Bullying in nursing evaluated by the Negative Acts Questionnaire-Revised: A systematic review and meta-analysis

To report a synthesis of the empirical studies that used the Negative Acts Questionnaire-Revised (NAQ-R) to assess bullying among nurses based on evaluation of the psychometric properties and use and usability of the instrument and identification of the variables associated with bullying.

Systematic review and meta-analysis.

Four databases were used in the literature search: PubMed, CINAHL, PsycINFO and Scopus. The search was limited to original publications describing results of empirical studies written in English or Polish and published in peer-reviewed journals between 2002 and 2018.

Two reviewers independently assessed eligibility, extracted data and conducted quality assessment. Based on the extracted data, three separate meta-analyses were conducted.

Thirty-one articles were included in the review, 13 of which were selected for meta-analysis. In studies where participants reported bullying (N = 19), its prevalence ranged from 17-94%. Variables most often associated with bullying were age, educational level and years of professional experience. Usability of this instrument in different countries was supported by a high reliability in each study. In two meta-analyses, which included 12 studies with mean NAQ-R and item scores, the heterogeneity of data was calculated as high and moderate respectively.

The good quality of the NAQ-R in determining variables related to bullying is endorsed. Variables related to bullying identified in this review could be used to map out a model of a potential bullying victim for preventative measures.

The NAQ-R is a useful and reliable tool for measuring bullying among nurses; however, there remains a strong need to assure that a verified, standardized and updated bullying taxonomy is used in future studies to ensure reliable and comparable data. A model of a potential bullying victim may help nursing directors foster a healthier workplace environment, thereby improving patient outcomes in the long-term.