Exploring Bystander Behavior Types as a Determinant of Workplace Violence in Nursing Organizations Focusing on Nurse-To-Nurse Bullying: A Qualitative Focus Group Study

Abstract

Aim. This study explored and analyzed the characteristics of bystander types of workplace violence in hospital nurses experiencing horizontal (nurse-to-nurse) violence. The primary research question was “What are the behavioral patterns of bystander types in peer-to-peer violence situations among hospital nurses?”. Background. Workplace violence is a result of environmental and structural conflicts, rather than deviant individual perpetrators. Research examining workplace violence suggests that bystanders are not merely witnesses of acts of aggression but can play a substantial role in escalating or deflecting violence. Types of bystander influence power dynamics within a group, resulting in changes in the pattern of violence. Methods. Employing a qualitative design, this study conducted focus group interviews with nurses from three tertiary hospitals. The qualitative data collected was analyzed using inductive and qualitative content analysis methods. Results. Nine focus group interviews (n = 26) were conducted on bystanders’ experiences of workplace violence. A total of 185 analysis units were identified and categorized into three main themes, based on their impact on workplace violence (reinforcing, avoiding, and suppressing) with six subcategories (facilitative reinforcer, diffuse reinforcer, condoning avoider, powerless avoider, empathic suppressor, and interventional suppressor). Conclusions. This study delineates a typology of bystander roles in workplace bullying/horizontal violence among nurses, identifying three distinct types of bystanders. The outcomes of workplace violence vary, based on the type of bystander involved as well as the dynamics among bystanders, perpetrators, and victims. Implications for Nursing Management. Nursing organizations should educate nurses about the concept of bystanders as this will help nurses understand that even if they may not be perpetrators or victims of workplace violence, they are still implicated as bystanders. Additionally, nursing organizations and leaders should empower nurses to play a positive bystander role.