Journal of Workplace Behavioral Health

ISSN: (Print) (Online) Journal homepage: www.tandfonline.com/journals/wjwb20

The association between workplace bullying and

the mental health of Jordanian nurses and its
predictors: A cross-sectional correlational study

Fatehi Abd Al-al, Nidal Eshah, Ahmad Rayan, Salam Bani Hani, Mohammed
ALBashtawy, Asem Abdalrahim & Abdullah Alkhawaldeh

To cite this article: Fatehi Abd Al-al, Nidal Eshah, Ahmad Rayan, Salam Bani Hani, Mohammed
ALBashtawy, Asem Abdalrahim & Abdullah Alkhawaldeh (19 Mar 2024): The association
between workplace bullying and the mental health of Jordanian nurses and its predictors:
A cross-sectional correlational study, Journal of Workplace Behavioral Health, DOI:
10.1080/15555240.2024.2322725

To link to this article: https://doi.org/10.1080/15555240.2024.2322725

Published online: 19 Mar 2024.

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JOURNAL OF WORKPLACE BEHAVIORAL HEALTH
https://doi.org/10.1080/15555240.2024.2322725

The association between workplace bullying and the

mental health of Jordanian nurses and its predictors: A
cross-sectional correlational study
Fatehi Abd Al-ala, Nidal Eshahb , Ahmad Rayanb , Salam Bani Hanic ,
Mohammed ALBashtawyd , Asem Abdalrahimd, and Abdullah
Alkhawaldehd
a
King Hussein Cancer Center, Amman, Jordan; bFaculty of Nursing, Zarqa University, Zarqa,
Jordan; cNursing Department, Faculty of Nursing, Irbid National University, Irbid, Jordan;
d
Department of Community and Mental Health, Princess Salma Faculty of Nursing, Al Al-Bayt
University, Mafraq, Jordan

ABSTRACT ARTICLE HISTORY

Background: Bullying at work is a major challenge that harms Received 15 April 2023
an employee’s overall well-being, job happiness, and mental Accepted 16 February 2024
health.
KEYWORDS
Objectives: To assess the relationship between workplace bul­
Workplace bullying; nurses;
lying and Jordanian nurses’ mental health. depression; anxiety; stress;
Materials and Methods: A descriptive, cross-sectional correl­ working environment;
ational design was used in this study, recruiting 146 nurses negative act
from three governmental hospitals in Jordan. A convenience
sample was used. The study used the Negative Acts
Questionnaire-Revised (NAQ-R) tool to measure the level of
bullying as a negative behavior. Also, the Depression Anxiety
Stress Scale (DASS-42) was used to assess nurse’s mental
status.
Results: Most of the participants 54.8% were victims of fre­
quent workplace bullying, while the mean score of the total
DASS-42 scale (M ¼ 43.45). About 64.4% of participants exhib­
ited symptoms of depression, 58.8% exhibited symptoms of
anxiety, and 46.6% exhibited symptoms of stress. A significant
relationship between workplace bullying and mental health
among Jordanian nurses was found (r ¼ 0.75, p < 0.001).
Conclusion: Bullying at work can harm a person’s mental
health, causing stress, worry, and depression. Like other pro­
fessions, nursing can be the target of workplace bullying,
which can take many different forms. However, maintaining a
safe and respectful workplace is a priority for healthcare pro­
viders including nurses.

LAY SUMMARY
� Bullying at the workplace is prevalent among nurses,
mostly among single, rotating shifts.
� More than half of nurses had moderate symptoms of
depression and anxiety that affected their mental health
status.

CONTACT Salam Bani Hani banihani.salam@yahoo.com, s.banihani@inu.edu.jo Nursing Department,

Faculty of Nursing, Irbid National University, Irbid, Jordan.
� 2024 Taylor & Francis Group, LLC
2 F. ABD AL-AL ET AL.

� Thorough studies should be conducted to ascertain the

prevalence, effect, and consequences of bullying in the
workplace among nurses.
� Policies and protocols should take place to prevent work­
place bullying among healthcare providers.
� In January 2022, Jordan did have laws and regulations per­
taining to work health and safety, including labor law,
occupational safety and health legislation, and the
Ministry of Labor that had regulations applicable to work­
place safety. However, none of these regulations and laws
take specific legislation related to workplace bullying.

Introduction
Generally, nurse’s mental health refers to the psychological and emotional
well-being of nurses, who are medical professionals tasked with supporting
and caring for patients (Varghese et al., 2021). The ability of nurses to
deliver high-quality treatment depends on their ability to manage a variety
of mental health concerns, such as stress, anxiety, burnout, fatigue, work­
place bullying, and harassment (Cheung & Yip, 2017).
The high prevalence rates of bullying at an alarming rate in the workplace
is a significant concern for organizations (Grimard & Lee, 2020). According
to the Negative Acts Questionnaire-Revised (NAQ-R), workplace bullying is
known as engaging one or more individuals in unfavorable actions toward a
single person or a group of people in the workplace repeatedly (Matthiesen
& Einarsen, 2010). Verbal abuse, offensive behavior, intimidation, humili­
ation, and other actions that foster an unwelcoming and unhealthy work
atmosphere are examples of these behaviors (Salin & Hoel, 2013).
Additionally, bullying is described as aggressive behavior that injures other
people’s feelings in a situation of power disparity (Volk et al., 2014).
Workplace bullying is regarded as one of the most serious problems that
impair nurse’s mental health in their institutions (Ekici & Beder, 2014). It is
a challenge for all nurses, whether they have recently graduated or have work
experience (D’ambra & Andrews, 2014). Bullying can take many different
forms; nurses have described being ignored by coworkers or managers, given
difficult or impossible duties, humiliated, having their responsibilities with­
drawn or taken over by others, and being kept in the dark about facts that
might have harmed their performance and mental health (Wilson, 2016).
Bullying can be categorized into two main types: vertical bullying, which
involves persons in higher positions of power bullying others in lower
ones, and horizontal bullying which involves violent, aggressive, and dam­
aging nonphysical behavior—as manifested in words, deeds, attitudes, or
behaviors—directed toward a group or coworker (Waschgler et al., 2013).
In a review study performed by Bambi et al. (2018), it was reported that
 JOURNAL OF WORKPLACE BEHAVIORAL HEALTH 3

bullying prevalence ranges from 2.4% to 8%. Up to 75% of victims may

experience physical and mental aftereffects, and 10% of bullied nurses get
symptoms of post-traumatic stress disorder. On the other hand, horizontal
bullying involves bullying among coworkers who are on the same hierarchy
level (Zhang et al., 2022). In a systematic review, it was revealed that the
prevalence of horizontal bullying ranged from 6.8 to 73.1% among newly
graduated nurses (Kiprillis et al., 2022).
In Greece, it was estimated that 53.1% of doctors and 53.6% of nurses
were the targets of workplace bullying (Chatziioannidis et al., 2018).
According to studies, 15–36% of working individuals experience bullying at
work (Aoki & Guirardello, 2019; Edmonson & Zelonka, 2019; Wilson,
2016). While in a Jordanian study that was conducted by Al Muala and Ali
(2016) that reported 49.5% of respondents had experienced high levels of
bullying behavior and 50.5 % had experienced the same harmful behaviors.
Additionally, they confirmed that patients’ companions experience the
highest bullying reaching 27%.
Previous research looked at both individual and organizational concerns
such as job ambiguity, role conflict, excessive work demands, boring activ­
ities, and unclear responsibilities as the key risk factors for workplace bully­
ing. The aforementioned factors, such as organizational type, work
environment, management concerns, procedural justice deficiencies, inad­
equate psychosocial safety, and leadership style, may contribute to a rise in
the occurrence of bullying incidents inside the organization. (Feij� o et al.,
2019; Rajalakshmi & Gomathi, 2015).
Several studies found a relationship between the level of workplace bully­
ing and physical and psychological health that documented a negative
impact on job satisfaction, self-esteem, productivity, and loyalty to the
organization (Giorgi et al., 2015; Glambek et al., 2016; Havaei et al., 2020).
Furthermore, limited studies revealed a significant positive association
between workplace bullying and mental health (Itzhaki et al., 2015).
Similarly, some studies reported a significant positive association between
workplace bullying and psychological status among nurses that affect their
job performance, turnover intention, and job satisfaction (Al Muala & Ali,
2016; Chatziioannidis et al., 2018). Furthermore, it was thought that one of
the most prevalent psychological symptoms among nurses who had experi­
enced bullying at work was posttraumatic stress disorder (Verkuil et al.,
2015) which has main consequences of fatigue, insomnia, problems with
decision-making, anxiety, and depression (Warszewska-Makuch et al., 2015).
Nurses as the main healthcare providers to both clients and patients are
more likely to experience negative mental health consequences such as
depression, anxiety, and stress due to the demanding nature of their work
(Saleh et al., 2022). According to Maharaj et al. (2019), depressive
4 F. ABD AL-AL ET AL.

symptoms are more common among nurses than the general population,
which might be due to stressful work circumstances. This result was con­
cluded by a cross-sectional cohort study that recruited about 102 Australian
nurses in which there was a disclosed lack of satisfaction with their work
leading to depression and stress symptoms. In Jordan, the context of the cur­
rent status of bullying and nurse’s mental health is reported in a study con­
ducted by Al-Hassan et al. (2023) who found that about 48.8%, 25.9%, and
25.3% of the nurses, respectively, were labeled as "not bullied," "occasionally
bullied," and "severely bullied." Mild depression (M ¼ 12.11) and moderate
anxiety (M ¼ 10.92) were present in the participant nurses. Despite that, the
prevalence of bullying among nurses in the Jordanian context was addressed,
but the impact of exposure to bullying on mental health status with its asso­
ciation is still not fully addressed in the Jordanian context.
Measuring exposure to bullying in the workplace and its impact on men­
tal health among nurses is essential to uncover the seriousness of this issue
and motivate managers to develop policies and set strategies that control
bullying, consequently improving nurses’ mental health. The findings of
this study will add to the body of knowledge regarding workplace bullying
and its consequences on nurses’ stress, depression, and anxiety in the
Jordanian context. This will help decision-makers to identify areas for
improvement that provide nurses with a safe and bully-free workplace.
Hence, the purpose of this study is to assess the relationship between work­
place bullying and Jordanian nurses’ mental health.

Research questions
This study aimed to answer the following questions:

1. What is the relationship between perceived workplace bullying and

mental health among Jordanian nurses?
2. What are the predictors of workplace bullying in mental health, after
controlling nurses’ socio-demographic, and work-related factors?

Materials and methods

Design
A descriptive, cross-sectional, correlational design was used in this study.

Settings and sampling

Three Jordanian government hospitals provided the data. These were the
biggest hospitals in the chosen cities, offering general medical care to
patients in various departments. The first hospital employed 849 nurses
 JOURNAL OF WORKPLACE BEHAVIORAL HEALTH 5

and had 1,101 beds, making it the largest governmental hospital in

Amman. The second hospital, which has 493 beds and 379 nurses overall,
serves the East area of Zarqa, the second-largest city in Jordan. The third
hospital is a teaching-affiliated facility with 152 beds and 109 nurses overall
that is situated in the Balqa governorate (MOH, 2020).
The following eligibility criteria were used to choose a convenience sam­
ple of registered nurses to take part in the current study: (1) Jordanian
nurses; (2) possess a minimum of a Bachelor’s degree in nursing; and (3)
have worked as a nurse for a minimum of six months.
Based on the G�power, 139 individuals were the bare minimum needed
to reach 80% power, a medium effect size (0.15), and an a of 0.05 (Faul
et al., 2009).

Data collection procedures

After receiving the necessary permissions, a computerized self-report
questionnaire written in Arabic was used to gather the data. To confirm
the validity and reliability of the study, piloting was conducted before
initiating the main investigation. The pilot study objectives were to iden­
tify any potential issues and assess the research’s instruments and proce­
dures. A sample of twenty nurses who were representative of the target
population was used. The results of the pilot study also indicated that
the data acquisition took 15 to 20 min. The staff communication book,
the resting area’s message boards, and nurse managers at the nursing sta­
tion were all given access to the link to the permission form and
questionnaire.

Instruments
Demographic datasheet
Demographic characteristics of the participants including age, gender, edu­
cational level, monthly income, clinical unit, marital status, years of experi­
ence in nursing, and years of experience in the current hospital were
collected as the first section of the questionnaire.

The negative acts questionnaire-revised (NAQ-R)

This tool was developed by Einarsen et al. (2020) to measure the level of
bullying as a negative behavior. An Arabic version of the NAQ-R was used
in the current study that consists of 22 items that cover three types: per­
son-related bullying (12 items); work-related bullying (7 items), and physic­
ally intimidating bullying (3 items). All items were positively worded. Each
6 F. ABD AL-AL ET AL.

item is rated on a 5-point Likert scale ranging from one to five (1¼ Never,
2¼ Now and then, 3¼ Monthly, 4¼ Weekly, and 5¼ Daily). The total
scores range from 22 to 110 points. Higher scores mean higher degrees of
bullying; more specifically, participants with scores < 33 were not being
bullied, 33–45 were occasionally bullied, and >45 were severely bullied
(Einarsen et al., 2009). This tool is reliable since it showed high internal
consistency reliability (Cronbach’s a for the entire scale was 0.95 ranging
from ‘0.76 to 0.920 . Besides, the Arabic version shows reliability coefficients
for total and subscale scores ranging from 0.63 to 0.90 (Makarem et al.,
2018). The NAQ-R has received international validation in several studies
(Charilaos et al., 2015; Nielsen et al., 2011). As evidenced by substantial
associations with depression and life satisfaction (p < 0.05), the Arabic
NAQ-R demonstrated good concurrent validity (Makarem
et al., 2018).
In the current study, the internal consistency of the NAQ-R as reflected
by Cronbach’s a was 0.987 which showed excellent reliability based on pre­
vious studies (Charilaos et al., 2015).

Depression anxiety stress scales (DASS-42)

The DASS is a 42-item self-reported questionnaire that was designed to
measure negative emotional states of anxiety, depression, and stress
(Lovibond & Lovibond, 1995). An Arabic version of the DASS-42 was
used (Moussa et al., 2017). All items were positively worded and rated
using a 4-point Likert scale ranging from 0¼ does not apply to me to 3
¼applied to me very much, or most of the time. The total scores range
from 0 to 126 points. Each subscale is described by summing the scores
for the relevant items. The higher score reflects higher self-reported
symptoms. Each of the three DASS-42 subscales contains 14 items. The
depression subscale measures hopelessness, dysphoria, self-deprecation,
devaluation of life, lack of interest/involvement, anhedonia, and inertia.
The anxiety subscale measures autonomic arousal, situational anxiety, and
subjective experience of anxious affect. The stress subscale measures diffi­
culty relaxing, being easily upset/agitated, nervous arousal, irritable/over-
reactive, and impatient. The DASS-42 is a valid and reliable tool that has
Cronbach’s a with an adequate level for the depression, anxiety, and
stress scales of 0.91, 0.84, and 0.90, respectively. In regards to the Arabic
version, reliability coefficients for the three scales ranged from 0.90 to
0.93 (Moussa et al., 2017). In the current study, the internal consistency
reliability of the DASS-42 is reflected by Cronbach’s a which was 0.99.
Further, the discriminant and convergent validity was reported to be
adequate (Crawford & Henry, 2003).
 JOURNAL OF WORKPLACE BEHAVIORAL HEALTH 7

Ethical considerations
The study was ethically approved by the responsible committee at the
School of Nursing/ Zarqa University, and data collection sites that were
affiliated to the Ministry of Health (MOH#/ REC/2020/5). After getting
access to the potential participants; the researcher explained the purpose,
procedures, risks, and benefits of the study to participants. Participants
were assured that participation is entirely voluntary without coercion
and they were reminded of their right to withdraw from the study at any
time without being affected in any way. They were also told that their
responses and data would be kept securely. Restricting access to the col­
lected data to only authorized personnel who are directly involved in
data analysis was also maintained. Participants were asked to sign an
electronic form before participating in the study. The consent form was
signed by clicking accept and continue or decline and exit from the
questionnaire.

Statistical analysis
Data analysis was performed using SPSS version 19. Data coding was com­
pleted taking into account the variable’s level of measurement. After com­
pleting the data entry, data screening was done to check for any missing
data, inconsistency, or outliers. For all statistical analyses, the level of sig­
nificance was p < 0.05. Descriptive statistics were used to describe the char­
acteristics of the study’s socio-demographic characteristics such as mean,
standard deviation, and percentages. Inferential statistics including the
Mann-Whitney U test and the Kruskal-Wallis tests were used to identify
the differences and relationships between variables. Pearson correlation was
used to assess the association between nurse’s mental health status and
workplace bullying. Multiple linear regression (hierarchical model) was uti­
lized to model the relationship between a nurse’s mental health status and
workplace bullying.

Results
The average age of the 146 participants in this study was 31.39 (SD± 5.09)
years. The average experience of the participants was 5.9 (SD± 4.25) years
at the current hospital, 7.67 (SD± 5.87) years in the current unit, and 8.47
(SD± 4.88) years in nursing. The bulk of participants (61.6%; n ¼ 90/146)
were female, reported being married (59.6%; n ¼ 987/146), and had a bach­
elor’s degree (79.5%; n ¼ 116/146). They also reported caring for 8.72 (SD
± 8.03) patients per shift. See Table 1.
8 F. ABD AL-AL ET AL.

Table 1. Socio-demographic characteristics and work-related history (n ¼ 146).

Variables % (n)
Gender
Female 61.6 (90)
Male 38.4 (56)
Marital status
Single 40.4 (59)
Married 59.6 (87)
Education Level
BSN 79.5 (116)
MSN 20.5 (30)
Work unit
Medical 27.4 (40)
Surgical 20.5 (30)
Pediatric 16.4 (24)
ER 16.4 (24)
ICU, CCU, OR 19.2 (28)
Type of working shift
Fixed shift 19.2 (28)
Rotation shifts 80.8 (118)
Monthly income in Jordanian Dinars
< 400 18.5 (27)
400-600 63 (92)
> 600 18.5 (27)
Do you consider yourself a social person?
Yes 88.4 (129)
No 11.6 (17)
Do you consider yourself a nervous person?
Yes 40.4 (59)
No 59.6 (87)
Did you have any hospitalized relatives within the last 3 months?
Yes 43.2 (63)
No 56.8 (83)

Bullying at the workplace

The NAQ-R scale as a whole had an average score of 53.39 (SD± 22.2).
The individuals were generally subjected to bullying more frequently at
work (x̅ ¼2.47, SD± 1.01), then personally (x̅ ¼2.41, SD± 1.03), and finally
physically intimidating bullying (x̅ ¼2.36, SD± 1.03). Twenty-five percent of
the participants reported never or very never being bullied at work, but the
majority of participants (54.8%) reported being bullied frequently.

Description of bullying Acts

Eighty individuals responded to the supplementary questions, which asked
them to describe how they had been bullied at work. Most of them said
that while they were bullied by their coworkers 72% of the time (n ¼ 58),
they were bullied infrequently (44%, n ¼ 35). See Table 2.

Nurses’ mental health status

The mean score of the total DASS-42 scale was 43.45 (SD ± 34.27), while
the mean score of the depression subscale was 15.12 (SD ± 11.42), the
 JOURNAL OF WORKPLACE BEHAVIORAL HEALTH 9

Table 2. Description of the bullying acts (n ¼ 80).

Circumstances around bullying % (n)
Have you been bullied at work?
Yes, but only rarely 43.7 (35)
Yes, now and then 33.7 (27)
Yes, several times per week 20.1 (16)
Yes, almost daily 2.5 (02)
When did the bullying start?
During the past 6 months 21.25 (17)
6-12 last months 21.25 (17)
1-2 years 27.5 (22)
> 2 years 30.0 (24)
Who was bullied?
Just me 37.5 (30)
My colleagues 47.5 (38)
Everyone 15 (12)
Did you witness bullying during the last six months?
Never 6 (5)
Yes, few 45 (36)
Occasionally 40 (32)
Frequently 9 (7)
Who was the bully?†
The supervisor 65 (52)
A coworker 72 (58)
A subordinate 20 (16)
A customer/ student 32 (26)

Table 3. Episodes of depression, anxiety, and stress (n ¼ 146).

Depression Anxiety Stress
Category %(n) % (n) % (n)
Normal 35.6 (52) 41.1 (60) 53.4 (87)
Mild 7.5 (11) 2.1 (3) 13.7 (20)
Moderate 25.3 (37) 18.5 (27) 10.3 (15)
Severe 12.3 (18) 9.6 (14) 14.4 (21)
Extremely severe 19.2 (28) 28.8 (42) 8.2 (12)

anxiety subscale was 13.42 (SD ± 11.63), and the stress subscale was 14.9
(SD ± 11.75). Results showed that 64.4% (n ¼ 94/146) of participants exhib­
ited symptoms of depression, 58.8% (n ¼ 86/146) exhibited symptoms of
anxiety, and 46.6% (n ¼ 59/146) exhibited symptoms of stress. See Table 3.

Demographic factors influencing workplace bullying based on their variables

The analysis revealed that single participants (x̅ ¼61.14, SD ± 23.2) were
more likely to be bullied than married participants (x̅ ¼ 48.14, SD ± 20) and
participants who work in rotating shifts (x̅ ¼ 55.65, SD ± 22.97) were more
likely to be bullied than those working in a fixed shift (x̅ ¼ 43.86,
SD ± 15.82).

Demographic factors influencing nurses’ mental health status

Single participants had statistically significantly higher depression
(U ¼ 1971, p ¼ 0.017), anxiety (U ¼ 1966, p ¼ 0.016), and stress (U ¼ 2015,
10 F. ABD AL-AL ET AL.

p ¼ 0.028) scores than the married participants. Similarly, participants who

had a hospitalized relative within the last three months had higher scores
of anxiety (U ¼ 1950, p ¼ 0.009). The Kruskal-Wallis test showed a a signifi­
cant difference in depression scores between different work areas, (v2(4) ¼
11.3, p ¼ 0.023). The pairwise comparison revealed that nurses working on
the medical floors had statistically significantly lower depression scores
than those who work in other areas. Similarly, there was a significant dif­
ference in stress scores between different work areas (v2(4) ¼ 10.3,
p ¼ 0.035). The pairwise comparison revealed that the participants working
on the medical floors had significantly lower stress score than those work­
ing in other areas.

Association between workplace bullying, mental health, and demographic

variables
Pearson correlation analysis showed a strong significant relationship
between workplace bullying and mental health among Jordanian nurses
(r ¼ 0.75, p < 0.001). Further NAQ-R score had a strong positive relation­
ship with depression (r ¼ 0.73, p < 0.001), anxiety (r ¼ 0.75, p < 0.001), and
stress (r ¼ 0.74, p < 0.001). In the same context, age, years of experience in
the nursing profession, years of experience in the current hospital, and the
number of patients assigned to care by the nurse correlated significantly
with bullying and mental health status. See Table 4.

Predicting mental health by perceived workplace bullying

Multiple linear regression (hierarchical model) examined the unique contri­
bution of perceived workplace bullying on nurses’ depression, anxiety, and
stress. A hierarchical regression method was used, in which the demo­
graphical variables were entered in the first block, work history in the
second block, and workplace bullying score in the third block (Table 5).

Predicting nurse’s mental health scores

The third model was significant [F (8,73) ¼ 13.22; p < 0.001; adjusted R2 ¼
0.54]. According to the results (59%) of the total variation in the total
DASS-42 score can be explained by independent variables. The R2 of
change in the third model was 0.25. Only perceived workplace bullying was
a significant predictor in the third model.

Predicting nurse’s depression scores

The third model was significant [F (8,73) ¼ 14.5; p < 0.001; adjusted R2 ¼
0.57]. According to the results (54%) of the total variation in the
Table 4. Association between workplace bullying, mental health, and demographic variables.
1 2 3 4 5 6 7 8 9 10 11 12 13
1. Total Bullying (NAQ-R) 1.00
2. Work-related bullying .97�� 1.00
3. Person-related bullying .99�� .94�� 1.00
4. Physically intimidating bullying .95�� .91�� .94�� 1.00
5. Total DASS score .75�� .76�� .73�� .69�� 1.00
6. Depression .73�� .73�� .72�� .66�� .98�� 1.00
7. Anxiety .75�� .76�� .73�� .71�� .98�� .93�� 1.00
8. Stress .74�� .76�� .72�� .68�� .99�� .96�� .95�� 1.00
9. Age −0.40�� −0.35�� −0.41�� −0.39�� −0.29�� −0.30�� −0.27� −0.27� 1.00
10. Experience in nursing −0.37�� −0.31�� −0.39�� −0.36�� −0.26� −0.29�� −0.24� −0.23� .92�� 1.00
11. Experience in the current hospital −0.24� −0.21� −0.25� −0.21� −0.16� −0.20� −0.14 −0.15 .79�� .88�� 1.00
12. Experience in the current unit −0.18� −0.17� −0.19� −0.14 −0.12 −0.12 −0.12 −0.21 .61�� .68�� .78�� 1.00
13. Number of assigned patients/shift −0.28�� −0.26�� −0.28�� −0.26�� −0.12 −0.12 −0.10 −0.14 .19� .15 −0.10 .04 1.00
Notes: NAQ-R ¼ Negative act questionnaire-revised; DASS-42 ¼ Depression, anxiety, stress scales.
�Correlation is significant at the 0.05 level (two-tailed).
��Correlation is significant at the 0.01 level (two-tailed).
JOURNAL OF WORKPLACE BEHAVIORAL HEALTH
11
12 F. ABD AL-AL ET AL.

Table 5. Multiple linear regression analysis to predict nurses’ mental health scores (model 3).
B SE Beta t Sig.
(Constant) −2.724 1.769 −1.540 0.12
Age .891 1.269 .154 .702 0.48
Marital status .009 .071 .014 .129 0.89
Having hospitalized relatives within the last 3 months −0.033 .053 −0.049 −0.628 0.53
Number of patients/shift .099 .110 .072 .901 0.37
Experience in the nursing profession .060 .317 .041 .189 0.85
Workplace bullying 1.629 .243 .711 6.702 0.00�
�Results statistically significant at p < 0.05.

depression score can be explained by the independent variables. The R2 of

change in the third model was 0.15. The perceived number of nurses work­
ing in medical units was a significant predictor in the third model.

Predicting nurse’s anxiety scores

The third model was significant [F (8,73) ¼ 14; p < 0.001; adjusted R2 ¼
0.56]. According to the results (56%) of the total variation in the anxiety
score can be explained by the independent variables. The R2 of change in
the third model was 0.27. Perceived workplace bullying was the only sig­
nificant predictor in the third model.

Predicting nurse’s stress scores

The third model was significant [F (7,74) ¼ 17.8; p < 0.001; adjusted R2 ¼
0.59]. According to the results (59%), the total variation in the stress score
can be explained by the independent variables. The R2 of change in the
third model was 0.22. The perceived workplace bullying, the number of
abusive females, and working in medical units were significant predictors
in the third model.

Discussion
The current study revealed an alarming situation of workplace bullying
among nurses. Bullying at work is a very common occupational stress in
healthcare settings. It is linked to several detrimental effects on nurses (Al
Muala & Ali, 2016; Labrague et al., 2018).
In terms of ‘personal-related bullying’, the majority of nurses reported
spreading gossip and rumors about them as the most frequent negative act.
According to Bulduk et al. (2016), gossip is a way to express anxiety and
anger feelings; it reflects the inadequacies in the organizational structure
and the unclear staff responsibilities. This should be of interest to the nurs­
ing and hospital administrators, who must act to find the sources and rea­
sons for these rumors and act upon them early (Liff & Wikstr€ om, 2021).
Because power dynamics, tensions, and pressures are naturally present in
 JOURNAL OF WORKPLACE BEHAVIORAL HEALTH 13

the workplace, reports of bullying incidents at work may be more common.

Bullying at work may take the shape of unfair workload distribution, infor­
mation withholding, or undermining of teammates’ efforts. People may
report these behaviors more frequently than bullying behaviors that are
related to personal relationships since they are more obvious and have a
direct impact on the workplace. Additionally, bullying at work may have
more noticeable effects on productivity and job satisfaction, leading people
to voice their concerns (Homayuni et al., 2021). Besides, the most common
personal-related bullying act may be gossip because it might involve
spreading rumors, talking about personal concerns, or harming reputations,
and doesn’t always have to be done in a work-related environment.
Compared to other types of bullying that may be more confrontational or
overt, this conduct could be simpler to engage in. Furthermore, gossip can
damage relationships and lower morale, which increases the likelihood that
it will be reported (Karatas et al., 2017).
The least often reported type of bullying was physical-intimidating bully­
ing, which is consistent with previous studies in Jordan (Harb et al., 2021).
Nurses reported being shouted at or the target of spontaneous anger.
Compared to physical assault, verbal violence against Jordanian nurses is
significantly more common (Albashtawy, 2013).
Nurses in the current study revealed that they were mostly bullied by
their colleagues, which is a concerning finding that requires immediate
action, particularly since previous bullies of Jordanian nurses were mostly
clients/ visitors (Harb et al., 2021) or supervisors rather than colleagues.
Expectedly, as nursing is a highly demanding profession, nurses in the
current study showed moderate levels of depression and anxiety and mild
levels of stress. Several previous studies reported nursing as a stressful pro­
fession (Alnazly et al., 2021; Maharaj et al., 2019) and that stress levels
among nurses vary according to specific attributes. For instance, nurses in
governmental hospitals might have higher levels of stress than nurses work­
ing in private hospitals. This finding is congruent with results from a
recent study that examined Jordanian nurses’ psychological reactions
(Mihdawi et al., 2020) that reported elevated prevalence of depression, anx­
iety, and stress of 57.8%, 51.4%, and 50.1%, respectively.
Several factors were identified that affected nurses’ exposure to bullying
and their mental health status. Single nurses were more likely to be bullied
and subsequently, being bullied had a higher impact on their mental health
than married nurses. This is congruent with a previous study (Karatza
et al., 2017) where single nurses not only had higher exposure to bullying
but they had higher scores in each bullying subscale. This might be related
to age and experience; most likely single nurses are younger and less expe­
rienced, which might make them more vulnerable to bullying. On the other
14 F. ABD AL-AL ET AL.

hand, according to Alnazly et al. (2021), single nurses have lower social
support when compared to married nurses, anticipating higher levels of
mental health disturbances.
Further, nurses working in rotating shifts were more likely to be bullied
than those working on a fixed shift; during the night shifts, there is a lim­
ited number of administrative staff who supervise and monitor the nurses’
interaction. Also, the presence of supervisors controls people’s conduct and
prevents them from engaging in inappropriate acts (Albashtawy, 2013).
Additionally, working in a rotating shift affects nurses’ quality of life and
exposes them to sleep disturbances and stress (Harb et al., 2021).
Similarly, nurses working on medical floors had a higher incidence of
depression and stress compared with nurses working in other departments,
which might be due to the demanding workload, patient kind, prognostic
results, style of connection among nurses on the floor, and even the unique
characteristics of those nurses. A previous study by Mosadeghrad and
Ferdosi (2013) revealed that medical floor nurses reported high workloads
and time pressure as possible reasons for feeling distressed.
In terms of age and years of experience, it was found that younger and
less experienced nurses were bullied more frequently, and this had a higher
impact on their mental health. Furthermore, older nurses are more aware
of their rights and have years of experience, in which they have been
exposed to several situations that improved their adaptation and built their
capacity to respond appropriately to stressors. Our results conform to pre­
vious studies that reported similar findings (Chatziioannidis et al., 2018;
Mosadeghrad, 2013).
At work, nurse’s emotions have an impact on how the team thinks.
Negative act explains how an individual’s affect interacts with their cognitive
functions and influences a variety of behaviors (Vos et al., 2020). Exposure to
workplace bullying was associated with elevated depression, anxiety, and
stress levels. This is congruent with several previous studies (Harb et al.,
2021; Leventhal et al., 2020). Exposure to workplace bullying might cause
people to feel oppressed, and they may remember and re-live the bullying
experience frequently. This is consistent with a study performed by Conway
et al. (2021) who reported that exposure to workplace bullying is positively
correlated with and linked to mental health issues and physical symptoms
including anxiety, stress, depression, burnout, and PTSD.

Strength and limitations

It should be noted that the current study was conducted during the
COVID-19 pandemic, which may indirectly affect nurses’ responses due to
the stressful work environment and customizing the clinical practice to the
 JOURNAL OF WORKPLACE BEHAVIORAL HEALTH 15

emerging patient’s needs during the crisis. Besides, the sample size is rela­
tively small which could affect the generalizability of findings. Also, a con­
venience sample was used which could be a potential for bias and lack of
diversity among nurses. However, this study is one of the few studies that
examined the relationship between workplace bullying and mental health
status among Jordanian nurses.

Implications
To maintain a positive and productive work environment and to improve
patient care, it is essential to address workplace bullying among nurses
€
(Uzar- €
Ozçetin et al., 2020). Raise the awareness of nurses about the damag­
ing effects that bullying has on their well-being, collaboration, and patient
outcomes. Workshops, seminars, and training sessions should be organized
to increase awareness and advance a culture of professionalism and respect
among nurses. Besides, it is crucial to establish clear, thorough policies to
prevent bullying at work, and make sure that everyone on staff is aware of
these policies and has access to them. Furthermore, nurses should be
encouraged to report events without worrying about consequences by creat­
ing a confidential reporting system for bullying incidents.

Conclusions
Bullying incidents were more frequent against single nurses and those
who worked on rotating shifts. Nurses claimed that their female cow­
orkers and peers were the main targets of bullying. More than half of the
nurses in the current study had moderate depression and anxiety symp­
toms, and about half of them had mild stress-related symptoms, according
to their mental health status. Regardless of the nurses’ qualities, exposure
to workplace bullying interprets their symptoms of depression, anxiety,
and stress. To accurately ascertain the prevalence and effects of workplace
bullying on nurses’ mental health, thorough research should be con­
ducted. It is necessary to look at the prevalence, nature, and intensity of
bullying behaviors as well as their immediate and long-term impacts on
nurses’ psychological health.

Acknowledgments
The authors of this study want to thank all the nurses who participated in this study.

Disclosure statement
No potential conflict of interest was reported by the author(s).
16 F. ABD AL-AL ET AL.

ORCID
Nidal Eshah http://orcid.org/0000-0001-6392-4655
Ahmad Rayan http://orcid.org/0000-0002-8377-2297
Salam Bani Hani http://orcid.org/0000-0003-0848-5615
Mohammed ALBashtawy http://orcid.org/0000-0002-6107-7605

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