in burnout. J Ren Care 47: 133-140. https://doi.org/10.1111/jorc.12353
|
| [25] | Mudallal RH, Othman WM, Al Hassan NF (2017) Nurses' burnout: The influence of leader empowering behaviors, work conditions, and demographic traits. Inquiry 54: 46958017724944. https://doi.org/10.1177/0046958017724944 |
| [26] |
Tang Y, Wang Y, Zhou H, et al. (2023) The relationship between psychiatric nurses' perceived organizational support and job burnout: Mediating role of psychological capital. Front Psychol 14: 1099687. https://doi.org/10.3389/fpsyg.2023.1099687
|
| [27] |
Galanis P, Vraka I, Fragkou D, et al. (2021) Nurses' burnout and associated risk factors during the COVID-19 pandemic: A systematic review and meta-analysis. J Adv Nurs 77: 3286-3302. https://doi.org/10.1111/jan.14839
|
| [28] |
Galanis P, Moisoglou I, Katsiroumpa A, et al. (2023) Increased job burnout and reduced job satisfaction for nurses compared to other healthcare workers after the COVID-19 pandemic. Nurs Rep 13: 1090-1100. https://doi.org/10.3390/nursrep13030095
|
| [29] |
Hayes LJ, O'Brien-Pallas L, Duffield C, et al. (2006) Nurse turnover: A literature review. Int J Nurs Stud 43: 237-263. https://doi.org/10.1016/j.ijnurstu.2005.02.007
|
| [30] |
Ki J, Choi-Kwon S (2022) Health problems, turnover intention, and actual turnover among shift work female nurses: Analyzing data from a prospective longitudinal study. PLoS One 17: e0270958. https://doi.org/10.1371/journal.pone.0270958
|
| [31] | Griffeth RW, Hom PW, Gaertner S (2000) A meta-analysis of antecedents and correlates of employee turnover: Update, moderator tests, and research implications for the next millennium. J Manage 26: 463-488. https://doi.org/10.1177/014920630002600305 |
| [32] |
Labrague LJ, De los Santos JAA, Falguera CC, et al. (2020) Predictors of nurses' turnover intention at one and five years' time. Int Nurs Rev 67: 191-198. https://doi.org/10.1111/inr.12581
|
| [33] |
Said RM, El-Shafei DA (2021) Occupational stress, job satisfaction, and intent to leave: nurses working on front lines during COVID-19 pandemic in Zagazig City, Egypt. Environmental Science and Pollution Research 28: 8791-8801. https://doi.org/10.1007/s11356-020-11235-8
|
| [34] |
Rotenstein LS, Brown R, Sinsky C, et al. (2023) The association of work overload with burnout and intent to leave the job across the healthcare workforce during COVID-19. J Gen Intern Med 38: 1920-1927. https://doi.org/10.1007/s11606-023-08153-z
|
| [35] |
Galanis P, Moisoglou I, Malliarou M, et al. (2024) Quiet quitting among nurses increases their turnover intention: Evidence from Greece in the post-COVID-19 era. Healthcare 12: 79. https://doi.org/10.3390/healthcare12010079
|
| [36] | Galanis P, Moisoglou I, Papathanasiou I V, et al. (2024) Association between organizational support and turnover intention in nurses: A systematic review and meta-analysis. Healthcare (Switzerland) 12: 291. https://doi.org/10.3390/healthcare12030291 |
| [37] | Chen H, Li G, Li M, et al. (2018) A cross-sectional study on nurse turnover intention and influencing factors in Jiangsu Province, China. Int J Nurs Sci 5: 396-402. https://doi.org/10.1016/j.ijnss.2018.09.012 |
| [38] |
Bruyneel A, Bouckaert N, Maertens de Noordhout C, et al. (2023) Association of burnout and intention-to-leave the profession with work environment: A nationwide cross-sectional study among Belgian intensive care nurses after two years of pandemic. Int J Nurs Stud 137: 104385. https://doi.org/10.1016/j.ijnurstu.2022.104385
|
| [39] |
Arslan Yürümezoğlu H, Kocaman G, Mert Haydarİ S (2019) Predicting nurses' organizational and professional turnover intentions. Japan Journal of Nursing Science 16: 274-285. https://doi.org/10.1111/jjns.12236
|
| [40] |
Lee EK, Kim JS (2020) Nursing stress factors affecting turnover intention among hospital nurses. Int J Nurs Pract 26: e12819. https://doi.org/10.1111/ijn.12819
|
| [41] |
Lee E, Jang I (2020) Nurses' fatigue, job stress, organizational culture, and turnover intention: A culture–work–health model. West J Nurs Res 42: 108-116. https://doi.org/10.1177/0193945919839189
|
| [42] |
Pang Y, Dan H, Jung H, et al. (2020) Depressive symptoms, professional quality of life and turnover intention in Korean nurses. Int Nurs Rev 67: 387-394. https://doi.org/10.1111/inr.12600
|
| [43] |
Kim H, Kim EG (2021) A meta-analysis on predictors of turnover intention of hospital nurses in South Korea (2000–2020). Nurs Open 8: 2406-2418. https://doi.org/10.1002/nop2.872
|
| [44] |
Labrague LJ, Gloe DS, McEnroe-Petitte DM, et al. (2018) Factors influencing turnover intention among registered nurses in Samar Philippines. Applied Nursing Research 39: 200-206. https://doi.org/10.1016/j.apnr.2017.11.027
|
| [45] | Al Muharraq EH, Baker OG, Alallah SM (2022) The prevalence and the relationship of workplace bullying and nurses turnover intentions: A cross sectional study. SAGE Open Nurs 8: 1-10. https://doi.org/10.1177/23779608221074655 |
| [46] |
Xia G, Zhang Y, Dong L, et al. (2023) The mediating role of organizational commitment between workplace bullying and turnover intention among clinical nurses in China: A cross-sectional study. BMC Nurs 22: 1-12. https://doi.org/10.1186/s12912-023-01547-8
|
| [47] |
Wolf LA, Perhats C, Delao AM, et al. (2021) Validation of a grounded theory of nurse bullying in emergency department settings. Int Emerg Nurs 56: 100992. https://doi.org/10.1016/j.ienj.2021.100992
|
| [48] |
Sawada S, Takemura Y, Isobe T, et al. (2022) Perceived impact of nurse turnover on the organization: A Delphi study on managers of nursing. J Nurs Manag 30: 3168-3177. https://doi.org/10.1111/jonm.13738
|
| [49] |
Einarsen S, Hoel H, Notelaers G (2009) Measuring exposure to bullying and harassment at work: Validity, factor structure and psychometric properties of the Negative Acts Questionnaire-Revised. Work Stress 23: 24-44. https://doi.org/10.1080/02678370902815673
|
| [50] |
Kakoulakis C, Galanakis M, Bakoula-Tzoumaka C, et al. (2015) Validation of the Negative Acts Questionnaire (NAQ) in a sample of Greek teachers. Psychology 6: 63-74. https://doi.org/10.4236/psych.2015.61007
|
| [51] | Hansen V, Pit S (2016) The single item burnout measure is a psychometrically sound screening tool for occupational burnout. Health Scope (Zahedan) 5: 32164. https://doi.org/10.17795/jhealthscope-32164 |
| [52] | Galanis P, Katsiroumpa A, Vraka I, et al. (2023) The single item burnout measure is a reliable and valid tool to measure occupational burnout. medRxiv . https://doi.org/10.1101/2023.03.06.23286842 |
| [53] |
Spector PE, Dwyer DJ, Jex SM (1988) Relation of job stressors to affective, health, and performance outcomes: A comparison of multiple data sources. J Appl Psychol 73: 11-19. https://doi.org/10.1037/0021-9010.73.1.11
|
| [54] |
Association WM (2013) World medical association declaration of Helsinki: Ethical principles for medical research involving human subjects. JAMA 310: 2191-2194. https://doi.org/10.1001/jama.2013.281053
|
| [55] |
Smith CR, Palazzo SJ, Grubb PL, et al. (2020) Standing up against workplace bullying behavior: Recommendations from newly licensed nurses. J Nurs Educ Pract 10: 35. https://doi.org/10.5430/jnep.v10n7p35
|
| [56] |
Anusiewicz C V., Shirey MR, Patrician PA (2019) Workplace bullying and newly licensed registered nurses: An evolutionary concept analysis. Workplace Health Saf 67: 250-261. https://doi.org/10.1177/2165079919827046
|
| [57] |
Bae SH (2022) Noneconomic and economic impacts of nurse turnover in hospitals: A systematic review. Int Nurs Rev 69: 392-404. https://doi.org/10.1111/inr.12769
|
| [58] |
Roche MA, Duffield CM, Homer C, et al. (2015) The rate and cost of nurse turnover in Australia. Collegian 22: 353-358. https://doi.org/10.1016/j.colegn.2014.05.002
|
| [59] |
Moisoglou I, Galanis P, Meimeti E, et al. (2019) Nursing staff and patients' length of stay. Int J Health Care Qual Assur 32: 1004-1012. https://doi.org/10.1108/IJHCQA-09-2018-0215
|
| [60] | NCSBNNCSBN Research projects significant nursing workforce shortages and crisis | NCSBN, 2023 (2023). Available from: https://www.ncsbn.org/news/ncsbn-research-projects-significant-nursing-workforce-shortages-and-crisis |
| [61] |
Boniol M, Kunjumen T, Nair TS, et al. (2022) The global health workforce stock and distribution in 2020 and 2030: A threat to equity and ‘universal’ health coverage?. BMJ Glob Health 7: e009316. https://doi.org/10.1136/bmjgh-2022-009316
|
| [62] |
Galanis P, Moisoglou I, Katsiroumpa A, et al. (2024) Association between workplace bullying, job stress, and professional quality of life in nurses: A systematic review and meta-analysis. Healthcare 12: 623. https://doi.org/10.3390/healthcare12060623
|
| [63] | Galanis P, Katsiroumpa A, Vraka I, et al. (2024) Nurses quietly quit their job more often than other healthcare workers: An alarming issue for healthcare services. Int Nurs Rev 1–10. https://doi.org/10.1111/inr.12931 |
| [64] |
Galanis P, Moisoglou I, Katsiroumpa A, et al. (2024) Impact of workplace bullying on quiet quitting in nurses: The mediating effect of coping strategies. Healthcare (Basel) 12: 797. https://doi.org/10.3390/healthcare12070797
|
| [65] |
Johnson AH, Benham-Hutchins M (2020) The influence of bullying on nursing practice errors: A systematic review. AORN J 111: 199-210. https://doi.org/10.1002/aorn.12923
|
| [66] |
Arnetz JE, Neufcourt L, Sudan S, et al. (2020) Nurse-reported bullying and documented adverse patient events: An exploratory study in a US hospital. J Nurs Care Qual 35: 206-212. https://doi.org/10.1097/NCQ.0000000000000442
|
| [67] |
Johnson J, Cameron L, Mitchinson L, et al. (2019) An investigation into the relationships between bullying, discrimination, burnout and patient safety in nurses and midwives: Is burnout a mediator?. Journal of Research in Nursing 24: 604-619. https://doi.org/10.1177/1744987119880329
|
| [68] |
Kakemam E, Chegini Z, Rouhi A, et al. (2021) Burnout and its relationship to self-reported quality of patient care and adverse events during COVID-19: A cross-sectional online survey among nurses. J Nurs Manag 29: 1974-1982. https://doi.org/10.1111/jonm.13359
|
| [69] |
Jun J, Ojemeni MM, Kalamani R, et al. (2021) Relationship between nurse burnout, patient and organizational outcomes: Systematic review. Int J Nurs Stud 119: 103933. https://doi.org/10.1016/j.ijnurstu.2021.103933
|
| [70] |
Schwendimann R, Blatter C, Dhaini S, et al. (2018) The occurrence, types, consequences and preventability of in-hospital adverse events - A scoping review. BMC Health Serv Res 18: 1-13. https://doi.org/10.1186/s12913-018-3335-z
|
| [71] |
Bates DW, Singh H (2018) Two decades since to err is human: An assessment of progress and emerging priorities in patient safety. Health Aff 37: 1736-1743. https://doi.org/10.1377/hlthaff.2018.0738
|
| [72] |
Luca CE, Sartorio A, Bonetti L, et al. (2024) Interventions for preventing and resolving bullying in nursing: A scoping review. Healthcare 12: 280. https://doi.org/10.3390/healthcare12020280
|
Petros Galanis, Ioannis Moisoglou, Aglaia Katsiroumpa, Panayota Sourtzi. Impact of workplace bullying on job burnout and turnover intention among nursing staff in Greece: Evidence after the COVID-19 pandemic[J]. AIMS Public Health, 2024, 11(2): 614-627. doi: 10.3934/publichealth.2024031
DownLoad: