Workplace mobbing,group cohesion and intraindividual variables in nurses from a rural hospital in Northern Greece: A correlation study

Abstract

BACKGROUND:

High levels of mobbing are reported in Greek nurses, but the intraindividual and perceived group emotional correlates are little investigated.

OBJECTIVE:

To determine the relationship between workplace mobbing (specifically in the nursing sector of a public rural hospital in Greece) and emotional correlates.

METHODS:

Questionnaires measuring emotional aspects such as Negative Act Questionnaire – Revised (NAQ-R) for measuring perceived exposure to bullying and victimization at work, Maslach Burnout Inventory (MBI), Overall Job Satisfaction Scale (OJS), Job Affect Scale (JAS: positive and negative subscales), Perceived Cohesion Scale (PCS), Ethical Climate Questionnaire (ECQ), and Short General Health Questionnaire (GHQ-12) were administered. For the analysis of the data, descriptive and parametric tests were performed through the Pearson correlations and regression for the relationship between variables.

RESULTS:

High mobbing levels were reported (M = 45.93) compared to already established cutoff scores. Statistically significant positive correlations were found for NAQ-R and MBI (Exhaustion subscale) (r = .569, p < .001), NAQ-R and JAS-negative affect (r = .610, p < .001), NAQ-R and GHQ-12 (r = .280, p = .002), and NAQ-R andeducational level (r = .196, p = .033). Statistically significant negative correlations were found for NAQ-R and ECQ (r = –.323, p < .001), NAQ-R and JAS-positive affect (r = –.556, p < .001), and NAQ-R and PCS (r = –.586, p < .001). Only burnout,negative affect, and perceived group cohesion predicted mobbing measured by NAQ- R.

CONCLUSION:

As mobbing and its consequences are related to specific emotional variables, these perceived individual and group indices, could be targeted in future prevention initiatives.

Keywords

Bullying victimization workplace violence health personnel burnout

1 Introduction

Although ‘mobbing’ refers to situations where a worker, supervisor, or manager is systematically and repeatedly targeted with intimidation, insult(s), exclusion, and generally unfair behavior [1], this workplace bullying, mistreatment and victimization by fellow workers, subordinates, or superiors has been investigated mainly in healthcare environments such as hospitals in US and Northern Europe.

According to recent reviews, general nurses are a group of healthcare workers acutely at risk of mobbing, showing serious physical and mental health disorders, accompanied by higher levels of anxiety and depression [2]. As a result of mobbing, labor productivity decreases, sickness rates increase, and nurses’ personal lives are disrupted [2]. This finding has also been supported in diverse cultural settings (other than Western), such as South-East Asian and Western Pacific regions [3].

Regarding mobbing there is literature in Mediterranean countries supporting high rates in nurses (80.1% of nurses encountering mobbing behaviors, including humiliation and degradation) [4]. Mobbing has been found to have a positive relationship with emotional exhaustion and depersonalization in healthcare professionals in leadership positions (including head nurses and assistant head nurses) in Turkish hospitals [5]. Another research from Turkey reports that mobbing is a significant regressor for emotional exhaustion, depersonalization and personal accomplishment only for the group of doctor residents [6].

In Cypriot healthcare workers, women are significantly more often exposed to at least one mobbing behavior than men, whereas nurses were significantly exposed to at least one mobbing behavior as compared to physicians [7]. In a relevant study with Cypriot nurses, workplace mobbing was found to associate with specific demographic variables (e.g. 26–35 years of age, single marital status), educational (Master’s education) and occupational (less than 5 years of work experience, district of employment) as well as with emotional exhaustion [8]. Additionally, a study from Italy revealed that not only healthcare workers in hospitals who have been in the same job for a considerable amount of time (e.g. more than 15 years) show the highest levels of emotional exhaustion and depersonalization, but they also report a worrying exposure to alcohol abuse, while those with high levels of emotional exhaustion tend to make use of both alcohol and tobacco, thus demonstrating high levels of emotional distress [9].

The above studies do not include variables that deal with perceived group dynamics at work. Only a few studies so far have examined mobbing including both intra-individual variables, such as stress, which has been found to positively associate with mobbing, as well as perceived group support and group identity, which were negative predictors of mobbing, supporting that the combination of low group identity and low group support precipitated mobbing among nurses [10]. A similar study again in Spanish nurses has found that personal characteristics related to high sensitivity to anxiety and low emotional intelligence implied greater presence of mobbing at work, but this mobbing may be buffered if the person perceives enough support from family, friends or significant others, thus implying the need to examine in more detail the role of social factors such as social support network (at work or in general) of nursing personnel to improve the work climate [11].

Still, little is known about the situation in Greece, as research so far is scarce and mainly emphasizes doctors/residents and secondarily nurses working solely at metropolitan hospitals [12]. Such findings support the value of family and friends for nurses working in public hospitals located in large urban centers, when they are coping with workplace bullying [13, 14], but the underpinning psychological and/or social variables that may predict mobbing are not examined at all. This renders the role of possible emotional correlates of this phenomenon such as burnout, job satisfaction, and perceived group cohesion unknown not only in urban hospital settings, but especially in the hospitals located in rural areas [15].

Based on the above findings from different countries about the emotional correlates of mobbing, the aim of this is research is to determine the relationship between experienced mobbing (as measured with the use of a self-report questionnaire focusing for the first time on Greek nurses, and more specifically in nurses working at a public rural hospital not located in a metropolitan area) and diverse emotional factors that reveal how the individual perceives outside emotional influences at workplace and in everyday life as measured by a number of questionnaires. More specifically based on the above literature regarding in general healthcare professionals [6 , 10], positive correlations are expected between mobbing, burnout, job dissatisfaction, and low perceived cohesion at work. A second aim of this study is to identify potential predictors of mobbing in an exploratory attempt as used in relevant regression analyses in similar studies [10 , 17].

2 Methods

In total 119 nurses (27 males, 92 females) who worked at the time of the administration in a public rural hospital in Northern Greece participated voluntarily in this research. In this quantitative, cross-sectional, correlational research participants were recruited from a single regional hospital in Northern Greece, and were approached via mailed letters and face-to-face contact. No financial compensation was provided for participation. The questionnaires were initially distributed to all 140 nurses working at the hospital (coming from all hospital departments), considering the dropout rate of 15% as very low.

The average age for the whole sample was 44.97 (SD = 5.53) years, and the average working experience was 20.26 (SD = 7.98). Overall, the majority of the participants had a bachelor’s degree in nursing from a Greek accredited higher- education institution (n = 64; 53.8 %), and additionally certified nursing assistants (n = 55; 46.2 %) were included. The majority of the participants were married (n = 79; 66.4 %), and the rest were bachelors (n = 28; 23.5 %), divorced (n = 9; 7.6 %), and widows (n = 2; 1.7%). Only n = 31 (26.1 %) did not have children at all, and the rest had 1–6 children (n = 88, 73.9 %).

Study inclusion criteria were similar to other studies [18]. Participants should be registered nurses having prior working experience of at least one year in a hospital, being a native Greek speaker, and being free of a formal diagnosis of psychiatric disorder (e. g. major depression, anxiety etc.).

2.1 Data collection

Participants were asked to complete a number of questionnaires anonymously in their own place (not necessary in their working place) and without a time limitation. The researchers requested full completion of all questionnaires that examined different aspects of emotions and were mailed out and completed by the participants in a paper-and-pencil way. All administered questionnaires met the requirements of brevity, sensitivity, and validity for the Greek population. The rationale for choosing the questionnaires was based on their psychometric properties (given that there are a few standardized instruments in use in the Greek language), and on their relevance to the examined psychological constructs. The following questionnaires were administered: a) Negative Act Questionnaire – Revised (NAQ-R) for measuring perceived exposure to bullying and victimization at work (23 questions, α= .95) [19], b) Maslach Burnout Inventory (MBI) – shorter 5-item version of the scale called “Exhaustion” (α= .75) [20], c) Overall Job Satisfaction Scale (OJS) (18 questions, α= .90) [21], d), Job Affect Scale (JAS) (17 questions: α= .83 for positive and α= .77 for negative subscales) [22], e) Perceived Cohesion Scale (PCS) (6 questions, α= .90) [23], f) Ethical Climate Questionnaire (ECQ) (36-item list, α= .80) [24], and g) Short General Health Questionnaire (GHQ-12) used as a screening tool for common mental disorders and psychological distress (12 questions, α= .84) [25].

Data was analyzed using SPSS version 22.0 for Windows. Pearson correlations were performed between the total scores of the administered questionnaires, demographics (such as age, education years, and working experience). Linear regression ‘ENTER Method’ was applied for NAQ-R as the dependent variable and all other administered emotion questionnaires as the independent variables.

2.2 Ethical considerations

The study was authorized by the Hospital Ethics Committee in which the research took place (Scientific Committee Approved Meeting Number: 14964/04-05- 2017). The participants were informed about the study objective, and their informed consent was obtained in writing following the principles of the Declaration of Helsinki.

3 Results

Pearson correlations including the seven questionnaires, as well as all the abovementioned demographics revealed that there statistically significant positive correlations between the total score of NAQ-R and MBI (Exhaustion subscale) (r = .569, p < .001), NAQ-R and negative affect (r = .610, p < .001), NAQ-R and GHQ-12 (r = .280, p = .002), and NAQ-R and educational level (r = .196, p = .033).

Statistically significant negative correlations were found for NAQ-R and ECQ (r = –.323, p < .001), NAQ-R and positive affect (r = –.556, p < .001), and NAQ-R and PCS (r = –.586, p < .001) (see Means and SDs for each questionnaire in Table 1).

Table 1
Means and SDs for total scores of all administered questionnaires

Questionnaires Minimum Maximum Mean SD

Negative Act Questionnaire – Revised (NAQ-R) 23.00 98.00 45.93 16.73

Maslach Burnout Inventory (MBI) 6.00 30.00 16.43 5.93

Ethical Climate Questionnaire (ECQ) 57.00 162.00 110.22 17.92

Job Affect Scale (JAS) – Positive affect 11.00 44.00 27.17 6.39

Job Affect Scale (JAS) – Negative affect 8.00 30.00 15.97 5.15

Overall Job Satisfaction (OJS) 35.00 59.00 48.27 4.75

Perceived Cohesion Scale (PCS) 7.00 42.00 31.17 8.67

Short General Health Questionnaire (GHQ-12) .00 10.00 1.83 2.56

Questionnaires	Minimum	Maximum	Mean	SD
Negative Act Questionnaire – Revised (NAQ-R)	23.00	98.00	45.93	16.73
Maslach Burnout Inventory (MBI)	6.00	30.00	16.43	5.93
Ethical Climate Questionnaire (ECQ)	57.00	162.00	110.22	17.92
Job Affect Scale (JAS) – Positive affect	11.00	44.00	27.17	6.39
Job Affect Scale (JAS) – Negative affect	8.00	30.00	15.97	5.15
Overall Job Satisfaction (OJS)	35.00	59.00	48.27	4.75
Perceived Cohesion Scale (PCS)	7.00	42.00	31.17	8.67
Short General Health Questionnaire (GHQ-12)	.00	10.00	1.83	2.56

Additionally, linear regression Enter” method analysis revealed that only burnout, negative affect, and perceived group cohesion predicted mobbing as measured by NAQ-R (R = .778; R² = .605; see Table 2).

Table 2

Regression analyses for NAQ-R as dependent variable and emotional aspects as independent variables

Model		Unstandardized coefficients		Standardized Coefficients	t	p
		B	Std. Error	Beta
	(Constant)	66.312	12.641	0.276	5.246	0
	MBI	0.79	0.221	–.029	3.58	0.001
	ECQ	–.027	0.068	–.116	–.399	0.691
1	JAS positive affect	–.302	0.23	0.289	–1.314	0.192
1		JAS negative affect	0.968	0.302	–.126	3.206	0.002
	OJS	–.442	0.238	–.279	–1.855	0.067
	PCS	–.533	0.165	0.015	–3.235	0.002
	GHQ-12	0.103	0.515	∼	0.2	0.842

a. Dependent Variable: NAQ-R.

4 Discussion and conclusion

Overall, workplace mobbing in Greek nurses representing the nursing sector of a rural public hospital seems to be of a high level (mean score 45.93, SD = 16.73; compared to the proposed cutoff score for high classification for the Greek population: 45–55) [19]. Workplace mobbing is found not to be related to prior years of working experience, gender or family status, but is mainly predicted by burnout (self-reports of exhaustion) and negative affect, while the individual perceptions of the cohesion in the work group seems to be the third factor that could change perception of mobbing. For the first time, an unexpected finding is that perceived health as measured by GHQ-12 positively correlates with high levels of mobbing, a finding that may be explained by the knowledge of and attention to health problems that nurses have as healthcare professionals compared to other groups of workers. An interesting point is that although moderate correlations were found, for the prevention of this phenomenon apart from the individual variables that could be used in future interventions (such as burnout and negative affect), a group variable and more specifically group cohesion is also proposed as a point that could be tackled.

A point that is of interest is that although a prior research from Brazil supports that higher levels of emotional exhaustion are found in healthcare professionals with lower educational levels [26], in the present study the role of education is highlighted as it correlates with perceived exposure to bullying and victimization at work. This specific correlation between mobbing and education has been also supported in a study with Cypriot nurses [8]. Of course, educational level may serve as a potentially fragilizing factor for an individual working as a nurse, but it is not possible to determine whether this happens because the low level of education corresponds to a lower level in hierarchy, which might be the reason for this finding (as in Greece usually academic qualifications-among other factors- are used for promotion to higher positions), thus rendering hierarchically lower situated individuals may be more prone to mobbing.

The principal limitation of this study is that self-report questionnaires measuring emotional variables were used and no other objective sources of information were included. In addition to that, the perceived experience of participants was measured mainly in women participants. Another point that needs to be considered is the fact that although preliminary regressions revealed some predictors of mobbing, in this study the nature of the research methodology (cross-sectional correlational) cannot fully answer questions with regard to causality or with regard to prediction. Despite this limitation, this study makes a novel contribution in the field of mobbing by establishing where we are today regarding self-perceived mobbing’s relation to a variety of other emotional variables and where should the research go to the future. The current research is timely, given that in recent years no major changes have been made regarding the function and structure of the nursing sector in Greek public hospitals (urban as well as rural), while the voices are growing regarding relevant and effective interventions in such settings [27, 28] due the deleterious effects regarding both intraindividual mental health problems (e.g. psychological distress, depression, and burnout) and physical problems (e.g. insomnia and headache) as well as the functioning and productivity of the health organizations [29 , 31].

Thus, future research may explore mobbing as well as other emotional variables that could include perceptions/emotions about the group functioning and not only the individual functioning [32] in a cross-cultural perspective (given the differences in mobbing antecedents found both in expression and perception of mobbing, such as vertical bullying more frequently found in higher power distance cultures, while individual antecedents are reported more frequently in collectivist cultures) [33, 34]. Also samples of different types of healthcare professionals working in hospitals (e.g. physicians, social workers, psychologists etc.) should be examined [35], as well as in nurses working solely in specific hospital units with high demands (e.g. Intensive Care Units, oncology clinics) [36 , 38]. Additionally, variables such as the public or private sector aspect should also be considered [39] in multilevel analyses regarding ‘leader-subordinate’ groups of employees in healthcare settings, something that may reveal if and how self-reported tendencies are experienced at an interindividual level [40], while mixed research designs should use apart from NAQ-R (as the main tool for assessing mobbing) [41], also qualitative approaches (such as interviews and focus groups), which could reveal aspects of the experience so far neglected in the existing questionnaires measuring these emotional variables [42 –47]. All the above will help us to detect the factors that encourage nursing mobbing and to clarify what changes are needed regarding human resources, workplace design, policy and organizational structures [48].

Ethical approval

The study was approved by the General Hospital of Kavala (Protocol number 10104/9-5-2017).

Informed consent

Written informed consent was obtained from all participants involved in the study.

Conflict of interest

None to report.

Footnotes

Acknowledgments

None to report.

Funding

None to report.

Author contributions

AV: design of the study, literature search, data collection and curation, initial data analysis; VG: design of the study, literature search, statistical analyses, interpretation of data, manuscript writing.

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