Original Article Egyptian Journal of Health Care, 2020 EJHC Vol. 11 No.

Nurses' Work Environment and Psychological Capital: Predictors

of Workplace Bullying

Ibrahim Abdullatif Ibrahim1, Zeinab Hassan Osman2, NehadSaad Elwekel3, Abdel-

Hady El-Gilany4
1,3 Nursing Administration, Faculty of Nursing, Mansoura University.
2. Psychiatric Mental Health Nursing Faculty of Nursing, El-Fayoum University.
4. Public Health and Preventive Medicine, Faculty of Medicine, Mansoura University.

Abstract

Background: Predictors of workplace bullying should be identified and eradicated to

reduce negative consequences on patients, staff, and health care organizations. Aim: To
explore the effect of the work environment and psychological capital on nurses' perception of
workplace bullying. Methods: Descriptive correlational design was used. Nursing work
environment scale, psychological capital scale, and negative acts- revised scale were used for
collecting data from nurses. Results: Stepwise linear regression analysis showed that
Psychological capital, nursing work environment, experience, and educational level are
independent predictors of workplace bullying score with R2of 0.26, 0.06, 0.03, and 0.02
respectively. Conclusion: Nurses' work environment and psychological capital were
negatively correlated with workplace bullying. Recommendations: To reduce workplace
bullying among nurses, nursing managers should create a positive work environment
characterized by a quality of leadership, effective work system, low interpersonal conflict,
and provides support for nurses. Psychological capital training programs should be
developed to reduce the probability of victimization of the workplace bullying, increase
nurses’ ability to cope with adversity, and help nurses to face challenging situations with
positivity.

Keywords: Work Environment, Psychological capital, Workplace.bullying

Workplace bullying is often termed as
Introduction
mobbing, assault, emotional abuse, workplace
Currently, workplace bullying is violence, or incivility. It includes a wide range
perceived as a serious problem with of negative behaviors as criticism, allocating
negative consequences toward nurses, unfair workloads, social exclusion (informally
patients, and health care organizations. or formally), asking a person to handle low-
Workplace bullying described as an status work, personal abuses, withholding
ongoing process in which nurses are opportunities for professional development,
systematically and frequently attacked with facial expressions (e.g., glaring, rolling eyes),
negative behaviors which may be related to and undermining the authority (Reknes, et al.,
work (e.g. Information retention) and/or a 2014).
person(e.g. insults) (Van den Brande, et
The contributing factors of workplace
al., 2016). It also refers to situations
bullying are poor working conditions, harsh
where an individual or group repetitively
work environments, individual personality types,
harasses, causes discomfort to, and
organizational culture, leadership, and
socially excludes another
psychological capital (Eastman, 2013;
individual(Hodgins, et al., 2014).
Trépanier, et al., 2016; Podsiadly & Gamian-
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Wilk, 2017; Fink-Samnick, 2018). The negative psychological effect. In other words,
bullied persons consistently report high levels of positive Psychological capital
unfavorable working conditions such as help individuals to combat unsafe behavior
high levels of role conflict, poor leadership (e.g., workplace bullying and reduce its
and supervisory behavior, lack of negative effect. Psychological capital is
information flow, and a negative social manageable, and the negative outcomes of
climate (Tuckey, et al., 2009). bullying can be mitigated by enhancing
individual's Psychological capital through an
The work environment is a broad intervention such as training programs
concept that can include (1) how work is (EASTMAN, 2013; Cassidy, et al., 2014;
organized (i.e., job characteristics such as Stratman & Youssef - Morgan, 2019)
overload, job control), (2) work group
characteristics and processes (i.e., Significance of the study
interpersonal relationships such as social
support and conflict), (3) the nature of the Nurses in the health care sector are
leadership, and (4) the culture of the known to be more susceptible to bullying
organization. Work environment factors (e.g., behaviors at the workplace, with incidence
leadership, job characteristics) are work-related rates vary from 13% to 86% (Tuna &
antecedents of bullying (Trépanier, et al., Kahraman, 2019). Workplace bullying is
2016). perceived as a serious problem with negative
consequences toward nurses, patients, and
Psychological capital described as health care organizations. Workplace bullying
"developing positive psychological state has severe negative outcomes for nurses' well-
among nurses that characterized by (1) having being physically (e.g., insomnia and headache)
confidence (efficacy) to take on and put in the and psychologically (e.g., depression, and
necessary effort to succeed at challenging tasks; anxiety), decrease job performance, increase
(2) making a positive attribution (optimism) job dissatisfaction, and intention to leave their
about succeeding now and in the future; (3) career. Further, adverse outcomes to patient
persevering toward goals and, when necessary, safety (e.g., medication errors), in addition to
redirecting paths to goals (hope) to succeed; decreasing quality of patient care (León-Pérez,
and (4) when beset by problems and adversity, et al., 2019; Lever, et al., 2019; Liu et al.,
sustaining and bouncing back and even beyond 2019). Therefore conducting the current
(resiliency) to attain success".Each component research will help nursing managers and
of psychological capital strengthens each other decision-makers to identify predictors of
and enhance nurses' capabilities to manage workplace bullying among nurses. So they will
negative work environment encounters be able to reduce the incidence and negative
(Jackson, et al., 2007; Rabenu, 2017). effects of bullying at the workplace.
Psychological capital is positively Aim of the study
related to job satisfaction, well-being,
mental health, and job performance.
Psychological capital was found to be The present study aims to explore
negatively related to stress, turnover nurses' work environment, psychological
intentions, burnout, anxiety, depression, capital as predictors of workplace bullying
negative affect, substance abuse, and among nurses through
counterproductive workplace behaviors as
workplace bullying (Luthans, et al., 1.Assessing the work environment,
2014; Rabenu, 2017). Psychological psychological capital, and workplace bullying
capital also plays a mediating role among nurses.
between workplace bullying and its
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2.Explore the relationship between characteristics of nurses such as age, gender,

work environment, psychological capital, and educational level, and experience. The second
workplace bullying. section includes the work environment scale
which was adapted from Yun, et al., (2014)
Research questions to assess nurses' perceptions regarding their
work environment features. This scale
1.What is nurses' perception toward includes 30 items categorized into four
their work environment? subscales; (1) institutional support (12 items)
2.What is the level of nurses' (e.g., Hospital management listens and
psychological capital? responds to staff nurses' concerns), (2) head
3.What is the level of workplace nurses' leadership (7 items) (e.g., Head nurse
bullying among nurses? listens to staff nurses' requests), (3) the basic
4.Is there a link between the work system of the work (6 items) (e.g., Work
environment and workplace bullying? system reflects nurse's opinion when planning
5.Is there a link between psychological work schedule), and (4) interpersonal
capital and workplace bullying? relationship (5 items) (e.g., Nurses and
physicians work cooperatively).
Subjects & Methods
Scoring system
Research Design
Responses were rated on a 5-point
The research design was descriptive Likert scale ranging from 1 (strongly disagree)
correlational design to 5 (strongly agree). The scores of items
were summed-up and the total score was
Setting divided by the number of the items, giving the
mean score for the part. Work environment
The present study was conducted at El perception was classified into three categories
Fayoum University hospital. It is occupied with based on the total score: poor (<25th
224 beds and includes 12 departments for percentile) (30-101), mixed (25th–75th
providing medical care for patients with percentiles) (102-129), or good (>75th
different medical diseases. percentile) (130-150) (Aiken, et al., 2008).

Study subjects Tool II: Psychological capital scale:

This scale was developed by Luthans, et al.,
The study included a convenience
(2007) to assess psychological capital
sample of all staff nurses (n=191)who were
among nurses. It includes 24 items under
providing direct patient care during the time of
four subscales namely; (1) Self-efficacy
data collection and having at least one year of (e.g., I feel confident analyzing a long-term
experience. problem to find a solution), (2) Hope (e.g.,
Right now I see myself as being pretty
Tools of data collection
successful at work), (3) Resilience (e.g., I
Data of the present study was usually manage difficulties one way or
collected by utilizing three tools as follows: another at work), and (4) Optimism (e.g., I
always look on the bright side of things
The tool I: Work environment regarding my job). Each subscale includes
scale 6 items.

This scale includes two sections; the

first section contains data related to personal

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Scoring system understanding, applicability, and easiness,

minor modifications were done based on
A six-point Likert scale was utilized experts' recommendations. The scales had
to rate the nurses' response regarding each acceptable Cronbach's alpha reliability; 0.91,
item from 1 ''strongly agree'' to 6 ''strongly 0.86, and 0.95 for work environment scale,
disagree''.The scores of items were psychological capital scale, and workplace
summed-up and the total score was divided bullying scale respectively.
by the number of the items, giving the
mean score for the part. The higher scores Ethical considerations
represent a higher level of psychological
capital. The total psychological capital Ethical approval was obtained before
score was classified into three levels; low gathering data of the study from the ethical
(<50%), moderate (50-75%), and high research committee, faculty of Nursing,
(>75%). Mansoura University. The aim of the study
was explained to the staff nurses, acceptance
Tool III: Negative Acts-Revised to participate in the study was voluntary and
scale: It was developed by Einarsen, et al., unsigned. In addition to their rights to refuse
(2009) to assess workplace bullying among or withdraw without giving reasons. They
nurses. It contains 22 statements and is were reassured that any obtained information
categorized into three domains; (1) Person- will be confidential, and will be used only for
related bullying (12 items) (e.g., spreading of the purpose of the study. The nurses were
gossip and rumors about you). (2) Work- asked to participate in the research through a
related bullying (5 items) (e.g., someone written invitation with a copy of the research
withholding information which affects your questionnaire and clarification about the
performance). (3) Intimidation-related research was provided. Filling and returning
bullying (5 items) (e.g., exposed to threats of back the questionnaire was an indication of
violence or physical abuse). acceptance to participate in the study.
Scoring system Pilot study
Responses ranged from 1 (never) to 5 The pilot study was included 21
(almost every day). The scores of items were staff nurses that represent 10 % of the total
summed-up and the total score was divided sample (n=212). The aim of conducting the
by the number of the items, giving the mean pilot study was to test the clarity and
score for the part. The higher score was feasibility of the tools. It also estimates the
indicating more workplace bullying. If total time needed to fill the questionnaire. The
scores below 40 indicate nurses are not time estimated to fill the questionnaire
bullied, total scores between 40 and 56 ranged from 20-30 minutes. The pilot
indicate nurses are occasionally bullied, and sample was excluded from the total sample
total scores above 56 indicate nurses are of staff nurses. Data obtained from the pilot
severely bullied at work (Gupta, et al., 2017). study were analyzed to assess the reliability
of the study tools.
Validity and Reliability
Fieldwork
The utilized scales were translated into
Arabic language and translated back into Data of the current study were
English to ensure the precision of the collected through a self-administered
translation and tested for its content validity questionnaire during the period from October
through a panel of five experts to ensure 2018 to January 2019 after (1) obtaining ethical
clarity, relevance, comprehensiveness, approval from the ethical research committee-

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faculty of nursing -Mansoura University, (2) assess the difference in the overall mean
permission from the director of the hospital, workplace bullying score regarding nurses'
and (3)following the ethical considerations characteristics. Post hoc-Tukey’s test was used
that mentioned previously. for multiple comparisons after ANOVA.
Pearson correlation coefficient test was
Statistical design conducted to estimate the correlation between
workplace bullying score and different
Data were analyzed utilizing SPSS variables. The variables with significant
version 21. Descriptive statistics (frequency correlation were inserted into stepwise multiple
and percentages) were utilized to summarize models of linear regression to identify the
the nurses' demographics. The reliability of the independent predictors of workplace bullying
scales was assessed through Cronbach's alpha score. P-value was considered to be statistically
coefficient. Analysis of variance (ANOVA) significant at ≤ 0.05.
and independent sample t-tests was used to
Table (1): Workplace bullying perception score according to characteristics of the
studied nurses(n=191).

Personal characteristics Total Workplace bullying Significance test

n (%) Mean (SD) t or f (p)
Overall 191 (100.0) 34.80 (13.91)
Age (mean±SD) 29.00±6.80
20-30 140 (73.3) 36.31 (14.62)a
31-40 34 (17.8) 29.41 (8.75)a 3.60 (≤0.05*)
>40 17 (8.9) 33.11 (14.04)
Gender
Male 54 (28.3) 33.81 (13.44)
0.61(0.54)
Female 137 (71.7) 35.18 (14.11)
Marital status
Single 49 (25.7) 33.93 (14.07)
Married 117 (61.3) 35.45 (14.25) 0.26 (0.85)
Divorced 10 (5.2) 32.30 (10.81)
Widowed 15 (7.9) 34.20 (13.28)
Religion
Muslim 179 (93.7) 34.42 (13.65) 1.44(0.14)
Christian 12 (6.3) 42.41 (16.94)
Educational level
Diploma degree 22 (11.5) 40.22 (19.34)a
Technical degree 127 (66.5) 32.09 (11.67)a,b 7.68 (≤0.001**)
Bachelor degree 42 (22.0) 40.14 (14.75)b
Experience (Mean±SD ) 7.78±7.25
1-5 102 (53.4) 38.73 (14.77)a,b
6-10 40 (20.9) 31.92 (14.03)a 10.15(≤0.001**)
>10 49 (25.7) 28.95 (8.48)b
* P≤0.05 \ ** p≤0.01

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Table (2): Levels of the study variables as reported by the studied nurses (n=191).
Study variables levels Score N %
Work environment
Poor 30-101 45 23.6
Mixed 102-129 99 51.8
Good 130-150 47 24.6
Psychological capital
Low 24-71 3 1.6
Moderate 72-108 41 21.5
High 109-144 147 77.0
Workplace bullying
Not bullied 22-39 145 75.9
Occasionally bullied 40-56 21 11.0
Severe bullied 57-110 25 13.0

Table (3): Descriptive statistics and Correlation Coefficients of workplace bullying

with the work environment and psychological capital(n=191).
Person- Work- Intimation -
Workplace
Variables Mean±SD related related related
bullying score
bullying bullying bullying
work environment 116.08±19.36 -0.46** -0.47** -0.36 -0.47**
Institutional support 44.31 ± 9.09 -0.43** -0.39** -0.26 -0.41**
the leadership of head
27.51±5.17 -0.37** -0.48** -0.37** -0.43**
nurse
Work system 23.19±4.65 -0.36** -0.39** -0.30** -0.38**
Interpersonal
21.05±3.60 -0.39** -0.36** -0.35** -0.40**
relationship
Psychological capital 113.08±14.68 -0.56** -0.39** -0.39** -0.51**
Self- efficacy 27.81 ±5.54 -0.58** -0.38** -0.39** -0.52**
Hope 32.71 ±5.32 -0.45** -0.34** -0.33** -0.42**
Optimism 26.45 ±3.38 -0.42** -0.22** -0.30** -0.36**
Resilience 26.09 ±3.30 -0.34** -0.32** -0.22** -0.33**
Mean (SD) 16.87±7.30 10.12±4.40 7.81±3.26 34.80 ±13.90

**(p ≤ 0.01)
Table (4): Correlation coefficient and multiple linear regression for independent predictors of
workplace bullying score among nurses (n=191).

Predictors β Added R2 t-value P-value

Psychological capital -0.32 0.26 4.91 ≤0.001**
Work environment -0.21 0.06 4.06 ≤0.001**
Experience -0.43 0.03 2.78 ≤0.01**
Education (1=diploma; 2= technical -4.53 0.02 3.39 ≤0.001**
degree; 3=bachelor)
Constant 108.95
Model F F=27.03, P= ≤0.001
Adjusted R2 0.35
** P ≤ 0.01

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Results

Table (1) showed that the majority Discussion

of the studied nurses aged from 20-30 years
(73.6%), were females (72.0%), married To achieve the aim of the study, and
(61.7%), Muslim (93.8%), having a answer the research questions, the research
technical degree of nursing (65.8%), and findings will be illustrated in three sections:
had experienced (1-5) years (53.9%). The
bullying score showed a significant I: Assessment of the study variables
variation with nurses’ age, educational (work environment, psychological capital,
level, and experience. and workplace bullying).

Table (2) illustrated that more than Regarding the work environment, the
half of the studied nurses perceived a mixed study revealed that half of the studied nurses
work environment, and the majority had a perceived their work environment as a mixed
high level of psychological capital and environment that sometimes good and
were not bullied. sometimes poor. This may be due to
continuous changing work systems, or
Table (3) showed that the mean unstable interpersonal relationships between
score of the work environment was nurses themselves /or physicians.
(116.08±19.36), while, the highest mean
score was (44.31±9.09) for the institutional This result in accordance with the
support domain, and the lowest mean score study of Yun et al., (2014) that was included
was (21.05±3.60) for the interpersonal 134 nurses from five hospitals in Korea and
relationship domain of work environment. reported moderate satisfaction with their work
The mean score of psychological capital environment. This result disagreed with the
was (113.08±14.68), while the highest study of Johansen & Cadmus, (2016), who
mean score was (32.71 ±5.32) for the hope reported more than the half of the studied
domain and the lowest mean score was nurses' perceived low levels of the support
(26.09 ±3.30) for the resilience domain. work environment. Also, it disagreed with the
The mean score of workplace bullying was study of Hayes, et al., (2015), reported that
(34.80 ±13.90). While, the highest mean nurses perceived overall the work
score was (16.87±7.30) for person-related environment as positive.
bullying, and the lowest mean score was
(7.81±3.26) for intimation related bullying. Regarding psychological capital, the
There was a statistically significant study revealed that nurses had a high level of
correlation between workplace bullying, psychological capital. This may be due to
work environment, and psychological effective organizational climate, effective
capital. communication between nurses and their
managers, or/ they perceived a low level of
Table (4) revealed that occupational stress. This result was supported
psychological capital, nursing work by the study of Shelton & Renard (2015),
environment, experience, and education who found that the majority of the nurses
were independent predictors of workplace exhibited high levels of psychological capital.
bullying score with R2 of 0.26, 0.06, 0.03, Also, the study of Estiri, et al., (2016) reported
and 0.02 respectively. that the studied Iranian nurses had a high level
of psychological capital. In the same line,
Çelik (2018) reported that the studied
samples' psychological capital level was

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above average. This result disagreed with qualification. These findings also disagreed
Metwaly & Ahmed (2018) revealed that the with Evans (2017), who reported that there
studied nurses had a low level of was no statistically significant correlation
psychological capital. between nurses' age, education level, or
experience years with the organization and
Regarding workplace bullying, the their exposure to bullying.
research findings revealed that the majority of
the studied nurses were not bullied. This may II: Work environment predicts
be due to an effective work system, workplace bullying among nurses.
organizational culture; clear policies, or
nurses had a high level of morale and The results of this study proved that
professional ethics. These findings agreed the nursing work environment was associated
with Butler, et al., (2018), who reported that negatively with nurses' workplace bullying
the majority of the studied nurses were not perception. This may be due to a poor work
bullied at their workplace. These findings environment that is characterized by
disagreed with Obeidat, et al., (2018), who ineffective leadership style, poor work system,
reported the majority of Jordanian nurses poor organizational culture, and interpersonal
working in private hospitals to perceive conflict, all these can increase the risk of
themselves as victims of either occasional or being a victim of workplace bullying. For
severe workplace bullying. It also disagreed example, an autocratic leadership style
with Tuna &Kahraman (2019), shown that increases the perception of workplace
the studied nurses are at significant risk of bullying, but transformational and authentic
being exposed to workplace bullying. leadership styles reduce the risk of exposure
to workplace bullying.
The study findings also revealed that,
nurses who were aged (20-30 years old), These findings were congruent with
having a diploma degree, and years of Baillien, et al., (2011), who revealed that
experience (1-5 years) perceived workplace stressful working conditions increase the risk
bullying behaviors than others. This may be of being a workplace bullying victim and
due to they did not have communication skills break existing organizational policies and
that help them to deal with negative behavior habits that may cause employees to join into
or they are not experienced about these negative acts towards others. Also in the same
behaviors and how to deal with it or they do line, with Salin and Hoel (2011) found that
not study workplace bullying during their negative work climate, changes at work (e.g.,
education stage. changes in supervisor, job duties or more
extensive organizational change), role
These findings supported by the study ambiguity/conflict, and internal re-structuring
of Fang, et al., (2016), which indicated were significantly due to bullying. In addition
young and inexperienced nurses were more to the study of Tong, et al., (2017), who
predicted to report and experience workplace found that negative aspects of the work
bullying behavior than others. Also, Obeidat, environment as less supportive leadership and
et al., (2018), reported that age and years of declining teamwork increase the occurrence
professional experience had strong negative of workplace bullying.
associations with nurses’ perceptions of
workplace bullying. On the contrary, Norton, III: Psychological capital predicts
et al., (2017), showed that, there was no workplace bullying among nurses.
relationship between the perception of
bullying behaviors and participants' age, This study revealed that
professional experience, and academic psychological capital was a significant

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Original Article Egyptian Journal of Health Care, 2020 EJHC Vol. 11 No. 3

predictor of being a target of workplace Recommendations

bullying and there was a negative
correlation between psychological capital Based on the prediction of the
and workplace bullying perception among current study. To reduce workplace
nurses. This may be due to nurses who had bullying perception among nurses, nursing
a high level of psychological capital will be managers should create a positive work
able to combat workplace bullying environment characterized by a quality of
behaviors as the high levels of optimism, leadership, effective work system, low
self-efficacy, hope, and resilience can help interpersonal conflict, and provides support
nurses to develop effective coping for nurses. Nursing educational programs
strategies that help nurses to protect should include topics about workplace
themselves against workplace bullying bullying and its preventive measures to
behaviors and vice versa. decrease the negative outcomes of
workplace bullying. Nursing managers
This finding was congruent with the should also develop psychological capital
study of Laschinger&Grau, (2012) that training programs as it will reduce
revealed that there was a negative victimization of workplace bullying among
correlation between higher levels of nurses, increase nurses’ ability to cope with
Psychological capital and experience of adversity, help nurses to face challenging
bullying among nurses. Also, Bond, et al., situations with positivity, and improve
(2010) reported that low psychological overall nurses’ well-being.
characteristics increase the risk of being
selected as a target of bullying. It was also Further researches are needed to
supported by Yun & Kang, (2018) who explore other factors associated with
reported that psychological capital has a workplace bullying as organizational
mediating role in the relationship between culture, leadership styles, and teamwork.
workplace bullying and its negative effects.
Read and Laschinger, (2013) reported that Financial support
the psychological capital of novice nurses was No funding was received
significantly linked with workplace Conflict of interest
mistreatment. Also, Luthans, et al., (2004) No
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