Defense Date


Graduation Date

Summer 8-11-2018


One-year Embargo

Submission Type


Degree Name




Committee Chair

Alison M. Colbert

Committee Member

Melissa Kalarchian

Committee Member

Peggy Chinn

Committee Member

Bonnie Dean


Workplace Bullying, Patient Safety, Feminism, Flourishing, Quality Framework, Practice Environment, Patient Falls, 30-Day Readmissions, Patient Satisfaction


Better nursing practice environments are associated with improved patient safety, yet little is known about the nurse’s experiences of bullying or flourishing within the practice environment. This study described nurses’ experiences of workplace bullying and flourishing and identified associations with patient outcomes.

The study used an exploratory cross-sectional survey design following Donabedian’s Quality Framework of structure-process-outcome and informed through critical feminist theory. The study took place at a large medical facility in the northeastern United States. A multi-instrument survey included four sections. The demographic section and the Practice Environment Scale of the Nurse Work Index (PES-NWI) were used to measure structure variables. The process variables were measured using the Negative Acts Questionnaire Revised for the United States (NAQR-US) to measure workplace bullying, and an investigator designed instrument was used to measure the workplace flourishing based on Chinn’s PEACE and Power model. Online survey results from 138 bedside nurses were correlated with outcome variables patient satisfaction from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys, and unit based patient safety rates. Patient falls, 30-day readmissions, medication errors, pressure injuries, overall patient satisfaction, and whether patients would recommend the hospital were averaged by patient unit and assigned to each nurse based on unit association. Following descriptive analysis, multiple regression models were conducted for each patient outcome.

The respondents were 76% female, 52 % had a bachelor’s degree or higher and the average time as an RN was 15 years. Nurse perception of the practice environment was inversely associated with patient falls (r=-0.21, pr=-0.26, p r=-0.26, p. Workplace flourishing had a moderate and significant positive association with the better practice environments (r=0.44, p

This study contributes to a better understanding of the nurses practice environment by the associations found with bullying and flourishing. Implicit in the PES-NWI description of strong nursing practice environments is nursing control and autonomy of practice. More work is needed to explore the concept of flourishing and what keeps nurses working in adverse environments. As the practice environment is linked to patient safety, an understanding of nurse’s work that includes the practice environments, work satisfaction, the absence of bullying and intentional work flourishing will contribute to better patient outcomes. Further research is needed to understand the complex nature of the nurses’ work environment and the impact on nurses and patients.



Additional Citations

Houck, N. M., & Colbert, A. M. (2017). Patient safety and workplace bullying an integrative review. Journal of Nursing Care Quality, 32(2), 164-171.