Workplace bullying in nursing: towards a more critical organisational perspective Workplace bullying is a significant issue confronting the nursing profession. Bullying in nursing is frequently described in terms of 'oppressed group' behaviour or 'horizontal violence'. It is proposed that the use of 'oppressed group' behaviour theory has fostered only a partial understanding of the phenomenon in nursing. It is suggested that the continued use of 'oppressed group' behaviour as the major means for understanding bullying in nursing places a flawed emphasis on bullying as a phenomenon that exists only among nurses, rather than considering it within the broader organisational context. The work of Foucault and the 'circuits of power' model proposed by Clegg are used to provide an alternative understanding of the operation of power within organisations and therefore another way to conceive bullying in the nursing workforce.
The findings draw in question the usefulness of current approaches to managing bullying and will be of use to nurse managers, particularly those tasked with providing safer and more productive workplaces.
BackgroundTraditionally, clinical decision making has been perceived as a purely rational and cognitive process. Recently, a number of authors have linked emotional intelligence (EI) to clinical decision making (CDM) and calls have been made for an increased focus on EI skills for clinicians. The objective of this integrative literature review was to identify and synthesise the empirical evidence for a role of emotion in CDM.MethodsA systematic search of the bibliographic databases PubMed, PsychINFO, and CINAHL (EBSCO) was conducted to identify empirical studies of clinician populations. Search terms were focused to identify studies reporting clinician emotion OR clinician emotional intelligence OR emotional competence AND clinical decision making OR clinical reasoning.ResultsTwenty three papers were retained for synthesis. These represented empirical work from qualitative, quantitative, and mixed-methods approaches and comprised work with a focus on experienced emotion and on skills associated with emotional intelligence. The studies examined nurses (10), physicians (7), occupational therapists (1), physiotherapists (1), mixed clinician samples (3), and unspecified infectious disease experts (1). We identified two main themes in the context of clinical decision making: the subjective experience of emotion; and, the application of emotion and cognition in CDM. Sub-themes under the subjective experience of emotion were: emotional response to contextual pressures; emotional responses to others; and, intentional exclusion of emotion from CDM. Under the application of emotion and cognition in CDM, sub-themes were: compassionate emotional labour – responsiveness to patient emotion within CDM; interdisciplinary tension regarding the significance and meaning of emotion in CDM; and, emotion and moral judgement.ConclusionsClinicians’ experienced emotions can and do affect clinical decision making, although acknowledgement of that is far from universal. Importantly, this occurs in the in the absence of a clear theoretical framework and educational preparation may not reflect the importance of emotional competence to effective CDM.Electronic supplementary materialThe online version of this article (10.1186/s12909-017-1089-7) contains supplementary material, which is available to authorized users.
HUTCHINSON M and JACKSON D. Nursing Inquiry 2013; 20: 11–22 Transformational leadership in nursing: towards a more critical interpretation
Effective nurse leadership is positioned as an essential factor in achieving optimal patient outcomes and workplace enhancement. Over the last two decades, writing and research on nursing leadership has been dominated by one conceptual theory, that of transformational leadership. This theoretical framework has provided insight into various leader characteristics, with research findings presented as persuasive evidence. While elsewhere there has been robust debate on the merits of the transformational model of leadership, in the nursing literature, there has been little critical review of the model and the commonly used assessment instruments. In this article, we critically review more than a decade of nursing scholarship on the transformational model of leadership and its empirical evidence. Applying a critical lens to the literature, the conceptual and methodological weaknesses of much nursing research on this topic, we question whether the uncritical adoption of the transformational model has resulted in a limited interpretation of nursing leadership. Given the limitations of the model, we advocate embracing new ways of thinking about nursing leadership.
A long-term, strategic solution is required that focuses on public engagement and interaction with the profession in a context wider than personal health/ill-health, and that goes beyond the marketing campaigns seen in the past to address recruitment crises.
This paper reports some of the findings from the first qualitative stage of a large national study of bullying in the nursing workplace currently being undertaken in Australia. The findings reported here reveal how relationships between bullies were embedded within informal organizational alliances, enabling bullies to control work teams and use emotional abuse and psychological violence as a means of enforcing bully-defined 'rules of work'. Within nursing teams, bullies controlled work roles, tasks, and status in the nursing hierarchy through enforcing their 'rules'. Bullies enforced these rules through a process of ritual indoctrination, destroying the self-confidence and self-image of those targeted, and forcing them to eventually resign their position or acquiesce to survive. The merciless, calculated and deliberate nature of the bullying resulted in profound harm for many of those targeted. The findings of this research have implications for the understanding and management of workplace bullying.
The detailed catalogue of bullying behaviours draws attention to the breadth of the bullying experience. It is anticipated the typology will be of use to nurses, managers and other professionals who are interested in responding to the problem of bullying in nursing.
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