Verbal abuse against nurses in the workplace, including abuse by other nurses, is both common and well-documented. The negative effects of that abuse and the adverse impact on patient care are also well-documented. Now, a study of newly licensed registered nurses (NLRNs) finds that nurses who are verbally abused by nursing colleagues report lower job satisfaction, unfavorable perceptions of their work environment, and greater intent to leave their current job.

The study, conducted by the RN Work Project, a program of the Robert Wood Johnson Foundation, was published online in the Journal of Nursing Scholarship. Investigators for the study were: Wendy Budin, RN-BC, PhD, FAAN, adjunct professor at the College of Nursing, New York University; Carol Brewer, PhD, RN, FAAN, professor at the School of Nursing, University at Buffalo; Christine T. Kovner, PhD, RN, FAAN, professor at the College of Nursing, New York University; and Ying-Yu Chao, RN, MS. Kovner and Brewer direct the RN Work Project.

The researchers surveyed 1,407 NLRNs about how often they were verbally abused by nurse colleagues: never (low level); one to five times in the last three months (moderate); or more than five times in the last three months (high). They found that nearly half (49 percent) of respondents experienced some verbal abuse, although only 5 percent had experienced abuse more than five times in the last three months. Being spoken to in a condescending manner and being ignored were the most frequently reported types of abuse. RNs working in Magnet hospitals and those working in intensive care units were the least likely to report high levels of verbal abuse.

“The verbal abuse we found to be most common is best characterized as passive-aggressive,” said Budin. “Rather than yelling, swearing, insulting or humiliating behavior, most early career RNs reported that the abuse they experienced involved condescension or lack of acknowledgement. This kind of subtle abuse is less likely to be reported and more likely to be overlooked as a problem, which makes it all the more insidious and it is all the more important that hospital administrators work to confront and prevent it.”

RNs working day shifts experienced higher levels of verbal abuse than those working evening and weekend shifts. RNs working eight-hour shifts were less likely to experience abuse than RNs working 12-hour shifts. Staffing shortfalls were also correlated with higher levels of abuse.

The study revealed that intent to leave a job was highly correlated with the levels of abuse new RNs experienced. RNs who reported no verbal abuse were least likely to plan to leave in the next three years. Those who experienced moderate to high levels of abuse were most likely to say they intended to leave in the next 12 months, but also indicated that they planned to leave their current positions, not the field of nursing.

“Verbal abuse of early career RNs remains an ongoing problem and this study shows that this abuse not only has an impact on their attitudes toward work, but also influences their decisions about whether to stay in their current positions,” said Brewer. “If hospital and health systems want to retain these new nurses, they need to make changes that will end this kind of abuse.”

The researchers note that there is a need for evidence-based strategies to decrease and eliminate verbal abuse and to help new nurses cope with abuse, including structured interventions. They suggest that therapeutic communication, assertiveness training and conflict management strategies may help new nurses cope with perceived abuse. The researchers recommend mandatory hospital-wide programs for all employees about the impact of verbal abuse and other disruptive behaviors, and zero-tolerance policies.

The RN Work Project is a 10-year study of NLRNs that began in 2006. It is the only multi-state, longitudinal study of new nurses’ turnover rates, intentions and attitudes—including intent, satisfaction, organizational commitment, and preferences about work. The study draws on data from nurses in 34 states, covering 51 metropolitan areas and nine rural areas.