Reducing Ambulatory New Graduate Nurse Bullying

BACKGROUND: Experiencing bullying as a new graduate RN is considered a rite of passage by some in the nursing profession. However, such behaviors erode new nurses' self-confidence, hinder their professional development, and can negatively affect patient outcomes. Research links workplace incivility and bullying to increased medication errors, patient falls, and greater hospital costs. Within a large, comprehensive cancer center, high rates of these behaviors have been reported, yet staff education on their impact remains limited. PURPOSE: This quality improvement project aimed to reduce bullying of new graduate RNs, improve their knowledge of these behaviors, and enhance confidence in communication techniques for those who experience them. METHODS: A literature review identified cognitive rehearsal training (CRT) as an effective intervention for nurse bullying. Consequently, CRT content was developed featuring scenarios on gossiping, negative nonverbal communication, and direct verbal remarks. Eleven new graduate RNs completed the training, which provided education on identifying harmful behaviors and executing appropriate responses. To determine the intervention's impact, bullying knowledge, bullying exposure/incidence, and perceived confidence in communication were assessed before, immediately after, and 30 days after the intervention using a Bullying Knowledge Questionnaire and the Negative Acts Questionnaire-Revised. RESULTS: Knowledge scores increased by 73% and confidence in communication levels improved by 108% immediately following the intervention, remaining stable for 30 days. Exposure/incidence of bullying decreased by 39% from the initial rate of 54.5% to 33.3% at follow-up. All participants reported satisfaction with the program. CONCLUSION: These results suggest that CRT can positively impact bullying knowledge, reduce exposure to and incidence of bullying, and improve confidence in communication techniques. However, future research should utilize a larger, more diverse sample size to enhance the generalizability and transferability of these findings.