Author ORCID Identifier
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Date of Award
12-31-2025
Document Type
Open Access Dissertation
Degree Name
Doctor of Philosophy (PhD)
Department
Nursing
First Advisor
Priscilla K. Gazarian, PhD, RN, FAAN
Second Advisor
Joanne Roman Jones, JD, PhD, RN
Third Advisor
Ashley Waddell, PhD, RN, FAAN
Abstract
Background: Nurse-to-nurse incivility and bullying behaviors in the workplace often occur in the presence of bystanders or observers, who can be co-workers, patients, and families. Education and training of employees rarely focuses on preparing bystanders. Given the triad of perpetrators, targets, and bystanders, this study focuses on understanding the position of nurse bystanders to fortify their positive effects in the hospital work environment. While directing training toward the perpetrators or toward the targets of bullying may be useful, by focusing interventions on all employees, potential bystanders might be prepared to prevent or respond appropriately. This broad-based approach may precipitate a shift in the norms in the workplace toward cooperative, positive relations between nursing coworkers.
Methods: This research study uses the overarching framework of the Conceptual Model of Nursing and Health Policy to apply Schein's model of organizational culture and leadership to determine what can be learned about the barriers and facilitators to bystander responses to nurse-to-nurse incivility and bullying behaviors in a hospital environment, using the qualitative research method Interpretive Description. The sample was comprised of hospital Registered Nurses (RNs) (N=23), exclusively from each of the six New England, USA states, with or without supervisory experience, who could be interviewed in English, and have had the experience of being a bystander to nurse-to-nurse workplace incivility or bullying behavior. An original method was designed to protect the participants' identities and ensure the privacy of the data from the interviews. The data were analyzed from the telephone interviews regarding their observed experiences, as well as barriers and facilitators to their responses. The discussion derived recommendations for the practice environment, nurse education, and future research.
Results: The data from 23 RN participants' interviews provided insights regarding the manifestations, the reactions from nurses and other bystanders, the barriers and facilitators of intervention by nurse bystanders, as well as potential organizational solutions in confirmation of existing remedies for the behavioral problem. The vivid accounts provided by the interviews also provided insights about the discrepancy between the observed behavior reported by the participants compared with the expected professional behaviors, which are based on guidelines such as the 2015 ANA Code of Ethics for Nurses with Interpretive Statements, as well as on their own New England hospital employers' publicized missions, values, and goals.
Conclusion: The key question for nurse leaders: Why are the professional values of the 2015 ANA Code of Ethics for Nurses with Interpretive Statements and the stated values of the hospitals not more closely aligned with the values and behaviors within the nursing subculture on the unit level? This study has shown that in some of the New England hospitals supportive work environments are lacking; for example, timely communication could be improved, as could leadership interventions, such as rewards for positive work environments and holding nurses accountable for transgressions. Nurse leaders ought to be empowered by the hospital leadership to analyze and address the issues themselves, with the support of the upper management. A problem caused by nurses in violation of nursing standards can be corrected by trained nurse leaders once it is addressed with courage and without barriers.
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Recommended Citation
Denoeux, Eliza G., "Bystanders to Nurse Incivility: Barriers and Facilitators to Bystander Responses in New England Hospitals" (2025). Graduate Doctoral Dissertations. 1121.
https://scholarworks.umb.edu/doctoral_dissertations/1121
Comments
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