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Exploring the Lived Experiences of Nurses Bullied by their Co-Worker,

Patients, and Patients Significant Others in Selected Hospitals in Metro
Manila, Philippines

Conference Paper · November 2016

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Fifth International Conference on

Violence in the
Health Sector
Broadening our view - responding together

Ian Needham
Kevin McKenna
Odile Frank
Nico Oud
 141

Exploring the Lived Experiences of Nurses Bullied by

their Co-Worker, Patients, and Patients Significant
Others in Selected Hospitals in Metro Manila,
Philippines
Sub-theme: Aggression and/or violence toward staff or service users

Paper

Jordan Tovera Salvador

University of Dammam, Dammam, Saudi Arabia

Keywords: Workplace Bullying, Filipino Nurses, Descriptive Phenomenology, Qualitative Research

Introduction and Background

Bullying has always have been a subject from various discussions and forums all over the world. A lot of
measures and action plans had been proposed and implemented in the past and still continues up to this
day, however, bullying has never come to an end. Bullying cannot only be seen in school’s playground or
in high school’s quadrangle; it can also be seen in different places such as offices, grocery stores, public
transportations, parks, hospitals, and other workplaces. Workplace bullying is currently one of the major
challenges nurses’ are facing nowadays. In fact, the Center for American Nurses (2008) stated, ‘lateral
violence and bullying have been extensively reported and documented among healthcare professionals with
serious negative outcomes for registered nurses, their patients, and healthcare employers’, this only means
that workplace bullying had been rampant already in various hospital in the United States and for sure all over
the world whether small or large scale healthcare facilities.

The Philippines is one of the Southeast Asian countries that produce huge populations of nursing graduates per
year. After successfully passing the licensure examination, nurses can be deployed in various hospitals around
the country. Newly registered nurses in their first day of work are excited and anxious of what will be in stored
for them. In the Philippines, the so-called ‘seniority system’ (determines in the length of experience a nurse
has, which makes a nurse powerful over the other staff members) has always been present in every healthcare
institution up to now, although, nursing administration tries to abolish this informal designation of authorities
and powers to senior nurses over the newly added nurses in the hospital. Sadly, no measures can eradicate this
system because it is nature of Filipino professionals, not only nurses, to show and give respect to their seniors,
because these people will still be their ‘go to persons’ in their everyday workplace duties. Simons and Mawn
(2010) investigated workplace bullying among the newly registered nurses through a qualitative research
design, which they found out that workplace bullying resulted negative job satisfactions and retention. Not
only newly registered nurses had been reported to experience workplace bullying, in fact, aging nurses in
their late 50’s and 60’s have also been subjected for bullying. Nurses who had been subjected for workplace
bullying by their co-workers, patients, and patient’s significant others have these specific characteristics or
criteria: racial stereotyping, socio-economic status, school and university affiliations, physical attributions,
and gender preferences. With these given facts and arguments, the enormous questions are, how bullying can
be eradicated in the workplace? How these nurses’ experienced workplace bullying heal their wounded souls?
What measures can be done to help bullied nurses? This qualitative study delved with the actual and witnessed
workplace bullying experiences to understand this worldwide phenomenon that had never been put in to stop.

Methods
The research design of this topic utilized the qualitative descriptive phenomenological design. Phenomenology
was chosen because it emphases in dealing with the lived experiences of nurses’ experienced workplace
bullying from co-workers, patients, employers, and patients’ significant others. An author stated about this
research design, ‘Phenomenology is a philosophy and a research method designed to explore and understand
people’s everyday lived experiences’ (Abu Sosha, 2012, p. 31).

Moreover, this study focused in one grand tour question, ‘what are the lived experiences of nurses’ bullied in
the hospital?’ The study was conducted with ten (10) nurses, no specific gender, who experienced bullying
in all forms for more than two (2) years and been employed in the same institution for at least three (3) years
142

to show comparison on how bullying was dealt in their respective locales. Other criteria in selecting the
participants were as follows: (1) willingness to share their lived experiences, (2) articulate in expressing their
thoughts either in English or Filipino languages, and (3) availability for follow-up consultations and meetings.

The narratives of the participants were transcribed using tape analysis alongside the use of field notes
(personal, transcript, and analytical files) to ensure the trustworthiness of the data. Semi-structured interviews
were done 45 minutes to 1 hour and each participant was interviewed not more than three times. The study
was conducted in the month of October 2015 and follow-up interviews were done to discuss the findings of
the study and to make sure that it reflected their own lived experiences. Other methods included video calls;
Skype, emails, and other multimedia were used to ensure the data saturation.

Collaizi’s (1978) seven strategies of descriptive phenomenological data analysis was utilized to explicate
the rich contextual narratives of the participants. It includes extraction, organization, and analysis of data
to generate an exhaustive description concerning the phenomenon pertaining workplace bullying among
nurses in the hospital. Significant statements were extracted from the transcript file to formulate contextual
categories and cluster themes, which eventually lead to the construction of the emergent or overall themes
that will represent and depict the lived experiences of the participants toward nurses’ workplace bullying. To
ensure the trustworthiness, rigour, validity, and reliability of this qualitative research in all aspects including
data collection and data analysis, numerous methods were done like member checking (final validation
from the participants), themes, theme clusters, and contextual categories were peer-reviewed by panel of
experts, and translations were meticulously scrutinized by a bilingual translator to ensure that narratives were
translated properly (Abu Sosha, 2012; Creswell, 2009; Creswell, 2003; Speziale & Carpenter 2007; Marshall
& Rossman, 2006). Finally, autonomy and confidentiality were strictly imposed throughout the study.

Results and Discussion

Through the gathered narratives from the interviews conducted with the participants, significant statements
were drawn and applied with the qualitative data analysis method of Collaizi (1978). Four (4) themes emerged
from the lived experiences of the nurses’ manifested workplace bullying. Each emergent theme will be
discussed extensively in the next paragraphs with its theme clusters and formulated meanings supported by
the participants’ significant statements.

The Target: Ideal Victim of Nurses’ Bullying

The first emergent theme depicted the kinds of nurses’ who have been exposed to workplace bullying. From
the formulated meanings generated from the significant statements, three (3) theme clusters were created:
age-related bias, social class discrimination and stereotyping, and individual differences. Age-related biases
refer to the unfairly treatment of a person or people discriminating certain age groups, which includes novice
nurses who were newly licensed and employed nurses in diverse health care facilities and nurses in the
mid-50s up to the retiring age, 60-65 years as mentioned by WHO. A study conducted by Simons (2006)
revealed that majority of the bullied nurses’ come from the population of newly licensed RNs. One female
participant stated about age-related biases, which she experienced first-hand:

“I am newly licensed and hired nurse in a tertiary hospital in Manila. My first two (2) years had been the
worst experience of my life. My co-staff nurses specifically the senior staff nurses always scold me. Instead
of helping me learn the things I have to know, they make things complicated for me. Patients were hesitant
to received nursing care because I am new. They believe I am not competent to do such interventions. The
family of the patients often asked me where I graduated, how many years of experience, and sometimes
request for a senior nurse to do the task instead of me. I often hear degrading comments about me being
a novice nurse. I almost quit the job but I have no choice.” (Transcript No. 2)

Another subjects for workplace bullying were nurses’ discriminated and stereotyped due to their social
class particularly when it comes to their races, religion, cultural, and socio-economical factors and nurses’
individual differences. In the narratives, majority of the participants came from distant provinces that belong
to the minority groups, different ethnicity and culture. Most of the time, they had been the subjects of
malicious jokes concerning their naïve customs and traditions. Cultural difference is one of the indicators
how well health workers understand each other (Wachtler et al. 2006). Participants verbalized that some of
the healthcare workers, hospital employees, patients, and patients significant others mimicked their native
accents, bad intonations and mispronunciations to the point of humiliating the nurse in front of other people.
Participants who experienced this felt disrespected and embarrassed resulting inability to perform their task
well. On the other hand, individual differences pertain to the substantial variations concerning individual’s
character, behavior, intelligence, memory, or physical factors like size, shape, etc. However, every person is
 143

created unique and different from each other. Nurses have certain distinct characteristics that separate from
the rest, however, individual differences may be attributed as negative rather than positive. Some of the
participants’ mentioned that ‘being unique is being weird’. Common target for workplace bullying in this
theme cluster were nurses with weak personality, sexual orientations (third sex), physical attributes (too short,
too big, or any body mutilations), poor job performances, etc.). A male participant uttered his experience
about discrimination and individual differences:

“Most of the time my co-workers laughed at my native tongue’s accent. They kept repeating my
mispronounced words. They were not minding the people in the vicinity. Most of the time, I felt embarrassed.
It’s actually habitual lately. I am trying my best to ignore them but there were times it’s already too much.
I am also a human being and they have to respect and accept me for who I am.” (Transcript # 12)

The Bully: The Art of Intimidating and Oppressing

The second emergent theme focuses on the proprietor of the act. Bullying as defined by Carbo & Hughes
(2010) as ‘behaviors can destroy the targets; dignity, self-esteem, confidence, and voice. The effects can be felt
both inside and outside of work’. Likewise, Juvonen & Grahams (2014) defined it as a habitual or repeated use
of force, threat, or coercion to aggressively dominate, intimidate, and abuse others. Other definition includes
‘repetitive behaviors of intimidating and oppressing people’. Hence, anyone who exercises harm to others
repetitiously can be called a ‘bully’. Common examples of nurse bullying provide negative feedbacks for job
performances of others to heighten their personal performance and ‘being ignored and excluded’ resulting
decrease patient outcomes and increase staff turnover and occupational stress (Etienne, 2014).

During the interviews, participants characterized various types of bullying they have experienced in their
respective workplaces as identified by Berger (2014) such as: (1) physical assaults and coercion (using body),
(2) emotional, verbal harassments and threats (uttering bad words, cursing, and even death threats), (3) cyber
bullying (fallacious and malicious postings in social networking sites), (4) relational (destroy social standing
of a person), and (5) mobbing/ganging up (collective bullying). All of these types may be experienced
separately or in combinations depending on the extent of workplace bullying. A participant testified on his
experience of cyber bullying stated:

“My patient and her family posted on my Facebook account their wrong accusations and bad experiences
about my work as a nurse. It went viral and ‘netizens’ started to bash me for things I didn’t do. I am
receiving threats in my message inbox about the possibility of revoking my license. It was really a bad
experience.” (Transcript #4)

The Face Off: Confronting Dilemmas

The end results of workplace bullying among nurses depend on how the target will respond on the act of
bullying. Simons (2006) determined that ramifications of workplace bullying include job dissatisfactions
and intentions to leave work. Felblinger (2008) assumed that negative outcomes of workplace bullying
among nurses lead to post-traumatic disorder and ‘burned out’. There were some studies hypothesized that
undesirable consequences lead to depression, which can also progress in committing suicide and violence
(Kim & Leventhal, 2008). One of the female participants uttered in a mellow tone:

“There was a time I don’t want to report for work because almost everyday I overhear bad comments
about me. I am sick and tired of their nagging and mischievous acts. I almost submitted my resignation
letter to end this bullying.” (Transcript # 11)

Support System from family, friends, groups, etc. can be a way to overcome the aftereffects of workplace
bullying. A study conducted by Inagaki & Eisenberger (2016) found out that social support increases health
outcomes, thus, it reduces ‘sympathetic nervous system related responses to stress’. Continuous support
coming from loved ones helped the participants to overcome their anxiety and stress as apparent in this
significant statement:

“I overcome this predicament through the support of my family and friends. My nurse manager did a great
job in resolving our organizational conflicts, thus, she transformed it to conducive working environment
for all of us”. (Transcript # 13)

The Butterfly Effect: Cessation of Workplace Bullying

Victims of bullying may also lead to constructive development, knowing ones uniqueness, and interpersonal
realization leading to one of the cluster themes, standing tall after the storm. Felblinger (2008) mentioned
that constructing a safe workplace decreases incidence of workplace bullying, thus, having absolute tolerance
144

cutbacks occurrence of ‘aggression and dissention’ (Etienne, 2014). Consequently, participants showed self-
reliance during the succeeding follow-up interviews. It manifest in the way they utter their words that they are
now stronger and wiser to deal diverse situations in life. Participants have all agreed that workplace bullying
has changed them for the better. The experience taught them how to maintain their composure at times they
were distressed. They learn how to fight and stand for what they believe is right for them.

Moreover, helping others is the last cluster themes for this emergent theme. At this point, participants at
present are actively participates in initiating campaigns and advocacies to workplace bullying. All of them felt
good in sharing their lived experiences that made them the best versions of themselves.

“My experience as a victim of bullying taught me so many lessons in life. It made me stronger and wiser.
I am confident that I know my capabilities and myself. I want to impart these lessons to others who are in
the same shoes I had before. To fight workplace bullying.” (Transcript # 14)

Conclusion
The lived experiences of the participants toward workplace bullying came up with four (4) emergent themes,
which depicted their lived experiences. The target: ideal victim of nurses’ bullying described the nurses
commonly bullied in the hospital. The bully: the art of intimidating and oppressing depicted the antagonistic
character that repeatedly commits atrocious acts to target, bullied nurses. The face off: confronting dilemmas
portrayed the struggles of the participants to fight their major enemies, themselves. However, through the
support of their family, friends, and other support groups, all of the participants managed to conquer their
fears, anxiety, stress, and depression. Lastly, the butterfly effect: cessation of workplace bullying represented
the metamorphoses of the participants into oppressed and weak personas into an enlightened and highly-
motivational nurses who are willing to share the lessons they have learned from their lived experiences.

The essence of the study centralizes on educating the nurses not only in the Philippines but also all over the
world, in spite of their racial and cultural backgrounds and underpinnings, socio-economic class, individual
difference, and perspectives in life, about their human rights, nature of workplace bullying, and how to
successfully overcome this phenomenon. Management should commence training and development that
builds team organization and camaraderie through team buildings, personality development, and seminars
about workplace bullying. Creation of anti-bullying programs and campaigns are highly recommended if
workplace-bullying cases do not decline. Finally, mentoring and coaching platforms should exist to nurses to
develop their knowledge, skills, and attitude in preparing them for the challenges of tomorrow.

Acknowledgements
The author is deeply grateful to the ten (10) Filipino registered nurses who participated in this research for
sharing their lived experiences. Special thanks to my colleagues in University of Dammam for their guidance,
suggestions, and advises to make this paper possible.

References
Abu Sosha, G. (2012). Employment of Collaizi’s Strategies in Descriptive Phenomenology: A Refelction of a Researcher. European
Scientific Journal. November Edition, Vol. 8, No. 27. ISSN:1857-7881 (Print) e-ISSN 1857-7431.
Berger, K. S. (2014). Invitation to the Life Span. New York: Worth Publisher. ISBN 1464172056.
Carbo, J., & Hughes, A. (2010). Workplace Bullying: Developing a Human Rights Definition from the Perspective and Experiences of
Targets. Working USA 13.3. pp. 387-403.
Center for American Nurses (2008). Lateral Violence in Bullying in the Workplace. Retrieved from: www.vanderbilt.edu/root/pdfs/
nursing/center_lateral_violence_and_bullying_position_statement_from_center_for_american_nurses.pdf
Creswell, J. (2003). Research Design: Qualitative, Quantitative, and Mixed Methods Approaches, (2nd ed). Thousand Oaks, CA: Sage
Publications, Inc.
Creswell, J. (2009). Research Design: Qualitative, Quantitative, and Mixed Methods Approaches, (3rd ed). Los Angeles: SAGE
Publication, Ltd.
Etienne, E. (2014). Exploring Workplace Bullying in Nursing. Workplace Health & Safety 62.1(Jan 2014): 6-11.
Felblinger, D. M. (2008). Incivility and Bullying in the Workplace and Nurses Shame Response. Journal of Obstetrics, Gynecology. &
Neonatal Nursing, 37 (2), 234-242. 10.1111/j.1552-6909.2008.00227.x
Inagaki, T. K., & Eisenberger, N. I. (2016). Giving Support to Others Reduces Sympathetic Nervous System-Related Responses to
Stress. Psychophysiology 53.4 (Apr 2016):427-435.
Juvonen, J., & Graham, S. (2014). Bullying in Schools: The Power of Bullies and the Plight of Victims/ Annual Review of Psychology
65: 159-85. Doi:10.1146/annurev-psych-010213-115030.
Kim, Y. S.,& Leventhal, B. (2008). Bullying and Suicide. A Review. International Journal of Adolescent Medicine and Health 20 (2):
133-54. Doi:10.1515/IJAMH.2008.20.2.133. PMID 18714552.
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 145

Speziale, H. J., & Carpenter, D. R. (2007). Qualitative Research in Nursing: Advancing the Humanistic Imperative, (4th ed.).
Philadelphia. Lippincott, Williams and Wilkins.
Stagg, S. J., Sheridan, D., Jones, R., & Speroni, K.G. (2011). Evaluation of a Workplace Bullying Cognitive Rehearsal Program in a
Hospital Setting. The Journal of Continuing Education in Nursing. pp 395-401; quiz 402-3.
Simons, S. R. (2006). Workplace Bullying Experienced by Nurses Newly Licensed in Massachusetts and Relationship to Intention to
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Simons, S. R., & Mawn, B. (2010). Bullying in the Workplace: A Qualitative Study of Newly Licensed Registered Nurses. AAOHN
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Learning objectives
Participants will…
1. have a better understanding of hospital bullying and its kinds.
2. have a better appreciation of the negative effects of workplace bullying especially with nurses.
3. be aware of the strategies of bullied nurses in coping, adapting, and adjusting in this kind of phenomenon.
4. Be able to construct ways and measures on how to eradicate workplace bullying specifically in the health
care department.
5. demonstrate awareness when does bullying starts and what measures can stop bullying.

Correspondence
Jordan Salvador
University of Dammam
6D Building, College of Nursing, New Campus, University of Dammam
31441
Dammam
Saudi Arabia
ogden_182003@yahoo.com
 Broadening our view -
responding together
Work-related aggression and violence within the health and social
services sector are major problems which diminish the quality of
working life for staff, compromise organizational effectiveness,
threaten workers’ health and ultimately impact negatively on the
provision and quality of care. These problems pervade both service
settings and occupational groups.

The specific aims of this fifth conference are:

1. To broaden our understanding of the causes and consequences of violence in health
settings based on up-to-date evidence from the multiple perspectives of violence –
including biological, psychological, experiential, legal, political, and societal.
2. To present and exchange experiences in handling violence, through violence prevention
and/or violence management, and seek convergence on promising and feasible
collaborative responses.

The key theme of the conference on this occasion is to broaden our view and to respond
together. This is reflected in the broad of array of themes presented in the abstracts as
well as in keynote addresses of the meeting which address a range of topics related to
violence including political violence and its appeasement, legal issues, communication
with stakeholders, challenging behavior in the health sector, neuro-cognitive dysfunction,
policy issues, and even a special workshop demonstrating the role of dance in a
choreography of catharsis.

Ian Needham
Kevin McKenna
Odile Frank
Nico Oud

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