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

Abstract Aims 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. Design Systematic review and meta‐analysis. Data sources 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. Review methods Two reviewers independently assessed eligibility, extracted data and conducted quality assessment. Based on the extracted data, three separate meta‐analyses were conducted. Results 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. Conclusion 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. Impact 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.