Workplace Bullying, Compassion Fatigue, and Organizational Silence Among Perioperative Nurses: A Cross-Sectional...

In operating room settings, organizational silence can hinder timely communication about safety concerns and may adversely affect surgical care. Drawing on conservation of resources (COR) theory, this study investigated how workplace bullying and compassion fatigue were associated with organizational silence among perioperative nurses. It also examined whether compassion fatigue conditioned the association between workplace bullying and organizational silence.

A multicenter cross-sectional study was conducted with 305 perioperative nurses from teaching hospitals in Iran. Participants were recruited through a multistage cluster sampling procedure. Data were obtained using validated measures, including the Workplace Bullying Questionnaire, the compassion fatigue subscale of the Professional Quality of Life Scale, and the Organizational Silence Behavior Scale. Descriptive statistics, Pearson correlation analysis, and hierarchical moderated regression were used to analyze the data.

Perioperative nurses reported moderate scores for workplace bullying and compassion fatigue, while organizational silence scores were comparatively high. Workplace bullying (β = 0.35, p < 0.001) and compassion fatigue (β = 0.27, p < 0.001) were each positively associated with organizational silence. The interaction between workplace bullying and compassion fatigue was also positive and statistically significant (β = 0.18, p = 0.002; total R² = 0.34), indicating that the association between workplace bullying and organizational silence was stronger at higher levels of compassion fatigue. Organizational silence scores were also higher among nurses employed on temporary contracts than among tenured staff.

The findings support a resource-oriented interpretation within COR theory, suggesting that workplace bullying and compassion fatigue are associated with greater organizational silence among perioperative nurses. Healthcare administrators should consider integrated workplace interventions that combine antibullying policies with psychological support strategies to reduce silence-promoting conditions and support nurses' willingness to voice safety-related concerns.

Nurse managers should address organizational silence through integrated strategies that combine antibullying policies, psychologically safe reporting systems, and compassion fatigue-focused support programs. Such interventions may help reduce silence-promoting conditions and support perioperative nurses' willingness to raise patient-safety concerns.