Association between workplace bullying and burnout, professional quality of life, and turnover intention among clinical nurses

Autoři: Yujeong Kim aff001;  Eunmi Lee aff002;  Haeyoung Lee aff003
Působiště autorů: College of Nursing, Kyungpook National University, Daegu, Republic of Korea aff001;  Department of Nursing, Hoseo University, Asan, Republic of Korea aff002;  College of Nursing, Chung-Ang University Red Cross, Seoul, Republic of Korea aff003
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article


Workplace bullying experienced by clinical nurses is associated with burnout, a factor that threatens the quality of nursing care and patient safety. This study examined the association of workplace bullying with burnout, professional quality of life, and turnover intention among clinical nurses. A descriptive cross-sectional study was conducted using a structured questionnaire. Data were collected from 324 nurses and were analyzed using t-test, one-way analysis of variance, and multiple regression. Controlling for the general characteristics of the participants, workplace bullying had a significant association with emotional exhaustion (B = 0.29, p < 0.01) and depersonalization (B = 0.15, p < 0.01) among the subdomains of burnout, compassion fatigue among the components of professional quality of life (B = 0.15, p < 0.01), and turnover intention (B = 0.05, p < 0.01). Thus, preventing workplace bullying is important to reduce clinical nurses’ burnout and turnover. The role of nursing leadership is crucial to develop interventions that reduce workplace bullying and successfully create a professional, nurturing, and supportive work culture.

Klíčová slova:

Emotions – Employment – Jobs – Labor studies – Material fatigue – Nurses – Psychological stress – Quality of life


1. Etienne E. Exploring workplace bullying in nursing. Workplace Health Saf. 2014;62:6–11. doi: 10.1177/216507991406200102 24571049

2. Jones AL. Experience of protagonists in workplace bullying: An integrated literature review. Int J Nurs Clin Pract. 2017;4:246. doi: 10.15344/2394-4978/2017/246

3. Hutchinson M, Jackson D, Wilkes L, Vickers MH. A new model of bullying in the nursing workplace: Organizational characteristics as critical antecedents. ANS Adv Nurs Sci. 2008;31:E60–71. doi: 10.1097/01.ANS.0000319572.37373.0c 18497582

4. Johnson SL. International perspectives on workplace bullying among nurses: A review. Int Nurs Rev. 2009;56:34–40. doi: 10.1111/j.1466-7657.2008.00679.x 19239514

5. Randle J. Bullying in the nursing profession. J Adv Nurs. 2003;43:395–401. doi: 10.1046/j.1365-2648.2003.02728.x 12887358

6. Castronovo MA, Pullizzi A, Evans S. Nurse bullying: A review and a proposed solution. Nurs Outlook. 2016;64:208–14. doi: 10.1016/j.outlook.2015.11.008 26732552

7. Sauer PA, McCoy TP. Nurse bullying: impact on nurses’ health. West J Nurs Res. 2017;39:1533–46. doi: 10.1177/0193945916681278 27920345

8. Hamblin LE, Essenmacher L, Ager J, Upfal M, Luborsky M, Russell J, et al. Worker-to-worker violence in hospitals: Perpetrator characteristics and common dyads. Workplace Health Saf. 2016;64:51–6. doi: 10.1177/2165079915608856 26450899

9. Laschinger HK, Grau AL, Finegan J, Wilk P. New graduate nurses’ experiences of bullying and burnout in hospital settings. J Adv Nurs. 2010;66:2732–42. doi: 10.1111/j.1365-2648.2010.05420.x 20722806

10. Tee S, Özçetin YSÜ, Russell-Westhead M. Workplace violence experienced by nursing students: A UK survey. Nurse Educ Today. 2016;41:30–5. doi: 10.1016/j.nedt.2016.03.014 27138479

11. Glasø L, Notelaers G. Workplace bullying, emotions, and outcomes. Violence Vict. 2012;27:360–77. doi: 10.1891/0886-6708.27.3.360 22852437

12. Lutgen‐Sandvik P, Tracy SJ, Alberts JK. Burned by bullying in the American workplace: Prevalence, perception, degree and impact. J Manag Stud. 2007;44:837–62. doi: 10.1111/j.1467-6486.2007.00715.x

13. Cardoso M, Fornés-Vives J, Gili M. Implications of psychological harassment on witnesses: An observational study in nursing staff. Enfermería Glob. 2016;15:313–23.

14. Salmivalli C. Participant roles in bullying: How can peer bystanders be utilized in interventions? Theory Pract. 2014;53(4):286–92. doi: 10.1080/00405841.2014.947222

15. Laschinger HKS, Grau AL. The influence of personal dispositional factors and organizational resources on workplace violence, burnout, and health outcomes in new graduate nurses: A cross‐sectional study. Int J Nurs Stud. 2012;49:282–91. doi: 10.1016/j.ijnurstu.2011.09.004 21978860

16. Laschinger HKS. Impact of workplace mistreatment on patient safety risk and nurse-assessed patient outcomes. J Nurs Admin. 2014;44:284–90. doi: 10.1097/NNA.0000000000000068 24759201

17. MacIntosh J, Wuest J, Gray MM, Cronkhite M. Workplace bullying in health care affects the meaning of work. Qual Health Res. 2010;20:1128–41. doi: 10.1177/1049732310369804 20463362

18. Stamm BH. The concise ProQoL manual. 2nd ed. Pocatello, ID:; 2010.

19. Burnett HJ Jr, Wahl K. The compassion fatigue and resilience connection: A survey of resilience, compassion fatigue, burnout, and compassion satisfaction among trauma responders. Int J Emerg Ment Health. 2015;17(1):318–26. doi: 10.4172/1522-4821.1000165

20. Barr P. Compassion fatigue and compassion satisfaction in neonatal intensive care unit nurses: Relationships with work stress and perceived social support. Traumatology. 2017;23:214. doi: 10.1037/trm0000115

21. Lawler EE. Satisfaction and behavior. In: Hackman HR, Lawler EE, Porter LW, editors, Perspectives on behavior in organizations. 2nd ed. New York: McGraw-Hill; 1983. pp. 78–107.

22. Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39:175–91. doi: 10.3758/bf03193146 17695343

23. Einarsen S, Hoel H, Notelaers G. Measuring exposure to bullying and harassment at work: Validity, factor structure and psychometric properties of negative acts questionnaire-revised. Work Stress. 2009:23;24–44. doi: 10.1080/02678370902815673

24. Nam W, Kim JW, Kim YK, Koo JW, Park CY. The reliability and validity of the Negative Acts Questionnaire-Revised (NAQ-R) for nurses for the assessment of workplace bullying. Korean J Occup Environ Med. 2010;22:129–39. doi: 10.35371/kjoem.2010.22.2.129

25. Maslach C, Jackson SE. The measurement of experienced burnout. J Organ Behav. 1981;2:99–113.

26. Kang JH, Kim CW. Evaluating applicability of Maslach burnout inventory among university hospitals nurses. Korean J Adult Nurs. 2012;24:31–7. doi: 10.7475/kjan.2012.24.1.31

27. Poghosyan L, Aiken LH, Sloane DM. Factor structure of the Maslach burnout inventory: An analysis of data from large scale cross-sectional surveys of nurses from eight countries. Int J Nurs Stud. 2009;46:894–902. doi: 10.1016/j.ijnurstu.2009.03.004 19362309

28. Bae Y, Lee T. Relationship of experience of violence and professional quality of life for hospital nurses. J Korean Acad Nurs Adm. 2015;21:489–500. doi: 10.11111/jkana.2015.21.5.489

29. Park HS. Relationship between perceived nursing care role orientation, job characteristics, and turnover among nurses. Unpublished Master’s thesis. Yonsei University, Seoul; 2002.

30. Yeun YR. A research of workplace bullying and burnout on turnover intention in hospital nurses. J Korea Acad Ind Coop Soc. 2015;16:8343–9. doi: 10.5762/KAIS.2015.16.12.8343

31. Abe K, Henly SJ. Bullying (ijime) among Japanese hospital nurses: Modeling responses to the revised Negative Acts Questionnaire. Nurs Res. 2010;59:110–8. doi: 10.1097/NNR.0b013e3181d1a709 20216013

32. Laschinger HKS, Wong CA, Grau AL. The influence of authentic leadership on newly graduated nurses’ experiences of workplace bullying, burnout and retention outcomes: A cross-sectional study. Int J Nurs Stud. 2012;49:1266–76. doi: 10.1016/j.ijnurstu.2012.05.012 22727121

33. Fang L, Huang SH, Fang SH. Workplace bullying among nurses in South Taiwan. J Clin Nurs. 2016;25:2450–6. doi: 10.1111/jocn.13260 27229942

34. Hampton D, Tharp‐Barrie K, Kay Rayens M. Experience of nursing leaders with workplace bullying and how to best cope. J Nurs Manag. 2016;27:517–26. doi: 10.1111/jonm.12706 30136408

35. Yun S, Kang J. Factors affecting workplace bullying in Korean hospital nurses. Korean J Adult Nurs. 2014;26:553–62. doi: 10.7475/kjan.2014.26.5.553

36. Ministry of Health & Welfare. OECD Health data 2015. 2015 [cited 2019 Apr 2]. In: [Internet]. Sejong: Ministry of Health & Welfare. Available from:

37. Johnson SL, Rea RE. Workplace bullying: Concerns for nurse leaders. J Nurs Adm. 2009;39:84–90. doi: 10.1097/NNA.0b013e318195a5fc 19190425

38. Vogelpohl DA, Rice SK, Edwards ME, Bork CE. New graduate nurses’ perception of the workplace: Have they experienced bullying? J Prof Nurs. 2009;29:414–22. doi: 10.1016/j.profnurs.2012.10.008 24267937

39. Johnson SL, Boutain DM, Tsai JHC, Beaton R, de Castro AB. An exploration of managers’ discourses of workplace bullying. Nurs Forum. 2015;50(4):265–73. doi: 10.1111/nuf.12116 25597260

40. Lee YJ. The convergence approach based on grounded theory methodology on nurse’s experience of workplace bullying. Journal of the Korea Convergence Society. 2018;9(12):429–40.

41. Chipps EM, McRury M. The development of an educational intervention to address workplace bullying: A pilot study. J Nurses Staff Dev. 2012;28:94–8. doi: 10.1097/NND.0b013e31825514bb 22617778

42. Heponiemi T, Sinervo K, Kuokkanen L, Perala M, Laaksonen EM. The association between violence and turnover intentions among Finnish registered nurses. Nurs Evid. 2009;7:11–9.

43. Lee Y, Lee M, Bernstein K. Effect of workplace bullying and job stress on turnover intention in hospital nurses. J Korean Acad Psychiatr Ment Health Nurs. 2013;22:77–87. doi: 10.12934/jkpmhn.2013.22.2.77

44. Occupational Safety & Health Administration. Guidelines for preventing workplace violence for healthcare and social service workers. Washington, DC: US Department of Labor, Occupational Safety and Health Administration; 1996.

45. European Foundation for the Improvement of Living and Working Conditions. Preventing violence and harassment in the workplace. 2003 [cited 2019 Apr 9]. In: Eurofound [Internet]. European Foundation for the Improvement of Living and Working Conditions. Available from: EN.pdf

46. Wiskow C. Guidelines on workplace violence in the health sector. 2003 [cited 2019 March 28] [Internet]. Geneva: ILO, ICN, WHO, PSI. Available from:

47. Forster AJ, Petty TM, Schleiger C, Walters CH. Know workplace violence: Developing programs for managing the risk of aggression in the health care setting. MJA. 2005;183:357–61. doi: 10.5694/j.1326-5377.2005.tb07083.x 16201953

48. Jacobson J. Violence and nursing: Nurses worldwide are speaking out against what they say are inadequate workplace protections. AJN. 2007;107(2):25–6. doi: 10.1097/00000446-200702000-00010 17251764

49. American Nurses Association. Violence, incivility, & bullying. 2015 [cited 2019 Mar 8]. In: ANA Enterprise [Internet]. Silver Spring, MA: American Nurses Association. Available from:

50. Shin K. Legal definition and requirement of work-related harassment. Journal of Labour Law. 2019;69:217–51.

51. Leiter MP, Maslach C. Research in occupational stress and well-being: Areas of worklife. In: Perrewe PL, Ganster DC, editors. A structured approach to organizational predictors of job burnout. Oxford: Elsevier; 2004. pp. 91–134.

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2019 Číslo 12
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