Exploring Workplace Mistreatment and Nurses' Ability to Provide Quality Patient Care

Saturday, 28 October 2017

Christine Moffa, MS
Christine E. Lynn College of Nursing, Florida Atlantic University, jupiter, FL, USA


Workplace mistreatment (interpersonal abuse demonstrated among co-workers) is a common problem that can have serious consequences for individuals and organizations. Consequences for the individual include: mental and physical health problems, impaired sleep, depression, and post-traumatic stress disorder (PTSD). Consequences for organizations include: staff turnover and decreased productivity. Experiencing negative behavior from a colleague can disrupt the nurse’s ability to concentrate and impact their ability to deliver high quality, compassionate care. This disruption may lead to errors and poor patient outcomes and therefore becomes a safety issue.


In this exploratory study, a descriptive correlational design was used to examine the relationship between workplace mistreatment, nurses’ ability to provide quality patient care, and a caring work environment.

Research question

The overall research question focused on the relationship between workplace mistreatment, quantified as threats to dimensions of nurses’ well-being (health, personal security, reasoning, respect, attachment, and self-determination), and nurses’ ability to provide quality patient care. In addition, this study considers the moderating effect of caring work environment compassion among co-workers on nurses' ability to provide quality patient care in the face of workplace mistreatment.


Demographic Data.

Participant characteristics of age, educational level, nursing specialty, race, number of years working as a nurse, number of years working in their current role, and sex were captured in survey format.

Workplace Mistreatment.

Workplace mistreatment data was collected through part one of the Healthcare Productivity Survey (HPS).

Ability to Provide Quality Patient Care.

Part two of the HPS was used to measure the participant’s ability to provide quality nursing care after an incident of workplace mistreatment. Part-two of the HPS is a 29-item survey, which measures change in productivity before and after an incident of workplace mistreatment. The respondent is instructed to rate if their work productivity increased, decreased, or stayed the same after experiencing workplace violence (or mistreatment in the case of this proposed study) in comparison to before the incident.

Caring Work Environment.

A caring work environment was measured through the culture of companionate love scale which addresses workplace affection, compassion, caring, and tenderness for others.


The population of interest is hospital employed nurses who were providing direct patient care during the time of the workplace mistreatment. The study used a convenience sample of registered nurses. Inclusion criteria required that participants be: registered nurses aged 18 or older; employed in the hospital setting in acute or sub-acute areas; providing direct patient care; able to read, write and understand English; subject of a workplace mistreatment event within 30 days prior to responding to the study. Exclusion criteria was working as an advanced practice nurse.


Participants were recruited in phases to ensure an adequate number of responses was reached, all phases included snowball sampling technique. The study was announced on the www.allnurses.com website with a hyperlink to the survey included in the announcement. In the second phase announcements of the study including a hyperlink to the survey were made available through the researcher’s social media accounts including Twitter, LinkedIn, and Facebook. The third phase consisted of a blast email sent to the nursing students at the Christine E. Lynn College of Nursing at Florida Atlantic University.

Data collection

Data was collected by electronic survey hosted by SurveyMonkey.

The participants were asked to write about an episode of workplace mistreatment from a colleague that occurred in the last 30 days. The second part of the instrument includes 29 items related to patient care which the participant answers based on the story just written.

Data analysis

Descriptive statistics was calculated to capture participant demographics. Narratives were analyzed using directed content analysis. Stories of workplace mistreatment were evaluated to determine which of the six categories provided by the social justice as well-being model and noted: health, personal security, reasoning, respect, attachment, and self-determination. The total of threatened dimensions of well-being were calculated for each story. To enhance trustworthiness of the results peer debriefing was used and an experienced researcher also read 20% of the narratives to determine inter-rater agreement.

A Pearson product-moment r correlation was conducted to assess the relationship between the number of threatened dimensions of well-being and nurses’ ability to provide quality patient care. A moderation analysis was conducted to assess a caring work environment (compassion) as a moderator of the relationship between threatened dimensions of well-being and nurses’ ability to provide quality patient care.


Data is currently being analyzed and results will be included during poster presentation.


A limitation to this research is potential for participant bias as participants who are more sensitive to workplace mistreatment are likely to complete the study disproportionately compared with potential participants who are not as sensitive to workplace mistreatment. Additionally, participants may over- or underreport the effect that workplace mistreatment had on their work productivity. The majority of participants were white females and therefore the results may not be generalizable.


This study investigated the relationship between workplace mistreatment and nurses’ ability to provide quality patient care in the hospital setting. The six dimensions of well-being (health, personal security, respect, reasoning, attachment, and self-determination), as described by Powers and Faden’s (2006) theory of social justice, were used to quantify impact of workplace mistreatment on the study participants. The study also examined the role of a caring work environment as expressed through compassion as a moderator on this relationship.