Journal 8

WORKPLACE BULLYING AND JOB SATISFACTION OF NURSES
IN SELECTED PUBLIC AND PRIVATE HOSPITALS
IN NEGROS ORIENTAL, PHILIPPINES
A Thesis Presented to the Graduate Faculty of the
College of Nursing and the University Graduate Programs
Silliman University, Dumaguete City
In Partial Fulfillment of the Requirements for the Degree of
Master of Science in Nursing
Major in Nursing Administration
SARAH ANNABELLE GO RAGAY
April 2019
i
ABSTRACT
Studies show that bullying exists among nursing professionals. Bullying is the antithesis
of the empathetic essence of nursing and the researcher sees this as a serious problem that must be
dealt with. Unrestrained bullying causes negative effects on the delivery of safe and quality care,
damages emotional and mental health of its victims, and interferes in the performance and job
satisfaction of nurses. All of these should be addressed by the nursing management as urgent
issues. The researcher conceptualized this study from the desire to contribute to the understanding
of the bullying phenomenon and the need to address this growing problem.
This descriptive-correlational study aims to determine the status of workplace bullying and
the level of job satisfaction among hospital nurses in Negros Oriental, Philippines. It also describes
the relationship between the status of workplace bullying in terms of person-related, work-related,
and physically intimidating with regards to certain demographic and non-demographic factors of
the study participants.
Self-administered questionnaires were used to gather data. Cluster random sampling with
proportional allocation of each hospital participant was used to obtain representativeness among
the selected public and private hospitals and its sample size. The sample size was 239 out of 595
nurses who met the inclusion criteria. All study participants are nurses with at least six months of
employment in their respective hospitals.
The demographic profile of the participants showed that the majority of the respondents
belonged to a young age group, were female, and single. Moreover, the status of workplace
bullying was described as follows: person-related bullying had “Never” been experienced, work-
related bullying had been encountered “Now and then”, and physically intimidating bullying
iii
behaviors had “Never” been experienced. Overall, the level of job satisfaction among study
participants was slightly satisfied.
The majority of the non-demographic factors have significant associations with bullying
compared to the demographic factors such as nurses’ work status and status of person-related
bullying (2 (2)= 6.881; p=0.032), nurses’ number of identified perpetrators and status of person-
related bullying (r=0.420; p=0.000), nurses’ area of work assignment and status of work-related
bullying (2 (4) = 13.383; p=0.010), nurses’ number of identified perpetrators and status of work-
related bullying (r=0.414; p=0.000), and nurses’ number of identified perpetrators and status of
physically intimidating bullying (r=0.419; p=0.000). Also, the level of job satisfaction showed
negative correlation between the person-related, work-related, and physically intimidating
bullying behaviors, with (r=-0.360; p=0.000), (r=-0.472; p=0.000), and (r=-0.285; p=0.000)
respectively.
Based on the findings of this study, it may be concluded that there is a negligible
association with demographic characteristics and the occurrence of bullying in the workplace.
Non-demographic variables on the other hand have more significant association with bullying.
Moreover, it is clear that the existence of person-related, work-related, and physically intimidating
bullying behaviors in the workplace can have implications on the level of job satisfaction among
nurses.
Conducting more related studies is recommended, particularly using qualitative approach,
to extend deeper understanding and to validate the workplace bullying concept in the Philippine
context. The significant data may serve as basis for staff management.
iv
ACKNOWLEDGMENT
I would like to give all the glory to our Almighty God in finally completing this thesis
writing and express profound gratitude to the following kind-hearted and beautiful people who
helped make this paper possible:
1. to Prof. Florenda F. Cabatit, former Dean of the College of Nursing, for her
professional guidance, invaluable and in-depth reviews, grammar corrections,
and unceasing encouragement as my research paper adviser
2. to Dr. Alice A. Mamhot, former Chairperson of the Mathematics Department,
for her patience in helping me on the data processing using statistical
procedures and sharing scholarly insights as my statistician
3. to Dr. Enrique G. Oracion, former Dean of the Graduate Programs, for helping
me in refining my research topic and providing useful suggestions during our
research problem presentation as my social research mentor
4. to Dr. Margaret Helen U. Alvarez, Dean of the University Graduate Programs,
Dr. Reynaldo Y. Rivera, former Dean of the Graduate Programs, Dr. Theresa A.
Guino-o, Dean of College of Nursing, Dr. Evalyn E. Abalos, former Dean of the
College of Nursing, and Mrs. Maria Susie D. Aguilar, Assistant Chief Nurse at
Negros Oriental Provincial Hospital (NOPH), for imparting their individual
expertise and wisdom as my panel of reviewers
5. to Ms. J. Marie R. Maxino, English Department faculty, for sharing her English
expertise on editing my research proposal paper
6. to Asst. Prof. Philip Van Peel, English Department faculty, for being helpful on
my informed consent content
v
7. to Ms. Aurora Doris D. Bataga, an MSN graduate of the Graduate Programs,
for her motivation and being an inspiration
8. to Prof. Staale Einarsen of Bergen Bullying Research Group in Norway, for
giving me permission to use the Negative Acts Questionnaire-Revised (NAQ-
R) instrument
9. to Prof. Paul Spector of the University of South Florida, for allowing me to adapt
his Job Satisfaction Survey (JSS) tool
10. to Dr. Clemente S. Hipe, IV, Chief of Hospital at Cong. Lamberto L. Macias
Memorial Hospital (CLLMMH), Siaton, for allowing me to conduct a pilot
study, Ms. Rica T. Gaga-a, Chief Nurse of CLLMMH, for providing me valuable
suggestions and wisdom, Mrs. Anne Marjorie F. Laguardia, former Surveillance
Nurse, for assisting me in the data collection, and to all CLLMMH nurses, for
patiently answering my questionnaires
11. to Dr. Henrissa M. Calumpang, Provincial Health Officer II, for allowing me to
conduct my data collection to all the selected government-owned hospitals
12. to the Chief of Hospitals, Hospital Administrators, Chief Nurses, Supervisor
Nurses, and Head Nurses of all the selected hospitals in Negros Oriental [Negros
Oriental Provincial Hospital (NOPH), Bayawan District Hospital, Bais District
Hospital, Governor William Villegas Memorial Hospital, Silliman University
Medical Center Foundation, Inc. (SUMCFI), and Holy Child Hospital (HCH)],
for facilitating access to my nurse-respondents
13. to all my nurse-respondents, for giving their precious time, effort and honesty
upon answering the questionnaires
vi
14. to the Nursing Service Office at NOPH, for granting my requested schedules for
graduate classes and activities, and to some of my previous colleagues at NOPH
who assisted me in the access of my data collection to some study participants
15. to my master’s program mentors, for the motherly advises, encouragement and
prayers in achieving our goals and hopes
16. to my classmates in the graduate classes, for sharing remarkable memories and
untiringly supporting our undertakings
17. to Mrs. Loyda Fontelo, Graduate Programs Secretary, for scheduling my
presentations and other related assistance
18. to Mrs. Flordivilla Florida, my dearest nurse friend, for constantly believing in
me, listening to my happiness and sorrows, and sincerely giving me personal and
professional advice throughout the years of our friendship
19. to my batch mate in the undergraduate classes, Mr. Noel Luis S. Nuñez, for
sharing his English expertise on refining my research paper
20. to my family: Jennifer Ragay-Papadopoulos, my older sister, for pushing me to
pursue master’s degree and for the unwavering financial and moral support; to
Eugene Ragay, my eldest brother, for patiently assisting and supporting me in
my endeavors; my nephews, Ziv Zecher, John Carl, Lance Gerald and Ivan
Christ, and niece, Marianna, for bringing joy into our lives; and finally to my
loving Mama Eding and Papa Genie, who have always been supportive of my
goals and dreams, and for literally being there during my travels to the distant
hospitals during my data collection.
SARAH ANNABELLE G. RAGAY
vii
TABLE OF CONTENTS
PAGE
TITLE PAGE i
APPROVAL SHEET ii
ABSTRACT iii
ACKNOWLEDGMENT v
TABLE OF CONTENTS viii
LIST OF TABLES xi
LIST OF FIGURES xv
LIST OF APPENDICES xvi
CHAPTER I THE PROBLEM AND ITS SCOPE
Introduction 1
Background of the Study 3
Statement of the Problem 6
Research Hypotheses 8
Significance of the Study 9
Scope and Limitations 11
Operational Definition of Terms 12
CHAPTER II REVIEW OF RELATED LITERATURE
Characteristics of a Professional Nurse 15
Scope of Nursing 16
Code of Ethics for Filipino Nurses 16
Workplace Bullying and its Origin 17
viii
Prevalence of Workplace Bullying in Nursing 19
Related Studies and Theories of Bullying 25
Manifestations of Workplace Bullying 29
Characteristics of the Target 30
Characteristics of the Bully 31
Work Environment 32
Job Satisfaction 32
Orientation Program for Graduate Nurses 33
Conceptual Framework 34
Conceptual Model 36
CHAPTER III METHODOLOGY
Research Design 37
Research Setting 38
Participants of the Study 38
Sampling Procedure 39
Research Instrument 40
Data Collection Procedure 43
Statistical Analysis 45
Ethical Considerations 45
CHAPTER IV PRESENTATION, ANALYSIS AND INTERPRETATION OF
RESULTS
Description of Demographic Characteristics 47
Description of Other Related Variables 50
ix
Association Between Status of Workplace Bullying in terms of
Person-Related, Work-Related, and Physically Intimidating Bullying,
and the Selected Demographic Characteristics 74
and Other Related Variables 80
and Level of Job Satisfaction 94
CHAPTER V SUMMARY, CONCLUSIONS, AND RECOMMENDATIONS
Summary of Findings 99
Conclusions 101
Limitations of the Study 103
Recommendations 103
REFERENCES 106
APPENDICES 121
x
LIST OF TABLES
PAGE
Table 4.1 Frequency and Percentage Distribution of the Study Participants according to
their Age, Gender and Civil Status 47
Table 4.2 Frequency and Percentage Distribution of the Study Participants according to
Work Status, Current Position, Length of Work Experience, Area of
Work Assignment, and Type of Hospital Working at 50
Table 4.3 Frequency Distribution of Study Participants’ Age Groups and their Identified
perpetrators of Bullying 57
Table 4.4 Frequency of Bullying in the dimensions of Person-Related, Work-Related, and

Physically Intimidating Bullying among Study Participants in Negros Oriental
for the Past Six Months 63
Table 4.5 Frequency and Percentage Distribution of Level of Job Satisfaction among
Study Participants 70
Table 4.6 Test for Significance of Relationship Between Status of Person-Related Bullying
and Demographic Characteristics 74
Table 4.7 Test for Significance of Relationship between Status of Work-Related Bullying
and Demographic Characteristics 76
Table 4.8 Test for Significance of Relationship Between Status of Physically Intimidating
Bullying and Demographic Characteristics 78
Table 4.10 Test for Significance of Relationship Between Status of Work-Related Bullying
Bullying and Other Related Variables 90
Table 4.12 Test for Significance of Relationship Between Nurses’ Status of Bullying in terms
of Person-related, Work-related, and Physically Intimidating Bullying and
Level of Job Satisfaction 94
Table 6.1 Cross-Tabulation on the Work Status and Status of Person-Related Bullying
among Study Participants for the Past Six Months 141
xi
Table 6.2 Number of Perpetrators and Status of Person-Related Bullying among Study
Participants for the Past Six Months 141
Table 6.3 Cross-Tabulation on the Area of Work Assignment and Status of Work-Related
Bullying among Study Participants for the Past Six Months 142
Table 6.4 Number of Perpetrators and Status of Work-Related Bullying among Study
Participants for the Past Six Months 142
Table 6.5 Number of Perpetrators and Status of Physically Intimidating Bullying among
Study Participants for the Past Six Months 143
Table 6.6 Cross-Tabulation on the Level of Job Satisfaction and Frequency of Bullying
among Study Participants in Negros Oriental for the Past Six Months 143
Table 6.7 Frequency and Percentage Distribution of Gender Among the Study
Participants 144
Table 6.8 Frequency and Percentage Distribution of Age Group Among the Study
Participants 144
Table 6.9 Frequency and Percentage Distribution of Civil Status Among the Study
Participants 145
Table 6.10 Frequency and Percentage Distribution of the Type of Hospital Presently
Working at Among the Study Participants 145
Table 6.11 Frequency and Percentage Distribution of Work Status Among the Study
Participants 145
Table 6.12 Frequency and Percentage Distribution of Current Position Among the Study
Participants 146
Table 6.13 Frequency and Percentage Distribution of Area of Work Assignment Among
the Study Participants 146
Table 6.14 Frequency and Percentage Distribution on the Length of Work Experience
(No. of Years) In the present Hospital Among the Study Participants 146
Table 6.15 Frequency and Percentage Distribution on the Length of Work Experience
(No. of Years) As a Nurse Among the Study Participants 147
Table 6.16 Frequency Distribution of Study Participants according to Identified Perpetrators

of Bullying such as Staff Nurse from the Past Six Months 147
xii
of Bullying such as Family Member of the Patient from the Past Six Months 147

of Bullying such as Doctors from the Past Six Months 148

of Bullying such as Patient from the Past Six Months 148

of Bullying such as Significant others (not relative of patient) from the Past Six
Months 148

of Bullying such as Senior Nurse from the Past Six Months 149

of Bullying such as Nurse Supervisor from the Past Six Months 149

of Bullying such as Consultant/Specialist from the Past Six Months 149

of Bullying such as Nursing Attendant from the Past Six Months 150

of Bullying such as Chief Nurse from the Past Six Months 150

of Bullying such as Administrative Staff from the Past Six Months 150

of Bullying such as Charge Nurse from the Past Six Months 151

of Bullying such as Government Officials from the Past Six Months 151

of Bullying such as Chief of Hospital from the Past Six Months 151

of Bullying such as Ancillary Staff from the Past Six Months 152
xiii
of Bullying such as Hospital Director/Administrator from the Past Six Months 152

of Bullying such as Family member of a staff nurse from the Past Six Months 152

of Bullying such as Relatives or significant others close to government officials
from the Past Six Months 153
Table 6.34 Frequency Distribution of Study Participants according to Identified Perpetrators of

Bullying such as Political Personality from the Past Six Months 153

Bullying such as Others from the Past Six Months 153
Table 6.36 Sampling Design Procedure used in this Study 154
xiv
LIST OF FIGURES
PAGE
Figure 2.1 Conceptual Model 36
xv
LIST OF APPENDICES
PAGE
Appendix A Permission Addressed to Concerned Offices 122
Appendix B Cover Letter of the Research Questionnaire 123
Appendix C Informed Consent 124
Appendix D Research Questionnaire 125
Appendix E Permission on the Use of Negative Acts Questionnaire-Revised (NAQ-R)

(Einarsen, et al., 2009) 134
Appendix F Permission on the Use of Job Satisfaction Survey (JSS) (Spector, 1994) 136
Appendix G Permission to Conduct Research Addressed to the Silliman University

Research Ethics Review Committee 138
Appendix H Silliman University Research Ethics Review Committee Approval Sheet 139
Appendix I Approval to Conduct Research in Silliman University Medical Center

Foundation, Inc. (SUMCFI) 140
Appendix J Cross-Tabulation on the Work Status and Status of Person-Related Bullying

Appendix K Number of Identified Perpetrators and Status of Person-Related Bullying

Appendix L Cross-Tabulation on the Area of Work Assignment and Status of Work-Related

Appendix M Number of Identified Perpetrators and Status of Work-Related Bullying

Appendix N Number of Identified Perpetrators and Status of Physically Intimidating

Appendix O Cross-Tabulation on the Level of Job Satisfaction and Frequency of Bullying

among Study Participants in Negros Oriental for the Past Six Months 143
Appendix P Frequency and Percentage Distribution of Gender Among the Study

Participants 144
xvi
Appendix Q Frequency and Percentage Distribution of Age Group Among the Study
Participants 144
Appendix R Frequency and Percentage Distribution of Civil Status Among the Study
Participants 145
Appendix S Frequency and Percentage Distribution of the Type of Hospital Presently

Working at Among the Study Participants 145
Appendix T Frequency and Percentage Distribution of Work Status Among the Study
Participants 145
Appendix U Frequency and Percentage Distribution of Current Position Among the

Study Participants 146
Appendix V Frequency and Percentage Distribution of Area of Work Assignment

Among the Study Participants 146
Appendix W Frequency and Percentage Distribution on the Length of Work Experience

(No. of Years) In the present Hospital Among the Study Participants 146
Appendix X Frequency and Percentage Distribution on the Length of Work Experience

(No. of Years) As a Nurse Among the Study Participants 147
Appendix Y Frequency Distribution of Study Participants according to Identified Perpetrators

of Bullying such as Staff Nurse from the Past Six Months 147
Appendix Z Frequency Distribution of Study Participants according to Identified Perpetrators

of Bullying such as Family Member of the Patient from the Past Six Months 147
Appendix AA Frequency Distribution of Study Participants according to Identified Perpetrators

of Bullying such as Doctors from the Past Six Months 148
Appendix AB Frequency Distribution of Study Participants according to Identified Perpetrators

of Bullying such as Patient from the Past Six Months 148
Appendix AC Frequency Distribution of Study Participants according to Identified Perpetrators

Months 148
Appendix AD Frequency Distribution of Study Participants according to Identified Perpetrators

of Bullying such as Senior Nurse from the Past Six Months 149
Appendix AE Frequency Distribution of Study Participants according to Identified Perpetrators

of Bullying such as Nurse Supervisor from the Past Six Months 149
xvii
Appendix AF Frequency Distribution of Study Participants according to Identified Perpetrators
of Bullying such as Consultant/Specialist from the Past Six Months 149
Appendix AG Frequency Distribution of Study Participants according to Identified Perpetrators

of Bullying such as Nursing Attendant from the Past Six Months 150
Appendix AH Frequency Distribution of Study Participants according to Identified Perpetrators

of Bullying such as Chief Nurse from the Past Six Months 150
Appendix AI Frequency Distribution of Study Participants according to Identified Perpetrators

of Bullying such as Administrative Staff from the Past Six Months 150
Appendix AJ Frequency Distribution of Study Participants according to Identified Perpetrators

of Bullying such as Charge Nurse from the Past Six Months 151
Appendix AK Frequency Distribution of Study Participants according to Identified Perpetrators

of Bullying such as Government Officials from the Past Six Months 151
Appendix AL Frequency Distribution of Study Participants according to Identified Perpetrators

of Bullying such as Chief of Hospital from the Past Six Months 151
Appendix AM Frequency Distribution of Study Participants according to Identified Perpetrators

of Bullying such as Ancillary Staff from the Past Six Months 152
Appendix AN Frequency Distribution of Study Participants according to Identified Perpetrators

of Bullying such as Hospital Director/Administrator from the Past Six Months152
Appendix AO Frequency Distribution of Study Participants according to Identified Perpetrators

of Bullying such as Family member of a staff nurse from the Past Six Months 152
Appendix AP Frequency Distribution of Study Participants according to Identified Perpetrators

from the Past Six Months 153
Appendix AQ Frequency Distribution of Study Participants according to Identified Perpetrators

of Bullying such as Political Personality from the Past Six Months 153
Appendix AR Frequency Distribution of Study Participants according to Identified Perpetrators

of Bullying such as Others from the Past Six Months 153
Appendix AS Sampling Design Procedure used in this Study 154
Appendix AT Curriculum Vitae 155
xviii
CHAPTER I
THE PROBLEM AND ITS SCOPE
Introduction
Caring is one of the first words that comes to mind when thinking about the practice of
nursing (Boykin & Savina, 2001). It is one of the core values in the personal and professional lives
of nurses. Nursing is a profession of compassion, competence, efficiency, empathy, good
communication skills, and good interpersonal relationships. Nurses in practice are expected to
honor, safeguard the reputation and dignity, and respect the rights of patients, co-workers and other
professionals.
However, studies show that there exists among nursing professionals the problem of
bullying, which is the antithesis of the empathetic essence of nursing. Einarsen, et al. (2009)
defined bullying at work as a situation where one or more persons feel subjected to negative
behavior from others in the workplace over a period of time and where they, for different reasons,
are unable to defend themselves against these actions.
In a recent study by Berry, et al. (2012), findings describe that 76% of new nurses will
experience bullying in the first 3 months of practice, and that 52% will be the direct target of
workplace bullying. Moreover, the American Nurses Association (2001) reports that between 18%
and 31% of nurses have been targets of bullying behaviors at all levels of practice.
Busy health care settings and difficult work situations are cited as factors that contribute to
bullying behaviors in the workplace. This may be proliferated by commission of role conflict and
interpersonal conflicts as mentioned by Hauge, et al. (2009). The latter includes bullying in
escalating proportions.
1
Bullying behaviors in the workplace have created a gap in communication between nurses,
patients, their families, and other members of the health care staff, which impedes the delivery of
safe and quality patient care. As pointed out by Vessey, et al. (2011), the open exchange of health
care information is endangered whenever there is no collaborative relationship among nurses, other
healthcare personnel, patients, and their families and this may put the patients at risk for negative
health outcome.
Furthermore, intimidating and disruptive behaviors may increase likelihood of medical
errors, add to poor patient satisfaction and to preventable adverse outcomes, increase the cost of
care, and cause qualified clinicians, administrators and managers to seek new positions in more
professional environments (The Joint Commission’s Sentinel Alert Issue No. 40). These may be
taken as signs of job dissatisfaction.
Bullying behaviors of some nursing/health personnel pose a threat to the performance of
the entire health care team. Thus, it is important that the nursing management must address this in
order to guarantee quality of and reinforce the culture of safety and discourage the existence of the
culture of blame regarding mistakes.
Disruptive behaviors have been noted to result in increased stress and lack of concentration
that eventually may cause a nurse to make a mistake. For example, poor communication in post-
operative situations result in delayed treatment, complication of aspiration, and the patient’s
eventual death (Rosenstein & O’Daniel, 2008). Committing a mistake at work can eventually lead
to job dissatisfaction among nurses.
Furthermore, the effect of bullying behaviors on nurses does not only present stress-related
illnesses like sleep disturbances, headaches, tension, and self-doubt but also more serious
consequences related to suicide. As reported by Hastie (2007), one young nurse who experienced
2
bullying in the workplace eventually took her life by asphyxiation. There may be more unreported
similar cases.
At present, there is a paradigm shift in the successful management of health care—the
cultivation of the “no blame” culture (as cited in Kelly & Tazbir, 2013) which may help stop
manifestations of disruptive behaviors. The focus of improvement is on the prevention of errors in
the interventions and management issues only, not on one’s personhood. A ‘‘no blame’’ work
environment looks at errors as a system function; the focus therefore is not on looking for a culprit
but on how one sees his or her participation in the situation–whether seeing one’s self as part of
the problem or part of the solution as one perceives the wholeness of the situation.
The researcher sees the seriousness of bullying problems among nurses in practice.
Unrestrained bullying causes negative effects on the delivery of safe and quality care, damages the
emotional and mental health of its victims, and interferes in the performance and job satisfaction
of nurses. All of these should be addressed by the nursing management as urgent issues. The
researcher conceptualized this study from the desire to contribute to the understanding of the
bullying phenomenon and the need to address this growing problem.
Background of the Study
Bullying in the nursing workplace has been reported around the world. In the United
Kingdom, between 10% and 20% of employees will label themselves as bullied for the last 6
months (Hoel, et al., 2004; Lewis, 1999; Quine, 1999; UNISON, 1997, 2000). Incidence measured
in this way (labeling) in Scandinavian countries is less than half this number (Zapf, Einarsen, Hoel,
& Vartia, 2003). Studies in Australia have findings similar to those done in the United Kingdom
(McCarthy et al., 1995). In the United States, the term bullying is not used, instead, Keashly, for
3
example, has used the term mistreated and found slightly higher incidence (Keashly & Jagatic,
2003) than in the United Kingdom.
With the purpose of increasing awareness and understanding of the phenomenon, many
studies have been conducted worldwide. However, nurse bullying still persists in the workplace.
Nurse bullying has contributed to negative effects on patient safety and outcome. This is elaborated
by Felblinger (2005) (as cited in Felblinger, 2008) who found that 25% of health care workers saw
a strong link between disruptive behaviors and patient mortality, and as many as 75% saw a strong
link to adverse clinical outcomes.
Bullying behaviors could take away a nurse’s ability to critically decide towards delivering
quality patient care. Team members oppressing one another results in job dissatisfaction,
psychological and physical stress, errors, reduced clinical outcomes and employee turnover
(Rosenstein, 2002; Kusy and Hollaway, 2009; and Porath and Pearson, 2009).
Whenever a nurse is disturbed with bullying behaviors among the health care team
members, he/she will highly likely be distracted—this may divert his/her focus and attention away
from the calculations of drug dosages and greatly contribute to medication error that may cause
adverse reactions in patients. According to several studies, medication errors occurring during the
prescription and administration stages account for 65-87% of all errors (Tang, et al, 2004).
Furthermore, disruptive behaviors in the workplace can often be fatal and increase the
overall mortality rate, especially in highly stressful environments like intensive care units (ICUs),
operating rooms, and emergency departments. Intensive Care Units (ICUs) are error-prone places
with error rates as high as 1.7% per day, especially in pediatric and neonatal ICUs (Tang, et al,
2004).
4
The root cause of communication breakdown includes disruptive behaviors and workplace
bullying among health care providers. This is cited in The Joint Commission’s (TJC) 2008 report
of an analysis of 3,548-inpatient sentinel events over a ten-year timeframe: communication
breakdown resulted to serious adverse outcomes or death.
Teamwork is essential particularly in the operating room wherein mixture of social–
emotional balance, competency, and willingness to work in teams are needed to bring out safe and
professional nursing care during operations (Silen, et al, 2004). Thus, bullying may undermine
teamwork and job satisfaction.
A study in the Philippines conducted by Fujishiro, et al. (2011) found that physical assault
(7%) and verbal abuse (34%) were associated with general health status and work-related health
problems among nurses. The nurses who participated in the study worked in an educational setting
(35.4%) and in an acute care hospital (23.1%).
Bataga (2012), who conducted her study in Zamboanga del Norte, Philippines, revealed
that most of the nurses who were being bullied admitted that they were unmotivated to work and
some of them were planning to stop working. She also found that the identified perpetrators of
nurses include the clients (37%), managers and supervisors (29%), doctors (19%), peers (11%),
and supervisees (4%). Furthermore, she also discussed that 80% of the nurses (83% are staff nurses
and 17% are in the managerial and supervisory positions) affirmed that workplace bullying exists
in the hospitals where they are working.
Bullying of nurses in the workplace is an increasing problem worldwide and locally. This
indirectly jeopardizes the safety and welfare of patients and nurses, thereby lowering their job
satisfaction. Seemingly, bullying has become a major problem in hospitals and other health
institutions, especially in the nursing service management. This study attempts to fill in the gap,
5
expound knowledge, and get involved by generating data needed in creating programs or policies
for the prevention of bullying and perhaps minimize the bullying behaviors towards Filipino
nurses.
Statement of the Problem
The persistence of negative behaviors of patients and some members of the hospital
staff/personnel toward some nurses contributes to the risk of harming patients and the lowering of
the nurses’ level of job satisfaction. Nurses who are victims of bullying may get distracted while
they attend to patients’ needs, thus contributing to errors and poor job performance. This rising
problem in nursing management in hospitals, clinics, and other health institutions needs to be
addressed.
This study aims to determine the status of workplace bullying in the dimensions of person-
related (interpersonal aspect), work-related (occupational aspect), and physically intimidating
(physical aspect), and the level of job satisfaction among hospital nurses in Negros Oriental,
Philippines. Additionally, this study describes the relationship between the status of workplace
bullying and some demographic factors, specifically the age, gender, and civil status of the
participants. This study likewise includes some non-demographic factors of the participants—
work status, current position, area of work assignment, length of work experience, type of hospital
where they are working, and perpetrators of bullying.
This study attempts to answer the following questions:
1. What is the demographic profile of the participants in terms of
a) Age;
b) Gender; and
6
c) Civil status?
2. What is the non-demographic profile of the participants in terms of?
a) Work status;
b) Current position;
c) Length of work experience;
d) Area of work assignment;
e) The type of hospital where they are working; and
f) Perpetrators of bullying?
3. What is the status of workplace bullying among nurses in Negros Oriental for the past
six months in terms of the following dimensions?
a) Person-related bullying;
b) Work-related bullying; and
c) Physically intimidating bullying?
4. What is the level of job satisfaction among the nurse participants?
5. Is there a significant relationship between the status of workplace bullying in the
dimension of person-related, work-related, and physically intimidating bullying, and
the nurse’s age, gender, and civil status in Negros Oriental?
6. Is there a significant relationship between the status of workplace bullying in term of
person-related, work-related, and physically intimidating bullying, and the nurse’s work
status, current position, area of work assignment, length of work experience, type of
hospital where they are working, and perpetrators of bullying in Negros Oriental?
7
7. Is there a significant relationship between status of workplace bullying according to
person-related, work-related, and physically intimidating bullying, and level of job
satisfaction among nurses in Negros Oriental?
Research Hypotheses
1. H0: There is no significant relationship between the status of workplace bullying in the
dimensions of person-related, work-related, and physically intimidating bullying, and
nurse’s age, gender, and civil status in Negros Oriental.
H1: There is significant relationship between the status of workplace bullying in the
the nurse’s age, gender, and civil status in Negros Oriental.
2. H0: There is no significant relationship between the status of workplace bullying in terms
of person-related, work-related, and physically intimidating bullying, and the nurse’s
work status, current position, area of work assignment, length of work experience,
type of hospital where they are working, and perpetrators of bullying in Negros
Oriental.
H1: There is significant relationship between the status of workplace bullying in terms of
person-related, work-related, and physically intimidating bullying, and the nurse’s
work status, current position, area of work assignment, length of work experience,
type of hospital where they are working, and perpetrators of bullying in Negros
Oriental.
3. H0: There is no significant relationship between status of workplace bullying in the
level of job satisfaction among nurses in Negros Oriental.
8
H1: There is significant relationship between status of workplace bullying in the
dimensions of person-related, work-related, and physically intimidating bullying,
and level of job satisfaction among nurses in Negros Oriental.
Significance of the Study
The widespread prevalence of bullying incidents among nurses in the workplace that
results in negative health outcomes not only to patients but also to nurses themselves that
consequently affects their job satisfaction should be seen as a challenge to nurses, clients, the
community, hospitals, and nurse administrators. This has to be adequately addressed as part of the
quality assurance and continuous quality improvement programs of every hospital or health
institution.
The significance of the current study includes the following:
Nurses. The data gathered in this study may heighten awareness among nurses that bullying
towards nurses is happening locally. Understanding the factors that contribute to the perpetuation
of bullying in the workplace needs a local study. With increased understanding of these factors,
preventive interventions may be developed. Nurses need to learn the nature of bullying for them
to be empowered and avoid becoming a victim or be a perpetrator of the act themselves. The
understanding of this phenomenon is needed to break the cycle and encourage the integration of a
“no blame” culture which stems from the awareness that there are many possible contributing
factors to the bullying problem. Alongside the identification of factors is the realization of one’s
role in all these. Disruptive behaviors at work weaken one’s competence to do the job. Such may
lead to nurses becoming non-therapeutic towards their patients, coworkers, and other members of
the health team. Moreover, bullying pushes nurses to think about quitting their jobs or, worse, to
9
commit suicide. Nurses need to pay more attention to the prevention of errors and not on disruptive
behaviors, hence bullying should be given attention for it to be controlled.
Clients. Clients seek hospital care and entrust their health needs to the health care
providers, especially nurses, who must give immediate and quality caring services. This study is
significant for strengthening patient care management, especially in ensuring safety and the highest
level of quality health care rendered by nurses.
Community. The gathered information is helpful in policy or program development towards
the prevention of bullying, which benefits the society in general and those involved in particular.
This ensures the promotion of peace in the workplace and in the community, and the optimum
delivery of services to the public. The data collected may also serve as a reference in the drafting
of ordinances that may render workplace bullying in health institutions a crime punishable by law.
Health Care Organizations and Nursing Service Administrators. The data is significant for
health care organizations and nursing service administrators in order to reinforce a “no blame”
culture and sustain the best quality of care and patient safety towards their clients. Specifically,
nursing management uses the gathered data as bases for the provision of good working conditions,
the making of hospital policies, the implementation of discipline, and the promotion of morale, job
satisfaction and productivity to their staff. Finally, the organization accentuates a culture of safety
rather than a culture of blame and bullying.
Nursing Profession. The data is significant in maintaining the essence of the nursing
profession which is care, compassion, respect, competency, having good communication skills,
and advocacy. Professional nurses further consider the feelings of their co-workers, while giving
the best quality care and safety to their patients.
10
Nursing Research. This study serves as a resource for research regarding bullying among
nurses in their work environment. Also, the results of this study adds to the extensive bullying
research conducted in other countries. The findings of this study increases understanding of the
workplace bullying concept in the Philippine context. Furthermore, the data gathered is substantial
in shaping appropriate interventions and programs addressing the growing problems of workplace
bullying among nurses that results in negative health outcomes towards nurses and patients.
Nurse Education. Student nurses are trained and prepared with the most ideal nursing
interventions toward their clients and the appropriate ethical codes of nursing discipline to practice
in the workplace. However, international studies have shown that workplace bullying resulted to
negative effects among new nurses. The findings of this study helps the Board of Nursing, nurse
educators, school administrators, faculty members and guidance counsellors to formulate new
nursing curricula to equip the student nurses for their future as professional nurses.
Scope and Limitations
This descriptive-correlational study focuses on the existence of workplace bullying and the
level of job satisfaction among the nurses in Silliman Medical Center Foundation, Inc., Holy Child
Hospital, Negros Oriental Provincial Hospital, Bayawan District Hospital, Bais District Hospital,
and Governor William Villegas Memorial Hospital in Negros Oriental, Philippines. These selected
hospitals are included in the inclusion criteria for having a minimum of 50 as their bed capacity, a
24/7 rotation of staffing with a minimum of 2 or more number of co-nurses or other hospital
employees in the ward assigned, and has a complete staffing team including a chief nurse,
supervisor or senior nurse, nursing aide, utility workers, and a resident on duty in the facility.
11
Significant relationships of the major variables of this study and the selected demographic
and non-demographic factors are also determined.
The participants of the study are nurses employed in the hospital by job order, contract or
permanent status. They worked for at least six months at their present employment. The age
bracket and gender are not restricted as long as the participant meets the criteria mentioned above.
Operational Definition of Terms
The following terms are the major variables of the study and are defined according to how
they are gathered, processed, and analyzed in order to test the hypotheses:
Age- refers to the number of years that a study participant has lived.
Civil status- refers to the family situation of the nurses whether he/she is single, married, or
widower/widow.
Current position- refers to the designation of the nurses whether he/she is a staff nurse, Senior
Nurse, Head Nurse, Nurse Supervisor, or Chief Nurse.
Gender- refers to the biological sex of the nurse, either male or female.
Job Satisfaction- refers to the feeling of fulfillment or contentment that a nurse derives from their
workplace. In order to assess employee attitudes about the job and aspects of the job, the
Job Satisfaction Survey (JSS) tool of Paul Spector (1994) is used in this study.
Length of work experience- refers to the total number of months and years the nurse is employed
either in the current hospital or previous other employments.
Nurses - refer to the registered nurses or licensed graduate nurses in the Philippines who are
employed in the selected hospitals of Negros Oriental, Philippines. They must be working
12
for at least six months in the facility with either a job order, contractual, or permanent
status.
Perpetrators of bullying- refer to the personnel/s who were perceived by the study participants
as demonstrating bullying behaviors toward them or others.
Type of hospital according to ownership- refers to the type of ownership of the health facility,
whether it is a government-owned or a private institution.
Work environment- It involves the social interactions at the workplace, including interactions
with peers, subordinates, and managers. This is also referred to as the area of work
assignment like perioperative areas (comprises of Operating Room, PACU, and Surgical
Ward), medical units (includes Intensive Care Unit, Medical Ward, and
Gastrointestinal/Endoscopy Unit), obstetrics department (such as Neonatal Intensive Care
Unit, Pediatrics Ward, Delivery Room, OB/Gyne Ward, and Pediatrics Intensive Care
Unit), emergency department (consists of Emergency Room, Out-Patient Department, and
Family Planning Clinic), and special services (entails Dialysis Unit, Nursing Service
Office, Animal Bite Treatment Center, and others ).
Work status – refers to the type of appointment by the employer to the staff nurse. It is either by
Job Order or Reliever (expected duration is 5-6 months with partial or without benefits),
Contractual (temporary contract for 6 months or more with or without selected benefits)
or Regular (permanent with complete benefits).
Workplace bullying - There is no legal definition of workplace bullying. However, experts
believe that bullying involves negative behavior being directed at an individual or groups,
repeatedly and persistently in the workplace (Safe Work Australia, 2011) over six months.
13
Furthermore, to know the status of workplace bullying, the existence of workplace
bullying in the hospital is measured through the use of Negative Acts Questionnaire-
Revised (NAQ-R) by Einarsen, et al., (2009). Finally, the workplace bullying is classified
into three dimensions such as:
Person-related bullying - refers to insulting comments about a person’s private
life or background, humiliating or intimidating behavior, rumors or false allegations, and
exclusion or isolation (Salin, 2005). It is the interpersonal aspect of bullying using
behavioral terms (Einarsen, et al., 2009).
Physically intimidating bullying - refers to verbal threats where a person is
criticized, yelled at or humiliated in public; physical violence or threats of such violence
(Einarsen, et al., 2009). It is the physical aspects of bullying using behavioral terms
(Einarsen, et al., 2009).
Work-related bullying - refers to unjustified criticism about a person’s work,
unreasonable deadline, somebody withholding information or somebody being
excessively monitored (Salin, 2005) It is the occupational aspect of bullying using
behavioral terms (Einarsen et al., 2009).
14
CHAPTER 2
REVIEW OF RELATED LITERATURE
This chapter presents a review of literature related and relevant to the study. It includes the
characteristics of a professional nurse, scope of nursing practice, Code of Ethics for Filipino
Nurses, workplace bullying and its origin, prevalence of workplace bullying in nursing, related
studies and theories of bullying, manifestations of workplace bullying, characteristics of the target
and bully, work environment, job satisfaction, and orientation program for graduate nurses. It also
includes a conceptual framework that discusses and illustrates relationships of the concepts used
in this study.
Characteristics of a Professional Nurse
The professional nurse creates numerous and unique contributions to client care as one of
the members of the interdisciplinary health team. In Hood’s (2010) Professional Nurse
Contribution Model, all health care team members share an altruistic attitude toward the persons
they serve. Ideally, many enter the nursing profession because they genuinely care about people
and have a desire to help others in times of need (compassion). Care, compassion, and commitment
are significant affective domains for optimal professional nursing.
Hood (2010) added that clients anticipate competence from health care providers.
However, before competence can be accomplished, professional nurses must have confidence in
their ability to perform the clinical, communication, and cognitive skills for operative practice.
Moreover, the roles assumed by professional nurses require that they have a repertoire of clinical,
cognitive, and communication skills. Nurses must always have sound reasons behind clinical
15
decisions and actions to be able to communicate them well. It is stressed that well-refined clinical,
cognitive, and communication skills distinguish professional nurses from all other members of the
health care team.
Nurses deliver care in complex systems so it is important that they understand the nature
of these systems and be able to manipulate them. Nurses habitually encounter complicated client
situations and must adapt to changes as new scientific evidence emerges (Hood, 2010).
Scope of Nursing Practice
Various health care settings have different registered nurses who work together with other
nurses and health care providers. They are guided and protected by the scope of nursing. It is stated
under the Republic Act No. 9173, Article VI. Section 28 or the Philippine Nursing Act 2002 that
Nurses provide nursing care through the utilization of the nursing process;
establish linkages with community resources and in coordination with the health
team; provide health education to individuals, families and communities; teach,
guide and supervise students in nursing education programs including the
administration of nursing services in varied settings such as hospitals and clinics;
and undertake nursing and health human resource development training and
research, which shall include, but not limited to, the development of advance
nursing practice.
Code of Ethics for Filipino Nurses
In July 14, 2004, a new Code of Ethics for Filipino Nurses was adopted under R.A. 9173
and was promulgated by the Board of Nursing (No. 220). It is clearly stated in Section 13 of Article
16
IV that the registered nurse is in solidarity with other members of the health care team in working
for the patient’s best interest, and maintains a collegial and collaborative working relationship with
colleagues and other health care providers. Moreover, there are guidelines that Registered Nurses
must observe, namely: maintain their professional role/identity while working with other members
of the health team; conform with group activities as those of a health team should based on
acceptable, ethico-legal standards; contribute to the professional growth and development of other
members of the health team; actively participate in professional organizations; not act in any
manner prejudicial to other professions; honor and safeguard the reputation and dignity of the
members of nursing and other profession, refrain from making unfair and unwarranted comments
or criticisms on their competence, conduct and procedures, or not do anything that will bring
discredit to a colleague and to any member of other professions; and respect the rights of their co-
workers.
Workplace Bullying and its Origin
Workplace bullying involves abuse or misuse of power and authority within an
organization (Murray, 2009). Citing the Center for American Nurses (2007), Felblinger (2008),
Longo & Sherman (2007), and Murray (2008) stated that workplace bullying is a serious issue
affecting the nursing profession. He further defined it as any type of repetitive abuse in which the
target of the bullying behavior suffers verbal abuse, threats, humiliating or intimidating behaviors,
or behaviors by the perpetrator that interferes with job performance and are meant to place at risk
the health and safety of the target.
As contended by Rutherford & Rissel (2004), workplace bullying has increasingly been
identified as a serious occupational health and safety issue. They mentioned that recognition and
17
management of bullying in the workplace is complicated by the lack of a consistent definition.
Simons and Mawn (2010) differentiated bullying from horizontal or lateral violence in several
ways: Horizontal or lateral violence can occur as a single isolated incident, without power
gradients between the individuals involved. In contrast, bullying is repeated over at least six
months. Horizontal or lateral violence and bullying do, however, share behaviors such as sabotage,
infighting, scapegoating, and excessive criticism.
The origin of the bullying problem may be due to individual, environmental, and/or
organizational factors. Individual factors consist of mental illnesses, female gender among
victimized health care workers, and drug and alcohol habits. Environmental factors comprise poor
lighting, lack of safety measures, and working with violent or aggressive patients and families.
Organizational factors include deficiency of resources, understaffing due to nursing shortage, poor
work group relationships, alterations in composition of work groups, low supervisor support,
increased amount of work, downsizing, and organizational restructuring (Cooper & Swanson,
2002; Salin, 2003).
Murray (2007) states that healthcare institutions today usually intimidate staff with reprisal
for reporting misconduct. Countless nurses uphold the white wall of silence and do not report
wrongdoing. He opposed that nurses do not need a white wall of silence, but, instead need a white
wall of protection for ethical behavior.
Furthermore, the Center for American Nurses (2008) promotes implementation of zero
tolerance policies that address disruptive behaviors (lateral violence and bullying) and point out
that negative behaviors will not be tolerated. They suggest that organizations have to adopt zero
tolerance policies that comprise appropriate investigation and due process essential to provide
adequate protections to nurses and others who are blamed for lateral violence or bullying.
18
Additionally, the human relation trait or pakikisama among Filipinos is considered one of
the factors that contribute to existing negative behaviors in the workplace. As explained by Andres
(1996), the Filipino wants to get along with everyone whom he/she considers as very necessary to
maintain good relations, in order to feel that he/she is socially accepted. Unfortunately, this
Filipino value has not been fully understood; in fact, it has been used many times in a negative
way. For example, pakikisama becomes the practice of yielding to the will of the leader or to the
group so as to make the group’s decision unanimous. When an individual conforms to the group’s
norms, he/she is rewarded with cooperation and support. On the other hand, non-conformity is
punished by withdrawal of support.
Prevalence of Workplace Bullying in Nursing
In 2001, Quine studied the nurses in a community National Health Service (NHS) trust in
south-east England. The aims of the study were to determine the prevalence of bullying, to
examine the association between bullying and occupational health outcomes, and to investigate
whether support at work could moderate the effects of bullying. Forty-four percent of nurses
reported experiencing one or more types of bullying in the previous 12 months compared to 35%
of other staff. Fifty percent of nurses had witnessed the bullying of others. Nurses who had been
bullied reported significantly lower levels of job satisfaction and significantly higher levels of
anxiety, depression, and propensity to leave. They were also more critical of aspects of the
organizational climate of trust. Support at work was able to protect nurses from some of the
damaging effects of bullying.
Seventy-three percent (n=778) of participants in Quine’s (2001) study, held professional
qualifications: 36% of the sample (n=396) were qualified nurses from a range of disciplines—for
19
example registered general nurses, registered mental health nurses, registered learning disabilities
nurses and health visitors; 12% (n=132) had secretarial or administrative qualifications; 10%
(n=111) had qualifications in the therapies (occupational, speech and language, chiropody,
physiotherapy); 5% (n=49) had medical degrees; 1% (n=11) had qualifications in clinical
psychology; and 9% (n=101) had a range of qualifications in other areas such as social work,
residential care, or health promotion.
A study by Hoel, et al (2001) explored in their study some epidemiological features of
bullying in Great Britain by means of a large-scale, nationwide survey, focusing on the differences
in experience with regard to organizational status. To measure exposure to negative behaviors
identified with bullying, a revised version of the Negative Acts Questionnaire (Einarsen & Raknes,
1997) was used. It consisted of 29 specific negative behaviors, and had been adapted to the UK
context by means of a focus-group study. Few differences were uncovered for the experience of
self-reported bullying between workers, supervisors, middle, or senior managers. The prevalence
of bullying, duration of experience, status of perpetrator, and whether or not the experience was
shared with others or not, were similar across these organizational status groups. However,
different factors may account for the experience of self-reported bullying for each of the
organizational status groups. More inconsistencies emerged when the behavioral experience of
bullying was compared across groups. Workers and supervisors were more frequently exposed to
negative acts than managers. They were also more likely to have been exposed to derogatory or
exclusionary behavior, while managers more frequently reported exposure to extreme work
pressure. Moreover, when the results were adjusted for the possible impact of gender, a number of
discrepancies between the organizational status groups arose. The interaction between status and
gender was explained by reference to cultural differences between men and women, the
20
phenomenon of the “glass-ceiling” and the interaction between such factors, and the prevailing
socio-economic situation.
In this study (Hoel, et al., 2001), a questionnaire was mailed to employees drawn from 70
organizations within the private, public, and voluntary sectors across Great Britain, that on request
from the researchers agreed to take part. The selection of study participants was undertaken
according to a procedure that ensured acceptable randomness and representativeness. A total of
5288 questionnaires were returned, giving a response rate of 42.8%. Respondents 52.4% were
men, 47.6% women. The average age for the sample was 40.2 (SD = 9.84). The respondents
identified their organizational status as workers (43.6%), supervisors (14.9%), middle
management (21.1%), senior management (7.3%), and others (13.1%).
In 2003, a descriptive study conducted by McKenna, et al., examined the prevalence of
horizontal violence or bullying experienced by 1,169 nurses residing in New Zealand within their
first year of practice. It was found that many new graduates were likely to have experienced
horizontal violence. One in three participants discussed a most distressing event. The negative
behavior was prevalent across all clinical settings. Most of the behavior experienced was indirect
and covert in nature, even though direct verbal statements were also common.
The characteristics of the participants of McKenna, et al., (2003) were the following: 21%
were nurses practicing in medical wards, 26% were in surgical wards, 30% were in other inpatient
services (including assessment and rehabilitation, care of older people, obstetrics, pediatrics,
accident and emergency, operating theatre and intensive care units), 13% were in mental health
services, 6% were in community services, and 4% were in other areas not easily categorized
(including nurse education and administration). Seventy percent graduated following the State
Registration Examination in November 1999, 3% in March 2000 and 27% in July 2000. With
21
regard to the demographic proﬁle of participants, 94% were female and 6% were male. Forty-six
percent were nurses aged below 30, 25% were between 30 and 39 years, 24%, were between 40
and 49, and 5%were aged 50 or over.
A study was done in New South Wales, Australia by Rutherford and Rissel (2004) to
explore the frequency, nature, and extent of workplace bullying in a health care organization. The
survey methodology achieved a 79% response rate (n=311). Overall, 50% (n=155) of the
participants reported they had experienced one or more forms of bullying behavior in the last 12
months while employed by the organization. The level of bullying reported was unexpectedly high
and will require development of strategies to address the issue. Furthermore, the most frequently
reported behavior was intimidating behavior, such as belittling, sneering, shouting or ordering
(32% of participants), followed by tones of voice or facial expressions that leave a person feeling
'put down' (26% of participants). Bullying was reported by 29% of staff who had worked in the
organization for less than 12 months; 63% of staff who had worked in the organization for 1 to 2
years; 53% of those who had worked in the organization for 2 to 5 years; and 50% of those who
had worked in the organization more than 5 years. Finally, the study revealed that the largest source
of bullying behavior was from peers or fellow workers (49%), followed by clients (42%), and
managers or supervisors (38%). Only 26% of participants who had been bullied had formally
reported it to a person.
Of the participants in the study of Rutherford and Rissel (2004), 64 were male (21%) and
246 were female (79%). Compared with demographics of the organization, men were slightly more
likely to return a questionnaire than women (16% of Division staff are male, 84% are female).
Most participants were 30 to 50 years of age, with 22% more than 50 years and 13% under 30
years. The largest proportion of participants had worked for the organization for more than 5 years
22
(47%); 26% of the staff had worked for the organization for 2 to 5 years; 13% for 1 to 2 years; and
14% for less than 12 months. Most participants were involved in face-to-face clinical work with
clients (60%); 23% described their work as mostly management, administration or clerical; and
16% as public health/health promotion, reflecting the distribution of the staff in the organization.
The response rate was not significantly different between occupational groups. Sixty-six (21%) of
the participants reported roles that involved managing staff.
In the U.S., Rosenstein and O'Daniel (2008) conducted a survey to assess the significance
of disruptive behaviors and their effect on communication and collaboration and impact on patient
care. The 22-question survey was administered by VHA West Coast to a convenience sample. Of
the 4,530 participants, 2,846 listed their titles as nurses, 944 as physicians, 40 as administrative
executives, and 700 as "other." The survey revealed that a total of 77% of the participants reported
that they had witnessed disruptive behavior in physicians—88% of the nurses and 51% of the
physicians. On the other hand, 65% of the participants reported witnessing disruptive behavior in
nurses at their hospitals—73% of the nurses and 48% of the physicians. Sixty-seven percent of the
respondents agreed that disruptive behaviors were linked with adverse events; the result for
medical errors was 71%, and patient mortality was 27%.
In Turkey, Yildirim (2009) conducted a cross-sectional and descriptive study entitled
Bullying among Nurses and its Effects. It showed that there was 37% out of the 286 female nurses
who participated in the research had never or almost never came across workplace bullying
behavior in the last 12 months, while 21% of the nurses had experienced these behaviors. It was
also revealed that there were no differences between position and educational level in workplace
bullying. The study found that workplace bullying leads to depression, lowered work motivation,
23
decreased ability to concentrate, poor productivity, lack of commitment to work, and poor
relationships with patients, managers and colleagues.
The following describes the demographic characteristics of the nurses who participated in
the Yildirim’s (2009) research: their mean age was 28.66 years; they worked a mean of 45.3 hours
per week; their total number of years of employment was a mean of 6.77; and their mean number
of years of employment at their current institution was 5.74. The majority of the nurses had a
baccalaureate degree (62%) or an associate degree (25%). The majority of the participating nurses
worked as either bedside nurses in the wards (55%) or in special care areas (such as the ICU or
operating rooms). The remaining 13% were ward head nurses.
Stelmaschuk (2010) studied the incidence of workplace bullying at two Midwestern
academic healthcare institutions in Ohio, USA. The results of this study showed that workplace
bullying is a problem for nurses and other non-nursing, unit-based staff at the 2 academic medical
centers that participated in the study. On average, participants experienced 1.74 bullying acts
weekly or daily. 13.7% of participants were considered targets for workplace bullying; however,
when nurses and other non-nursing, unit-based staff were asked explicitly whether or not they had
been bullied in the past 6 months, only 4.4% claimed they had been bullied weekly or daily. When
comparing the results to this question with the percentage of staff that were considered targets for
workplace bullying based on the scores of the Negative Acts Questionnaire, it seems that there is
a normalization of bullying behavior among healthcare staff. While nurses and other non-nursing,
unit-based staff have identified that they experience some of the 22 negative behavioral acts
defined by the NAQ, they do not necessarily equate these actions with workplace bullying shown
by the 9.3% discrepancy between those considered targets for workplace bullying and those who
identify with being bullied on a daily or weekly basis.
24
Finally, the study of Stelmaschuk (2010) used a convenience sample which included
volunteer registered nurses (RNs), licensed practical nurses (LPNs), health unit coordinators/unit
clerks, patient care assistants, surgical technicians and service technicians that work on the
respective nursing units. The sample for this study in hospital A included RNs (n=71), unit clerks
(n=3), patient care assistants (n=13), and surgical/perioperative technologists (n=30). In hospital
B, participants included RNs (n=91), LPNs (n=1), health unit coordinators (n=9), patient care
nursing assistants (n=12), and surgical equipment technicians (n=63). A total of 6 people chose
not to share their job title.
Related Studies and Theories of Bullying
Theories provide frameworks that can be useful in understanding the factors and
progressions of bullying phenomenon.
While it is clear that workplace bullying is prevalent among nurses, serious implications
can result from this problem. A popular theory of workplace bullying is the oppressed group theory
which attributes workplace hostility and aggression as a defense mechanism among a group of
social equals that are also part of an oppressed group (Johnson, 2009; Simons, 2008). In this
model, colleagues on the same level of an organization experience aggression from members
higher in the organizational hierarchy, and as a result of low self-esteem and poor group identity
they direct abusive behavior towards one another (Hutchinson, et. al., 2008) (as cited in
Stelmaschuk, 2010).
Gary (2002) offered that members of oppressed groups who most closely exemplify the
characteristics of their oppressor often are promoted and given rewards and privileges. This is the
most common way to gain status and move up within oppressed structures. When constituents of
oppressed groups accept promotions, they take some of the work of their oppressors and join the
25
attacks on subordinate group members. These nurse leaders have frequently been identified as
perpetrators of horizontal violence in nursing. To maintain their leadership positions these
individuals must act in unity with the oppressors and maintain the status quo. Nurse leaders within
the oppressed system who acknowledge the reports of bullying as credible threats to the positions
(Roberts, S., 1997; Dunn, 2003).
As a subordinate group, nurses exhibit traits of intergroup aggression. Some nurse
researchers noted this and began to question why they were such stark incongruities between the
professional caring relationships nurses developed with their patients and the aggressive
relationships they had with one another. This inconsistency is perplexing because nurses generally
have the skills to deal with these types of circumstances with their patients, but appear to not
transfer those skills to their interpersonal relationships with peers. The paternalistic environment
in which nurses worked for many years may be a contributing factor to a nurse’s hesitancy to make
this crossover (Cox, 1987; Sunderland, & Hunt, 2001; Hutchinson et al., 2005; Sweet, 2005).
Other researchers claim that workplace bullying is caused by organizational factors such
as tolerance of bullying behavior, misuse of authority, and the lack of organizational policies and
procedures for addressing workplace bullying (Hutchinson, et al., 2006; Johnson, 2009) (as cited
in Stelmaschuk, 2010).
A person is considered as an open system. According to a biologist, Ludwig von
Bertalanffy, organisms should be studied as complex wholes. His work came to fruition in 1950
with publication of the famous article "The Theory of Open Systems in Physics and Biology."
What von Bertalanffy did was to distinguish between two types of systems—closed and open. A
system is closed if no material enters or leaves it. A closed system obeys the second law of
thermodynamics, gradually running down, increasing entropy, and reaching an equilibrium state
26
when no energy can be obtained from it. A system is open if it imports and exports material and,
in the process, changes components. In addition, an open system depends on its environment and
lives off it (Katz & Kahn, 1966).
The Person Environment Congruence Theory was used in a study which looked at nurses’
work environment and the potential for workplace violence (Dendas, 2004). This theory argues
that people either fit in their environment or they do not. The environment is seen as exerting
multiple demands upon individuals and has been recognized as one of the factors that lead to acts
of violence. When the individual and the environment fit well together or are congruent,
satisfaction and fulfillment are achieved. A poor fit or incongruence leads to a negative outcome
which could result in horizontal violence.
In a qualitative study examining bullying in a paramilitary organization, Owoyemi (2011)
(as cited in Lipinski & Crothers, 2013) found that most participants were bullied by a superior.
Because bullying is based, in part, on the perception and reaction of the victim, the use of tactics
that are meant to keep employees in line or to create unity can quickly escalate into bullying when
the individual singled out does not respond to the tactics, or responds in a negative way. The use
of authoritarian practices and an organization's desire to emphasize conformity can create an
environment that tolerates or even condones workplace bullying.
Leymann suggests that a strong hierarchy, an authoritarian leadership style and work
climate, and poor communication are risk factors for the likelihood of workplace bullying (1992,
as cited in Björkqvist et al., 1994). Einarsen and Skogstad (1996) analyzed data from almost 8,000
individuals employed across various organizations and professions, and found several
organizational characteristics that were consistent with workplace bullying. Bullying was reported
most frequently in organizations that employed a larger number of workers, focused on manual
27
types of labor (such as manufacturing), and were comprised primarily of male employees. It is
evident that the military, paramilitary organizations and blue-collar organizations typically have
such characteristics and may be a breeding ground for bullying.
A study was conducted by Laschinger and Finegan (2005) to evaluate the effects of
employee empowerment on perceptions of organizational justice, respect, and trust in
management. Using Rosabeth Kanter's theoretical framework of organizational empowerment and
numerous other research findings, the authors surveyed a sample of 273 medical-surgical and
critical care nurses in Ontario, Canada. The results of this study revealed that structural
empowerment had a direct effect on interactional justice, respect, and organizational trust.
Similarly, empowerment had a cascading effect on organizational trust, job satisfaction, and
organizational commitment.
Laschinger and Finegan’s (2005) characteristics of the participants were mostly nurses who
worked either full (59.7%) or part time (40.3%) was in medical-surgical (70%) areas, while 30%
of the participants worked in critical care. In terms of educational background, majority (63%) of
the participants were diploma prepared, while 37% held baccalaureate degrees. The nurses’
average age was 33 years with 9 years of nursing experience, and 2 years work experience on their
current unit.
In addition, Armstrong and Laschinger (2006) conducted an exploratory study that tested
a theoretical model, linking the quality of the nursing practice environments to a culture of patient
safety. This study was based on Kanter's theory of structural empowerment. Kanter defines power
as an ability to mobilize resources and achieve goals, as opposed to the notion of power in the
traditional hierarchical context. Employees are empowered when they have access to information,
support, resources, and opportunities to learn and grow in their work setting. Jobs that provide
28
discretion and that are central to the organizational purpose increase access to these empowering
structures. Similarly, strong networks with peers, superiors, and other organizational members
increase access to these structures. These systemic conditions, labeled formal and informal power
by Kanter, influence empowerment, which then results in increased work effectiveness. Thus,
power is associated with autonomy and mastery, instead of domination and control, and maximizes
the power enjoyed by each member of the organization. In this study, strong relationships were
found not only between structural empowerment and Magnet hospital characteristics but also
between the variables and perceptions of patient safety culture within the unit. These relationships
are consistent with the hypothesis that access to structural empowerment factors and characteristics
of Magnet hospitals are attributes of hospitals that have a strong culture of patient safety. This
suggests that healthcare organizations that provide nurses with high levels of access to information
support and resources are also organizations that exhibit high levels of Magnet hospital
characteristics, which support professional nursing practice. The results also suggest that
organizations in which nurses are empowered to practice their profession optimally are
organizations that optimize conditions for providing safe patient care.
This exploratory study of Armstrong and Laschinger (2006) used a predictive, non-
experimental design as part of a quality improvement strategy in a small community hospital in
central Canada. A total of 40 surveys were returned for a response rate of 51%. Most (60%) of the
staff nurses who responded were 40 years of age or older, and 50% had been in the organization
for 13 years or more.
Manifestations of Workplace Bullying
The following instances of bullying behaviors indicate that a nurse is being bullied
(Felblinger, 2008; Longo & Sherman, 2007; Murray, 2008):
29
• The supervisor nurse has never expressed appreciation to the nurse even though he/she
tried everything to learn a new procedure or carried out a task.
• The supervisor nurse calls a nurse for an unplanned meeting where there are other nurses
listening during her reproach that gives him/her further humiliation.
• A nurse is accused of being incompetent even with expertise and history of excellence in
the field of practice.
• The nurse is being shouted or yelled at in front of others to make him/her appear bad.
• Co-workers are reprimanded to stop communicating with a nurse at work and in public
places.
• A nurse persistently feels worried or dreadful waiting for further destructive happenings.
• A nurse is told to “get a tougher skin” or “work out your differences” after a nurse has
asked for help from his/her senior leader.
• Co-workers and senior leaders have recognized that the bully is a problem for the nurse,
but take no action.
Characteristics of the Target
Bullies usually do not torment everyone. The factors that affect target selection include the
depth of the bully’s inadequacy, the bully’s fluctuating self-esteem at any given moment, the
bully’s position at work, the bully’s ability to bully without being punished, the target’s resistance,
and the target’s personality (Namie & Namie, 2003).
Anyone can become a target. Being a target hinges on two characteristics: a desire to
cooperate and a non-confrontational personal style. Bullied targets may even blame themselves
(Namie & Namie, 2003). Individuals can be targeted no matter who they are. Unless the number
of targets is overwhelming in a short time (atypical of bullies), the chosen target is presumed at
30
fault and labeled as antisocial, a wrong fit, not able to work well with others, etc. Most targets have
demonstrated many positive qualities throughout their professional careers, including competence,
intelligence, creativity, integrity, camaraderie, accomplishment, and dedication. Targets were
mostly people Goleman (2005) describes as emotionally intelligent.
Characteristics of the Bully
The characteristics of workplace bullies have been difficult to study, and characterization
has often been based on the opinions of targets. The behavior of bullies has been characterized in
terms of various personality disorders, and these personality traits have been suggested to originate
from the bullies’ early childhood (Vartia-Väänänen, 2003). Obsessive and narcissistic behavior of
workplace bullies is evidenced in their selfish behavior and their compulsion to have their own
needs met at all costs. Bullies are often attractive and seductive, clever, and manipulative (Namie,
2006). Bullies in the workplace often view the innocent acts of coworkers as hostile and personally
threatening and seek revenge for perceived attacks through intimidation or physical means
(Middleton-Moz & Zadawski, 2002). The compulsion to act aggressively is also highlighted in
bullies’ constant demands for respect and consideration, rarely extending the same treatment to
others. There is considerable consensus that workplace bullies are selfish, self-obsessed,
inadequate, insecure, and totally insensitive. Workplace bullies display gross inadequacies in their
ability to communicate in an open and healthy manner. They frequently lack vision or initiative
and they are often threatened by competence (Kitt, 2004).
The nurse bully types have been described as follows: the super nurse (more experienced,
educated, or specialized; conveys an elitist or superior attitude), the resentful nurse (develops and
holds grudges), the putdown gossip and rumor nurse (shares negativity), the backstabbing nurse
(cultivates friendships, then betrays them; "two-faced”), the green-with-envy nurse (tends toward
31
envious and bitterness), and the cliquish nurse (uses exclusion for aggression; shows favoritism
and ignores others) (Dellasega, 2009). The bullying spectrum is broad and its hurtful strategies are
quite creative, flexible, and amenable to being carefully tailored for the target (Dellasega, 2009;
Johnson & Rea, 2009; Simons, 2008).
Work Environment
Some places and situations are more conducive to bullying than others. A harsh, malicious,
or harmful worker would not survive in a healthy organization. People need to dominate others
and the workplace provides them with a location, for social, environmental, and biological reasons
that, if not properly managed, allows them to exercise their need to control (Harvey, et al., 2006).
A concern is that bullying appears to be tolerated and, is therefore, becoming embedded in many
organizational cultures. Yandrick (1999) noted that bullying “is a problem that knows no
geographic boundaries and is not confined to a particular industry”. The work group itself may
play a role in the bully environment. Coworkers may stand by as silent witnesses. Previous studies
indicate adult bullying is a more common event than thought and can have serious consequences
for organizations (Namie & Namie, 2003; Needham, 2003; Rayner et al., 2002). Thus, bullying
remains one of the workplace’s most overlooked issues, lowering morale, job satisfaction, and
productivity while driving health-care-related costs up and making employers vulnerable to
lawsuits or disability claims (Holt, 2004).
Job Satisfaction
Namie and Namie (2003) released results from an online survey that examined many
unhealthy workplaces and found that bullies on the job can cause irreparable harm to their
32
colleagues. The survey also showed that targets of bullying waste between 10% and 52% of their
time at work defending themselves and networking for support, thinking about the situation, being
demotivated and stressed, and taking sick leave due to stress-related illnesses. Bullies corrupt their
working environment with low morale, fear, anger, and anxiety (Canada Safety Council, 2002;
Vartia-Väänänen, 2003). Although violent or vengeful workers occasionally make the news,
workplace bullying is largely a silent epidemic. A bully’s behavior causes other people to suffer
shame, humiliation, and depression, which can affect their nonwork life as well as their job
performance (Namie & Namie, 2003).
Orientation Program for Graduate Nurses
An exploratory and descriptive study of Melad (1990) revealed that there is an existing
orientation program which is either structured or unstructured for graduate nurses upon
employment in government and non-government tertiary hospitals in Region VII of the
Philippines. The orientation program includes the institution’s philosophy, procedures, personnel
and environment. There are both strong and weak points of the orientation program. Not all of the
orientation programs in the respective hospitals utilize an evaluation tool, and consequently, not
all of the knowledge, skills, and attitudes of graduate nurses are improved throughout an
orientation program.
Furthermore, Melad’s (1990) study revealed that nurse-respondents in one hospital
identified six strong points in the hospital’s orientation program. These were: the orientation
program assisted, encouraged, and stimulated the nurse-respondent to make her professional role
a lot easier; more time was spent on routine procedures and nursing care specific to the unit, rather
than on general orientation; there was sufficient time for the whole orientation period; the hospital
33
personnel, especially the nursing service, were supportive and accommodating; the orientation
program met the nurse-respondent’s objectives as an orientee; and the orientation played a major
role in developing the nurse-respondent to become a responsible and accountable nurse in terms
of giving good quality nursing care.
Finally, Melad (1990) recommended that those who are employed in hospitals with an
unstructured orientation program should ponder and reflect on the importance of formulating a
structured one that is more beneficial to the orientee, the institution and most especially, the client.
Conceptual Framework
The participants in this study comprise one group of nurses who are seen as the most
exploited in the negative act of bullying. A person is considered as an open system by Ludwig von
Bertalanffy (1968) (as cited in Katz & Kahn, 1966) and is indicated by a broken circle that may be
influenced by factors, specifically demographic (age, gender, and civil status) and non-
demographic (work status, current position, length of work experience, area of work experience,
type of hospital where they belong, and perpetrators of bullying) toward the manifestation of the
different dimensions of bullying behaviors in their workplace such as person-related, work-related,
and physically intimidating, and to the degree of job satisfaction.
By using an eclectic approach, this study leans in various relevant theories in elaborating
the related variables. Although there may be a lot of other factors that may lead towards or from
bullying, this study focuses on workplace bullying and job satisfaction of nurses. Hence, the work
environment is enclosed in a perforated triangle to denote that there are possibilities of other
influential factors.
34
According to the oppressed group theory, workplace hostility and aggression are
manifestations of a defense mechanism among a group of social equals that are also part of an
oppressed group (Johnson, 2009; Simons, 2008). In this theory, colleagues on the same level of an
organization experience aggression from members higher in the organizational hierarchy, and as a
result of low self-esteem and poor group identity they direct abusive behavior towards one another
(Hutchinson, et. al., 2008). Meanwhile, Filipino nurses often disregard the bullying behaviors,
which they usually do not report to the higher authority. The reason may be that the bully is the
senior nurse, charge nurse, supervisor nurse, or chief nurse. This is supported by other researchers
who claimed that workplace bullying is caused by organizational factors such as tolerance of
bullying behavior, misuse of authority, and the lack of organizational policies and procedures for
addressing workplace bullying (Hutchinson, et al., 2006; Johnson, 2009).
The use of Person Environment Congruence Theory in a study found that when the
individual and the environment fit well together, satisfaction and fulfillment results. However, a
poor fit or incongruence leads to horizontal violence or bullying in the workplace.
This study is carried out to determine the relationship of nurses working at the private and
public hospital between the status of workplace bullying in terms of person-related, work-related,
and physically intimidating. Health care teams (nurses, doctors, nursing aides, and others) may be
experiencing repetitive and habitual acts of bullying in their assigned working environment that
may continue to exist for at least six months and more (Einarsen, 2000), symbolized from the back
and forth arrows.
Meanwhile, Namie and Namie (2003) believes that a bully’s behavior causes other people
to suffer shame, humiliation, and depression, which can affect their nonwork life as well as their
job performance. The status of workplace bullying and its identified behaviors such as work-
35
related, person-related (Salin, 2005), and physically intimidating (Einarsen, et al., 2009), greatly
affects the level of job satisfaction among nurses.
Nevertheless, the bullying behaviors encompass the withdrawal of Kanter’s Theory of
Structural Empowerment factors such as access to information (work-related), support (work-
related), resources (work-related), and opportunities to learn and grow in their work settings (work-
related), thereby affecting the level of job satisfaction among nurses.
Study’s Conceptual Model
Licensed Graduate Nurse
Demographic Profile Non-Demographic Profile

Age Work Status
Gender Current position
Civil status Area of work assignment
Length of experience
Type of hospital
Perpetrators of bullying
JOB SATISFACTION
Figure 2.1 The Relationship Between Workplace Bullying, Selected Factors

36
and Job Satisfaction among Hospital Nurses
CHAPTER III
METHODOLOGY
This chapter describes the research design, research setting, participants of the study,
sampling procedure, research instrument, data collection procedure, statistical analysis employed,
and ethical considerations.
Research Design
This study uses a descriptive-correlational research design. The gathering of data is done
through self-administered questionnaires. According to Polit and Beck (2006), this design has no
intention in giving a causal relationship between the status of workplace bullying in the dimension
of person-related bullying, work-related bullying, and physically intimidating bullying behaviors
and the level of job satisfaction that are affecting the nurses in the public and private hospital but
desires to establish whether correlations exist between the variables. This study also examines the
correlations of the participant’s demographic factors (age, gender, and civil status) and non-
demographic factors (work status, current position, length of work experience, area of work
assignment, type of hospital where they are working, and perpetrators of bullying) with the status
of workplace bullying in the dimensions of person-related, work-related, and physically
intimidating bullying behaviors. Furthermore, correlations between status of workplace bullying
in the dimensions of person-related bullying, work-related bullying, and physically intimidating
bullying behaviors are also described.
37
The aims of this study are to describe the demographic characteristics in terms of age,
gender, and marital status; non-demographic characteristics in terms of working status, current
position, length of work experience, area of work assignment, type of hospital where the nurses
are working, and perpetrators of bullying; the status of workplace bullying in the dimensions of
person-related, work-related, and physically intimidating bullying behaviors in terms of the
demographic characteristics; and the level of job satisfaction among the participants.
Research Setting
The study is conducted in selected public and private hospitals in Negros Oriental,
Philippines. The public hospitals chosen comprise a minimum of 50 bed capacity regardless of the
level of health care with a general ward and an emergency and delivery room. These hospitals are
Negros Oriental Provincial Hospital (250 bed capacity), Bais City District Hospital (50 bed
capacity), Bayawan City District Hospital (75 bed capacity), and Governor William Villegas
Memorial Hospital (75 bed capacity). Meanwhile, two private hospitals exist in Negros Oriental
that have special care units, specifically Silliman University Medical Center Foundation, Inc. (250
bed capacity) and Holy Child Hospital (100 bed capacity). Both are chosen sites of the study.
Participants of the Study
The participants that are recruited for the study include male and female nurses who must
have at least six-month or more of work experience whether by job order, contract or permanent
position (work status) in the selected public and private hospitals in Negros Oriental. The
participants are from hospitals with a minimum of 50 as their bed capacity, a 24/7 rotation of
staffing with a minimum of 2 or more number of co-nurses or other hospital employees in the ward
38
assigned, and a complete staffing team including a chief nurse, supervisor or senior nurse, nursing
aide, utility workers, and a resident on duty in the facility.
Sampling procedure
Cluster random sampling is used in the study. Hospitals were first grouped into private and
public facilities. From the list of the hospitals, six hospitals were qualified based on the inclusion
criteria: hospital facilities must have a minimum of 50 as their bed capacity regardless of whether
they operate with general wards or according to specialty wards and must also operate an
emergency and delivery room. The participating hospitals provided list of names of the qualified
nurses who are employed in the hospital within six months and above. There were two identified
clustered private hospitals, namely: Silliman University Medical Center and Holy Child Hospital
with a total of 336 nurses. Meanwhile, there were four qualified clustered public hospitals as
follows: Negros Oriental Provincial Hospital, Bayawan District Hospital, Bais District Hospital,
and Governor William Villegas Memorial Hospital with a total of 259 nurses. There were 595
nurses in both clusters who met the inclusion criteria.
Slovin’s formula is used to compute the sample size of 239 of nurses. Then, proportional
allocation is used to obtain the sample size that approximates representativeness among the
identified hospitals. This was carried out by getting 40 per cent of the number of nurses from each
hospital: Silliman Medical Center Foundation, Inc. with 95 actual number of nurses out of 240
nurses, Holy Child Hospital with 39 actual number of nurses out of 96 nurses, Negros Oriental
Provincial Hospital with 74 actual number of nurses out of 184 nurses, Bayawan District Hospital
with 12 actual number of nurses out of 28 nurses, Bais District Hospital with 11 actual number of
39
nurses out of 27 nurses, and Governor William Villegas Memorial Hospital with 8 actual number
of nurses out of 20 nurses.
The proportional allocator, which was 40%, is determined by dividing the sample size over
the total population of qualified nurses (239/595). To get the actual number of nurses from each
hospital based on the computed allocation, 40% of the nurses from each hospital were taken as
participants. For example, in Silliman Medical Center Foundation, Inc., the 40% of the 240 total
number of nurses was 95 (see Appendix AS).
Finally, the list of all the qualified nurses’ names in each hospital is assigned with numbers,
starting from 1 and ending with the last number, by attaching it at the left side of each item. Then
simple random sampling is used with the help of the random number generator of a scientific
calculator to determine the participant numbers from each hospital. Two participants refused to
answer the questionnaires due to personal reasons, and therefore, the researcher repeated the steps
in generating the two other participants.
The chosen participants were approached with permission from the head nurses during
their duty period and were asked to complete the questionnaire after an informed consent was
secured.
Research Instrument
A self-administered questionnaire adapted from different existing tools is the main
instrument for gathering data. The demographic profile of the participants—which are described
in terms of their age, gender, and civil status, and non-demographic profile in terms of work status,
current position, length of work experience, area of work assignment, and type of hospital where
they are working—comprises Part I of the questionnaire. Part II of the tool is the Negative Acts
40
Questionnaire-Revised (NAQ-R) of Einarsen, et al., (2009) which is used to determine the status
of bullying. Also, perpetrators of bullying are identified as appended at the end part of this section.
In Part III, the Job Satisfactions Survey designed by Paul E. Spector (1994) is used to assess job
satisfaction of the participants.
Negative Acts Questionnaire-Revised
The Negative Acts Questionnaire-Revised (NAQ-R) is a research inventory developed by
Professor Stale Einarsen of the University of Bergen, Norway for measuring perceived exposure
to bullying and abuse at work to allow participants to self-identify as targets of bullying and
recognizes a broader range of negative behavior related to bullying. Einarsen, et al., (2009)
revealed 0.90 as Cronbach’s alpha for the 22 items in the NAQ-R showing excellent internal
consistency while also suggesting that it may be a reliable instrument with an even fewer number
of items. Furthermore, all factor loadings exceed 0.70 with no cross loadings or error correlations.
Yet, although the three-factor solution is associated with the best fit, the correlations between the
factors or dimensions are very high: 0.96 between person-related and work-related bullying, 0.89
between work-related and physically intimidating bullying, and 0.83 between person-related and
physically intimidating bullying. Hence, several underlying dimensions of reported workplace
bullying can be distinguished, but they do not discriminate well between different types of bullying
behaviors, suggesting co-occurrence of these different types of bullying. (Einarsen, et al., 2009).
The bullying behaviors are rated using the following scale:
Never - the participants have not been exposed to negative acts that might be
perceived as bullying over a period of time covering the last six
months;
41
Now and then - the participants have been subjected to negative acts that
might be perceived as bullying now and then over a period of time
covering the last six months;
Monthly - the participants have been subjected to negative acts that might
be perceived as bullying once a month over a period of time
covering the last six months;
Weekly - the participants have been subjected to negative acts that might
be perceived as bullying once a week over a period of time
covering the last six months; and
Daily - the participants have been subjected to negative acts that might be
perceived as bullying once a day over a period of time covering
the last six months (Einarsen et al., 2009).
Job Satisfaction Survey Tool
The Job Satisfaction Survey (JSS) is a 36 item, nine-facet scale to assess employee attitudes
about the job and aspects of the job. Each facet is assessed with four items, and a total score is
computed from all items. A summated or Likert rating scale format is used with six choices per
item ranging from "strongly disagree" to "strongly agree". The nine facets are Pay, Promotion,
Supervision, Fringe Benefits, Contingent Rewards (performance-based rewards), Operating
Procedures (required rules and procedures), Coworkers, Nature of Work, and Communication
(Spector, 1985).
Furthermore, N.van Saane (2003) studied the reliability and validity of job satisfaction
tools which included JSS. They reported that the JSS instrument met the quality criteria for
reliability and validity. The response format, a six-point Likert scale ranging from ‘disagree very
42
much’ (1) to ‘agree very much’ (6) was tested. Reliability and construct validity resulting from the
stability of some sub-scales was moderate. The convergent validity was established with the multi-
trait multimethod and the Job Descriptive Index (JDI) used as the validity instrument. Spector did
not mention the total convergent validity score but only the correlations between the sub-scales of
the two instruments. The discriminant validity among the sub-scales was moderate to low. There
was no evidence of responsiveness to change. Content validity was also done to determine the
degree of inclusion of work factors in the selected instruments.
The two existing tools adopted in this study are with letters of permissions from the authors,
copies of which are found in Appendix E & F.
A pretesting of the tool is conducted with 13 nurses from a non-participating hospital,
particularly at Cong. Lamberto L. Macias Memorial Hospital (25 bed capacity), which shared
similar characteristics with the participating hospitals of this study. This allowed assessment of the
contextualization of the tool and provided a basis to modify the tool by removing ambiguities. The
participants are asked to answer completely the questionnaire and to write comments thereafter on
the comprehensibility and appropriateness of the items and the length of time needed to complete
the questionnaire. The used questionnaires are destroyed by manually shredding them after having
the data encoded into the computer for processing.
Data Collection Procedure
Procedure before data collection
With regards to the communication procedure, a formal letter of permission is sent to the
research adviser, the Dean of the College of Nursing and the Dean of the Graduate Programs
requesting for the pretesting and actual collection of data for the current study entitled “Workplace
43
Bullying and Job Satisfaction of Nurses in Selected Public and Private Hospitals in Negros
Oriental, Philippines”. Next, the Research Ethics Review Committee form is completed and
submitted for approval before the pretesting and actual data collection. When the research ethics
panel approval is achieved, a formal letter is sent to the hospital administrators, the hospital’s
chairman of research committee, the public health officer, the chief of hospital, and the chief nurses
of the selected private and public hospitals of Negros Oriental in order to conduct this study.
Finally, once the hospital approved the letter of request, the researcher provided a copy of the letter
to the head nurses and Human Resources Department in order to get the list of nurses that have a
work length of experience of at least six months in the selected hospital.
Procedure during data collection
First of all, the intention and coverage of the study, which are included in the structured-
questionnaire, are explained to the participants. Next, an informed consent letter is secured after
entertaining questions for clarifications before the participants fill all the survey forms. Then, the
tools are distributed during the participant’s scheduled shift. Participants are allowed to answer the
tool in their assigned ward or any convenient place in the hospital where she/he prefers.
Furthermore, it is emphasized to the participants that utmost confidentiality of their responses is
assured by referring to their participant number and not their full names. Lastly, after they filled
up the forms, they are instructed to drop it into the sealed box in a designated area on that same
day.
Procedure after data collection
Participants are thanked for accomplishing the self-administered questionnaire. Also, the
questionnaires are kept in a sealed box while waiting for data to be entered into the computer for
analysis.
44
Statistical Analysis
With the use of descriptive statistics, the data are grouped according to the sequence of the
research questions, summarized using appropriate measures of central tendency, and presented
with the use of tables. Frequency and percentage distributions are presented in table forms.
Status of workplace bullying, frequency of exposure to bullying, and level of job
satisfaction were determined by the measure of central tendency called mean, whose formula is as
follows: 𝑥 = ∑∑𝑓𝑟
𝑓
where 𝑥 = mean score, 𝑥 = a score, and f = frequency of a particular score.
To determine if a significant relationship exists between two variables dealing with
categorical data, the Chi-Square test for independence is used at 0.05 level of significance. The
2
formula for this is as follows: 𝑥 2 = ∑ (𝑓𝑜−𝑓𝑒𝑓𝑒) where 𝑥 2 = Chi-Square statistic, 𝑓𝑜 = observed
frequency, and 𝑓𝑒 = expected frequency.
To test significant associations between two variables with interval data, Pearson r or the
Pearson product-moment correlation coefficient is utilized using the SPSS Statistics 17.0 Software.
Ethical Considerations
Permission for the conduct of the study is obtained from the hospital administrators, the
hospital’s chairman of research committee, the provincial health officer, the chief of hospitals, and
the chief nurses of all selected hospitals. When permission is gained from the concerned persons,
the researcher communicated with the participants and informed them that participation in this
study is voluntary and may be refused any time. An informed consent form is completed upon
receiving the tool and is secured from the participant with their names and signatures. The signed
consent is detached from the tool and returned to the researcher. Confidentiality is assured since
no identifying information is included in the tool, specifically on what type of hospital the
45
participant is employed. Confidentiality is further assured to the highest level when the participants
are asked to drop the completed questionnaire into a sealed drop box, which only the researcher
can open.
46
CHAPTER 4
PRESENTATION, ANALYSIS AND INTERPRETATION OF RESULTS
This chapter contains the presentation, analysis, and interpretation of data according to the
research questions of the study. There were two (2) private hospitals and four (4) public hospitals
in Negros Oriental that matched the selection criteria. Two hundred thirty-nine (239) qualified
participants served as study sample, who consented and answered the questionnaires. The gathered
data are presented through figures and in tabular form.
4.1 DESCRIPTION OF DEMOGRAPHIC CHARACTERISTICS
Table 4.1 Frequency and Percentage Distribution of the Study Participants according to their
Age, Gender and Civil Status
Number of Nurses (n=239)
Variables Frequency Percent
AGE (years): 20 - 29 111 46
30 - 39 68 29
40 - 49 36 15
50 - 59 20 8
60 - 69 4 2
GENDER: Male 44 18.4
Female 195 81.6
CIVIL STATUS: Single 133 55.6
Married 102 42.7
Separated 1 0.4
Widow 3 1.3
4.1.A Age
Table 4.1 presents the frequency and percentage distribution of respondents according to
their age, gender, and civil status. Majority of the respondents belonged to young age group with
46% (n=111) ranging from 20-29 years and 28.5% (n=68) in the 30-39 age range while four of the
respondents were those with ages that ranged from 60-69 years. This means that the study
participants are mostly new graduate nurses who recently passed the board exam with ages 21-24,
47
which is also reflected in the study of Pring and Roco (2012). The number of participants in the
age range of 60-69 is understandably few considering the retirement age of 65 (now reduced to
60) for health workers. The lowering of the retirement age is a provision contained in RA No. 7641
(Retirement Pay Law) that stipulates an employee may retire upon reaching the age of sixty (60)
years or more, but not beyond sixty-five (65) years, and who has served at least five (5) years in
the said establishment.
The New Zealand study of McKenna et. al. (2003) on the horizontal violence or also known
as bullying shows a similar age profile with the current study. Of the 547 who indicated their age,
251 (46%) were below 30, 138 (25%) were between 30 and 39 years, 130 (24%) were between 40
and 49, and 28 (5%) were 50 and above.
Mostly, the data shown in Table 4.1 indicates that most of the nurses in the hospitals are in
their twenties. The young age of the nurse respondents may imply that the majority of them are
new nurses working in the hospital and have less work experience. The age profile is expected
considering the age ranges of typical nursing graduates.
4.1.B Gender
Table 4.1 further details that female group (81.6%) dominates the male group (18.4%).
Previous studies found the same results. In the study by McKenna et. al. (2003), their study
revealed 94% female and 6% male respondents. There were also similar findings from the study
done by Rutherford and Rissel (2004); their participants were 79% female and 21%, male. In the
Philippines, Perrin et. al.’s (2007) study reported that hospital Registered Nurses were
predominantly female (85%). Private hospitals had significantly more male RNs (21%) than
government hospitals (10%) (P = 0.014).
48
The similar results on the number of females compared to male nurses from the mentioned
studies including this study still demonstrates the older issue of feminization in nursing (Davies
1998; Harloyd et al. 2002). Florence Nightingale considered nursing as a suitable job for women
because as it was an extension of their domestic roles. Nightingale’s image of a nurse as a
subordinate, nurturing, domestic, humble, self-sacrificing as well as not too educated became
prevalent in the society during her time and which is still seen today to a lesser extent. The social
construction of what it means to be a nurse has typically meant a caring, hard-working woman
(Evans, 1997). In the study done by Ozdemir et. al. (2008) on determining what female and male
undergraduate nursing students think of males in nursing, the results indicate that nursing
continues to be seen as a dominant female position especially by male students despite the
increasing numbers of men in nursing.
4.1.C Civil Status
Finally, as observed from Table 4.1, there were more single respondents with 55.6%
(n=133) compared to married with 42.7% (n=102). The result matches the findings of Bataga
(2012) in Zamboanga del Norte, Philippines where study participants comprised of 57% (n=124)
single and only 41% (n=89) married nurses. This trend of single nurses these days may be
explained by the article written by Yamsuan from the Philippine Daily Inquirer (2017, March 12)
wherein she shared J. Walter Thompson’s research results revealing that 58% of single individuals
would delay getting married and/or having children to pursue their chosen career. His study sample
included 4,300 Filipino women across socioeconomic levels, from 18 to 70 years old.
In general, the Table 4.1 describes that many of the nurse respondents are single in their
family affiliation. This may suggest that these nurses are more inclined to follow the ladder of
career development than to settle down at a young age. The priority of young nurses fresh from
49
graduation seems to be focused on their newly acquired profession, the desire to secure a job, and
to do good in that job.
In summary, Table 4.1 describes that the majority of the nurses who participated in this
study are young, female, and are single, typical characteristics of most new nurses in the country.
4.2 DESCRIPTION OF OTHER RELATED VARIABLES
The table below shows the frequency and percentage distribution of the respondents
according to work status, current position, length of work experience (which is subdivided into the
present hospital and as a nurse), area of work assignment, and type of hospital.
Table 4.2 Frequency and Percentage Distribution of the Study Participants according to Work
Status, Current Position, Length of Work Experience, Area of Work Assignment, and
Type of Hospital Working at
Number of Nurses ( n=239 )
Variables Frequency Percent
WORK STATUS: Job Order/Reliever 40 16.7
Contractual 45 18.8
Regular 154 64.4
CURRENT POSITION: Staff Nurse 191 79.9
Senior Nurse 23 9.6
Nurse Supervisor 20 8.4
Chief Nurse 3 1.3
Head Nurse 2 0.8
LENGTH OF WORK EXPERIENCE (Number of Years)
A. In the present Hospital: 0.50 – 10.39 168 70.3

10.40 – 20.29 44 18.4
20.30 – 30.19 18 7.5
30.20 – 40.09 9 3.8
50
B. As a Nurse: 0.50 – 10.39 165 69
10.40 – 20.29 42 17.6
20.30 – 30.19 18 7.5
30.20 – 40.09 14 5.9
AREA OF WORK ASSIGNMENT:
Perioperative Areas 52 21.8
Medical Units 81 33.9
Obstetrics Department 45 18.8

Emergency Department 33 13.8
Special Services 28 11.7
TYPE OF HOSPITAL PRESENTLY WORKING AT:

Private 134 56
Government-Owned 105 44
4.2.A Work Status

The work status signifies whether the participant in the study is a regular employee or non-
regular worker (Contractual or Job Order/Reliever). Two-thirds of the participants (64.4%) were
Regular workers compared to Contractual (18.8%) and Job Order/Reliever (16.7%).
In order to elaborate on the existence of regular and non-regular workers in the Philippines,
an article written by Hirsch (2015) entitled “Different Employee Types and their Rights under
Philippine Laws” discussed that under the Philippine law, regular employees are those hired for
activities which are necessary or desirable in the usual business of the employer. Hence, a regular
employee enjoys the benefit of security of tenure as guaranteed by the Labor Laws of the land.
Meanwhile, the author further explained that non-regular or probationary employee pertains to
51
workers who are placed on a probationary status for the first six months on the job, as is customary
with the general practice. He further stated that here, the employee is in the evaluating or qualifying
stage, and he/she may be converted to regular status if his/her performance is up to par with the
company standard.
Furthermore, the preliminary results of the 2018 Annual Labor and Employment Estimates
of Labor Force Survey by the Philippine Statistics Authority reported that the total employed
persons in 2018 had 68.4 % full-time workers and had 30.8 % part-time workers.
Regular workers composed the largest proportion (Table 4.2) of the nurses in this study
while the remaining are non-regular workers. The findings can be attributed by the still ongoing
proposal of regularization program by the government. Eventually, the end of the practice of
contractualization will favor more security of tenure among employees including nurses.
4.2.B Current Position
Following the current position of the study participants, the results in Table 4.2 revealed
that the majority of the randomly selected respondents comprised of staff nurses at the rate of
79.9% (n=191). Meanwhile, other positions of the respondents were as follows: Senior Nurse at
9.6% (n=23), Nurse Supervisor at 8.4% (n=20), Chief Nurse at 1.3% (n=3) and, lastly, Head Nurse
at only 0.8% (n=2). Logically, the difference of percentages among the current positions of the
nurse participants reflects that most of the nurses in the hospitals today are in the staff nurse level,
who render more actual and direct care to patients assigned to them. On the other hand, Nursing
Service Administrators such as Nurse Supervisors and Chief Nurses may be few in number since
they have less interaction with the patients; they deal more in organizing health programs,
formulating and implementing policies, and directing and scheduling staff nurses. More so, the
Head Nurses had the least total number for they handle one or two specific area of work assignment
52
and serve as mediators between the top-level manager positions and staff nurses level. The higher
the position a nurse is promoted, the bigger the responsibilities on hand like training of a large
number of new staff nurses and more indirect contact with patients. From the results, it shows that
there are few Nurse Administrators who are supervising and catering to the needs of the staff
nurses. The organizational structure of most hospitals would show that there is only one Chief
Nurse or Nursing Director for the whole hospital, while the number of Nurse Supervisors generally
corresponds to the number of either the shifts, or special nursing services the hospital offers, or
both.
To substantiate the discussion on Table 4.2, the various item position presented reflects
the common organizational composition wherein the majority of nurses in the staff nurse position
occupy the most number in the nursing workforce. As described by Sullivan & Decker (2005), an
organizational structure is an arrangement of the work group and important to maintain command,
reinforce authority, and provide a formal system for communication to provide success and
survival of an organization.
To know more on the nature of the nurse’s item position, it is important to list down the
nurses’ different types of managerial positions while employed. The categories are as follows: first
level managers are concerned with specific unit workflows such as Charge Nurse, Team Leader,
Primary Nurse, and staff nurse; second, middle-level managers include Head Nurse, Department
Head, Unit Supervisor/Manager who conduct day-to-day operations with some involvement, long
term planning, and policy-making; lastly, top-level managers consist of Chief Executive Officer,
President, Vice-President, and Chief Nursing Officer (Vera, 2012).
The non-demographic data of this study further corroborate the findings of Hoel, et. al.
(2001) that identified their organizational status as workers (43.6%), supervisors (14.9%), middle
53
management (21.1%), senior management (7.3%), and others (13.1%). Also, Bataga’s study
(2012) revealed that 83% are staff nurses and 17% are in the managerial and supervisory positions.
4.2.C Length of Work Experience
4.2.C.1 Length of Experience in the Present Hospital
As shown in Table 4.2, most of the study participants had a length of experience in the
present hospital ranging from 6 months to 10 years and 4 months and 22 days at 70.3% (n=168).
This is followed by nurses who were working in the present hospital from 10 years and 4 months
and 25 days up to 20 years and 3 months and 15 days at 18.4% (n=44). It can be interpreted that
most of the nurses employed at their present hospital are new staff nurses with less than ten years
of exposure to clinical practice. On the other hand, nurses who are employed ranging from 20 years
and 3 months and 17 days up to 40 years and 1 month belonged to the least group who probably
possess mastery of skills and procedures to the hospital since they have not left the hospital after
two decades of employment. Nurses in this age range may have followed a career change either
by getting promoted to higher positions, seeking other fields of practice, or go back to school,
hence a reduction in their number in the workforce. The same may be said for those who have
worked for thirty to forty years and above. It may seem appropriate to say that attrition of those
nurses who belonged to the older group could be attributed to the application of the mandatory
retirement age
4.2.C.2 Length of Experience as a Nurse
As shown in Table 4.2, majority of the participants had 6 months to 10 years and 4 months and
22 days for the length of experience as a nurse at 69% (n=165). This is followed by nurses who are
working in the present hospital from 10 years and 4 months and 25 days at 17.6% (n=42). More
so, nurses who have work experience as a nurse with duration of 20 years and 3 months and 22
54
days up to 30 years and 2 months and 9 days had 7.5%(n=18). The data on Table 4.2 could be
interpreted to mean that most of them have no other work experience outside their present hospital
except for ten nurses who have worked from other hospitals and who are older. It appears that
nurses in this study stay employed with the same employer over a considerable period of time.
Results in this study may imply that most of the staff nurses’ first nursing job is in the
hospital where they are presently employed.
4.2.D Area of Work Assignment
The figures presented in Table 4.2 show that the highest number of respondents were
practicing in medical units at 33.9% (n=81), followed by perioperative areas at 21.8% (n=52),
obstetrics department at 18.8% (n=45), emergency department at 13.8% (n=33), and lastly, special
services at 11.7% (n=28).
In the study of Bataga (2012), similar results on the non-demographic characteristic
revealed that the highest number of respondents worked at the medical ward (19%), then nurses
assigned in emergency room (16%), followed by nurses assigned at the surgical ward (11%) and
Intensive Care Unit (ICU) at 10%.
The data gathered in the current study describes that most nurses are assigned in the
medical units among the selected hospitals in Negros Oriental. It gives the idea that there are more
patients who needs bedside and actual care from nurses in the medical units such as ICU, Medical
Ward and Gastrointestinal/Endoscopy Unit compared to the perioperative areas, obstetrics
department, emergency department, and special services. More so, it confirms that Nursing Service
Administrators are utilizing high-acuity nursing as demonstrated by the largest number of nurses
in this data assigned at medical units wherein patients are usually admitted due to high levels of
health status demand. Based on the researcher’s experience, there were several times that their
55
Nurse Supervisor had requested the researcher during employment period to reinforce nursing
services at the other station of medical ward due to the increased number of admitted patients with
high acuity illnesses.
This interpretation can be supported by the Philippine Revised Organizational Structure
and Staffing Standards for Government Hospitals (2013, Ed.). It is explained here that the goal of
staffing is to provide the appropriate number and mix of nursing staff (nursing care hours) to the
actual or projected patient care needs that will lead to the delivery of effective and efficient nursing
care. It means determining the level of care, average daily census, and hours of care provided for
24 hours a day, seven days a week. Determining the nursing staffing needs is done in consideration
to patients’ acuity of illness. Furthermore, high-acuity patients need frequent observation to ensure
that they improve or remain stable. As a result, high-acuity units and facilities must maintain higher
staffing levels (Arkansas State University Academic Partnerships, 2017).
4.2.E Type of Hospital Presently Working At
Finally, the number of respondents according to the type of hospitals, as presented on Table
4.2, where they are presently working are 56% (n=134) private nurses and 44% (n=105) nurses
from government-owned hospitals. The non-demographic data in this study show that most of the
randomly sampled participants in the locality of Negros Oriental has more employed nurses in the
private hospitals than government-owned which is contrary to the common belief that public
hospitals require more number of nurses to cater the public health needs. Different hospitals have
different hospital policies, procedures, manner of remuneration, fringe benefits, and more. In this
light, the nurses in this study probably work more in the private health facilities because of the
extra benefits like sack of rice, groceries, educational support for their children and others they are
receiving aside from the tenureship benefits from the organization. Although in public hospitals
56
there are also benefits like health insurance, retirement pay, and others, nevertheless, these are not
given to the non-regular workers and may not suffice to meet the needs of regular workers. Also,
there is a lesser chance of getting a regular item position in the government-owned hospital due to
limited availability of positions.
The demographic characteristics on Table 4.2 shows similar findings in the study of
Somani et.al, (2015) wherein there were 37.3% (n=171) nurses who were working in the
government healthcare settings and 62.7% (n=287) nurses were working in the private healthcare
settings.
In general, most of the nurses who participated in this study typically were staff nurses
with a regular job status. Many of them worked for less than 11 years in mostly the medical units
of private institutions where they had been employed.
4.2.F Identified Perpetrators of Bullying
Table 4.3 Frequency and Percentage Distribution of Study Participants’ Age Groups and to their
Identified Perpetrators of Bullying
Age (years)
Rank Identified Perpetrators of Bullying 20-29 30-39 40-49 50-59 60-69 Total
1 Staff Nurse 51 23 10 9 1 94
2 Family Member/s of the Patient 51 23 11 7 1 93
3 Doctors 45 27 8 9 1 90
4 Patient 40 19 7 2 0 68
5 Significant others (not relative of patient) 36 14 8 2 0 60
6 Senior Nurse 27 11 2 3 0 43
7 Nurse Supervisor 22 12 4 3 0 41
8 Consultant/ Specialist 21 13 3 0 0 37
9 Nursing Attendant 18 10 3 1 0 32
10.5 Chief Nurse 30 14 2 0 0 46
10.5 Administrative Staff 14 8 1 3 0 26
12 Charge Nurse 10 5 2 1 0 18
13 Government Officials 7 3 1 2 0 13
57
14.5 Chief of Hospital 3 0 1 4 0 8
14.5 Ancillary Staff 6 1 0 1 0 8
16 Hospital Director/Administrator 4 1 1 1 0 7
18.5 Family member of a staff nurse 1 0 0 0 0 1
18.5 Relatives or significant others close to 0 1 0 0 0 1

government officials
18.5 Political Personality 0 1 0 0 0 1
18.5 Others 0 0 1 0 0 1
Total 383 186 64 44 3 680
Interestingly, Table 4.3 reveals the top three perpetrators of bullying as identified by the
nurse respondents, namely: their co-staff nurses (n=94), family member/s of patients (n=93), and
doctors (n=90). Analyses of these data reveals that co-staff nurses are the number one perpetrators
of bullying behaviors as perceived by study participants who mostly belong to young age group
from 20-29 years. This result is not a usual scenario when you talk about bullying. Many
individuals think that bullying is mainly performed by higher authorities or ranks in an
organization. However, this is not true in this study. Co-staff nurses as identified perpetrators of
bullying behaviors in this study conforms to the oppression group theory. Roberts (1983) described
how nurses exhibited oppressed group behaviors because of the frustration and powerlessness that
they experienced as a result of actions from those higher positions. Not daring to retaliate towards
management, the nurses lash out against each other and those of lesser status (as cited in Bloom,
2014). To give details on this finding, other researchers mentioned that as a subordinate group,
nurses exhibit traits of intergroup transgression. Some nurse researchers noted this and began to
question why there were such stark incongruities between the professional caring relationship
nurses developed with their patients and the aggressive relationships they had with one another.
This inconsistency is perplexing because nurses generally have the skills to deal with these types
58
of circumstances with their patients but appear not to transfer those skills to their interpersonal
relationships with peers. The paternalistic environment in which nurses worked for many years
may be a contributing factor to a nurse’s hesitancy to make this crossover (Cox, 1987; Sunderland,
& Hunt, 2001; Hutchinson et al., 2005; Sweet, 2005). The subservience among nurses is related to
a paternalistic orientation popularizing the label for nurses as handmaidens of doctors.
Assertiveness is downplayed so as to avoid confrontations and maintain harmonious working
relationships. Another related study may seem to expound this finding. Middleton-Moz &
Zadawaski (2002) posited that bullies in the workplace often view the innocent acts of coworkers
as hostile and personally threatening and seek revenge for perceived attacks through intimidation
or physical means.
The second top identified perpetrator of bullying are the family members of the patient. It
can be observed that family members of the patient are so much worried about the health status of
their patient that they wanted to get the best immediate health care delivery services from the
hospital. Probably, one of the reasons family members manifest aggressive emotions or behaviors
directly at nurses is because nurses serve as frontliners in the delivery of health care services.
Moreover, the Person Environment Congruence Theory expounds more on why family members
of the patient were identified as perpetrators of bullying. According to Dendas (2004), this theory
argues that people either fit in their environment or they do not. The environment is seen as
exerting multiple demands upon individuals and has been recognized as one of the factors that
leads to acts of violence. Therefore, it can be reflected that family members who seem to find a
poor fit or incongruence to the health care delivery may resort bullying behaviors. Moreover, the
staffing pattern of the hospital may need to be considered. In the public hospital setting, a staff
nurse with a partner nurse are assigned to forty to fifty or more patients in every shift of duty while
59
in the private hospitals, staff nurses are only responsible for five to twelve patients with a total care
nursing modality, which means that the nurse performs all the procedures, referrals, everything
else without a partner nurse. Also, priority procedures and medicines are performed first before
the mild health needs of other patients. This may explain why family member/s usually get angry
towards the staff nurses because most of them perceive a delay in the care rendered to patients.
The third top identified perpetrator of bullying, doctors, were mostly claimed by the young
age group. It could mean to say that young nurses are likely to be vulnerable to the irritability and
high expectations in accomplishing all the patient orders from doctors on duty. More so, in the
Philippine setting, most nurses have high regard for doctors. To give more reason why doctors
may perform negative behaviors towards nurses, a doctor reflected in the open forum website
Quora at www.quora.com that some doctors think they are better than nurses because they have
studied more years, invested more time, money, etc. Another explanation to this is that nurses
traditionally are educated in teams; however, physicians have traditionally been educated to
believe that they are in charge. This according to Rowell (2007) is a basis for stress between
physicians and nurses. Oppressive behavior related to the perception of being subordinate to a
more powerful group affects nurse-physician relationships as well as, and perhaps most
distressing, nursing peer relationships (as cited in Bloom, 2014).
The top three results of most frequent sources of abuse in this study have also been
confirmed in a study conducted by Rowe and Sherlock (2005) as follows: nurses (27%), followed
by patients’ families (25%), and doctors (22%). Another similar finding in Rutherford and Rissel’s
(2004) study showed that the largest source of bullying behavior was from peers or fellow workers
(49%), followed by clients (42%), and managers or supervisors (38%).
60
It could be generalized from Table 4.3 that it is possible that the top three identified
perpetrators of bullying may happen at the same period of time at nurses’ area of work assignment
due to similar frequencies. It might be happening because of the dominance of young age group,
female gender, and staff nurse position of the study participants that belong to the first line level
position. It needs to be pointed out that intergroup aggression in a subordinate group possibly
happen due to the factor of paternalistic view of nurses.
However, Bataga’s study (2012) revealed contradicting results and showed that the
patient’s family were the leading source of bullying behaviors. Her findings further showed that
the next four identified bullies were the managers and supervisors, doctors, peers, and supervisees.
Based on Table 4.3, the other respondents identified more sources of bullying such as
patients, significant others (not relative of patient), senior nurses, nurse supervisors,
consultants/specialists, nursing attendants, chief nurses, administrative staff, charge nurses,
government officials, chief of hospital, ancillary staff, hospital directors/administrators, and
others. These perpetrators of bullying may be perceived by the nurse respondents with lesser
number compared to the top three identified perpetrators probably because of the fewer
interactions with the staff nurses during duty hours. It can be noted that the study participants who
identified these perpetrators of bullying mostly belong to young age group ranging from 20-29
years. Furthermore, patient and significant others (not relative of patient) come next to the top
three identified perpetrators of bullying. Nurses who are giving bedside care to patients are
witnessed by significant others (not relative of patient). There are times that patients get irritable
when they feel the severity of their health condition, and or others manifest negative behaviors like
insulting nurses for not complying with their needs. Significant others (not relative of patient) do
the same or even threaten the nurses with physical assault if their patient is not discharged, even if
61
this is against hospital advise. Also, other identified perpetrators can be elaborated by some studies
that found out nurse leaders that may include charge nurses, senior nurses, nurse supervisors and
chief nurses, performs negative behaviors in order to maintain their leadership positions and the
status quo. Nurse leaders within the oppressed system acknowledge the reports of bullying as
credible threats to their positions (Roberts, 1997; Dunn, 2003), although in this study, there were
few of these type of nurses compared to co-staff nurses who are interacting together in a very close
proximity at their area of work assignment.
On the other hand, consultant/specialist and chief of hospital are doctors who have mostly
completed an advanced education or specialty and belong to the administrative position in the
health facility, respectively. They may be less identified by the nurses as perpetrators of bullying
because these types of doctors have the least frequency of visits to patients. Like the
consultant/specialist, they are only called when there is a health condition that requires their
specialty or if the issue involves the hospital as a whole. Moreover, the chief of hospital’s position
is the highest doctor position and is very often concerned with the organization’s planning and
decision-making functions for the betterment of the institution and to its clienteles. Meanwhile,
non-nursing department personnel like ancillary staff, administrative staff and hospital
director/administrator are also identified by the nurse respondents as sources of bullying but in a
lesser amount. It could be interpreted that they also contribute to the negative bullying behaviors
in the work environment of nurse respondents. Young nurses who are new to the job may bring
irritation to non-nursing personnel when they seek assistance more often than necessary, thereby
disrupting their activities.
Finally, all the identified perpetrators of bullying including family members of a staff
nurse, government officials, political personalities, relatives or significant others close to
62
government officials, and others were identified one to seven times by nurse respondents aged 20
to 40. Power plays are sometimes demonstrated by some government officials, political
personalities, and relatives or significant others close to government officials and other prominent
personalities.
Overall, there were 19 identified perpetrators of bullying in this study that probably
affected the majority of study participants who were young. There were few older age groups who
identified perpetrators of bullying. It may seem to indicate that older nurses have considered the
bullying behaviors normal to their daily work or they have learned to adapt some ways to handle
the behaviors demonstrated by perpetrators.
4.3 Status of Bullying
Table 4.4 Frequency of Bullying in the dimensions of Person-Related, Work-Related, and

Physically Intimidating Bullying among Study Participants in Negros Oriental for the
Past Six Months
Types of Bullying Frequency of Bullying

1) Person-Related Bullying ̅
𝒙 Description
Being humiliated or ridiculed in connection with your work 1.90 Now and then
Having key areas of responsibility removed or replaced with more trivial or
unpleasant tasks 1.72 Never
Spreading of gossip and rumours about you 1.91 Now and then
Being ignored or excluded 1.61 Never
Having insulting or offensive remarks made about your person (i.e. habits
and background), attitudes or your private life 1.81 Now and then
Hints or signals from others that you should quit your job 1.34 Never
Repeated reminders of your errors or mistakes 1.76 Never
Being ignored or facing a hostile reaction when you approach 1.62 Never
Persistent criticism of your work and effort 1.59 Never
Practical jokes carried out by people you don't get on with 1.77 Never
Having allegations made against you 1.49 Never
Being the subject of excessive teasing and sarcasm 1.64 Never
Overall 1.68 Never
2) Work Related Bullying Behavior
Someone withholding information which affects your performance 1.86 Now and then
Being ordered to do work below your level of competence 1.80 Now and then
63
Having your opinions and views ignored 1.68 Never
Being given tasks with unreasonable deadlines 1.58 Never
Excessive monitoring of your work 1.72 Never
Pressure not to claim something to which by right you are entitled (e.g. sick
leave, holiday entitlement, travel expenses) 1.78 Never
Being exposed to an unmanageable workload 2.19 Now and then
Overall 1.80 Now and then
3) Physically Intimidating Bullying
Being shouted at or being the target of spontaneous anger (or rage) 1.63 Never
Intimidating behaviours such as finger-pointing, invasion of personal space,
shoving, blocking your way/barring the way 1.42 Never
Threats of violences or physical abuse or actual abuse 1.29 Never
Overall 1.43 Never
*Frequency of Workplace Bullying:
1.00 – 1.79 Never
1.80 – 2.59 Now and then
2.60 – 3.39 Monthly
3.40 – 4.19 Weekly
4.20 – 4.99 Daily
Study participants’ perceptions of exposure to workplace bullying were measured utilizing
the NAQ-R (Einarsen, et.al., 2009). This instrument was the optimal tool to measure workplace
bullying in nursing. Content experts have established and endorsed the tool’s content validity
(Einarsen, et. al., 2009) by saying that it has excellent validity and reliability (Cronbach’s alpha,
0.92), is the most commonly utilized instrument to measure workplace bullying, and has been used
world-wide for both nursing and non-nursing populations (as cited in Olender, 2013). The
Negative Acts Questionnaire-Revised measures the three forms of bullying behaviors: person-
related bullying, work-related bullying, and physically intimidating bullying.
4.3.A Person-Related Bullying Behavior
Person-related bullying behavior is the interpersonal aspect of bullying using behavioral
terms (Einarsen, et al., 2009). It refers to insulting comments about a person’s private life or
64
background, humiliating or intimidating behavior, rumors or false allegations, and exclusion or
isolation (Salin, 2005).
Table 4.4 provides information that the study participants had “Never” (mean= 1.680) been
exposed to person-related bullying behaviors for the past six months in the facility they are
working at. As presented on the table, the NAQ-R items that answered “Never” been exposed to
person-related bullying as perceived by the nurses were as follows: Having allegations made
against you; Being ignored or excluded; Hints or signals from others that you should quit your job;
Repeated reminders of your errors or mistakes; Being ignored or facing a hostile reaction when
you approach; Persistent criticism of your errors or mistakes; Practical jokes carried out by people
you don't get along with; and Being the subject of excessive teasing and sarcasm. Likewise, other
nurses in this study reported that they had been exposed to person-related bullying behaviors “Now
and then” while employed in the hospital for six months such as Being humiliated or ridiculed in
connection with your work; Spreading of gossip and rumours about you; and Having insulting or
offensive remarks made about your person (i.e. habits and background), attitudes, or your private
life.
Overall, it can be described that person-related bullying had revealed more incidences on
“Never” than “Now and then” as perceived by the nurse respondents. It can be interpreted that
majority of the nurse respondents who were young, female, single and staff nurse level have mostly
not encountered person-related bullying behaviors. However, it is still a concern that there were
few numbers of the nurse respondents who experienced this type of bullying in the facility they
work at which is “Now and then”. In public hospitals there are 40 to 50 and above patients a nurse
should attend to despite of the constraints of medical supplies and medicines for the patients. Given
that the data in this study showed that top three of the identified perpetrators of bullying were co-
65
staff nurses, doctors, and family members of the patient, the nurses who said “Now and then” may
be victimized by the perpetrators of bullying at the same time of the day or another day. It can also
be analyzed by the results of this study that possibly these study participants who are Filipinos
disregard the bullying behaviors that, usually, they do not report to the higher authority. The reason
may be that the bully is the senior nurse, charge nurse, nurse supervisor or chief nurse. But in our
data, it was identified that particularly, co-staff nurses are perpetrators of bullying behaviours. In
here, we can say that this is a type of horizontal violence that is happening, not vertical violence.
Other researchers claimed that workplace bullying is caused by organizational factors such as
tolerance of bullying behavior, misuse of authority, and the lack of organizational policies and
procedures for addressing workplace bullying (Hutchinson, et.al., 2006; Johnson, 2009).
4.3.B Work-Related Bullying
Work-related bullying behavior is the occupational aspect of bullying using behavioral
terms (Einarsen et al., 2009). It refers to unjustified criticism about a person’s work, unreasonable
deadline, somebody withholding information or somebody being excessively monitored (Salin,
2005).
Findings of this study (Table 4.4) identified that study participants encountered work-
related bullying “Now and then” (mean= 1.801) for the past six months while at work in the
hospital. The negative acts of work-related bullying which were perceived by majority of the
nurses that they had encountered “Now and then” were the following: Someone withholding
information which affects your performance; Being ordered to do work below your level of
competence; and Being exposed to an unmanageable workload. Meanwhile, other respondents
answered that they were “Never” bullied within the six months of their work in the hospital. They
believed they did not experience situations like Being given tasks with unreasonable deadlines;
66
Excessive monitoring of their work, and Pressure not to claim something to which by right they
are entitled (e.g. sick leave, holiday entitlement, travel expenses). In general, the incidences of
“Now and then” have been experienced more than “Never” by the nurse respondents for the past
six months in their workplace. It can be reflected that the work-related bullying behaviors are
manifestations of a defense mechanism among a group of social equals that are also part of an
oppressed group. This is the so-called oppressed group theory as discussed in the study’s
conceptual framework.
4.3.C Physically Intimidating Bullying
Physically intimidating bullying behaviors is the physical aspects of bullying using
behavioral terms (Einarsen, et al., 2009). It refers to verbal threats where a person is criticized,
yelled at or humiliated in public; physical violence; or threats of such violence (Einarsen, et al.,
2009).
According to the results of this study (Table 4.4), the study participants from the selected
hospitals of Negros Oriental, Philippines had “Never” (mean= 1.431) been exposed to physically
intimidating bullying behaviors for the past six months while employed in the health facility. The
NAQ-R items revealed the status of physically intimidating bullying behavior of the nurses in the
coverage of six months as follows: Being shouted at or being the target of spontaneous anger;
Intimidating behaviours such as finger-pointing, invasion of personal space, shoving, blocking
your way; and Threats of violence or physical abuse or actual abuse. Majority of the nurse
respondents believed that they were not exposed to physically intimidating bullying based on the
many number of incidences of “Never” in the data. Physically intimidating behaviors are very
rarely encountered by nurses in this study. This result may imply that the availability of law and
67
procedures against physical assault stops the identified perpetrators of bullying behaviors to
perform physically intimidating acts.
The results are similar to a study by Bataga (2012) that revealed more nurses were exposed
to work-related bullying than person-related bullying and physically intimidating bullying among
the study participants in Zamboanga Del Norte, Philippines. Another related study of Rutherford
and Rissel (2004) reported that the most frequently reported behavior was intimidating behavior,
such as belittling, sneering, shouting or ordering (32% of participants), followed by tones of voice
or facial expressions that leave a person feeling 'put down' (26% of participants).
In this study, the results found that study participants were exposed to workplace bullying
in terms of person-related bullying as “Never”, work-related bullying as “Now and then”, and
physically intimidating bullying as “Never”. In comparison to the number of identified perpetrators
of bullying behaviors from the past six months (Table 4.3), it is possible that these results have the
same analysis in the study of Stelmaschuk (2010). The results of Stelmaschuk’s (2010) study
showed that workplace bullying is a problem for nurses and other non-nursing, unit-based staff at
the two academic medical centers that participated in his study. On average, participants
experienced 1.74% bullying acts weekly or daily. Also, 13.7% of participants were considered
targets for workplace bullying. However, when nurses and other non-nursing, unit-based staff were
asked whether or not they experienced being targets of bullying in the past 6 months, only 4.4%
claimed they had been bullied weekly or daily. When comparing the results to this question with
the percentage of staff who were considered targets for workplace bullying based on the scores of
the Negative Acts Questionnaire, it seems that there is normalization of bullying behavior among
healthcare staff.
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In order to elaborate the possibility of normalization on bullying behavior among
healthcare workers, Freire’s (2005) conceptual framework, as cited in Brenda Kay William’s
(2016) dissertation, pointed out that once the bullying (oppression) starts, it is passed from
generation to generation, becoming the norm with both oppressor and oppressed, growing
insensitive to the fact that it is wrong before becoming normalcy. Furthermore, he noted that nurses
often do the same things to themselves. Some nurses have been practicing bullying (oppression)
for so long they no longer realize they are doing it.
Furthermore, the normalization of bullying occurs vis-à-vis other variables. According to
Einarsen and Skogstad’s (1996) study, young employees are frequently victims of direct attacks
and negative behaviors from older and more experienced employees. On the other hand,
MacKusick and Minick (2010) explained that before the mid-2000s, bullying between nurses was
called paying your dues or the rite of passage—an old, established act of intimidation and
harassment in all types of medical education. The senior nurse took great pleasure in assigning the
hardest, dirtiest, most disgusting jobs, the most complex patients, and the meanest doctors to the
new nurse.
More so, Barber (2012) stated that management styles range from laissez-faire to bullying
with no clear-cut lines to let managers know they are bullying subordinates instead of encouraging
them to be more productive. She further stated that the new employees can see the toxic behavior
emanating from this culture and accept it as usual. Also, the first reason why nurses would not aid
a co-worker is fear of retaliation and job loss due to the bully (Williams, 2016).
Indeed, workplace culture may normalize intimidating behavior if low-level violence has
been tolerated or ignored by senior management for some time and perpetrators believe their
behavior is acceptable (Mayhew & Chapell, 2001a).
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Generally, Table 4.4, presents information that there was an absence of bullying among
nurses in Negros Oriental, Philippines for the past six months in terms of frequency of exposure
to bullying behaviors. Although the person-related and work-related bullying cases have been
reported “Now and then” by other nurse respondents, there were more cases of “Never” resulting
to an overall mean score of 1.680 and 1.801, respectively. The mean scores of each type of
workplace bullying were computed using the assigned weight of the responses in the 5-Point Likert
Scale.
4.4 Level of Job Satisfaction

Table 4.5 Frequency and Percentage Distribution of Level of Job Satisfaction among Study
Participants
Number of Nurses ( n=239)
Level of Satisfaction Frequency Percent
1.00 – 1.82 Very dissatisfied 0 0

1.83 – 2.65 Moderately dissatisfied 14 6
2.66 – 3.48 Slightly dissatisfied 100 42
3.49 – 4.31 Slightly Satisfied 98 41
4.32 – 5.14 Moderately Satisfied 27 11
5.15 – 6.00 Very Satisfied 0 0
Overall level of Satisfaction: 3.551 Slightly Satisfied
In this study, the level of job satisfaction was determined by adopting the Job Satisfaction
Survey (JSS) tool of Paul Spector (1994) to assess respondent attitudes about the job and aspects
of the job using a nine-facet scale such as pay, promotion, supervision, fringe benefits, contingent
rewards (performance-based rewards), operating procedures (required rules and procedures), co-
workers, nature of work, and communication. A 6-Point Likert Scale was used to measure the data
in these items.
As shown in Table 4.5, a proportion of 42% (n=100) among the nurse-respondents
expressed that they were slightly dissatisfied, 41% (n=98) believed they were slightly satisfied,
70
11% (n=27) felt they were moderately satisfied, and 6% (n=14) said they were moderately
dissatisfied. Overall, the level of job satisfaction among study participants was slightly satisfied
with mean score of 3.551. The mean score of the data showed more nurse respondents felt they
were slightly satisfied with their work although the highest number of study participants reported
slightly dissatisfied. Even though majority of the nurse respondents are regular workers in the
facility they are employed, more factors could be the reason why they felt slightly satisfied like
they are mostly young, female, single, staff nurse level, and have less than 11 years working
experience in the hospital. These characteristics of a person could probably still look for more
benefits that could suit their economic needs. As observed, more young nurses today are leaving
the country to work abroad where they can earn better compensation. Apparently, in this study,
majority of the nurses perceived that, at their workplace, they were slightly satisfied on their pay
because they felt unappreciated by the organization when they consider whether it is a fair amount
for the work they do. However, they felt slightly satisfied with their chances for salary increase.
Another possible reason why most nurses are slightly satisfied could be the promotion. In
this facet, very few contractual nurses get a regular item in the Philippines. Some nurses, in the
public hospitals, for example, wait from five to fifteen years or more until they get a regular
position. However, very few non-regular became regular workers in a matter of two to three years
on their length of work experience that may be due to very high competency-based score
requirement or strong backer system. Also, some regular nurses have very few chances of getting
promoted from Nurse I to Nurse II, III, IV, V, or VI, due to unavailability of vacant positions.
These probable reasons could be based on the result that most of the nurses in this study slightly
believed that nurses get ahead as fast in the current hospital as they do in other health facilities,
and they are slightly satisfied with their chances for promotion.
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Study participants in this study felt they had been slightly satisfied with the supervision in
the hospital. It is apparent they are slightly satisfied at their workplace because, even though other
nurses said they like their supervisor, some of the nurse respondents perceived that their supervisor
shows too little interest in the feelings of subordinates. As observed from the supervisors in the
hospitals, some display more authoritative command than listening and/or giving moral support to
the staff nurses, especially when one commits mistakes during duty hours.
Moreover, fringe benefits are only for regular workers. Although a few contractual nurses
have certain retirement and health insurance benefits given by their employer, the majority felt
slightly satisfied. It could be interpreted that nurse respondents have slight satisfaction on the
hospital benefits they receive; and the benefits they receive are as good as what most other
organizations offer and the benefit package that they have is equitable.
Contingent rewards (performance-based rewards) are rarely given to the non-regular and
regular workers in the hospitals. In this study, more nurse respondents claimed that there are few
rewards for those who work in their hospital and they don't feel that their efforts are rewarded the
way they should be. Probably, the reason for this result is that during nurses’ meeting, most of the
topics are the errors committed by staff nurses and recognition of good performances are often
ignored.
Nurse respondents claimed that they are slightly satisfied on the operating procedures
(required rules and procedures) in the hospitals. Results showed that they agree slightly on many
of the hospital rules and procedures because they make doing a good job difficult. Nevertheless,
the nurses felt that their efforts to do a good job are seldom blocked by the official procedures.
Co-workers of the study participants have been identified as the top one perpetrator of
bullying based on Table 4.3. It could mean that nurses in this study are slightly satisfied of their
72
co-workers due to the following reasons: they find they have to work harder at their job because
of the incompetence of people they work with and there is too much bickering and fighting at
work.
Nature of work means the nurses perform their functions as nurses in the hospital, and
doing their job made them experience slight satisfaction. They believe that they like doing the
things they do at work and that their job is enjoyable.
Lastly, communication in an organization is very important to carry the daily tasks and
goals of the hospitals. In this study, the results seem to show that the nurses are slightly satisfied
on the communication in the hospital because they often feel that they do not know what is going
on with the organization and work assignments are not fully explained. It implies that a structured
orientation program for new nurses should be conducted before they expose themselves to their
workplace.
However, the overall result of the level of job satisfaction in this study does not agree with
Rosales et. al. (2013) findings in which nurse-respondents were slightly unsatisfied with their
work. Presumably, since the majority in this study are regular workers, this could mean that most
respondents are tenured and provided with hospital benefits like discounted fees on hospitalization,
laboratory, diagnostic tests, medicines, tuition for their children, and others. David K. Williams
(2012), CEO of Fishbowl Inventory Software, shared ten good reasons to stay at a company for
ten or more years: seniority, leadership, opportunities, stability, home ownership and retirement
funds, increased benefits, self-improvement, dependability, flexibility, perseverance, and a say in
the company’s future.
In general, even though the majority of nurse respondents felt slightly dissatisfied towards
their work in terms of the nine-facet of their job such as pay, promotion, supervision, fringe
73
benefits, contingent rewards, operating conditions, co-workers, nature of work, and
communication, nurses who claimed they are slightly satisfied dominated the overall measurement
among the level of job satisfaction. Analyses on these results can suggest that there are factors that
affects the contentment of the nurses towards their work in this study.
4.5 ASSOCIATION BETWEEN STATUS OF WORKPLACE BULLYING IN TERMS OF

PERSON-RELATED, WORK-RELATED, AND PHYSICALLY INTIMIDATING
BULLYING, AND THE SELECTED DEMOGRAPHIC CHARACTERISTICS
4.5.A Status of Person-Related Bullying and Selected Demographic Characteristics
and Demographic Characteristics
Paired Variables Statistical Treatment Interpretation
( α = 0.05 )
Nurses’ Age & r = -0.023 Not significant

Status of Person-Related Bullying p-value = 0.721
Nurses’ Gender & 2 (2) = 2.409 Not Significant

Nurses’ Civil Status & 2 (2) = 0.812 Not Significant

The tests presented in Table 4.6 did not confirm any significant relationships between
status of person-related bullying and demographic characteristics in terms of age, gender, and civil
status of the study participants. The findings also suggest that regardless of the nurses’ age, gender,
or civil status, exposure to the negative acts of person-related bullying behaviors at their work
places is still present. This current study finds affirmation with the findings of Bataga (2012) that
age of nurses does not affect person-related bullying behavior.
74
Relatively, in other studies (Wright and Khatri, 2015), person-related bullying showed
significant positive relationships with psychological/behavioral responses such as stress, anxiety,
and medical errors.
In order to expand more on the interpersonal dimension of the person-related bullying, it
is essential to provide a short discussion on the interpersonal aspect of Filipino nurses on how
these might affect them in the exposure of negative acts. It is possible that Filipino characteristics
like being timid or the tendency to do self-blame if others react to them negatively may play a
significant part in exposing themselves to bullying behaviours. Notably, some positive traits of the
Filipinos such as respect for authority, high regard for amor proprio (self-esteem), and smooth
interpersonal relationships (Hays, 2013) may give an explanation for this.
Firstly, galang or respect for authority for Filipinos is based on the special honor paid to
elder members of the family and, by extension, to anyone in a position of power (Library of
Congress as cited in Hays, 2013). Engaging in arguments, especially with someone who is older
or holds an authority position, is considered uncivilized. Furthermore, Filipinos also have difficulty
turning down requests from supervisors to whom they feel obligated (Joyce & Hunt, 1982). This
can create risk within the healthcare as cited in Samuelsson and Thach (2018).
Secondly, the Filipino hiya or shame trait stems from losing amor propio, which is a
Spanish word meaning pride. Filipinos find it difficult to confront someone so as not to humiliate
the person or cause the person to lose his amor propio (Hays, 2013). Also, Filipinos feel uneasy if
they are instrumental in making waves, rocking the boat, and exposing someone’s volatile amor-
propio to injury (Hays, 2013).
Finally, (Selmer & De Leon, 2014) as Filipinos place a high premium on maintaining
smooth interpersonal relationships, conflict is perceived to be a dangerous pitfall rather than an
75
opportunity for change. As cited in Calaguas’ study (2012), interpersonal relationships among
Filipinos would be impossible if pakikisama is not included either as a concept or trait. It is a trait
worth-having and taken seriously. This pakikisama trait comes from the word “sama”, which
means to “go along” (Andres, 1994; Limpingco, et al, 1999) and involves yielding to the wish of
the majority even if it contradicts one’s ideas (Panopio, et al, 1994) as cited in Saito (2010).
More so, in other studies, they explained that once bullied, the person’s self-esteem is
traumatized to the point of being afraid to leave the job at the hospital (Gaffney et al., 2012), and
nurses feel like it was their fault and a direct reflection on them (Douglas, 2014).
To sum up, Table 4.6 showed that the interpersonal aspect of workplace bullying was
statistically insignificant when correlated to the young, female, and single nurses who participated
in this study. It means that each variable could not influence either of them.
4.5.B Status of Work-Related Bullying and Demographic Characteristics
Table 4.7 Test for Significance of Relationship between Status of Work-Related Bullying
and Demographic Characteristics
( α = 0.05 )

Status of Work-Related Bullying p-value = 0.077


Table 4.7 presents results in the testing that some demographic variables have relationship
with the status of work-related bullying. It shows that there is no significant correlation between
the status of work-related bullying and the selected demographic characteristics. The data above
76
shows the occupational aspect of the bullying behaviors experienced by nurse respondents. The
data implies that notwithstanding the nurses’ age, gender, or civil status, exposure to the negative
acts of work-related bullying behaviors at their workplaces are still existing.
Analyses of the data reveals that the majority of these young, female, and single nurses do
not suggest on how many times they experienced work-related bullying behaviors such as having
key areas of responsibility removed or replaced with more trivial or unpleasant tasks; Being
ignored or excluded; Hints or signals from others that you should quit your job; Repeated
reminders of your errors or mistakes; Being ignored or facing a hostile reaction when you
approach; Persistent criticism of your work and effort, and more. In the experience of the
researcher, work-related bullying behaviors were performed by co-workers to either old or young,
female or male, and single or married. It seems that the perpetrator of work-related bullying does
not consider the age, gender or civil status of their targets.
However, this insignificant result differs from Bataga’s (2012) finding that that younger
nurses can be the targets of work-related bullying behaviors. Being a novice shows that younger
nurses experienced work-related bullying.
The data from the current study did not show any relationship at all between the work-
related bullying behaviors and the age, gender, and civil status. However, these results do not
appear to corroborate with the findings of Yildirim’s (2009) cross-sectional and descriptive study.
His study showed that bullying was negatively associated with nurses’ age (P < 0.01). Yildirim’s
study used regression analysis to examine the connection between nurses being exposed to
bullying and their age, workload, and total years of services (b = 0.48; F = 39.70; P < 0.00). The
results showed that 15% (P<0.01) were affected by their age (being younger). His study also found
that young nurses faced more types of negative behaviors than older nurses. Moreover, according
77
to Wright and Khatri (2015), male nurses experienced higher work-related bullying than female
nurses.
All in all, Table 4.7 demonstrated that there is no significant relationship between the work-
related bullying behaviors and the demographic characteristics of the nurse respondents such as
age, gender, and civil status. The results revealed that young, female, and single nurses in this
study do not influence the existence of work-related bullying.
4.5.C Status of Physically Intimidating Bullying and Demographic Characteristics
Bullying and Demographic Characteristics
( α = 0.05 )

Status of Physically Intimidating Bullying p-value = 0.190


The table above proves that there is no significant relationship between the status of
physically intimidating bullying and the demographic variables according to age, gender, and civil
status. The data show that age, gender, and civil status do not indicate the existence of physically
intimidating bullying. It is also worth noting that based on the description of demographic
characteristics of the study participants (Table 4.1), there was a majority of young age group (20-
29 years) than older group (60-69 years), female (81.6%) than male (18.4%) and single status
(55.6%) than married (42.7%). The inequality of the sample size in each demographic variable
may affect the absence of significant results.
78
Based on the results of this study, it is possible to contemplate that majority of these young,
female, and single nurses do not convey the frequency of exposure to physically intimidating
bullying behaviors. They may or may not be exposed to work-related bullying behaviors such as
Being shouted at or being the target of spontaneous anger (or rage); Intimidating behaviours such
as finger-pointing, invasion of personal space, shoving, blocking your way/barring the way;
Threats of violences or physical abuse or actual abuse and more. It gives the impression that the
perpetrator of physically intimidating bullying does not consider age, gender, or civil status of their
targets.
On the contrary, the results of this study did not have the same findings from the survey
conducted by Wright and Khatri (2015) in the Midwest that found there was a positive association
between physically intimidating bullying and age. Wright and Khatri’s (2015) study participants
were 1, 078 nurses employed across three facilities at a university hospital system. Meanwhile, the
sample in this study were 239 nurses from six hospital facilities in Negros Oriental.
To recap, the data presented on Table 4.8 describes that there is no correlation between the
physically intimidating bullying behaviors and the demographic characteristics of the nurse
respondents according to their age, gender, and civil status. It is clear from the results that young,
female, and single nurse respondents do not have the tendency to influence the existence of
physically intimidating bullying.
In general, the data of this study reveals that there is no statistical significance between the
different dimensions of workplace bullying such as person-related, work-related, and physically
intimidating bullying, and demographic profile in terms of age, gender, and civil status from the
past six months in the hospital they are employed. It can be interpreted that person-related, work-
79
related, and physically intimidating bullying behaviors can take place irrespective of the nurses
being young, female, and single in this study.

BULLYING, AND OTHER RELATED VARIABLES
4.6.A Status of Person-Related Bullying and Other Related Variables
and Other Related Variables
Paired Variables Statistical Interpretation
Treatment ( α = 0.05 )
Nurses’ Work Status & 2 (2) = 6.881 SIGNIFICANT

Nurses’ Current Position & 2 (2) = 2.685 Not Significant

Nurses’ Area of Work Assignment & 2 (4) = 1.690 Not Significant

Nurses’ Length of Present Employment & r = -0.049 Not Significant

Nurses’ Length of Experience as a Nurse & r = -0.017 Not Significant

Type of Hospital Working at & 2 (2) = 1.023 Not Significant

Nurses’ Number of Perpetrators & r = 0.420 SIGNIFICANT

The correlation analysis presented in Table 4.9 revealed a significant association between
nurses’ work status and status of person-related bullying. Using Chi-Square test, both variables
resulted into 2 (2) = 6.881 with p-value of 0.032. Analysis on the results of this current study
reflect that the interpersonal aspect of the workplace bullying towards the nurse respondents have
a strong possibility that nurses may experience it in regards to their type of work status such as Job
80
Order/Reliever, Contractual, and Regular. The data in this study revealed that majority of the
nurses’ work status belonged to Regular. It means that regular nurses have passed the on-probation
stage and are equipped with necessary skills and knowledge to practice in the hospital where they
work. It appears that regular nurses exist in the hospital while person-related bullying is
experienced among them. This can be explained by a popular theory of workplace bullying, the
oppressed group theory, that attributes workplace hostility and aggression as a defense mechanism
among a group of social equals that are also part of an oppressed group (Johnson, 2009; Simons,
2008). In relation to this theory, it could be strongly suggested that those skillful regular nurses are
being oppressed by their co-workers (the top one identified perpetrator of bullying) as a defense
mechanism if their position is threatened or as a way of getting even if they themselves are victims
of such bullying. Additionally, these perpetrators may get the necessary support for their behavior
from their social groups, even more so if the victims get promoted and climb up the career ladder.
Mainly, the results of this study showed that regular nurses can have higher risk to
experience person-related bullying than contractual and Job Order/Reliever respondents. These
two variables appear to influence each other. It may imply that regular workers would be
experiencing more person-related bullying behaviors such as having key areas of responsibility
removed or replaced with more trivial or unpleasant tasks; Being ignored or excluded; Hints or
signals from others that you should quit your job; Repeated reminders of your errors or mistakes
and more.
Further, the data in Table 4.9 shows no significant relationship between nurses’ current
position and status of person-related bullying. Either a staff nurse, Senior Nurse, Head Nurse,
Nurse Supervisor, or Chief Nurse can face the negative acts of person-related bullying. The non-
significant result may be explained by inequality of nurses’ current position in this study. This
81
insignificant result contradicts the theory that the bully is someone of higher position. More so, it
is contrary to the result of the study of Owoyemi (2011) that most participants were bullied by a
superior. Furthermore, this opposite view from the theory and study of Owoyemi (2011) claims
that the use of authoritarian practices and an organization’s desire to emphasize the conformity
can create an environment that tolerates or even condones workplace bullying.
The data in the table above reveals that there is no significant association between nurses’
area of work assignment and status of person-related bullying. Based on the test results, the Chi-
Square value of 1.690 with p-value of 0.792 is more than 0.05 level of significance. It may be
analyzed that person-related bullying behaviors does not suggest strong correlation to the area of
work assignment of the nurse respondents.
As presented in the data of this study, there is no association manifested between the
nurses’ length of present employment and person-related bullying using Pearson’s product-
moment correlation coefficient or Pearson r which revealed the test value of -0.049 with p-value
of 0.450. This data result might give us the idea that whether a study participant is employed as a
nurse to the current hospital as early as six months up to ten years or more does not influence
experience of person-related bullying dimension.
On the other hand, respondents of Rutherford and Rissel (2004) in their similar study in
New South Wales, Australia reported the least bullying among 29% of staff who had worked in
the organization for less than 12 months. Sixty-three percent (63%) of those who had worked in
the organization for 1 to 2 years; 53% of those who had worked in the organization for 2 to 5 years;
and 50% of those who had worked in the organization more than 5 years all reported more bullying.
However, a similar descriptive study conducted by McKenna, et al. (2003) revealed an
opposite significant result in this current study. McKenna, et al. (2003) examined the prevalence
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of horizontal violence or bullying experienced by 1,169 nurses residing in New Zealand within
their first year of practice. Many new graduates were likely to have experienced horizontal
violence. “A most distressing inter-collegial incident” was described by 170 (31%) of respondents.
The most common descriptions included rude, abusive or humiliating comments (n = 70 of 170;
41%) and being given too much responsibility without appropriate supervision (n = 40 of 170;
24%).
More so, according to the findings of Table 4.9, there is no significant relationship between
the nurses’ length of experience as a nurse and the person-related bullying (test value of -0.017
with p-value of 0.790). The results of this study may reflect that whether a nurse is employed as
early as 6 months up to 10 years or more from different employers does not have the capacity to
effect the exposure to person-related bullying behaviors.
Based on the study results, there is no association between the type of hospital working at
and the person-related bullying which showed the test value of 1.023 with p-value of 0.600. The
results of this research also showed that person-related bullying does not have an effect in both
private and public hospitals. In this study, there were more study participants in the private
institutions than in the public. This implies that the type of hospital where nurse participants are
working does not have relationship on the existence of person-related bullying behaviors.
Lastly, the data in Table 4.9 shows that there is positive significant correlation between the
nurses’ number of identified perpetrators and status of person-related bullying. The test value
result is 0.420 with p-value of 0.000. In this study, the respondents were allowed to identify more
than one perpetrator of bullying if they think they are being bullied in their workplace. Hence, the
number of identified perpetrators of the study participants may affect the occurrence of status of
person-related bullying. The top three sources of bullying as identified by the respondents were
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their co-staff nurses (n=94), family member of the patient (n=93) and doctors (n=90). It can be
suggested that the more nurse respondents identify perpetrators of bullying behaviors, the more
they may also experience person-related bullying. Table 6.2 (Appendix K) shows the cross-
tabulation for this significant result which provides an understanding on the nature of association
that exists between them. It can be said that those nurse-respondents who declared they have none
to 5 perpetrators have the tendency to say they have “Never” experienced being bullied while
working in the hospital. But those nurse-respondents who declared they have 6-7 perpetrators have
the tendency to state they are being bullied every “Now and then”.
Generally, there is a significant relationship between the nurses’ work status and the
number of identified perpetrators of bullying, and person-related bullying behaviors. Analyses on
these significant findings may suggest that regular nurses who are dominant in this study have the
tendency to expose themselves to person-related bullying behaviors. More so, the results in this
study has a strong tendency to show that the more number of identified perpetrators of bullying,
the more these nurses are exposed to person-related bullying.
On the other hand, other statistical findings showed no significant association between
nurses’ current position, nurses’ area of work assignment, nurses’ length of present employment,
nurses’ length of experience as a nurse, and type of hospital working at. The results might mean
that nurses’ current position, nurses’ area of work assignment, nurses’ length of present
employment, nurses’ length of experience as a nurse, and type of hospital working at do not give
effect to the existence of person-related bullying behaviors.
4.6.B Status of Work-Related Bullying and Other Related Variables
84
Table 4.10 Test for Significance of Relationship Between Status of Work-Related Bullying and
Other Related Variables
Nurses’ Work Status & 2 (4) = 3.313 Not Significant


Nurses’ Area of Work Assignment & 2 (4) = 13.383 SIGNIFICANT





The correlation analysis illustrated in Table 4.10 signifies that nurses’ work status and
status of work-related bullying was not statistically significant in this study. The Chi-Square test
revealed the value of 3.313 with p-value of 0.507 that is more than 0.05 level of significance. A
Job Order/Reliever, Contractual or Regular worker can experience negative acts of work-related
bullying. The absence of correlation may be explained by the majority of Regular work status
(64.4%) than Contractual (18.8%) and Job Order/Reliever (16.7%) based on Table 4.2.
In this study, there is no significant relationship found between the nurses’ current position
and status of work-related bullying. A possible explanation that non-significant correlation has
resulted is due to inequality of sample size among nurses’ current position (as shown in Table 4.2)
85
where 79.0% were staff nurses, 9.6 % were Senior Nurses, 8.4% were Nurse Supervisors, 1.3%
were Chief Nurses, and 0.8% were Head Nurses. An equal sample size among the nurses’ current
position may yield different results. Nevertheless, this result does not support the findings of
Yildirim (2009) that due to excessive workload and time pressure, nurses cannot finish their duties
in a timely manner, often resulting in nurse managers treating other nurses, especially the younger
staff in the workplace, in a negative manner.
Further tests displayed in Table 4.10 unveiled that there is a significant relationship (p-
value=0.010) between nurses’ area of work assignment and status of work-related bullying. This
result supports the view of Einarsen, et. al., (2000) that health care teams that include nurses may
be experiencing repetitive and habitual acts of bullying in their assigned working environment that
may continue to exist for at least six months and more. Some of the work-related bullying
behaviors that nurses in this study experienced “Now and then” are as follows: Someone
withholding information which affects your performance; Being ordered to do work below your
level of competence; and Being exposed to an unmanageable workload. This result can be more
elaborated in Table 6.3 (Appendix L) which highlighted the highest percentage of nurses who
expressed they have experienced work-related bullying every “Now and then” belonged to the
medical units (38%) that comprised of Intensive Care Unit, Medical Ward, and
Gastrointestinal/Endoscopy Unit. It is disturbing to know (based from the tabulated results) that 1
nurse, belonging to a medical unit, experiences “Daily” work-related bullying while about 2.5%
or 6 nurses out of 239 experience “Weekly” work-related bullying. Significantly, the results may
serve as guide on what areas are prone for work-related bullying behaviors.
This current study may have the tendency that work-related bullying behaviors are existing
more in the medical units than the rest of the areas of work assignment of the nurse respondents.
86
In comparison, William (2016) posited that bullying was related to which department the nurse
worked. There were different degrees of specialties of nurses who worked in a hospital, and nurses
were judged based on where they worked. William (2016) reported that bullying occurs in all
spheres of nursing.
Based on the data in this study, medical units have the highest number of study participants.
It may reflect that this significant result confirms the view of Hauge, et.al. (2009) that busy health
care settings and difficult situations are cited as factors that contribute to bullying behaviors in the
workplace. They further mentioned that this may be proliferated by commission of role conflict
and interpersonal conflicts.
However, Bataga’s (2012) similar study showed an absence of correlation (p-value=
0.7059) between the respondents’ clinical assignments and work-related bullying. Presumably,
this varied finding may be because of the difference of sample size on the respondents compared
to this study. She further revealed that the highest number of respondents were assigned at the
Medical Ward (19%) and at the Emergency Room (16%).
As shown in Table 4.10, the tests revealed that there is non-significant correlation (p-value
=0.123) between nurses’ length of present employment and status of work-related bullying. It
implies that nurses’ length of present employment has nothing to do with the existence of work-
related bullying. This data result might give us the impression that whether a nurse is working at
the current hospital as early as 6 months up to 10 years or more does not relate their exposure to
work-related bullying behaviors.
In other studies, nurses who worked less than 10 years in the hospital showed different
results wherein bullying was reported by 29% of staff who had worked in the organization for less
than 12 months; 63% of staff who had worked in the organization for 1 to 2 years; 53% who had
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worked in the organization for 2 to 5 years; and 50% who had worked in the organization more
than 5 years (Rutherford and Rissel, 2004).
Table 4.10 found that there is no significant relationship (p-value=0.132) between nurses’
length of experience as a nurse and status of work-related bullying. The results of this study may
suggest that whether a nurse is employed as early as 6 months up to 10 years or more from different
employers does not connect to the existence of work-related bullying behaviors. Thus, the data in
this study could be interpreted that a nurse with less than 11 years’ work experience in the clinical
practice does not have the capacity to influence the existence of work-related bullying behaviors.
This insignificant result is supported by Yildirim’s (2009) cross-sectional and descriptive study
which examined the connection between nurses being exposed to bullying and their age, workload,
and total years of services using regression analysis. It was determined that the total number of
years working in nursing showed no effect on bullying behaviors (P > 0.05).
There is no significant relationship (shown in Table 4.10) between the type of hospital
working at and status of work-related bullying. The statistical test resulted with p-value of 0.156
that is more than 0.05 level of significance. This result does not affirm the common belief that
private-employed nurses are more exposed to bullying behaviors than government-employed
nurses. In fact, the type of hospital where the nurse is working at has nothing to do with the
existence of work-related bullying. The results of this study revealed that there were more private-
employed nurses than government-employed nurses. Nevertheless, this has no effect on the
existence of work-related bullying in their workplace.
Moreover, the data in this study had similar results to a study done by Somani et.al, (2015)
in Pakistan with the following findings: demographic characteristics of 37.3% (n=171) nurses were
working in the government healthcare settings and 62.7% (n=287) nurses were working in the
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private healthcare settings. The study reported 33.8% prevalence of bullying/mobbing behaviour
among all kinds of violence. There was no significant difference between the government and
private settings as a factor to the prevalence of bullying/mobbing behaviour. In contrast to the
result of this study, Yildirim and Yildirim’s (2007) study revealed that the nurses working at
private hospitals faced statistically significantly more mobbing behaviors than those at public
hospitals (p ≤ 0.02).
Lastly, Table 4.10 reveals that there is a positive correlation between the nurses’ number
of perpetrators and status of work-related bullying (r=0.414; p-value=0.000). This finding denotes
that the more identified perpetrators of bullying behaviors in the workplace, the more frequent the
nurses are exposed to work-related bullying behavior. The cross-tabulation for this significant
result is shown in Table 6.4 (Appendix M) that elaborates the nature of relationship that exists
between the variables. Results from this study revealed that among those who declared they have
9 or 10, or 11 perpetrators, half of them have the tendency to say they are being bullied every
“Now and then” and the rest of the responses tend to be more frequent than “Monthly”. It is worth
to noting that there were 6 nurses who had experienced work-related bullying “Weekly” and 1
nurse experienced “Daily”.
In general, there is a statistically significant association between the nurses’ area of work
assignment and the number of identified perpetrators of bullying and the work-related bullying
behaviors. Analyses on these significant results may mean that nurses who are dominantly
assigned in the medical units have the tendency to attract more work-related bullying behaviors.
Meanwhile, other test findings revealed non-significant relationship between nurses’ work
status, nurses’ current position, nurses’ length of present employment, nurses’ length of experience
as a nurse, and type of hospital working at. The findings may suggest that nurses’ work status,
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nurses’ current position, nurses’ length of present employment, nurses’ length of experience as a
nurse, and type of hospital working at do not have the tendency to influence the existence of work-
related bullying behaviors.
4.6.C Status of Physically Intimidating Bullying and Other Related Variables
Bullying and Other Related Variables
Nurses’ Work Status & 2 (2) = 1.833 Not Significant


Nurses’ Area of Work Assignment & 2 (4) = 5.443 Not Significant





The results of this study (Table 4.11) show that there is no significant relationship between
nurses’ work status and status of physically intimidating bullying. The computed statistical value
was 2 (2) = 1.833 with p-value of 0.400. The non-significant result of this study indicates that the
work status of nurses in this study does not correlate to the exposure of nurses to physically
intimidating bullying. It is likely that the lack of relationship may be described by the majority of
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Regular work status (64.4%) than Contractual (18.8%) and Job Order/Reliever (16.7%) (as shown
in Table 4.2). Being a Regular, Contractual, or Job Order/Reliever nurse does not suggest that they
are expose to or not expose to physically intimidating behaviors such as Being shouted at or being
the target of spontaneous anger (or rage); Intimidating behaviours such as finger-pointing, invasion
of personal space, shoving, blocking your way/barring the way; and Threats of violences or
physical abuse or actual abuse. In this study, the nurse respondents declared that they were “Never”
bullied with physically intimidating behaviors. A possible reason that physically intimidating
bullying behaviors are not experienced by study participants would be the existing law that can
penalize physical assaults if proven guilty.
The data in Table 4.11 found that there is no significant relationship between nurses’
current position and status of physically intimidating bullying (2 (2) =0.665 p-value=0.717). It
can be said that in this study, current position does not pave way for nurses to be exposed to
physically intimidating bullying behaviors. The result differs from the common belief that staff
nurses are frequently subjected to such bullying behavior. In this study, a staff nurse, Charge
Nurse, Senior Nurse, Head Nurse, Nurse Supervisor or Chief Nurse do not connect towards the
experience of physically intimidating behaviors at their workplace. Being on the middle or top-
level manager position does not guarantee that they would be free from physically intimidating
behaviors. The result supports the finding of Yildirim (2009) that there were no differences
between position and educational level in workplace bullying. This result may further indicate that
organization status of nurses does not play an important role for nurses to experience negative acts
of physically intimidating bullying.
Moreover, Table 4.11 demonstrates that there is no significant correlation (2 (4) = 5.443;
p-value= 0.2445) between nurses’ area of work assignment and status of physically intimidating
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bullying. The nonsignificant result in this study provides a notion that area of work assignment
does not influence the frequency of exposure to nurses on physically intimidating bullying
behaviors. Likely, all areas of work assignment such as perioperative areas, medical units,
obstetrics department, emergency department, and special services may expose nurses to
physically intimidating bullying behaviors without any relationship. Although the results of this
study contradict the common belief that highly stressful areas like medical units, perioperative
areas, obstetrics and emergency department could probably cause the existence of physically
intimidating acts, the result revealed no significant relationship between them. This result does not
agree on the view of Johnston, et.al. (2010) that bullying occurs more in the areas of nursing that
are fast-paced and high stress as in the Emergency Department and Medical/Surgical floors.
The data from this study (as shown in Table 4.11) also revealed that there is an absence of
correlation (r =-0.089; p-value=0.171) between nurses’ length of present employment and status
of physically intimidating bullying. The non-significant result implies that nurses who are less than
11 years or more in the hospital does not affect the existence of exposure to physically intimidating
bullying. In this study, the largest respondents (70.3%) belonged to 6 months to 10 years and 4
months of work experience while the remaining nurses belonged to more than 10 years and 4
months. It can be analyzed that a nurse with less than 11 years of experience in the hospital does
not actually affect the frequency of physically intimidating bullying behaviors.
Further, this study uncovered that there is not enough evidence to prove a significant
relationship between nurses’ length of experience as a nurse and status of physically intimidating
bullying. The statistical test result was r = -0.071 with p-value of 0.271. The result in this study
appears that most of the study participants had less than 11 years of experience in the nursing
practice. This data result might give us the impression that whether a nurse is working as early as
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6 months up to 10 years or more from different hospitals, occurrence of physically intimidating
bullying behaviors is not determined. However, this result contradicts the previous study of
McKenna, et. al. (2003) that examined the prevalence of horizontal violence or bullying
experienced by 1,169 nurses residing in New Zealand within their first year of practice. It
highlighted that many new graduates were likely to have experienced horizontal violence.
As shown in Table 4.11, the data determines that type of hospital working at has no
significant relationship with status of physically intimidating bullying. Using Chi-Square test, the
result was 2 (2) = 5.837 with p-value of 0.054. The finding in this study suggests that the type of
hospital a nurse is connected with has nothing to do with his/her status of physically intimidating
behavior. Subsequently, the frequency of occurrence on the dimension of physically intimidating
bullying behavior does not give us an idea of the type of hospital where he/she is working.
Therefore, the private or public type of hospital cannot be associated with the nurses’ exposure to
physically intimidating bullying.
Finally, based on Table 4.11, the results revealed a significant relationship between nurses’
number of perpetrators and status of physically intimidating bullying (r = 0.419; p-value = 0.000).
This result may show that nurses’ identified number of perpetrators can be associated with the
status of physically intimidating bullying. Apparently, the greater the number of identified
perpetrators in the workplace, the more nurses are unprotected to negative acts of physically
intimidating bullying. Likewise, it can be said that the higher the status of physically intimidating
bullying, the higher the number of perpetrators claimed by the nurses. Table 6.5 (Appendix N)
provides an overview of the correlation between the nurses’ number of perpetrators and status of
physically intimidating bullying behaviors. The results marked that one-third, the highest percent,
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of those who declared that they are being bullied “Monthly” come from those who claimed they
have about 6 perpetrators.
As a whole, there is a positive correlation between the nurses’ number of identified
perpetrators of bullying and the physically intimidating bullying behaviors. This significant result
can be interpreted that the greater number of identified perpetrators of bullying are claimed by the
nurses, the more the nurses in this study are experiencing physically intimidating bullying
behaviors.
On the contrary, other results of this study found that there is a non-significant association
between nurses’ work status, nurses’ current position, nurses’ area of work assignment, nurses’
length of present employment, nurses’ length of experience as a nurse, and type of hospital
working at. It is apparent that the data in this study may likely reflect that nurses’ work status,
nurses’ current position, nurses’ length of present employment, nurses’ length of experience as a
nurse, and type of hospital working at do not give an influence toward the existence of physically
intimidating bullying behaviors.

BULLYING, AND LEVEL OF JOB SATISFACTION
Table 4.12 Test for Significance of Relationship Between Nurses’ Status of Workplace Bullying
According to Person-Related Bullying, Work-Related Bullying, and Physically
Intimidating Bullying, and Level of Job Satisfaction
Nurses’ Level of Job Satisfaction & r = -0.360 SIGNIFICANT


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The table above depicts the negative correlation between nurses’ status of workplace
bullying according to person-related bullying, work-related bullying, and physically intimidating
bullying, and level of job satisfaction. The significant results support the view of this study that
the dimensions on the status of workplace bullying such as person-related, work-related, and
physically intimidating, have the tendency to affect the level of job satisfaction among nurses in
this study. In this study, the general status of person-related and physically intimidating bullying
as perceived by respondents during the past six months while employed in the facility was “Never”
except to work-related bullying that was “Now and then”. The results on the status of workplace
bullying in terms of its dimensions have a strong correlation towards the overall level of job
satisfaction among nurses, that is, slightly satisfied.
The test result between nurses’ level of job satisfaction and status of person-related
bullying showed a negative relationship (r = -0.360; p-value = 0.000). It can be analyzed that since
the overall status of person-related bullying had “Never” been encountered within the short period
of time, then it can be strongly suggested that in this dimension of workplace bullying, the level
of job satisfaction among nurses in this study is enhanced. Person-related bullying refers to the
interpersonal dimension of the workplace bullying that consists of the behavioral terms (Einarsen,
et. al., 2009) like Being humiliated or ridiculed in connection with your work; Having key areas
or responsibility removed or replaced with more trivial or unpleasant tasks; Spreading of gossip
and rumors about you; Being ignored or excluded, and more. The results in this study may reflect
that the absence of person-related bullying behaviors has the tendency to influence the nurses to
declare greater level of satisfaction towards their work. Table 6.6 (see Appendix O) provides an
overview of the association between the variables. As observed from the table, 116 out of 172
nurses who felt they were slightly satisfied with their job had responded that they have “Never”
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been exposed to person-related bullying during the past six months. Therefore, when there is fewer
person-related bullying behaviors in the workplace, there is a strong tendency that a higher level
of job satisfaction would be perceived by the nurse respondents.
The significant result in this study can also strongly contemplate that more person-related
bullying behaviors in the workplace would make the nurse respondents claim lower satisfaction
towards their work. To explain why exposure of nurses to person-related bullying behavior can
have the possibility of resulting in lower level of job satisfaction, the view of Namie and Namie
(2003) theorized that a bully’s behavior causes other people to suffer shame, humiliation, and
depression, which can affect their nonwork life as well as their job performance.
Furthermore, the data (Table 4.12) revealed that there is a negative relationship between
the nurses’ level of job satisfaction and status of work-related bullying (r = -0.472; p-value =
0.000). This result affirms that work-related bullying may interfere on the level of job satisfaction
among nurses in this study. In this occupational aspect of workplace bullying according to
Einarsen, et.al. (2009), some of the work-related behaviors are as follows: Someone withholding
information which affects your performance; Being ordered to do work below your level of
competence; Being exposed to an unmanageable workload, and more. The results from this study
revealed that the less exposure of the nurses to work-related bullying, the strong tendency to cause
higher level of job satisfaction. Moreover, the “Now and then” existence of work-related bullying
in this study might strongly affect the slight satisfaction among nurses towards their work. It can
be seen from Table 6.6 (Appendix O) that 49 out of 172 study participants who perceived that they
were slightly satisfied with their job had reported that they encountered work-related bullying
“Now and then” for the past six months. Noticeably, the data further provides results that 6 out of
239 nurse respondents had identified themselves as bullied “Now and then” in terms of work-
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related behaviors for the past six months which made them feel slightly dissatisfied with their
work. Hence, the presence of work-related bullying behaviors in the workplace of nurses would
influence a decline on the level of satisfaction among nurses towards their job.
There is a similar result of the current study with Rosales et. al.’s (2013) that determined
the level of job satisfaction and burnout among nurses in three government hospitals of Samar,
Philippines. The results showed a statistically significant relationship between the nurse-
respondents level of burn-out and their level of job satisfaction which may affect the quality of
care given to their patients. Therefore, the absence of work-related bullying can improve the level
of job satisfaction among nurses, thereby performing better patient care.
Finally, the results of this study (Table 4.12) established that nurses’ level of job
satisfaction is negatively correlated to status of physically intimidating bullying (r = -0.285; p-
value = 0.000). Physically intimidating bullying is the physical aspect of workplace bullying that
includes behavioral terms (Einarsen, et. al., 2009) such as Being shouted at or being the target of
spontaneous anger; Intimidating behaviors such as finger-pointing, invasion of personal space,
shoving, blocking your way; and Threats of violence or physical abuse or actual abuse. This
negative relationship reveals that the more nurses are less exposed to physically intimidating
bullying behaviors, the more satisfied the nurse might feel toward his/her job. To expound the
significant result in this study, Table 6.6 (Appendix O) illustrated that 141 out of 172 nurse
respondents who reported that they were slightly satisfied toward their job had revealed that they
“Never” experienced physically intimidating bullying for the past six months. Therefore, the
absence of physically intimidating bullying behaviors at the workplace of nurse respondents would
indicate that there would be a strong tendency of an improvement on the job satisfaction among
them. More so, the negative relationship between nurses’ level of job satisfaction and the status of
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physically intimidating bullying may also suggest that presence of physically intimidating bullying
among nurses would lower the level of satisfaction towards their job. This significant result of the
study substantiates the study of Rowe and Sherlock (2005) that concludes nurses who regularly
experience verbal abuse may be more stressed, may feel less satisfied with their jobs, may miss
more work, and may provide a substandard quality of care to patients.
Furthermore, the significant results in this study suit the Person Environment Congruence
Theory which claims that people either fit in their environment or they do not. In this theory, the
environment is seen as exerting multiple demands upon individuals and has been recognized as
one of the factors that lead to acts of violence. When the individual and the environment fit well
together or are congruent, satisfaction and fulfillment are achieved. A poor fit or incongruence
leads to a negative outcome which could result in horizontal violence (as cited in Dendaas, 2004).
Overall, the three dimensions of workplace bullying such as person-related, work-related,
and physically intimidating bullying behaviors revealed a negative relationship between the level
of job satisfaction among the study participants. In analysis, the absence of person-related, work-
related, and physically intimidating bullying behaviors may have the tendency to improve level of
job satisfaction among the nurses towards their workplace. In general, it can be strongly implied
that the absence of workplace bullying behaviors in this study resulted to the slight satisfaction
among the nurse respondents toward their job.
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CHAPTER 5
SUMMARY, CONCLUSIONS, AND RECOMMENDATIONS
SUMMARY
This study has described the demographic characteristics and other related variables of the
study participants and discussed their relationships with the status of workplace bullying in terms
of person-related bullying, work-related bullying, and physically intimidating bullying guided by
various theories and studies. The following provides a summary of the answers to the research
questions observed in this study:
1. The demographic profile of the participants show that:
1a. Majority of the respondents belonged to young age group with 46% (111 nurses)
ranging from 20-29 years and 28.5% (68 nurses) in the 30-39 age range while the
oldest respondents were just a small number at 1.7% (4 nurses) with age range of
60-69 years.
1b. Female group (81.6%) dominated the male group (18.4%).
1c. There were more single respondents with 55.6% (133 nurses) compared to married
with 42.7% (102 nurses).
2. The non-demographic profile of the participants reveals that:
2a. Approximately two-thirds of the participants (64.4%) were Regular workers compared
to Contractual (18.8%) and Job Order/Reliever (16.7%).
2b. Majority of the randomly selected respondents comprised of staff nurse position at
79.9%. Meanwhile, other positions of the respondents were as follows: senior nurse at
9.6%, nurse supervisor at 8.4%, chief nurse at 1.3% and, lastly, head nurse at only
0.8%.
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2c1. Most of the respondents had 6 months to 10 years and 4 months’ length of experience
in the present hospital
2c2. Majority of the participants had 6 months to 10 years and 4 months for the length of
experience as a nurse.
2d. The highest number of respondents were assigned in medical units (33.9% or 81
nurses), followed by perioperative nurses (21.8% or 52 nurses), obstetrics department
(18.8% or 45 nurses), emergency department (13.8% or 33 nurses), and lastly, special
services (11.7% or 28 nurses).
2e. The type of hospital where the respondents were presently working at was almost equal:
there were 134 private nurses and 105 nurses working at government-owned hospitals.
2f. Top three perpetrators of bullying as identified by the respondents were their co-staff
nurses (94 nurses), family member of the patient (93 nurses), and doctors (90 nurses).
Other sources of bullying were as follows: patient (68 nurses), significant others (not
relative of patient) (60 nurses), senior nurse (43 nurses), nurse supervisor (41 nurses),
consultant/specialist (37 nurses), nursing attendant (32 nurses), chief nurse (26 nurses),
administrative staff (26 nurses), charge nurse (18 nurses), government officials (13
nurses), chief of hospital (8 nurses), ancillary staff (8 nurses), hospital
director/administrator (7 nurses), and others.
3. Status of workplace bullying was described among nurses in Negros Oriental for the past
six months in the hospital where they are presently working at in terms of the following:
3a. Person-related bullying had “Never” (mean= 1.680) been experienced among nurse
respondents
3b. Work-related bullying had been encountered “Now and then” (mean= 1.801)
among nurse respondents
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3c. Physically intimidating bullying behaviors had “Never” (mean= 1.431) been
experienced among nurse respondents
4. Description of the level of job satisfaction among the nurse participants reveal that a
proportion of 42% (100 nurses) among the nurse-respondents expressed that they were
slightly dissatisfied, 41% (98 nurses) believed they were slightly satisfied, 11% (27 nurses)
felt they were moderately satisfied, and barely 6% (14 nurses) said they were moderately
dissatisfied. Overall, the level of job satisfaction among study participants was slightly
satisfied (mean score = 3.551).
CONCLUSIONS
Based on the findings of this study, it may be concluded that there is a negligible
association of demographic characteristics between the occurrence of bullying in the workplaces.
However, non-demographic variables have more significant association that has the tendency to
affect the latter. Moreover, it is clear that the existence of workplace bullying in terms of person-
related, work-related, and physically intimidating bullying behaviors can have implications on the
level of job satisfaction to nurses. The correlation analysis of this study presents the following
results:
1. There is no significant relationship between the status of bullying in terms of person-
related, work-related, and physically intimidating behaviors, and the nurse’s age, gender,
and civil status in Negros Oriental, Philippines.
2. There is a significant association between status of person-related bullying and nurses’
work status. Using the Chi-Square test, both variables resulted into 2 (2) = 6.881 with p-
value of 0.032.
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3. There is no significant relationship between status of person-related bullying and other
related variables in terms of nurses’ current position, area of work assignment, length of
present employment, length of experience as a nurse, and type of hospital where the nurse
participants worked.
4. There is a positive correlation between the status of person-related bullying and nurses’
number of identified perpetrators. Using Pearson’s product-moment correlation
coefficient or Pearson r, the test value result was 0.420 with p-value of 0.000.
5. There is no significant relationship between status of work-related bullying and other
related variables in terms of nurses’ work status, current position, length of present
employment, length of experience as a nurse, and type of hospital where nurse participants
were working.
6. There is a significant relationship (2 (4) = 13.383; p-value=0.010) between status of work-
related bullying and nurses’ area of work assignment.
7. There is a positive relationship between the status of work-related bullying and nurses’
number of perpetrators (r=0.414; p-value=0.000).
8. There is no significant correlation between the status of physically intimidating bullying
and other related variables in terms of nurses’ work status, current position, length of
present employment, length of experience as a nurse, and type of hospital where they
worked.
9. There is a positive relationship between the status of physically intimidating bullying and
nurses’ number of perpetrators (r = 0.419; p-value = 0.000).
10. There is a negative relationship between the level of job satisfaction and status of
workplace bullying in terms of person-related bullying (r = -0.360; p-value = 0.000),
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work-related bullying (r = -0.472; p-value = 0.000), and physically intimidating bullying
(r = -0.285; p-value = 0.000).
LIMITATIONS OF THE STUDY
1. The use of self-reports alone may be a limitation to assess workplace bullying behaviors. The
concern may not have been sufficiently addressed by the study’s operational criteria and
respondents’ subjective interpretation of the questionnaire.
2. Some nurse respondents create their own definitions of workplace bullying. It is possible that
these varying definitions may have influenced their responses.
3. The site where the quantitative data are gathered in this study is limited only in the locality of
Negros Oriental, Philippines. Thus, caution is exercised in generalizing the findings to the
larger population of the Philippines.
RECOMMENDATIONS
This study expands the body of scientific knowledge on workplace bullying among nurses
working in the private and public hospitals in which there are only a few studies conducted in the
Philippines and none in the locality of Negros Oriental. This study gives a vital baseline data about
the status of workplace bullying and level of job satisfaction among nurses in the province. The
following recommendations are provided based on the study results and limitations:
Community
The gathered information from this study can serve as a baseline in formulating of policies
or program development towards the prevention of bullying that will benefit the society in general
and those involved in particular. The data from this study can be use as references in the crafting
of ordinances that may render workplace bullying in health institutions a crime possibly making it
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a deterrent to the proliferation of bullying. Subsequently, creation of preventive measures can be
used with a legal basis.
Health Care Organizations and Nursing Service Administrators
Nursing service management may utilize the findings in the provision of good working
conditions, formulation of hospital guidelines, policies and programs like regular stress
management programs, implementation of discipline, developing orientation programs, and the
promotion of healthy morale, job satisfaction, and productivity among their staff. Specifically, it
is recommended that significant results on the non-demographic factors be incorporated into the
structured orientation program for new nurses as part of the staff development and continuous
quality improvement programs of every hospital or health institution. The non-demographic
factors had more significant associations than demographic profile in this study. For example, the
greater the number of perpetrators were identified by the nurse respondents, the more they can be
exposed to person-related, work-related, and physically intimidating bullying. The focus of
intervention may then be narrowed. Also, the level of job satisfaction had negative correlation
between the person-related, work-related, and physically related bullying behaviors. It means that
the more the nurse respondent experiences person-related, work-related and physically
intimidating bullying, the more they feel less satisfied toward their job. Good interpersonal
relationships can be cultivated by focusing on specific areas of bullying, hence these significant
data may serve as basis for staff development and management. This study and future related
studies may serve to support the implementation of the zero-bullying policy in their workplaces in
order to promote high level of job satisfaction among nurses and consequently deliver best quality
care and patient safety to the clientele. It is also recommended to use a multidisciplinary approach
in policy development to curtail bullying in the workplace. Sessions in structured orientation
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programs may be designed to bring the physicians and other members of the team together,
allowing the meeting of goals in terms of staff working relationships.
Nursing Profession
Nurse professionals can conduct intensive seminars, workshops, and forum to raise
awareness of nurses on how to prevent workplace bullying. More so, this current study and future
related studies can heighten the nursing profession on its awareness to workplace bullying and its
correlation to job satisfaction. Consequently, nurses shall consider the feelings of their co-workers
at the same time that they are giving the best quality care and safety to their patients.
Nursing Research
It is recommended to conduct more related studies, particularly qualitative approach, to
extend understanding and validate the workplace-bullying concept in the Philippine context. This
study may provide data towards evidence-based practice among nurses in shaping appropriate
interventions and programs in the future that would curtail workplace bullying. Furthermore, other
nurse researchers are encouraged to replicate this study in other localities in the Philippines in
order to strengthen the generalizability of findings on the exposure of nurses to bullying practices
in hospitals and any other health care institutions. In formulating or modifying the questionnaire,
it is further recommended to utilize less threatening words in the contextual use.
Nurse Education
The significant results in this study can be a basis for curriculum revision towards
maintaining the very core of the nursing profession which involves caring, compassion, respect,
competence, having therapeutic communication skills, and advocacy. Moreover, prevention of
bullying may be integrated in the courses under the new curriculum.
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APPENDICES
121
Appendix A. Permission Addressed to Concerned Offices
Emerald Ville Homes, Corner Aldecoa St., Laguna, Looc, Dumaguete City March 28, 2016
Mr. Roberto D. Montebon, MBA

President/ Administrator
Silliman University Medical Center Foundation, Inc.
Dear Sir:
Pleasant greetings!
Please allow me to introduce myself. I am a part-time nurse of the Negros Oriental Provincial Hospital
assigned to the Medicine Department and currently a graduate student of Silliman University Graduate
Studies Program. I am enrolled in the Master of Science in Nursing program, Major in Administration. I
am now in my thesis writing stage working on the proposed study, “Workplace Bullying and Job
Satisfaction in Selected Public and Private Hospitals in Negros Oriental, Philippines” as part of the
requirements for the degree. This study is designed to determine the relationship of participants’
demographic and non-demographic factors and the status of workplace bullying. Additionally, the study
aims to describe the level of job satisfaction of nurse participants and correlate it to the status of workplace
bullying. The participants will be registered nurses who are working in any of the selected hospitals.
It is in this light that I am writing this letter to humbly request from your good office permission to conduct
the actual study in your hospital using self-administered questionnaire. A copy of the tool is attached for
your perusal. Please allow me to share this to the nurses assigned in the different nursing units of your
distinguished facility. Also, I would like to request data on the number of nurses in your hospital. Please
use the attached survey forms for the latter.
I hope that this request merits your utmost consideration and approval. I welcome the opportunity of further
discussing this matter with you at your most convenient time. Please feel free to contact me at 09178738078
or e-mail me at sarahragay@gmail.com. I am hoping for your favorable response.
Thank you.
Respectfully yours,
(Sgd.) Sarah Annabelle G. Ragay, RN
Noted by:
(Sgd.) Florenda F. Cabatit, MAN (Sgd.) Evalyn E. Abalos, PhD RN

Adviser Dean, SUCN
Attachments: Chapter 1: Research Problem; Chapter 3: Research Methodology; Research Instrument with
cover letter and informed consent form; and Population survey forms
122
Appendix B. Cover Letter of the Research Questionnaire
Date:__________________ Participant Number: _______
Dear Fellow Nurses:
Pleasant greetings!
I am a graduate student of Silliman University Graduate Studies Programs currently working on

my research study entitled “Workplace Bullying and Job Satisfaction of Nurses in Selected Public
and Private Hospitals in Negros Oriental, Philippines”. This is part of the requirements for the
degree, Master of Science in Nursing, Major in Nursing Administration. This study is designed to
determine the relationship of participants’ demographic and non-demographic factors between the
status of workplace bullying and describe level of job satisfaction of nurses and correlates to the
status of workplace bullying. The participants will be the registered nurses who are working in any
of these selected hospitals.
In this regard, I humbly would like to request your support by honestly and accurately answering
this questionnaire. Rest assured that all answers elicited from you will be held in strict confidence.
Names of persons will not be revealed in any part of this study.
Thank you very much for contributing to the success of this study.
Respectfully yours,
(Sgd.) Sarah Annabelle G. Ragay, RN
Noted by:
(Sgd.)Florenda F. Cabatit, MAN (Sgd.)Evalyn E. Abalos, PhD RN

Adviser Dean, SUCN
123
Appendix C. Informed Consent
INFORMED CONSENT
I am giving my consent to be a participant in this study entitled “Workplace Bullying and Job
Satisfaction of Nurses in Selected Public and Private Hospitals of Negros Oriental, Philippines”.
I agree to be a participant on the basis that I am a nurse employed in one of the hospitals in Negros
Oriental. I will answer the questionnaires honestly. I understand that my participation will help
achieve the aims of this study.
I agree to provide my demographic and non-demographic profile, yet have the option to keep my
full name anonymous. I understand that this information will be held in strict confidence. I am
aware that I have the freedom to withdraw at any point in the conduct of this study.
Furthermore, I understand that the results of this study will be made available to me, upon my
request. I express my agreement for the results of this study to be used towards the promotion of
patient safety and quality patient care.
I have received sufficient information about the study. Additionally, I have been assured that I will
receive answers to any question I may have regarding this study and my participation in it from
the researcher. I am provided with contact numbers for this purpose.
______________ _____________________________
Date Participant’s Name and Signature
124
Appendix D. Research Questionnaire
“Bullying and Job Satisfaction Questionnaire for Hospital Nurses”
Part I. Demographic and Non-Demographic Profile
Instructions: Please fill up the information asked below by putting a check mark (√) on the box
provided before your chosen answer or by supplying the necessary information as
requested.
1.1 Age: _________ years old (as of last birthday)
1.2 Gender: Male Female
1.3 Civil Status: Single Married Separated Widow/er
1.4 Type of Hospital Employed: Private Government owned
1.5 Work Status: Job Order/Reliever Contract Regular
1.6 Current Position: Staff Nurse Senior Nurse Nurse Supervisor
Chief Nurse Others, please specify______________
1.7 Area of Work Assignment:
Emergency Room Delivery Room
ICU Operating Room
NICU PACU
Dialysis Unit OPD
Medical Ward Surgical Ward
Pediatrics Ward OB/GYN Ward
Nursing Service Office Others, please specify______________
1.8 Length of employment/ working in this hospital: ______ years _____months
1.9 Length of experience as a nurse (include outside the present hospital)
______ years _____months
125
Part II. Set A-Workplace Bullying: Forms of Bullying Behavior Manifested and
Experienced By Nurses (As Adopted and Modified from Einersan, et. al, 2009)
Instructions: The completion of this questionnaire will be 5-10 minutes of your time.
1. Please answer the questions as objectively and honestly as you can.

2. Under the bullying behavior that has been encountered for the past 6 months, kindly put a
circle around the number which best describes your answer using the equivalent score
below:
1 2 3 4 5
Never Now and then Monthly Weekly Daily
Example:
Bullying Behavior:
Seen when someone withholds information which affects your performance.

1 2 3 4 5
Please START here:
1. Someone withholding information which affects your performance
1 2 3 4 5
2. Being humiliated or ridiculed in connection with your work
1 2 3 4 5
3. Being ordered to do work below your level of competence
1 2 3 4 5
4. Having key areas of responsibility removed or replaced with more trivial or unpleasant tasks
1 2 3 4 5
5. Spreading of gossip and rumours about you
1 2 3 4 5
126
6. Being ignored or excluded
1 2 3 4 5
7. Having insulting or offensive remarks made about your person (i.e. habits and background),
your attitudes or your private life
1 2 3 4 5
8. Being shouted at or being the target of spontaneous anger (or rage)
1 2 3 4 5
9. Intimidating behaviour such as finger-pointing, invasion of personal space, shoving,
blocking/barring the way
1 2 3 4 5
10. Hints or signals from others that you should quit your job
1 2 3 4 5
11. Repeated reminders of your errors or mistakes
1 2 3 4 5
12. Being ignored or facing a hostile reaction when you approach
1 2 3 4 5
13. Persistent criticism of your work and effort
1 2 3 4 5
14. Having your opinions and views ignored
1 2 3 4 5
15. Practical jokes carried out by people you don’t get on with
1 2 3 4 5
127
16. Being given tasks with unreasonable or impossible targets or deadlines
1 2 3 4 5
17. Having allegations made against you
1 2 3 4 5
18. Excessive monitoring of your work
1 2 3 4 5
19. Pressure not to claim something which by right you are entitled to (e.g. sick leave, holiday
entitlement, travel expenses).
1 2 3 4 5
20. Being the subject of excessive teasing and sarcasm
1 2 3 4 5
21. Being exposed to an unmanageable workload
1 2 3 4 5
22. Threats of violence or physical abuse or actual abuse
1 2 3 4 5
128
II. Set B- Perpetrators of Bullying in the Workplace
Instructions:

2. If you experienced being bullied, please check (√) which of the person/ persons did the
bullying behavior to you. You can check more than one.
3. If not bullied, please do not answer.
( ) staff nurse ( ) patient
( ) charge nurse ( ) family member of the patient
( ) senior nurse ( ) significant others (not relative of patient)
( ) nurse supervisor ( ) nursing attendant
( ) chief nurse ( ) ancillary staff
( ) doctor ( ) administrative staff
( ) consultant/specialist ( ) hospital director/administrator
( ) chief of hospital ( ) government officials
( ) Others, please specify ____________________________
129
Part III. Job Satisfaction Survey for Nurses (As Adopted and Modified from Paul E.
Spector, 1994)
Instructions: This is a Job Satisfaction Survey—an instrument designed to measure job

satisfaction among nurses in the workplace. Please complete the questionnaire with
your answers that reflect your own experience in the work that you are engaged in
currently.
2. Please encircle the one number for each question that comes closest to reflecting your
opinion about it:
1 2 3 4 5 6
Disagree Disagree Disagree Agree Agree Agree very
very much moderately slightly slightly moderately much
EXAMPLE:
I feel I am being paid a fair amount for the work I do

1 2 3 4 5 6
Please START here:
1. I feel I am being paid a fair amount for the work I do.
1 2 3 4 5 6
2. There is really too little chance for promotion on my job.
1 2 3 4 5 6
3. My supervisor is quite competent in doing his/her job.
1 2 3 4 5 6
4. I am not satisfied with the benefits I receive.
1 2 3 4 5 6
5. When I do a good job, I receive the recognition for it that I should receive.
1 2 3 4 5 6
130
6. Many of our rules and procedures make doing a good job difficult.
1 2 3 4 5 6
7. I like the people I work with.
1 2 3 4 5 6
8. I sometimes feel my job is meaningless.
1 2 3 4 5 6
9. Communications seem good within this organization.
1 2 3 4 5 6
10. Salary increases are too few and far between.
1 2 3 4 5 6
11. Those who do well on the job stand a fair chance of being promoted.
1 2 3 4 5 6
12. My supervisor is unfair to me.
1 2 3 4 5 6
13. The benefits we receive are as good as most other organizations offer.
1 2 3 4 5 6
14. I do not feel that the work I do is appreciated.
1 2 3 4 5 6
15. My efforts to do a good job are seldom blocked by the official procedures.
1 2 3 4 5 6
16. I find I have to work harder at my job because of the incompetence of people I work with.
1 2 3 4 5 6
131
17. I like doing the things I do at work.
1 2 3 4 5 6
18. The goals of this organization are not clear to me.
1 2 3 4 5 6
19. I feel unappreciated by the organization when I think about what they pay me.
1 2 3 4 5 6
20. People get ahead as fast here as they do in other places.
1 2 3 4 5 6
21. My supervisor shows too little interest in the feelings of subordinates.
1 2 3 4 5 6
22. The benefit package we have is equitable.
1 2 3 4 5 6
23. There are few rewards for those who work here.
1 2 3 4 5 6
24. I have too much to do at work.
1 2 3 4 5 6
25. I enjoy my coworkers.
1 2 3 4 5 6
26. I often feel that I do not know what is going on with the organization.
1 2 3 4 5 6
27. I feel a sense of pride in doing my job.
1 2 3 4 5 6
132
28. I feel satisfied with my chances for salary increases.
1 2 3 4 5 6
29. There are benefits we do not have which we should have.
1 2 3 4 5 6
30. I like my supervisor.
1 2 3 4 5 6
31. I have too much paperwork.
1 2 3 4 5 6
32. I don't feel my efforts are rewarded the way they should be.
1 2 3 4 5 6
33. I am satisfied with my chances for promotion.
1 2 3 4 5 6
34. There is too much bickering and fighting at work.
1 2 3 4 5 6
35. My job is enjoyable.
1 2 3 4 5 6
36. Work assignments are not fully explained.
1 2 3 4 5 6
Note: Please detach the cover letter and informed consent (with your name) after you answer all
the questions. Kindly drop the questionnaire into a secured box provided in a designated
area.
133
Appendix E. Permission on the Use of Negative Acts Questionnaire-Revised
(NAQ-R) (Einarsen, et al., 2009)
From: sarah ragay <sarahragay@gmail.com>

To: Stale.Einarsen@uib.no
Date: Wed, Feb 17, 2016 at 9:43 PM
Subject: RE: Thesis Writing from Philippines
Mailed-by: gmail.com
Dear Professor Stale Einarsen,
Pleasant Greetings!
I am currently writing my research paper regarding "Workplace Bullying and Job Satisfaction
among Nurses in Selected Public and Private Hospitals of Negros Oriental, Philippines". I humbly
would like to ask permission from your good office to use your valuable Negative Act
Questionnaire-Revised tool for my study.
Thank you very much and more power!
Sincerely,
Sarah Annabelle Ragay, RN

Masters of Science in Nursing
Major in Administration Level II
Silliman University
Philippines
134
From: Øystein Løvik Hoprekstad <Oystein.Hoprekstad@uib.no>
To: "sarahragay@gmail.com" <sarahragay@gmail.com>
Date: Thu, Feb 18, 2016 at 7:46 PM
Subject: NAQ-R
Mailed-by: uib.no
Encryption: Standard (TLS)
Dear Sarah,
Thank you for your interest in the Negative Acts Questionnaire.
My name is Oystein Hoprekstad, and I am writing to you now on behalf of Professor Staale
Einarsen, as his research assistant.
I have attached the English version of the NAQ, a SPSS database, psychometric properties of the
questionnaire and the articles suggested on our website. Please use the Einarsen, Hoel and
Notelaers article (2009) in Work and Stress as your reference to the scale. I have also attached a
book chapter on the measurement of bullying where you also find information on the one item
measure.
We will grant you the permission to use the scale on the condition that you accept our terms for
users found in the word-file attached in this e-mail. Please fill this in and return. Normally, it is
free to use the scale as long as it is not for profit and research only. If not, please be in contact.
One of our terms is that you send us your data on the NAQ with some demographical data when
the data is collected. These will then be added to our large Global database which now contains
some 50,000 respondents from over 40 countries. Please send them as soon as your data is
collected. A SPSS database is attached to this mail in the NAQ info file.
If you have any questions, we will of course do our best to answer them.
Best regards,
Oystein Hoprekstad, Research Assistant

On behalf of
Professor Staale Einarsen
Bergen Bullying Research Group
135
Appendix F. Permission on the Use of Job Satisfaction Survey (JSS) (Spector, 1994)
From: sarah ragay <sarahragay@gmail.com>

Date: 19 February 2016 at 9:47:23 PM GMT+8
To: pspector@usf.edu
Cc: Sarah Annabelle Ragay <sarahannabelleragay@icloud.com>
Subject: RE: Thesis writing from the Philippines
Dear Professor Paul Spector,
Pleasant greetings!
I am currently on my thesis writing regarding a descriptive correlational study entitled "Workplace

Bullying and Job Satisfaction among Nurses in Selected Public and Private Hospitals in Negros
Oriental, Philippines". I humbly would like to ask permission from your good office to use your
tool, particularly, the Job Satisfaction Survey (JSS) on my research.
Thank you very much and more power!
Sincerely,
Sarah Annabelle Ragay, RN

Masters of Science in Nursing Level II
Major in Administration
Silliman University
Philippines
136
From: Spector, Paul <pspector@usf.edu>
To: sarah ragay <sarahragay@gmail.com>
Date: Sat, Feb 20, 2016 at 10:14 PM
Subject: RE: Thesis writing from the Philippines
Mailed-by: usf.edu
Signed-by: usfedu.onmicrosoft.com
Encryption: Standard (TLS)
Dear Sarah:
You have my permission for noncommercial research/teaching use of the JSS. You can find copies
of the scale in the original English and several other languages, as well as details about the scale's
development and norms. I allow free use for noncommercial research and teaching purposes in
return for sharing of results. This includes student theses and dissertations, as well as other student
research projects. Copies of the scale can be reproduced in a thesis or dissertation as long as the
copyright notice is included, "Copyright Paul E. Spector 1994, All rights reserved." Results can
be shared by providing an e-copy of a published or unpublished research report (e.g., a
dissertation). You also have permission to translate the JSS into another language under the same
conditions in addition to sharing a copy of the translation with me. Be sure to include the copyright
statement, as well as credit the person who did the translation with the year.
Thank you for your interest in the JSS, and good luck with your research.
Best,
Paul Spector, Distinguished Professor

Department of Psychology
PCD 4118
University of South Florida
Tampa, FL 33620
813-974-0357
pspector [at symbol] usf.edu
http://shell.cas.usf.edu/~spector
137
Appendix G. Permission to Conduct Research Addressed to the Silliman University Research
Ethics Review Committee
138
Appendix H. Silliman University Research Ethics Review Committee Approval Sheet
139
Appendix I. Approval to Conduct Research in Silliman University Medical Center Foundation,
Inc. (SUMCFI)
140
Appendix J. Cross-Tabulation on the Work Status and Status of Person-Related Bullying among
Study Participants for the Past Six Months
Table 6.1 Cross-Tabulation on the Work Status and Status of Person-Related Bullying among
Status of Person-Related Bullying
Work Status Never Now and Monthly Weekly Daily Total
Then
Job Order/Reliever 33 (83%) 6 (15%) 1 (2%) 0 0 40

Contractual 26 (58%) 13 (29%) 5 (11%) 0 1 45
Regular 96 (62%) 47 (31%) 9 (6%) 1 1 154
Total 155 66 15 1 2 239
Appendix K. Number of Identified Perpetrators and Status of Person-Related Bullying among

Table 6.2 Number of Perpetrators and Status of Person-Related Bullying among Study
Participants for the Past Six Months
Status of Person-Related Bullying
Number of Never Now and Monthly Weekly Daily Total
Perpetrators Then
0 67 10 2 0 0 79
1 24 4 1 0 0 29
2 12 5 0 0 1 18
3 19 9 4 0 0 32
4 10 5 0 0 0 15
5 9 8 3 0 0 20
6 5 9 2 0 0 16
7 1 9 0 0 0 10
8 2 2 0 0 0 4
9 3 4 1 0 0 8
10 1 0 1 0 0 2
11 2 1 1 1 1 6
Total 155 66 15 1 2 239
141
Appendix L. Cross-Tabulation on the Area of Work Assignment and Status of Work Related
Bullying among Study Participants for the Past Six Months
Table 6.3 Cross-Tabulation on the Area of Work Assignment and Status of Work-Related
Bullying among Study Participants for the Past Six Months
Status of Work-Related Bullying
Area of Work Never Now and Monthly Weekly Daily Total
Assignment Then
Perioperative Areas 39 (75%) 10 (19%) 1 (2%) 2 (4%) 0 52
Medical Units 38 (47%) 31 (38%) 9 (11%) 2 (3%) 1 (1%) 81
Obstetrics 27 (60%) 9 (20%) 8 (18%) 1 (2%) 0 45

Department
Emergency 19 (58%) 10 (30%) 4 (12%) 0 0 33

Department
Special Services 21 (75%) 3 (10.7%) 3 (10.7%) 1 (3.6%) 0 28
Total 144 63 25 6 1 239
Appendix M. Number of Identified Perpetrators and Status of Work-Related Bullying among

Table 6.4 Number of Identified Perpetrators and Status of Work-Related Bullying among Study
Status of Work-Related Bullying
Number of Never Now and Monthly Weekly Daily Total
Perpetrators Then
0 60 16 2 1 0 79
1 21 5 2 1 0 29
2 11 6 1 0 0 18
3 20 5 7 0 0 32
4 8 6 1 0 0 15
5 10 7 1 2 0 20
6 6 5 5 0 0 16
7 4 5 0 1 0 10
8 3 0 1 0 0 4
9 1 4 3 0 0 8
10 0 1 1 0 0 2
11 0 3 1 1 1 6
Total 144 63 25 6 1 239
142
Appendix N. Number of Identified Perpetrators and Status of Physically Intimidating Bullying
among Study Participants for the Past Six Months
Table 6.5 Number of Perpetrators and Status of Physically Intimidating Bullying among Study
Number of Status of Physical-Related Bullying

Perpetrators Never Now and Then Monthly Weekly Daily Total
0 74 2 3 0 0 79
1 26 3 0 0 0 29
2 17 0 0 1 0 18
3 23 6 3 0 0 32
4 14 1 0 0 0 15
5 19 1 0 0 0 20
6 9 3 4 0 0 16
7 5 4 1 0 0 10
8 2 2 0 0 0 4
9 6 2 0 0 0 8
10 1 0 1 0 0 2
11 3 1 0 1 1 6
Total 199 25 12 2 1 239
Appendix O. Cross-Tabulation on the Level of Job Satisfaction and Frequency of Bullying

among Study Participants in Negros Oriental for the Past Six Months
Table 6.6 Cross-Tabulation on the Level of Job Satisfaction and Frequency of Bullying among
Study Participants in Negros Oriental for the Past Six Months
Level of Job Satisfaction
Frequency of Moderately Slightly Slightly Moderately Total
Bullying Dissatisfied Dissatisfied Satisfied Satisfied (n=239)
(n1= 1) (n2=44) (n3=172) (n4=20)
A. Person-Related
Never 0 33 116 6 155
Now and then 1 11 44 10 66
Monthly 0 1 10 4 15
Weekly 0 0 1 0 1
Daily 0 0 2 0 2
B. Work-Related
Never 1 37 101 4 143
Now and then 0 6 49 9 64
Monthly 0 1 19 5 25
143
Weekly 0 1 3 2 6
Daily 0 0 1 0 1
C. Physical-Related
Never 1 41 141 16 199
Now and then 0 3 19 3 25
Monthly 0 1 10 1 12
Weekly 0 0 2 0 2
Daily 0 0 1 0 1
Appendix P. Frequency and Percentage Distribution of Gender Among the Study Participants
Table 6.7 Frequency and Percentage Distribution of Gender Among the Study Participants
Gender Total No.

Type of of Nurses
Male Female
Hospital
f % f %
Public 17 38.6 88 45.1 105
Private 27 61.4 107 54.9 134
Total 44 100 195 100 239
Appendix Q. Frequency and Percentage Distribution of Age Group Among the Study
Participants
Table 6.8 Frequency and Percentage Distribution of Age Group Among the Study Participants
Total
Age Group
Type of No. of
Hospital 20-29 30-39 40-49 50-59 60-69 Nurses
f % f % f % f % f %
Public 30 27 28 41.2 24 66.7 19 95 4 100 105
Private 81 73 40 58.8 12 33.3 1 5 0 0 134
Total 111 100 68 100 36 100 20 100 4 100 239
144
Appendix R. Frequency and Percentage Distribution of Civil Status Among the Study
Participants
Table 6.9 Frequency and Percentage Distribution of Civil Status Among the Study Participants
Civil Status Total

Type of No. of
Hospital Single Married Separated Widow/er Nurses
f % f % f % f %
Public 44 33.1 58 56.9 1 100 2 66.7 105
Private 89 66.9 44 43.1 0 0 1 33.3 134
Total 133 100 102 100 1 100 3 100 239
Appendix S. Frequency and Percentage Distribution of the Type of Hospital Presently Working
at Among the Study Participants
Table 6.10 Frequency and Percentage Distribution of the Type of Hospital Presently Working at
Among the Study Participants
Type of hospital presently
working at Total No.
of Nurses
Private Public
f % f %
0 0 105 100 105
134 100 0 0 134
134 100 105 100 239
Appendix T. Frequency and Percentage Distribution of Work Status Among the Study
Participants
Table 6.11 Frequency and Percentage Distribution of Work Status Among the Study Participants
Work Status Total

Type of No. of
Hospital Job Order/Reliever Contractual Regular Nurses
f % f % f %
Public 12 30 36 80 57 37 105
Private 28 70 9 20 97 63 134
Total 40 100 45 100 154 100 239
145
Appendix U. Frequency and Percentage Distribution of Current Position Among the Study
Participants
Table 6.12 Frequency and Percentage Distribution of Current Position Among the Study
Participants
Current Position Total

Type of Staff Senior Nurse Chief Head No. of
Hospital Nurse Nurse Supervisor Nurse Nurse Others Nurses
f % f % f % f % f % f %
Public 79 41.4 14 60.9 9 45 3 100 0 0 0 0 105
Private 112 58.6 9 39.1 11 55 0 0 2 100 0 0 134
Total 191 100 23 100 20 100 3 100 2 100 0 0 239
Appendix V. Frequency and Percentage Distribution of Area of Work Assignment Among the
Study Participants
Table 6.13 Frequency and Percentage Distribution of Area of Work Assignment Among the
Study Participants
Area of Work Assignment Total

Type of Perioperative Medical Obstetrics Emergency Special No. of
Hospital Areas Units Department Department Services Nurses
f % f % f % f % f %
Public 19 36.5 38 46.9 20 44.4 15 45.5 13 46.4 105
Private 33 63.5 43 53.1 25 55.6 18 54.5 15 53.6 134
Total 52 100 81 100 45 100 33 100 28 100 239
Appendix W. Frequency and Percentage Distribution on the Length of Work Experience (No. of
Years) In the present Hospital Among the Study Participants
Table 6.14 Frequency and Percentage Distribution on the Length of Work Experience (No. of
Years) In the present Hospital Among the Study Participants
Length of Work Experience (No. of Years) Total
Type of In the present Hospital No. of
Hospital 0.50-10.39 10.40-20.29 20.30-30.19 30.20-40.09 Nurses
f % f % f % f %
Public 57 33.9 22 50 17 94.4 9 100 105
Private 111 66.1 22 50 1 5.6 0 0 134
Total 168 100 44 100 18 100 9 100 239
146
Appendix X. Frequency and Percentage Distribution on the Length of Work Experience (No. of
Years) As a Nurse Among the Study Participants
Table 6.15 Frequency and Percentage Distribution on the Length of Work Experience (No. of
Years) As a Nurse Among the Study Participants
Length of Work Experience (No. of Years) As a Total

Type of Nurse No. of
Hospital 0.50-10.39 10.40-20.29 20.30-30.19 30.20-40.09 Nurses
f % f % f % f %
Public 54 32.7 22 52.4 15 83.3 14 100 105
Private 111 67.3 20 47.6 3 16.7 0 0 134
Total 165 100 42 100 18 100 14 100 239
Appendix Y. Frequency Distribution of Study Participants according to Identified Perpetrators

of Bullying such as Staff Nurse from the Past Six Months
Bullying such as Staff Nurse from the Past Six Months
Identified Perpetrator
of Bullying (Rank 1) Age (years)
Staff Nurse 20-29 30-39 40-49 50-59 60-69 Total
Public 12 8 7 9 1 37
Private 39 15 3 0 0 57
Total 51 23 10 9 1 94
Appendix Z. Frequency Distribution of Study Participants according to Identified Perpetrators

of Bullying such as Family Member of the Patient from the Past Six Months
Bullying such as Family Member of the Patient from the Past Six Months
Family Member of the 20-29 30-39 40-49 50-59 60-69 Total
Patient
Public 14 5 9 7 1 36
Private 37 18 2 0 0 57
Total 51 23 11 7 1 93
147
Appendix AA. Frequency Distribution of Study Participants according to Identified Perpetrators
of Bullying such as Doctors from the Past Six Months
Bullying such as Doctors from the Past Six Months
Doctors 20-29 30-39 40-49 50-59 60-69 Total
Public 10 7 4 8 1 30
Private 35 20 4 1 0 60
Total 45 27 8 9 1 90
Appendix AB. Frequency Distribution of Study Participants according to Identified Perpetrators

of Bullying such as Patient from the Past Six Months
Bullying such as Patient from the Past Six Months
Patient 20-29 30-39 40-49 50-59 60-69 Total
Public 14 4 4 2 0 24
Private 26 15 3 0 0 44
Total 40 19 7 2 0 68
Appendix AC. Frequency Distribution of Study Participants according to Identified Perpetrators

Months
Bullying such as Significant others (not relative of patient) from the Past Six Months
Significant others (not 20-29 30-39 40-49 50-59 60-69 Total
relative of patient)
Public 9 2 7 2 0 20
Private 27 12 1 0 0 40
Total 36 14 8 2 0 60
148
Appendix AD. Frequency Distribution of Study Participants according to Identified Perpetrators
of Bullying such as Senior Nurse from the Past Six Months
Bullying such as Senior Nurse from the Past Six Months
Senior Nurse 20-29 30-39 40-49 50-59 60-69 Total
Public 8 5 1 3 0 17
Private 19 6 1 0 0 26
Total 27 11 2 3 0 43
Appendix AE. Frequency Distribution of Study Participants according to Identified Perpetrators

of Bullying such Nurse Supervisor from the Past Six Months
Bullying such as Nurse Supervisor from the Past Six Months
Nurse Supervisor 20-29 30-39 40-49 50-59 60-69 Total
Public 8 6 4 3 0 21
Private 14 6 0 0 0 20
Total 22 12 4 3 0 41
Appendix AF. Frequency Distribution of Study Participants according to Identified Perpetrators

of Bullying such as Consultant/Specialist from the Past Six Months
Bullying such as Consultant/Specialist from the Past Six Months
Consultant/ Specialist 20-29 30-39 40-49 50-59 60-69 Total
Public 0 0 2 0 0 2
Private 21 13 1 0 0 35
Total 21 13 3 0 0 37
149
Appendix AG. Frequency Distribution of Study Participants according to Identified Perpetrators
of Bullying such as Nursing Attendant from the Past Six Months
Bullying such as Nursing Attendant from the Past Six Months
Nursing Attendant 20-29 30-39 40-49 50-59 60-69 Total
Public 7 2 1 1 0 11
Private 11 8 2 0 0 21
Total 18 10 3 1 0 32
Appendix AH. Frequency Distribution of Study Participants according to Identified Perpetrators

of Bullying such as Chief Nurse from the Past Six Months
Bullying such as Chief Nurse from the Past Six Months
of Bullying (Rank 10.5) Age (years)
Chief Nurse 20-29 30-39 40-49 50-59 60-69 Total
Public 15 7 1 0 0 23
Private 15 7 1 0 0 23
Total 30 14 2 0 0 46
Appendix AI. Frequency Distribution of Study Participants according to Identified Perpetrators

of Bullying such as Administrative Staff from the Past Six Months
Bullying such as Administrative Staff from the Past Six Months
Administrative Staff 20-29 30-39 40-49 50-59 60-69 Total
Public 1 1 1 3 0 6
Private 13 7 0 0 0 20
Total 14 8 1 3 0 26
150
Appendix AJ. Frequency Distribution of Study Participants according to Identified Perpetrators
of Bullying such as Charge Nurse from the Past Six Months
Bullying such as Charge Nurse from the Past Six Months
Identified Perpetrator Age (years)
of Bullying (Rank 12)
Charge Nurse 20-29 30-39 40-49 50-59 60-69 Total
Public 6 3 2 1 0 12
Private 4 2 0 0 0 6
Total 10 5 2 1 0 18
Appendix AK. Frequency Distribution of Study Participants according to Identified Perpetrators

of Bullying such as Government Officials from the Past Six Months
Bullying such as Government Officials from the Past Six Months
Government Officials 20-29 30-39 40-49 50-59 60-69 Total
Public 3 1 1 2 0 7
Private 4 2 0 0 0 6
Total 7 3 1 2 0 13
Appendix AL. Frequency Distribution of Study Participants according to Identified Perpetrators

of Bullying such as Chief of Hospital from the Past Six Months
Bullying such as Chief of Hospital from the Past Six Months
Chief of Hospital 20-29 30-39 40-49 50-59 60-69 Total
Public 0 0 1 4 0 5
Private 3 0 0 0 0 3
Total 3 0 1 4 0 8
151
Appendix AM. Frequency Distribution of Study Participants according to Identified Perpetrators
of Bullying such as Ancillary Staff from the Past Six Months
Bullying such as Ancillary Staff from the Past Six Months
Identified Perpetrator Age (years)
of Bullying (Rank 14.5)
Ancillary Staff 20-29 30-39 40-49 50-59 60-69 Total
Public 1 0 0 1 0 2
Private 5 1 0 0 0 6
Total 6 1 0 1 0 8
Appendix AN. Frequency Distribution of Study Participants according to Identified Perpetrators

of Bullying such as Hospital Director/Administrator from the Past Six Months
Bullying such as Hospital Director/Administrator from the Past Six Months
Hospital 20-29 30-39 40-49 50-59 60-69 Total
Director/Administrator
Public 0 0 1 1 0 2
Private 4 1 0 0 0 5
Total 4 1 1 1 0 7
Appendix AO. Frequency Distribution of Study Participants according to Identified Perpetrators

of Bullying such as Family member of a staff nurse from the Past Six Months
Bullying such as Family member of a staff nurse from the Past Six Months
Family member of a 20-29 30-39 40-49 50-59 60-69 Total
staff nurse
Public 1 0 0 0 0 1
Private 0 0 0 0 0 0
Total 1 0 0 0 0 1
152
Appendix AP. Frequency Distribution of Study Participants according to Identified Perpetrators
from the Past Six Months
Bullying such as Relatives or significant others close to government officials from the
Past Six Months
Relatives or significant 20-29 30-39 40-49 50-59 60-69 Total
others close to
government officials
Public 0 1 0 0 0 1
Private 0 0 0 0 0 0
Total 0 1 0 0 0 1
Appendix AQ. Frequency Distribution of Study Participants according to Identified Perpetrators

of Bullying such as Political Personality from the Past Six Months
Bullying such as Political Personality from the Past Six Months
Political Personality 20-29 30-39 40-49 50-59 60-69 Total
Public 0 1 0 0 0 1
Private 0 0 0 0 0 0
Total 0 1 0 0 0 1
Appendix AR. Frequency Distribution of Study Participants according to Identified Perpetrators

of Bullying such as Others from the Past Six Months
Bullying such as Others from the Past Six Months
Others 20-29 30-39 40-49 50-59 60-69 Total
Public 0 0 1 0 0 1
Private 0 0 0 0 0 0
Total 0 0 1 0 0 1
153
Appendix AS. Sampling Design Procedure used in this Study
Table 6.36 Sampling Design Procedure used in this Study
Sampling Design Procedure
Step 1. Cluster sampling The clustered private hospitals were Silliman University Medical Center and Holy
Child Hospital that had a total of 336 nurses.
The clustered public hospitals were Negros Oriental Provincial Hospital,
Bayawan District Hospital, Bais District Hospital and Governor William Villegas
Memorial Hospital that had a total of 259 nurses.
There were a total of 595 nurses who met the inclusion criteria.
Step 2. Determining the Slovin’s formula is used to compute the sample size of the study that resulted to
sample size 239 nurses.
Slovin’s formula and computation below:
𝑁
𝑁=
1 + ⅇ 2𝑁
595
𝑁=
1 + (0.05)2 (595)
𝑁 = 239
Step 3. Proportional It is used to obtain the sample size which approximates representativeness
allocation among the identified hospitals.
Determine the proportional allocator by using the following formula:

Multiply p by the number of nurses in the hospital.
239
𝑝= = 0.4
595
Forty percent is taken from each hospital to determine the actual number of nurses
to recruit as reflected from the computations below:
 Silliman University Medical Center: 240 nurses x 0.4 = 96 ≈ 95 nurses
 Holy Child Hospital: 96 nurses x 0.4 = 38.4 ≈ 39 nurses
 Negros Oriental Provincial Hospital: 184 nurses x 0.4 =73.6 ≈ 74 nurses
 Bayawan District Hospital: 28 nurses x 0.4 = 11.2 ≈ 12 nurses
 Bais District Hospital: 27 nurses x 0.4 = 27 nurses x 0.4 =10.8 ≈11 nurses
 Governor William Villegas Memorial Hospital: 20 nurses x 0.4= 8 nurses
Step 4. Simple random Is used so that qualified participants are given an equal chance of being selected
sampling as a sample.
A scientific calculator, particularly, the random number generator is used to gather
the total simple random numbers from each hospital.
154
Appendix AT. Curriculum Vitae
155
156
157

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WORKPLACE BULLYING AND JOB SATISFACTION OF NURSES

IN SELECTED PUBLIC AND PRIVATE HOSPITALS

IN NEGROS ORIENTAL, PHILIPPINES

A Thesis Presented to the Graduate Faculty of the

College of Nursing and the University Graduate Programs

Silliman University, Dumaguete City

In Partial Fulfillment of the Requirements for the Degree of

Master of Science in Nursing

Major in Nursing Administration

SARAH ANNABELLE GO RAGAY

the study participants.

employment in their respective hospitals.

participants was slightly satisfied.

negative correlation between the person-related, work-related, and physically intimidating

Conducting more related studies is recommended, particularly using qualitative approach,

helped make this paper possible:

professional guidance, invaluable and in-depth reviews, grammar corrections,

and unceasing encouragement as my research paper adviser

2. to Dr. Alice A. Mamhot, former Chairperson of the Mathematics Department,

for her patience in helping me on the data processing using statistical

procedures and sharing scholarly insights as my statistician

me in refining my research topic and providing useful suggestions during our

research problem presentation as my social research mentor

4. to Dr. Margaret Helen U. Alvarez, Dean of the University Graduate Programs,

Negros Oriental Provincial Hospital (NOPH), for imparting their individual

expertise and wisdom as my panel of reviewers

expertise on editing my research proposal paper

my informed consent content

for her motivation and being an inspiration

8. to Prof. Staale Einarsen of Bergen Bullying Research Group in Norway, for

giving me permission to use the Negative Acts Questionnaire-Revised (NAQ-

his Job Satisfaction Survey (JSS) tool

Memorial Hospital (CLLMMH), Siaton, for allowing me to conduct a pilot

suggestions and wisdom, Mrs. Anne Marjorie F. Laguardia, former Surveillance

patiently answering my questionnaires

conduct my data collection to all the selected government-owned hospitals

12. to the Chief of Hospitals, Hospital Administrators, Chief Nurses, Supervisor

Oriental Provincial Hospital (NOPH), Bayawan District Hospital, Bais District

Hospital, Governor William Villegas Memorial Hospital, Silliman University

for facilitating access to my nurse-respondents

upon answering the questionnaires

graduate classes and activities, and to some of my previous colleagues at NOPH

who assisted me in the access of my data collection to some study participants

prayers in achieving our goals and hopes

untiringly supporting our undertakings

17. to Mrs. Loyda Fontelo, Graduate Programs Secretary, for scheduling my

presentations and other related assistance

professional advice throughout the years of our friendship

sharing his English expertise on refining my research paper

20. to my family: Jennifer Ragay-Papadopoulos, my older sister, for pushing me to

Eugene Ragay, my eldest brother, for patiently assisting and supporting me in

hospitals during my data collection.

SARAH ANNABELLE G. RAGAY

TABLE OF CONTENTS viii

LIST OF APPENDICES xvi

CHAPTER I THE PROBLEM AND ITS SCOPE

Background of the Study 3

Statement of the Problem 6

Significance of the Study 9

Scope and Limitations 11

Operational Definition of Terms 12

CHAPTER II REVIEW OF RELATED LITERATURE

Characteristics of a Professional Nurse 15

Code of Ethics for Filipino Nurses 16