Organizational Betrayal, Avoidant Leadership Practices and Well-being among Nurses Exposed to Workplace Bullying

Abstract

Background: The work environment and organizational culture are theoretically important in the profession of nursing. Nurses trust that the organizations in which they practice will provide support and safety for them and for their patients, including safety and support in response to issues such as workplace bullying. Organizational betrayal can occur if a nurse’s organization betrays the trust for safety and support in response to a negative workplace event. Ineffective response to a workplace issue could also be considered avoidant leadership; avoidant leadership has been defined as hostility towards the person who was bullied, normalizing the bullying, and equivocation regarding the bullying. Organizational betrayal and avoidant leadership could impact nurses’ workplace well-being, which is a concern for health systems leaders because well-being is associated with healthcare outcomes. Study Aims: The aims of this study are: 1) to describe the prevalence of weekly/daily bullying among nurses; 2) to describe associations of demographic and workplace characteristics and workplace well-being (burnout, job dissatisfaction, and absenteeism) among nurses who have experienced any bullying behaviors; 3) to explore associations of organizational betrayal and support with workplace well-being (burnout, job dissatisfaction and absenteeism) after controlling for demographic and workplace characteristics among nurses who have experienced bullying behaviors; 4) to describe frequencies of types of avoidant leadership in response to bullying among nurses who have experienced bullying behaviors; 5) to examine associations between types of avoidant leadership in response to bullying (hostility, normalizing, equivocation) and workplace well-being (burnout, job dissatisfaction and absenteeism) among nurses who experienced bullying behaviors; and 6) to estimate the size and direction of associations between covariates (experiencing who experienced bullying behaviors acts of avoidant leadership, and demographic and workplace characteristics) and workplace well-being among nurses who experienced bullying behaviors. Methods: A cross-sectional study was conducted using an online survey. The target population was registered nurses in the U.S. The inclusion criteria were to have been working in nursing job for at least six months as a registered nurse. Participants were recruited using advertisements and direct outreach on social media. Study variables were demographics/workplace characteristics, bullying, organizational betrayal and support, burnout, job satisfaction, and absenteeism. Bullying was measured using the Negative Acts Questionnaire-Revised for Nursing. Organizational betrayal and avoidant leadership were measured using the Institutional Betrayal Questionnaire for Health (IBQ-H). Burnout was measured using the Well-Being Index (WBI). Job satisfaction was measured using a satisfaction Likert scale question. Absenteeism was measured by asking respondents how many days of work were missed in the past 12 months for illness or personal reasons. Demographic and workplace characteristics were also collected, including age, gender, race/ethnicity, workplace type, work role, years of experience in nursing, hours worked per week, and Magnet Recognition Program® designation of workplace. Descriptive statistics were used to describe the characteristics of the sample, prevalence of bullying and prevalence of avoidant leadership types. Testing of normality showed non-normal distribution of some dependent variables; thus, non-parametric tests were used. Cut scores were used to dichotomize variables. Cut score for the WBI was based on the published cut score. For the IBQ-H subscales, a score of 1 was used to determine exposure to any act of betrayal, support, or avoidant leadership (hostility, normalizing, equivocation). Cut scores for absenteeism were based on sample mean. Chi square tests were used to analyze bivariate relationships between categorical variables. Logistic regression analyses were used to examine the size and direction of associations between independent variables variates (organizational betrayal and support, experiencing acts of avoidant leadership, and demographic and workplace characteristics) and workplace well-being among nurses who experienced bullying behaviors. Institutional review board approval was obtained. Results: There were 242 total responses to the survey. There was complete data for the NAQR-US scale. Prevalence of weekly or daily bullying was 31%. (N=242). Among nurses who had experienced at least one bullying behavior (N=173), organizational betrayal increased the odds of burnout, OR =2.62, 95% CI [1.14,6.03], job dissatisfaction, OR =2.97, 95% CI [1.01,8.73], and absenteeism, OR= 6.11, 95% CI [2.26,16.54]. Organizational support decreased the odds of job dissatisfaction, OR= .30, 95% CI [.15,.60] and absenteeism, OR= .50, 95% CI [.25,.99]. For avoidant leadership, many nurses who experienced bullying behaviors reported experiencing at least one act of hostility (n=132, 76%), of normalizing (n=131, 75%), and of equivocation (n=115, 66%). In chi-square tests, the three types of avoidant leadership all had significant relationships with burnout, job dissatisfaction, and absenteeism. In the logistic regression models, equivocation was associated with burnout, and normalizing was associated with job dissatisfaction after controlling for demographic and workplace characteristics. Experiencing at least on act of equivocation increased odds of burnout, OR = 3.78, 95% CI [1.35,10.53], and experiencing at least one act of normalizing was increased odds of job dissatisfaction, OR =5.03, 95% CI [1.16,21.72]. None of the avoidant leadership types were significantly associated with absenteeism. Conclusion: In this study, organizational betrayal was associated with increased odds of burnout, job dissatisfaction, and absenteeism. Organizational support was associated with decreased odds of job dissatisfaction and being absent from work. Avoidant leadership was associated with higher rates of poor workplace well-being. Normalizing the bullying increased likelihood of burnout, and equivocation (e.g. showing lack of concern) of bullying increased the likelihood of job dissatisfaction. Nurse leaders should be aware that organizational betrayal is a negative work environment experience, and that avoidant leadership is problematic towards nurses’ workplace well-being. Future studies could employ wider recruitment strategies to increase sample size and diversity to better match the target population, provide more controls for organizational and individual characteristics such as recruitment from specific health systems, and could employ longitudinal design to capture better cause-and-effect relationships.