To stand back or step in? Exploring the responses of employees who observe workplace bullying.

Bullying remains a pervasive problem in healthcare, and evidence suggests systems in place are not utilised due to perceptions of ineffectiveness and inequity. This study examines bystander responses to bullying and factors that influence decisions to intervene. We explore relationships between bystanders' perceptions of psychological safety across three levels (organisation, supervisor and colleague) and reactions to witnessing bullying. We suggest psychological safety would be positively associated with the decision to intervene. Findings indicate the most pervasive reaction to witnessing incidents of bullying is to discuss with colleagues, a low-involvement reaction. We find perceptions of supervisory and organisational safety/support are positively related to high-involvement decisions such as formal reporting of the incidents, highlighting the importance of support from those in power. However, perceptions of collegial support may lead to low-involvement responses, which risk reinforcing and underpinning dysfunctional organisational dynamics by providing informal social and emotional responses that may substitute more formal organisational responses to this persistent problem. This study highlights the importance of support from individuals in power if bystanders are to feel comfortable making high-involvement interventions.

Supporting patients during their breast cancer journey: the informational role of clinical nurse specialists.

BACKGROUND: Research evidence suggests that a multidisciplinary team approach improves the outcomes of patients with breast cancer. However, limited attention has examined the extent to which the clinical nurse specialist's (CNS's) role can impact Irish patients' care, particularly given the novelty of this role in Ireland. OBJECTIVE: The objective of this study was to examine the informational role of CNSs in supporting Irish patients during their breast cancer journey and the extent of its impact on their care. METHODS: Three Irish breast cancer teams were investigated. A Picker questionnaire was administered to more than 100 patients per team who had completed treatment. Questions focused on the patients' journey from diagnosis through to treatment completion. Follow-up interviews with the teams' CNSs were conducted to achieve a deeper understanding of the care received. RESULTS: While patients reported an overall positive impression of their care, they were least satisfied with the amount of information and emotional support they received during their chemotherapy. Clinical nurse specialists commented that there is insufficient staffing in medical oncology to address this need in part because the ill-defined job description makes it difficult to quantify the impact of this role. CONCLUSIONS: The informational role of the CNS is inadequately recognized and is thus not currently able to fully address patients' care needs. IMPLICATIONS FOR PRACTICE: Clarification of the CNS's role description in oncology care in Ireland is needed as is sufficient CNS staffing to maintain the vital informational role of CNSs throughout the patients' breast cancer journey.