Other Titles
From Novice to Target: Reducing Ambulatory New Graduate Nurse Bullying, A Quality Improvement Project [Title Slided]
Abstract
Background: The bullying of new graduate nurses is often considered a rite of passage in the nursing profession.1 Bullying within nursing has led to poor professional development, reduced self-confidence, and has the potential to negatively impact patient outcomes; with links to increased medication errors, falls, and hospital costs.1,9 Within a comprehensive cancer center, high rates of nurse bullying have been reported. Currently, this institution lacks staff education regarding bullying and the negative impacts it poses to staff and patients.
Purpose: The purpose of this quality improvement project was to reduce the bullying of new graduate registered nurses (RNs), improve the knowledge of bullying, and enhance the communication techniques of individuals who may experience these behaviors.
Methods: A literature review was completed to determine current evidence-based methods to combat bullying, finding that cognitive rehearsal training (CRT) to be effective at reducing bullying behaviors within nursing.3,4,5,6,7,8 CRT content was developed and included scenarios of gossiping, non-verbal communication, and direct verbal remarks.3 Participants completed CRT which included education on bullying and how to communicate effectively in these situations. Bullying knowledge, exposure/incidence, and perceived confidence were assessed via survey before, immediately after, and 30-days post-intervention to assess impacts using a Bullying Knowledge Questionnaire and the Negative Acts Questionnaire-Revised (NAQ-R) (permission granted from S. Einarsen).2
Results: There was a significant increase in bullying knowledge (91%) and confidence levels in communication (92%) before and immediately after (n=11), which did not change at the 30 day-post intervention survey (82% response rate, n=9). There was a decrease in bullying incidence/exposure of 39% from pre-intervention (54%, n=11) to 30-day post intervention (33%, n=9). All participants (100%) reported satisfaction with the program.
Conclusion: CRT can positively impact bullying knowledge, incidence/exposure, and communication techniques. Future studies should include a large, diverse sample size to ensure transferability and generalizability.
Notes
Extensive reference list included in attached slide deck.
References:
1. Edmonson, C., & Zelonka, C. (2019). Our own worst enemies: The nurse bullying epidemic. Nursing Administration Quarterly, 43(4), 274-279. doi: 10.1097/NAQ.0000000000000353
2. Einarsen, S., Hoel, H., & Notelaers, G. (2009). Measuring exposure to bullying and harassment at work: Validity, factor structure and psychometric properties of the Negative Acts Questionnaire-Revised. Work & Stress, 23(1), 24-44. doi: 10.1080/02678370902815673
3. Fehr, F. C., & Seibel, M. (2021). Nursing students and cognitive rehearsal training as an antibullying strategy: A Canadian national study. Journal of Nursing Education, 61(2), 80-87. doi: 10.3928/01484834-20211213-04
4. Griffin, M. (2004). Teaching cognitive rehearsal as a shield for lateral violence: An intervention for newly licensed nurses. The Journal of Continuing Education in Nursing, 35(6), 257-263.
5. Kang, J., & Jeong, Y. J. (2019). Effects of a smartphone application for cognitive rehearsal intervention on workplace bullying and turnover intention among nurses. International Journal of Nursing Practice, 25, 1-10. doi: https://doi.org/10.1111/ijn.12786
6. Park, M., & Choi, J. S. (2023). Development and evaluation of a workplace bullying cognitive rehearsal-based nursing simulation education program: A mixed-methods study. International Journal of Environmental Research and Public Health, 20(4974), 1-13. doi: https://doi.org/10.3390/ijerph20064974
7. Seibel, L. M., Fehr, F. C., Sarwal, S., & Panchuk, H. J. (2022). Impact of cognitive rehearsal training over time for new registered nurses. The Journal of Continuing Education in Nursing, 53(5), 203-211. doi: 10.3928/00220124-20220414-02
8. Tsai, S. T., & Chou, F. H. (2023). Developing and testing a prototype smartphone educational application to address incivility and bullying in nursing workplaces. Nurse Education Today, 130(2023), 1-8.
9. Yang-Heui, A., & Choi, J. (2019). Incivility experiences in clinical practicum education among nursing students. Nurse Education Today, 73, 48-53. doi: 10.1016/j.nedt.2018.11.015
Sigma Membership
Mu Delta
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Quality Improvement
Research Approach
Other
Keywords:
New Graduate Nurses, Bullying, Work Environment, Stress/Coping, Psychological Stress, Coping
Recommended Citation
Matousek, Christina; Brooks, D'Ana; Elwell, Joy; Alexander, Ivy M.; and Carafeno, Tracy, "From Novice to Target: Reducing New Graduate Nurse Bullying, A Quality Improvement Project" (2026). Creating Healthy Work Environments (CHWE). 51.
https://www.sigmarepository.org/chwe/2026/presentations_2026/51
Conference Name
Creating Healthy Work Environments
Conference Host
Sigma Theta Tau International
Conference Location
Washington, DC, USA
Conference Year
2026
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2026-04-29
From Novice to Target: Reducing New Graduate Nurse Bullying, A Quality Improvement Project
Washington, DC, USA
Background: The bullying of new graduate nurses is often considered a rite of passage in the nursing profession.1 Bullying within nursing has led to poor professional development, reduced self-confidence, and has the potential to negatively impact patient outcomes; with links to increased medication errors, falls, and hospital costs.1,9 Within a comprehensive cancer center, high rates of nurse bullying have been reported. Currently, this institution lacks staff education regarding bullying and the negative impacts it poses to staff and patients.
Purpose: The purpose of this quality improvement project was to reduce the bullying of new graduate registered nurses (RNs), improve the knowledge of bullying, and enhance the communication techniques of individuals who may experience these behaviors.
Methods: A literature review was completed to determine current evidence-based methods to combat bullying, finding that cognitive rehearsal training (CRT) to be effective at reducing bullying behaviors within nursing.3,4,5,6,7,8 CRT content was developed and included scenarios of gossiping, non-verbal communication, and direct verbal remarks.3 Participants completed CRT which included education on bullying and how to communicate effectively in these situations. Bullying knowledge, exposure/incidence, and perceived confidence were assessed via survey before, immediately after, and 30-days post-intervention to assess impacts using a Bullying Knowledge Questionnaire and the Negative Acts Questionnaire-Revised (NAQ-R) (permission granted from S. Einarsen).2
Results: There was a significant increase in bullying knowledge (91%) and confidence levels in communication (92%) before and immediately after (n=11), which did not change at the 30 day-post intervention survey (82% response rate, n=9). There was a decrease in bullying incidence/exposure of 39% from pre-intervention (54%, n=11) to 30-day post intervention (33%, n=9). All participants (100%) reported satisfaction with the program.
Conclusion: CRT can positively impact bullying knowledge, incidence/exposure, and communication techniques. Future studies should include a large, diverse sample size to ensure transferability and generalizability.
Description
Bullying in the nursing profession can have detrimental impacts on the well-being of staff and the patients they care for. This project used cognitive rehearsal training sessions to provide education on bullying and how to effectively communicate when faced with these behaviors. Following implementation, a significant improvement in bullying knowledge, bullying exposure/incidence, and confidence levels with communication techniques were observed, helping to promote a healthy workplace.