The Journal of School Nursing2021, Vol. 37(6) 449–459© The Author(s) 2020Article reuse guidelines:sagepub.com/journals-permissionsDOI: 10.1177/1059840519897308journals.sagepub.com/home/jsn
The frequency and consequences of bullying directed at school nurses (SNs) are poorly understood. The purpose of this study was to describe the prevalence and impact of bullying directed at school nurses, determine predictors of bullying directed at school nurses, and evaluate the individual and organizational impact of exposure to bullying directed at school nurses. School nurses (n = 334) completed an online survey comprised of the Negative Act Questionnaire–Revised, Perceived Stress Scale, National Institute for Occupational Safety and Health General Social Survey 2010 Quality of Worklife Module, Michigan Organizational Assessment Questionnaire, and open response items to determine their experiences with, and impact of, bullying. Descriptive and inferential statistics were calculated for quantitative data, while content analysis was used to analyze responses to open-ended survey items. One third of participants reported occasional or frequent bullying. Content analysis revealed three themes, including unexpected parent behavior, staff incivility, and formal reporting. Findings support the development of an educational intervention to assist school nurses in the prevention and management of bullying exposure.
school nurse, bullying, quantitative research, workplace
Exposure to workplace bullying is an occupational risk across the nursing discipline (Berry et al., 2016; Evans, 2017; Johnson, 2016, 2018; Simons, 2008). The World Health Organization (2010) has categorized workplace bullying as a serious public health threat, reaching epidemic levels worldwide. The overall prevalence of bullying in any workplace varies between 5% and 30% depending on concept definition and study methodology (Paoli & Merille, 2001; Zapf et al., 2003). According to the Workplace Bullying Institute (2017), 60.3 million workers in the United States report being affected by bullying. Nearly 50% of nurses working in hospitals report being bullied daily (Etienne, 2014). Workplace bullying is an antecedent to tremendous psychological and physiological impacts, as well as an economic burden costing billions of dollars (Beech & Leather, 2006; Madangeng & Wilson, 2009; Schmidtke, 2011).
When bullying behaviors are sensed as threatening (targeted, repeated, unwanted), stress and anxiety increase. One’s ability to cope becomes compromised through consistent negative behaviors (Lazarus & Folkman, 1984). Sauer and McCoy (2017) noted that nurses who experience bullying in the workplace have diminished mental and physical health, which affects their quality of life and inhibits their ability to deliver safe, effective care. In one study of 191 nurses, 90% of participants reported moderate to severe stress when exposed to workplace bullying (Vessey et al., 2009). Additionally, nurses in the workplace reported feelings of anxiety, depression, and isolation when exposed to prolonged bullying behaviors (Berry et al., 2016; Evans, 2017; Karatza et al., 2016; Murray, 2009). Other psychosomatic symptoms nurses described included nervousness, headaches, eating disorders, sleep disturbances, and onset of chronic illnesses (Murray, 2009). Further, systematic and persistent bullying may lead to post-traumatic stress disorder (PTSD; Tehrani, 2004). Tehrani (2004) noted symptoms of PTSD were present in 44% (n = 72) of care professionals exposed to chronic bullying behaviors. Socioeconomic burdens to victims of bullying and institutions include increased health-care expenditures, absenteeism, staff turnover, intent to leave, and impaired work performance (Field et al., 2002; Hesketh et al., 2003; Jauregui & Schnall, 2009; Laschinger et al., 2009; Martin, 2008; McKenna et al., 2003; Rosenstein et al., 2002; Simons, 2008).
Nurses working across settings experience bullying in physical or nonphysical forms (Etienne, 2014; Simons, 2008; Spector et al., 2014). Nurses who are bullied report job dissatisfaction that leads to decreased productivity and attrition of nursing staff (Cleary et al., 2010). Staff turnover is costly to the health-care system as a whole, but for each victim of bullying, the costs of treating injuries, work absenteeism, and psychological distress also accumulate (Castronovo et al., 2016).
Predictors for bullying among nurses include role stress and role ambiguity (Balducci et al., 2012; Bortoluzzi et al., 2014). Other work-related stressors associated with workplace bullying among nurses are role overload, excessive workloads, and working with limited resources (Ekici & Beder, 2014; Hamblin et al., 2015; Tong et al., 2017). Stressful, fast-paced workplaces, shift work, shifts that extend past 12 hr, and lack of breaks contribute to chronic fatigue in nursing (Chen et al., 2014). While fatigue has not been shown to be directly associated with workplace bullying, research supports that those who are chronically fatigued are more likely to exhibit anger, aggression, and uncivil behaviors (Kamphuis et al., 2012; Meier & Gross, 2015). If displayed regularly, these behaviors constitute workplace bullying. Lastly, leadership styles have been acknowledged as one of the key determinants of workplace bullying (Demir & Rodwell, 2012; Spence Laschinger et al., 2012; Tong et al., 2017; Yokoyama et al., 2016).
Not unlike nursing, teaching is considered a high-risk occupation for bullying (Fahie & Devine, 2014). Research examining the bullying teachers endure began at the turn of the century in the United Kingdom (Pervin & Turner, 1998; Terry, 1998) and the United States (Blase & Blase, 2002) and subsequently other regions of the world such as India (Sinha & Yadav, 2017), Lithuania (Bernotaite & Malinauskiene, 2017), Australia (Casimir et al., 2012), and South Africa (de Vos & Kirsten, 2015) among others. Similar to the findings from this research, when teachers are the targets of workplace bullying within the school environment, an assortment of school personnel and associates may be the perpetrators of bullying including their colleagues, principals and other members of the school management team, administrative and support staff of their school, parents, and learners (de Wet & Jacobs, 2018).
The purpose of this study was to determine the current state of school nurse (SN) bullying experiences. The study aims included (1) describing the prevalence and experience of bullying directed at school nurses, (2) determining predictors of bullying directed at school nurses, and (3) identifying the impact to individuals and organizations when school nurses experience bullying.
Significance to school nursing. While bullying has been studied in the school setting, most of this work focuses on teachers and students (Blase & Blase, 2002; de Wet & Jacobs, 2018; Fox & Stallworth, 2010). Scant work to date has explored rates of bullying among school nurses, despite school nurse reports of being victims of bullying by school principals, members of the management and administrative staff of their schools, teachers, and fellow school nurses, parents, and learners (Cowell & Dewey Bergren, 2016; de Wet & Jacobs, 2018). Examining the experiences of school nurses who experience bullying will allow for a deeper understanding of impact, outcomes, and relationships related to bullying behavior specifically in the school setting. Feelings of isolation, disrespect, attacks of the victim’s professionalism, and belittlement have been reported in the literature (Matsela & Kirsten, 2014). Recently, Cowell and Dewey Bergren called for research to explore experiences of bullying among school nurses, so that appropriate interventions may be created and implemented. Problems such as decreased productivity, job dissatisfaction, and attrition of nursing staff following experiences of bullying in nonschool health settings have been established (Castronovo et al., 2016; Cleary et al., 2010). Further, if school nurses intend to leave positions and fear for safety in the workplace because of bullying, the quality of care schoolchildren receive may be diminished (Cowell & Dewey Bergren, 2016).
A work organization framework (Center for Disease Control National Institute for Occupational Safety and Health [NIOSH], 2002) that supports comprehensive and integrated safety, health, and well-being programs was used to better understand the prevalence and impact of workplace bullying exposure among school nurses. The Organization of Work conceptual framework (Kwoka, 1976) includes the influence of external circumstances (economic, legal, technological, and demographic forces at the national/international levels), organizational circumstances (management structures, supervisory practices, production method, and human resources policies), and work circumstances (culture and climate, physical and psychological job demands, social interactions, worker roles, and career development). These factors affect the extent of exposure to psychosocial and physical threats that in turn affect the health of employees and may lead to illness and injury.
In this cross-sectional quantitative study with content analysis, U.S. school nurses shared experiences surrounding bullying through a web-based survey. Institutional review board approval was obtained from the University of Massachusetts Lowell.
The population of interest for this study was school nurses. Members of the National Association of School Nurses (NASN) formed the sample frame. NASN membership is estimated to be approximately 16,000 (E. Maughan, personal communication, February 13, 2017). A random sample of 2,000 NASN members were invited to participate in this web-based survey. The sample size was directed by NASN membership research procedures (National Association of School Nurses, 2016). NASN managed all contact with invited participants via e-mail.
An initial recruitment e-mail containing information about the study purpose, compensation for participants, and an embedded link to access the survey was sent in October 2018. The survey was hosted on Qualtrics© (Provo, Utah). The survey opened with an introductory statement of consent outlining the purpose of the study, risks, benefits, information about the researchers, and assurance of anonymity. Participants had the opportunity to read and acknowledge this statement of consent before beginning the survey online. Participants received one e-mail reminder 2 weeks after the initial invitation. The study team estimated completion of this survey would take approximately 30 min.
To incentivize participation (Dickert & Grady, 1999), participants were invited to provide contact information after completing the survey for a chance to win one of three NASN annual conference registrations. Contact information shared for the purposes of raffle entry and survey responses were stored separately.
The survey included 25 items from the following validated instruments to measure bullying: the Negative Act Questionnaire–Revised (NAQ-R; Einarsen et al., 2009), Perceived Stress Scale (Cohen et al., 1983), and Michigan Organizational Assessment Questionnaire (Cammann et al., 1983). Bullying was assessed using the NAQ-R with permission (Einarsen et al., 2009). The NAQ-R consists of 22 items describing different kinds of behaviors that may be perceived as bullying if they occur on a regular basis. The response choices were daily or almost daily, more than once a week, more than once a month, at least once during the past 6 months, and not in the past 6 months or never. All items were written in behavioral terms with no reference to the word bullying. This allowed participants to respond to each item without the bullying label (Einarsen et al., 2009). The internal reliability of the NAQ-R was .92 as measured by Cronbach’s α. The NAQ-R had a Pearson’s product moment correlation coefficient of —.42 with measures of both mental and physical health, .35 with intention to quit the job, and —.24 with selfassessed overall job performance (Einarsen et al., 2009).
Einarsen et al. (2009) suggest calculating a summative score as a measure to determine the intensity of bullying using the NAQ-R. Scores were assigned as follows: 1 = not in the past 6 months or never, 2 = at least once during the past 6 months, 3 = more than once a month, 4 = more than once a week, and 5 = daily or almost daily. Accordingly, a cutoff score as suggested by Notelaers and Einarsen were set at less than 33 for not bullied, between 33 and 44 for occasionally bullied, and greater than or equal 45 for victims of bullying.
After responding to the 22 NAQ-R items, a definition of bullying was given and participants subjectively indicated whether they consider themselves as bullied. The definition included “as having taken place when abusive behavior is repeated over a period of time and when the victim experiences difficulties in defending him or herself in this situation. It is not bullying if the incident does not occur repeatedly.” The participants were then asked to quantify how often they had experienced workplace bullying in the previous 6 months. Response options for these questions were as follows: daily or almost daily and more than once a week, which was collapsed into victims of bullying; more than once a month as occasionally bullied; and once during the past 6 months or never, which were collapsed into not bullied (Einarsen et al., 2009).
Two items measuring the amount of work and home stress in the past month within the Center for Promotion of Health in the New England Workplace (2014) Healthy Workplace All Employee Survey with the following response choices: extreme stress, substantial stress, moderate stress, a little stress, and no stress. The responses were collapsed into three categories: no stress, moderate stress (a little stress and moderate stress), and high stress (extreme stress and substantial stress).
Intention to leave and job satisfaction was each be measured using 1 item from a subscale of the Michigan Organizational Assessment Questionnaire. Internal consistency reliability of the intention to turnover subscale is .83 as measured by Cronbach’s α (Cammann et al., 1983).
Demographics such as age, gender, ethnicity, educational level, licensure, tenure, and hours worked per week to attempt to determine predictors of bullying were collected. Responses to open-ended text boxes prompting school nurses to share memorable lived experiences of bullying, health-care costs accrued, missed work days, work productivity changes, and intent to leave positions following bullying were also collected.
All data were de-identified and stored on passwordprotected computers. For quantitative data such as demographic information, student population data, and measurement tool items, descriptive and inferential statistics were calculated using SPSS© (IBM Corp. Released 2017, Version 25). Some survey items were open-ended, inviting participants to share narrative responses about experiences with bullying in the workplace. Content analysis of open-ended responses was performed to identify themes across participant responses NVIVO for Mac (Version 10, 2014).
A total of 334 (16.7%) school nurses participated in the survey. After accounting for missing data, 290 (14.5%) participant responses were analyzed. The 290 participants were, on average, 50.4-year-old (range = 23–72), Caucasian females with a bachelor’s degree. Respondents had been licensed as nurses for a mean of 23.8 years and worked in the school setting for a mean of 11.7 years. Most worked full time and were licensed at the registered nurse level. Most (66%) respondents were responsible for one school building with an average nurse-to-student ratio of 1:920. Students cared for were mostly White (55.5%). Table 1 displays demographic and professional characteristics of respondents. The sample features of this study, specifically the age, gender, and experience of the SNs along with the number and type of schools, are consistent with the findings of the national SN survey conducted by Willgerodt and colleagues.
Respondents were invited to share experiences with bullying from their job. Twenty-three percent of participants (N = 68) contributed experiences via open-text boxes. Following a summative content analysis of the 77 responses, three themes were identified: unexpected parent behavior, staff incivility, and formal reporting. The themes are detailed across each results section.
Exposure to an unmanageable workload was most commonly reported, with 17.65% of participants reporting such exposure on a daily basis. School nurse respondents also reported being ordered to work below their level of competence (7.27%), being ignored or shunned (6.94%), and having their opinions and views ignored (6.23%) as daily occurrences. Analysis results of responses to the NAQ-R items are found in Table 2.
One third of participants (n = 90) met criteria for being either occasionally or frequently bullied based on NAQ-R criteria for such designations (Einarsen et al. (2009)). However, when participants were asked whether they perceived being bullied, fewer (n = 44, 15.2%) reported being either occasionally or frequently bullied. Parents were the most common perpetrator of bullying (26.2%) followed by educational administrators (23%) and teachers (11%). Tables 3 and 4 display the prevalence of bullying.
Within the open-ended responses, participants reported incivility from staff members of all disciplines, including administrators, other nurses and directors, counselors, and teachers. Gossip and unprofessional behaviors were directed at many respondents:
a teacher talks negatively about me in the staff lounge … I’ve tried speaking to this teacher but she looks right through me and acts as if I’m not present (or a ghost).
Staff members also displayed behaviors consistent with psychological abuse, including sabotage and purposeful exclusion. Beyond school nurses, students were noted to be victims of such behaviors. Respondents noted making efforts to ensure students were not affected by uncivil behaviors:
The staff that [choose] to neglect to include me in planning and events have been addressed personally and by their administrator. Unfortunately, they gas lighted (In this context, gaslighting means to “manipulate someone by psychological means into doubting their own sanity”, [Lexico, n.d.]) my concerns and continue to carry on as normal. It requires extra effort on my part but I get the job done so the students’ best [interests are] always assured.
Few school nurses sought resolution of bullying (14%) or acknowledged bullying experiences and confronted the situation (10.8 %). When the perpetrator of bullying was an administrator, teacher, or other professional, more respondents avoided the experience (12.9%) compared to situations in which parents and students were the perpetrators (6.3%). Conversely, reporting the experience to a supervisor or human resource associate was higher (12%) when the bullying was by parent/student to when the bullying was by administrators, teachers, other professionals, or nurse colleagues (7.8%). Respondents described taking formal steps to report experiences of bullying within the openended response opportunities. Thorough documentation was seen as an essential component of reporting on-the-job bullying. Nurses found a log of the date, time, location, involved parties, and steps taken to help establish a pattern of bullying and facilitate accurate recall of events when seeking help at work was necessary. However, some school nurse respondents reported an end to bullying after reporting it:
Bullying was extreme, and after quite some time it was reported to the human resource director. Administration got involved and removed any contact from the offender except in supervised meetings. It is much better now.
Many respondents did not realize resolution following their reporting efforts. Even when legal teams were involved, reporting was not effective for nurse respondents:
I have attempted to handle it head on however my supervisors permit the bullying to continue and have not been supportive in defending the nurses by addressing the bullying. Bullying and intimidation has also come from the district legal counsel … the nurse has not been part of the conversation, but was [directed] by the lawyer.
Respondents also noted bullying from an administrator or bullying with particular circumstances as a barrier to reporting uncivil behavior:
when the bully is also your supervisor, you can’t report without them knowing. Even if the bully was not your supervisor, some of the things I would have to report are so specific they would know it was me.
The quantitative analysis did not identify significant predictors of bullying. When assessing the bivariate association for the predictors of bullying, minimal variability was noted among the predictor variables such as gender, race, ethnicity, and licensure. However, the qualitative analysis suggests that a lack of understanding regarding the role of the school nurse and the scope of practice may contribute to parent and administrator aggression. Respondents thought parents did not respect the role and responsibility of the school nurse, noting:
bullying has come from parents and their entitlement that the rules don’t apply to them.
Some respondents also expressed that parents could be perpetrators of bullying through a mismatch of their reactions to the significance of a problem. Parents were noted as quick to escalate a problem and disregard established reporting and resolution channels. For example:
A mom was unhappy about the way I addressed her in a group meeting. She told the school that she was unhappy with me and reported me to our state licensing board. No negative finding[s] were found by the school district or licensing board.
School nurse respondents shared some ways they cope with or address bullying from parents. Respondents reported seeking support from colleagues and school administrators:
I reported the parent who swore at me on the phone [to my principal]. The resolution was the principal would contact the parent so I wouldn’t be subjected to that.
School nurses also reported setting limits with parents displaying unexpected behavior:
I can usually reason with [parents] but will no longer tolerate inappropriate behaviors.
While some nurses did describe supportive relationships with administrators, a lack of support from administration was noted as a contributor to abuse of nurses by parents. In school facilities, where nurses were not included in planning or seen as part of the team, uncivil behaviors were reported.
The χ2 analysis of self-reported impact of NAQ and subjective reporting of bullying is summarized in Table 3. Participants who were either occasionally or frequently bullied according to the NAQ-R (70.5%) were more likely to be dissatisfied with their jobs (p ≤ .001). Similarly, those who subjectively reported being either occasionally or frequently bullied (46.6%) were more likely to be dissatisfied with their jobs (p ≤ .001).
Fifty-one percent of those who were either occasionally or frequently bullied, according to the NAQ-R, as well as participants who subjectively reported being occasionally or frequently bullied (36.2%) were more likely to leave their current position (p = .001). Participants (60.2%) who were either occasionally or frequently bullied, according to the NAQ-R, were more likely to report high levels of work stress (p = .001). Stress at home was not significantly related to bullying.
Experiences of workplace bullying may affect the quality of care that a school nurse delivers to the school community, individual students, or school faculty seeking care. As a hypothetical example, if a student with a chronic condition is the perpetrator of bullying toward a school nurse, the nurse may be prohibited from or uncomfortable with implementing adequate self-management educational interventions. Additionally, if a school nurse were a victim of bullying from nurse colleagues or other school staff, this could affect school nurse sensitive indicators such as medication administration accuracy, as on-the-job errors and accidents have been established as consequences of bullying in other health-care settings. Hutchinson and Jackson (2013) discovered that negative interpersonal actions among nurses were associated with perceived threats to safe, quality patient care secondary to diminished teamwork, and low morale. Eventually, this hampered nurses’ ability to deliver safe, high-quality patient care. Negative patient safety cultures have been linked to high medication error rates, increased work-related injuries, and reluctance to report errors (Chiang & Pepper, 2006; Clarke et al., 2002; Hofmann & Mark, 2006). The importance of high-quality nursing environments has been demonstrated as necessary for the provision of safe patient care (Institute of Medicine, 2003).
In a study describing the makeup of the U.S. school nurse workforce, Willgerodt et al. (2018) estimated that most school nurses were Caucasian (84.3%) female (97.7%), over age 40 (75.9%), holding a bachelor’s degree or higher (76.5%), and responsible for care in one school building (43.7%). These findings closely approximate the sample in the present study in terms of personal demographics and education; however, we cannot make a comparison based on years of experience as a nurse or school nurse.
Bullying may jeopardize the physical and mental wellbeing of SNs. Victims may experience stress, anxiety, depression, PTSD, helplessness, loss of concentration, fatigue, impaired social skills, and sleep disturbance (Yarbrough & Davis, 2019). This may eventually alter the care SNs are able to provide to their students. Similar to nurses in different settings, experiencing bullying in the workplace may also influence SNs to exit the role (Bambi et al., 2019; Gellasch, 2015).
In a recent examination of the individual and organizational characteristics linked to bullying of school nurses in Virginia (n = 178; Sharma et al., 2019), 80.3% did not perceive that they were the victims of bullying. This is similar to the results of this study where 84.8% of participants did not perceive that they were victims. SNs may lack knowledge regarding how bullying behaviors may be manifested. Sharma et al. (2019) determined that 60.1% of Virginia SNs experienced bullying, and 39.9% did not experience any bullying behavior. This study found that 13.2% of respondents were bullied and 67% were not bullied according to the NAQ-R.
The study findings indicate a lack of awareness of the school nursing role and scope of practice by the school administrators and public, which may lead to bullying behaviors. Parents and educators believe school nurses mainly provide first aid care and administer medications (Maughan & Adams, 2011). Nearly 15% of participants in this study reported they were ordered to do work below their level of competence or asked to perform duties outside of their scope of practice. A lack of appreciation for the role of the school nurse and the increasing complex needs of the students cared for contributes to school nurses’ experiences of bullying. Further action should be taken to engage the public in meaningful discussion about the value of school nurses and the care they provide. The results of this study may be leveraged to demonstrate to the community that bullying directed at school nurses is a problem with some low or no-cost fixes, such as learning more about the school nurses’ duties. School nurses may drive such discussion through participation in back-to-school nights, penning of articles for school newsletters, community newspapers, or other forms of media that parents and other stakeholders may consume.
The stressful nature of school nursing work itself is of concern, with nearly 40% of participants reporting high levels of work stress within the last 30 days. The pressure of having responsibility for the health and well-being of hundreds of students may be one antecedent of school nurse stress. Limited resources and a lack of support from parents and administrators exacerbate the problem. Individual school nurses may have difficulty taking action (Rocker, 2008) to stand up for themselves when experiencing bullying behaviors. While much of school nursing work is carried out alone, that is, without contact or support from another nurse, school nurses may consider forming a network for consultation and debriefing with nurses from their own district or neighboring districts.
School nurses should plan to request training and support surrounding bullying from their school district human resources department, their local school nurse organization/association, or the NASN. Either proactively or in response to such requests, state and national school nurse associations should develop continuing education opportunities or toolkits for school nurses facing workplace bullying. Participants of this study displayed a discrepancy between subjective reports of bullying (15.2%) and confirmation of bullying through use of validated bullying scales (33%). School nurses may require training on which behaviors are consistent with bullying. Such training will allow nurses to first identify unexpected behaviors and appropriately seek help in the workplace, as well as support for their own mental health. Trainings should include information on the impact of workplace bullying, methods for identifying uncivil workplace behaviors, and strategies for conflict management. A district tool kit could include drafts of policies and procedures to share with school district administrators, which explicitly prohibit bullying directed at school nurses from peers, parents, and students.
In an effort to safeguard nurses from bullying, incivility, and workplace violence, the American Nurses Association (ANA) calls for the implementation of several strategies including advocacy, policy, and resources in order to establish and maintain healthy, safe, and respectful work environments (ANA, 2015, 2019). The most recent ANA campaign urges victims of bullying behaviors to report the exposure. Endeavors such as these led by the ANA must be inclusive of community-based nurses, including school nurses. In fact, given that school nurses are experts in not only their own experiences but also physical and emotional health, they should feel empowered to lead and actively participate in efforts to develop and implement bullying policies and programs, and leading organizations should be actively soliciting the participation and expertise of this qualified group of experts. Programs should incorporate interventions to prevent and manage bullying exposure. Interventions should be straightforward with few barriers to implementation, given that school nurses may have limited district resources or supports compared to hospital systems that are addressing bullying directed at school nurses.
The experience of school nurses, particularly concerning bullying, is glaringly absent in the nursing workforce literature. This study is a step; however, additional research is needed to determine the prevalence of school nurse bullying internationally, as well as its effect on school nurses’ health and intent to leave school nursing. The current and worsening national shortage of school nurses is a public health threat (Camera, 2016). Future research should include the financial impact of school nurse mistreatment, including missed workdays and costs to school districts to hire substitute nurses when they are available, and the effect on student health when they are not.
Bullying is a health and safety issue for school nurses, as well as schoolchildren. Determining the effect of school nurse exposure to bullying on school nurse sensitive indicators and missed care are priorities for future study. Future research also should investigate the conditions of work and the effects on school nurse and student health. The long-term goal is to develop an educational intervention to assist school nurses to prevent and manage exposure to bullying. Additional steps include identifying the difference between stated policies and actual school nurse experiences with bullying and seeking resolution. Future research priorities outlined here can contribute to a position statement regarding the best approaches to addressing school nurse bullying.
The sample population was limited to members of NASN; therefore, the study may not represent the population of school nurses as a whole. The response rate of 14.5% for those surveyed was low which can be attributed to both the method of data collection through an online survey and the incentive being entered into a raffle, rather than an individual incentive for each participant. The evidence strongly suggests that prize drawings and lotteries are not as effective as traditional cash incentives or material incentives in increasing response rates (Dillman et al., 2014). Nurses who participated were self-selecting, so the experiences of nurses who chose not to participate are missing from this study. The limitations of low response rate, response bias, and common method bias diminish the generalizability of the study findings to the wider population of school nurses.
The results of this study shed light on the prevalence and experience of bullying directed at school nurses in their practice, as well as potential interventions to reduce bullying. Continuing education specific to bullying for school nurses can improve these professionals’ health, safety, and workplace experiences. School nurses are capable of leading and participating in bullying resource and program development at the school, district, and national level and should be actively recruited for such efforts given their expertise and lived experiences surrounding bullying. Addressing bullies and advocating for a culture of kindness, civility, and compassion benefits everyone within the school community.
Anya Peters, Brenna Quinn, and Mazen El-Ghaziri contributed to the conception and design of the manuscript. Data were acquired, analyzed, and interpreted by Anya Peters, Brenna Quinn, Mazen El-Ghaziri, and Shellie Simons. All authors were involved in the draft preparation, gave final approval, and agreed to be accountable for all aspects of work ensuring integrity and accuracy.
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: this research was supported by a NASN research grant.
Anya Peters, PhD, RN, CNE https://orcid.org/0000-0002-3579-9575
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Anya Peters, PhD, RN, CNE, is an assistant professor at University of Massachusetts Lowell, Lowell, MA, USA.
Mazen El-Ghaziri, PhD, RN, is an assistant professor at University of Massachusetts Lowell, Lowell, MA, USA.
Brenna Quinn, PhD, RN, NCSN, CNE, is an assistant professor at University of Massachusetts Lowell, Lowell, MA, USA.
Shellie Simons, PhD, RN, is an associate professor at University of Massachusetts Lowell, Lowell, MA, USA.
Rosemary Taylor, PhD, RN, is an assistant professor at University of Massachusetts Worcester, Worcester, MA, USA.
1 University of Massachusetts Lowell, MA, USA
2 University of Massachusetts Worcester, MA, USA
Corresponding Author:Anya Peters, PhD, RN, CNE, University of Massachusetts Lowell, 113 Wilder Street, Ste. 200, Lowell, MA 01854, USA.Email: anya_peters@uml.edu
