The effects of bullying on nurses' turnover intentions, patient care, and somatic health complaints: Examining the importance of staffing adequacy and stress mindsets

Abstract

Background: Bullying in nursing is a pervasive and persistent problem that contributes to elevated stress levels and a range of negative employee outcomes, including poor job attitudes and deteriorating well-being. Prior research has largely focused on the harmful consequences of bullying, with limited attention to the factors that may buffer these effects. Addressing this gap is critical for identifying pathways to support nurses and improve healthcare environments.

Purpose: This study examines how organizational and individual resources can mitigate the adverse outcomes of workplace bullying among nurses. Specifically, it investigates whether staffing adequacy (an organizational resource) and stress mindset (an individual resource) moderate the indirect effects of bullying on turnover intentions, perceived patient care quality, and health complaints, via stress.

Methods: A two-wave survey was conducted with 422 nurses employed in various healthcare settings across the United States. The study employed a moderated mediation model to test the relationships among workplace bullying, stress, and outcome variables, while examining the moderating roles of staffing adequacy and stress mindset. Stress mindset refers to an individual's belief that stress can either be enhancing or debilitating.

Discussion: Findings reveal that bullying indirectly increases turnover intentions, diminishes perceived quality of patient care, and elevates health complaints by increasing stress. Importantly, both adequate staffing and a stress-is-enhancing mindset can buffer nurses against these negative effects. However, the protective effects of a stress-is-enhancing mindset are only evident when staffing is perceived to be moderately to highly adequate. When staffing is low, a positive stress mindset alone is insufficient to offset the consequences of bullying.

Conclusion: This study highlights the importance of both organizational and psychological resources in reducing the harmful effects of workplace bullying in nursing. Bullying exerts its influence through stress, but this pathway is moderated by both staffing adequacy and stress mindset. To safeguard nurse well-being and performance, healthcare organizations should prioritize adequate staffing levels and support interventions aimed at cultivating more adaptive stress mindsets among nursing staff.

Keywords: Nurse well-being; Nursing staff; Occupational health; Patient care quality; Turnover intentions; Workplace bullying.