All ETDs from UAB

Advisory Committee Chair

Patricia A Patrician

Advisory Committee Members

Gordon L Gillespie

Nataliya V Ivankova

Peng Li

Pauline A Swiger

Document Type


Date of Award


Degree Name by School

Doctor of Philosophy (PhD) School of Nursing


Workplace bullying (WPB) in nursing is a workplace problem that can undermine the safety culture necessary to minimize adverse patient events and improve health care quality. Nurses continue to experience and report WPB despite a substantial and growing body of evidence reflecting the negative effects of WPB on nurses, published position statements and alerts, and the initiation of workplace violence policies and protocols. To decrease WPB and inform the development of effective anti-bullying interventions, there has been a shift in focus from individual factors and interpersonal relationships among nurses and health care workers to organizational factors that contribute to nurse-reported WPB. Thus, determining the association between the nursing work environment, which is comprised of modifiable organizational factors, and nurse-reported WPB is warranted. Furthermore, poor nursing outcomes associated with nurse-reported WPB are well documented. However, there is less empirical evidence establishing a link between nurse-reported WPB and patient outcomes. In the context of the demand for safe, high quality patient care, it is important to further explore the associations between nurse-reported WPB and patient outcomes. The purpose of this dissertation was to explore the nursing work environment and patient outcomes (i.e., nurse-reported quality of care and patient safety grade) associated with nurse-reported WPB. Using a concurrent Quan + Qual mixed methods research design, this goal was accomplished in a stepwise manner. First, the psychometric properties of the Short Negative Acts Questionnaire (SNAQ), the instrument used to measure WPB in this study, and its ability to identify WPB status in a sample of inpatient staff nurses working throughout Alabama was explored. Second, the associations between the nursing work environment and nurse-reported WPB, and nurse-reported WPB and patient outcomes were quantitatively explored using the identified WPB statuses. Third, a qualitative study was conducted to further understand how nurses’ experiences of WPB occurring within the nursing work environment influences their abilities to provide patient care. Lastly, the quantitative and qualitative results were integrated to identify components in each study strand that could enhance and clarify the research phenomenon. The resulting body of work indicated that the nursing work environment is associated with nurse-reported WPB and, in turn, nurses’ experiences of WPB are associated with patient outcomes (i.e., nurse-reported quality of care and patient safety grade) and to some extent, nurses’ abilities to provide patient care. Further, this research confirmed that the SNAQ is a reliable and valid instrument to explore WPB in a sample of inpatient staff nurses working throughout Alabama. The findings of this dissertation study are of interest to nursing/health care organization leaders and researchers as they seek to develop and implement strategies to improve health care quality and patient outcomes.

Included in

Nursing Commons



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