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1. Nurse Leader Communication Skills Characteristics
Nurse Leader Communication Skills Characteristics ON Nurse Leader Communication
Skills CharacteristicsThe nurse leader must have strong interpersonal communication skills,
be able to effectively manage conflict, and be able to build and develop high functioning
teams. The purpose of this paper is for you to discuss a highly effective leader in your
organization following the criteria in items 1-5.Describe the characteristics of a highly
effective leader. Which of these characteristics does the leader exhibit?Describe the leader’s
communication skills with staff, physicians, other members of the interdisciplinary team,
peers, and executives. What techniques do they use to address sensitive topics and conflict?
Is it effective? Be specific.Discuss the types of interpersonal power they use to accomplish
work and overcome resistance to change.Describe the leader’s team(s). Are they high-
performing? If so, please explain why the team is high performing. If not, why does the team
not perform well?Discuss the leadership skills the leader uses to building and manage
groups and teams.ReferencesMinimum of four (4) total references: two (2) references from
required course materials and two (2) peer-reviewed references. All references must be no
older than five years (unless making a specific point using a seminal piece of information).
Peer reviewed references include references from professional data bases such as PubMed
or CINHAL applicable to population and practice area, along with evidence based clinical
practice guidelines. Examples of unacceptable references are Wikipedia, UpToDate,
Epocrates, Medscape, WebMD, hospital organizations, insurance recommendations, &
secondary clinical databases.StyleUnless otherwise specified, all the written assignment
must follow APA 6th edition formatting, citations and referencesNumber of
Pages/WordsUnless otherwise specified all papers should have a minimum of 600 words
(approximately 2.5 pages) excluding the title and reference pages.TextbooksDiane Huber
(2018)Chapters 7, 8, 9, 10, 20Nurse Leader Communication Skills
Characteristicsattachment_1attachment_2attachment_3Unformatted Attachment
PreviewOriginal Article Workplace violence against nursing staff in a Saudi university
hospital Hanan A. Ezzat Alkorashy1,2 Moalad3 RN, MScN BScN, MSc, PhD & Fawziah
Bakheet Al 1 Assistant Professor, Nursing Administration Department, Faculty of Nursing,
Alexandria University, Alexandria, Egypt 2 Assistant Professor, Nursing Administration and
Education Department, College of Nursing, King Saud University, Riyadh, KSA 3 Director of
Nursing Services, King Abdul Aziz Hospital and Oncology Center, Jeddah, Saudi Arabia
ALKORASHY H.A.E. & AL MOALAD F.B. (2016) Workplace violence against nursing staff in a
Saudi university hospital. International Nursing Review 63, 226–232 Background: Violence

2. against nurses is a major challenge for healthcare administrators. It is gaining more
attention because it has a negative impact on nurses, the quality of health care and health
organization. Common types of violence include physical harassment, sexual abuse,
aggression, mobbing and bullying. Patients, their relatives and co-workers are considered
the main perpetrators. Aim: To determine the prevalence rate of workplace violence against
nursing professionals in a university hospital in Riyadh, Saudi Arabia, most frequent type
and perpetrators as well as the contributing factors. Methods: This quantitative cross-
sectional study adapted a survey questionnaire from the Massachusetts Nurses Association
Survey on Workplace Violence/Abuse to collect data from a quota sample of 370 nursing
personnel. Results: Almost half of the participants had experienced violence in the
professional setting during the 12 months prior to the study. The majority of subjects
perceived workplace violence as verbal abuse. Nearly all nursing professionals identified
patients as the leading cause. Slightly more than half mentioned understaffing,
misunderstandings, long waits for service and lack of staff training and policies for
preventing crisis as contributing factors. Conclusion and Implications for Nursing and
Health Policy: The prevalence rate is extremely high among nurses in the targeted Saudi
university hospital. Saudi health as well as university hospitals’ administration and policy
makers should adopt and introduce a ‘zero tolerance policy’, set standards and develop
practical measures for preventing the incidence and for controlling the prevalence of
violence against nurses. Besides, healthcare organizations, particularly hospitals, can fulfil
their obligations to provide both staff and patients with more secure environment. Further
research on the topic is needed. Nurse Leader Communication Skills
CharacteristicsKeywords: Hospitals, Nursing staff, Saudi Arabia, Teaching hospital,
Workplace violence, mobbing, bullying, harrassment, abuse, violence Correspondence
address: Hanan A. Ezzat Alkorashy, Nursing Administration and Education Department,
College of Nursing, King Saud University, Riyadh, Saudi Arabia; Nursing Administration
Department, Faculty of Nursing, Alexandria University, Alexandria, Egypt; Tel:
+966553121296; Fax: +966118050835; E-mails: halkorashy@ksu.edu.sa;
hanan_alkorashy@yahoo.com. Conflict of interest No conflict of interest has been declared
by the authors. Funding This research project was ed by a grant #GSS-212-668 from the
“Research Center of the College of Nursing”, Deanship of Scientific Research, King Saud
University. © 2016 International Council of Nurses 226 Workplace violence against nursing
staff Introduction Workplace violence (WPV) is a serious organizational issue in all
countries and is strongly linked to inappropriate healthcare outcomes. According to the
World Health Organization (WHO 2002), WPV refers to occupational settings or incidents
wherein workers are threatened, abused or assaulted. Verbal harassment, abuse, threats
and bullying are common examples of WPV. Subtle behaviours and coercion are also
considered types of WPV (Dionisi et al. 2012, p. 398). WPV against nursing professionals
continues to increase within healthcare organizations (Kuehn 2010). The International
Council of Nurses (ICN) acknowledged WPV as a significant issue in nursing and requested
that attention be given to clinical issues and competence in dealing with violence (Franz
2010). Nursing professionals are the leading victims of WPV worldwide. Verbal misconduct
and threats by patients and other staff members against new nursing professionals are

3. common (Teferralikassa & Jira 2015). Teaching hospitals in Saudi Arabia, as in many other
countries, serve a large number of patients and provide patients with free services;
therefore, many patients seek medical and nursing care. However, the presence of medical
students and medical, nursing and paramedical staff lead to difficult working conditions and
hospital overcrowding and result in nurses’ overload, stress and lack of interest in work
(Teferralikassa & Jira 2015). Moreover, studies have shown that specific features of the
workplace site such as poor working conditions, poor lighting, low security, a high number
of hours worked and poor staffing are known risk factors for WPV (AbuAlRub & Khawaldeh
2014; Banerjee 2008). Additionally, nurses’ attitudes and witnessing previous workplace
assaults have been reported as risk factors contributing to future assaults (Spector et al.
2014). Concomitantly, no effective prevention protocol or official reporting method about
violence in Saudi healthcare settings is available. Literature review International studies
have reported high prevalence rates of WPV against nurses: ranging from 6% up to 74%
(Esmaeilpour et al. 2011; Kennedy & Julie 2013; Pai & Lee 2011; Speroni 2014; Talas et al.
2011). For the regional prevalence, several Arab studies have shown a rapid increase in the
prevalence of WPV against nurses and ranged between 7% and 91.6% (Abbas & Selim
2011; AbuAlRub & Khawaldeh 2014; Deeb 2003; Taher 2010). Concomitantly, in the
Kingdom of Saudi Arabia, the situation is comparable (Algwaiz & Alghanim 2012; Almalki et
al. 2012). © 2016 International Council of Nurses 227 An enhanced understanding of the
risk factors of WPV will help identify strategies to prevent WPV (Esmaeilpour et al. 2011).
The main factors influencing WPV include gender, age, education and previous experiences
(Taher 2010). Patients, relatives, healthcare workers, and visitors are common sources of
WPV (Angland et al. 2014; Esmaeilpour et al. 2011). Communication barriers can also result
in an increased risk of WPV (Shafipour et al. 2014). In this context, Shafipour et al. (2014)
stated that effective and appropriate communication is necessary between nurses and
patients for the delivery of health care. Impaired communication will result in the patients’
disappointment and anger. The negative consequences of widespread WPV significantly
affect the delivery of healthcare services, reducing the quality of care and increasing the
number of healthcare workers leaving the profession (World Health Organization (WHO)
2002). Aims of the study This study aimed to determine the prevalence rate of WPV against
nurses in a Saudi university hospital and to identify the common types, perpetrators and
precipitating factors of WPV, as well as its impact on nurses. Methods Setting and
Participants This cross-sectional study was conducted in an 860-bed university hospital in
Riyadh City, Saudi Arabia. It used a quota sample of bedside nurses (n = 425) and all head
nurses and charge nurses (n = 75). From the accessible population (n = 1232), the sample
size was calculated using the G*power 3.0 program. The number of subjects needed to
achieve an effect size of 0.3 (medium), a level of significance (a) of 0.05, and a test power (1
b) of 0.95 was 293. As the inclusion of participants was not random (convenience instead),
the sample was further increased by 15% to account for contingencies such as non-
response and/or potential drop-outs, bringing the final sample size to 500 nurses. Nurse
Leader Communication Skills CharacteristicsThe inclusion criteria were professional nurses
working in all/some of the shifts, those in technical or administrative positions, those with
at least 1 year of experience in the selected setting, and those who were willing to

4. participate in the study. Study instrument This study adapted the survey questionnaire
from the Massachusetts Nurses Association Survey on Workplace Violence/ Abuse, with a
permission. The questionnaire was developed in English language, validated and used in a
previous study conducted by the Massachusetts Nurses Association Congress 228 H. A. E.
Alkorashy and F. B. Al Moalad on Health and Safety and Workplace Violence and Abuse
Prevention (MNA 2008). The questionnaire contains 40 structured multiple-choice
questions related to the prevalence of WPV, forms and perpetrators as well as precipitating
factors for WPV. As the official language in the work setting is the English language, the
decision was no translation was required and the questionnaire was used in its original
language. A pilot study on 30 participants had been conducted. Two words were changed:
“Union representative” in question 13, was changed to “hospital security office” because
there is no union in KSA and in question 20, “Employer” was changed to “hospital” and
“tolerating undesirable behaviour, such as violence” instead of “zero tolerance policy”
because the latter was not clear for the most of the subjects in the pilot study. The reliability
for the tool was determined by Cronbach’s alpha (a = 0.7615). Data collection The self-
administered questionnaires were distributed to the participants after receiving approval
to conduct the study from the research/ethical committee and the administration of the
university hospital. The data were collected from March to May 2011. Perceptions of WPV
by violence experience and job category The results of this study revealed that more nurses
who had experienced WPV perceived it as verbal abuse (v2 = 27.838, P < 0.001), and
consider it as a serious problem (v2 = 107.484, P < 0.001) as compared with those who had
not experienced WPV. On the other hand, more nurses who had no experience with WPV
perceived it as physical attacks compared with those who had experienced WPV (v2 =
4.885, P = 0.027) (Table 1). Perpetrators and forms of violence Participants who had
experienced WPV in the 12 months prior to data collection (n = 175) were asked to indicate
the form and source of the violence. From all violence incidents (n = 1103), all the
participants identified patients as the main perpetrators (f = 204), followed by the patients’
relatives (f = 195). Verbal abuse was the most frequently reported forms of violence 435
(38.5%) exhibited by the 99 (56%) physicians, 89 (50.9%) patients and 82 (47.0%)
patients’ relatives. Followed by verbal or written threats, 289 (27.4%); and threatening
behaviours, 226 (19.6%) (Table 2). Precipitating factors of WPV Data analysis The data
were analysed using descriptive and inferential statistics. Spearman’s chi-square test had
been used to compare variables across groups and to investigate the relationship of selected
demographic characteristics with the perceptions of WPV. Several factors contribute to the
emergence of WPV against nurses. These include organizational, individual and situational
Table 1 Variance between the perceptions of WPV of those with and without WPV
experience Perception of nurses Ethical considerations The content and method of this
study was approved by the college of nursing administration, in the target Saudi university,
the research centre (IRB# 10-2576) and the ethics committee (EC# 14158) of the target
hospital setting prior to study conduction. The participants signed an informed consent
form after being informed about their information anonymity and voluntary participation.
Nurse Leader Communication Skills CharacteristicsResults From the 500 distributed
questionnaires, 404 were returned, resulting in a response rate of 80.8%. Among the

5. returned questionnaires, 34 were excluded due to insufficient answers or missing data.
Thus, 370 questionnaires (74%) were used for analysis. The majority of participants were
staff nurses (80.3%) and worked 8-h shifts (54.2%). Moreover, most of the nurse
participants were female (93.2%), aged 31–39 (35.8%) or 26–30 (24.8%), married (70%),
Asian (83.9%) and held a diploma degree (61.6%). © 2016 International Council of Nurses
Yes (n = 175) Definition Verbal abuse 147 (83.9) Verbal/written threats 117 (66.8)
Threatening behaviour 97 (55.7) Physical attack 82 (46.9) Sexual harassment 55 (31.6)
Sexual assault 41 (23.6) All of the above 36 (20.7) Seriousness of violence problem Very
serious 25 (14.0) Somewhat serious 56 (32.1) Not sure 17 (9.6) Not too serious 57 (32.6)
Not at all serious 21 (11.7) *Significant at P < 0.05. v2 (P) Suffered violence experience No
(n = 195) 133 121 103 106 73 57 46 (68.15) (62.3) (53.0) (54.6) (37.3) (29.2) (23.4)
27.838* (<0.001) 1.858 (0.173) 0.594 (0.441) 4.885* (0.027) 2.888 (0.089) 3.270 (0.071)
2.421 (0.075) 4 28 42 68 52 (2.1) (14.6) (21.5) (35.0) (26.9) 107.484* (<0.001) Workplace
violence against nursing staff 229 Table 2 Frequency of exposure to forms of violence from
different perpetrators as reported by nurses who experienced violence (n = 175) Form of
violence Verbal abuse Verbal/written threats Threatening behaviour Physical attack Sexual
harassment Sexual assault Total* Perpetrators f (%) Patient Patient’s Relative Physician
Supervisor Nurse Others Total† 89 42 30 34 8 1 82 46 52 9 6 0 99 39 33 0 6 0 64 69 32 0 5 5
83 40 26 10 16 0 18 (10) 53 (30) 53 (30) 0 (0.0) 44 (25) 9 (5) 177 435 (38.5) 289 (27.4)
226 (19.6) 53 (5.03) 85 (8.1) 15 (1.4) 1103‡ (50.9) (23.8) (17.2) (19.6) (4.7) (0.8) 204
(47.0) (26.1) (29.7) (5.2) (3.4) (0.0) 195 (56) (22.0) (18.6) (0.0) (3.4) (0.0) 177 (36.4)
(39.4) (18.2) (0.0) (3.0) (3.0) 175 (47.2) (22.6) (15.1) (5.7) (9.4) (0.0) 175 *Exposure to
specific perpetrator. †Exposure to specific form of violence. ‡Total number of violence
incidents of all forms from all perpetrators. factors. The findings indicated that
understaffing, particularly during meal times and visiting hours, was the most frequently
reported factor (53.6%) by the participants. Moreover, “misunderstandings” was cited due
to the communication barrier among nurses and patients (54.4%) and “working directly
with volatile individuals” (42.5%). About a third (32.6%) of the participants reported “long
waits for service” and a similar proportion (31.9%) cited “inadequate security” as factors
leading to WPV. “Lack of staff training and policies for preventing crisis” was the only
organizational factor that showed a statistically significant difference between groups (v2 =
5.375, P = 0.020); it was reported more frequently by staff nurses (24.9%) than by nurse
managers (12.3%) (Table 3). Table 3 Precipitating factors of WPV reported by participants
according to job category (n = 370) Factors Organizational factors Working when
understaffed Poor environmental design Lack of staff training and policies Overcrowded,
uncomfortable waiting rooms Unrestricted movement of the public Poorly lit corridors,
rooms, parking lots Individual factors Working directly with volatile people Working alone
Drug and alcohol abuse Personal problem of co-worker Misunderstanding Situational
factors Inadequate security Concern of patients Access to firearms Transporting patients
Long waits for service *Significant at P < 0.05. © 2016 International Council of Nurses Nurse
Mgrs (n = 73) Staff Nurses (n = 297) Total v2 (P) 35 3 9 5 6 1 (47.9) (4.1) (12.3) (6.8) (8.2)
(1.4) 163 35 74 38 20 10 (55.0) (11.8) (24.9) (12.8) (6.7) (3.2) 198 38 83 43 26 11 (53.6)
(10.4) (22.5) (11.7) (7.0) (2.8) 1.169 3.790 5.375* 2.021 0.207 0.712 (0.280) (0.052)

6. (0.020) (0.155) (0.649) (0.399) 26 13 12 10 40 (35.6) (17.8) (16.4) (13.7) (54.8) 131 47 40
59 161 (44.1) (15.7) (13.4) (19.8) (54.3) 164 62 54 72 210 (42.5) (16.1) (14.0) (18.7) (54.4)
1.739 0.204 0.449 1.456 0.006 (0.187) (0.652) (0.503) (0.228) (0.941) 30 15 1 12 22 (41.1)
(20.5) (1.4) (16.4) (30.1) 88 64 3 41 99 (29.7) (21.7) (1.0) (13.7) (33.2) 118 79 4 53 121
(31.9) (21.5) (1.0) (14.2) (32.6) 3.533 0.049 0.098 0.353 0.257 (0.060) (0.826) (0.755)
(0.552) (0.612) 230 H. A. E. Alkorashy and F. B. Al Moalad Discussion The findings of this
study revealed that nurses’ perceived level of WPV was lower than that of previous studies.
Various factors that may trigger violent incidents against nurses in hospital settings were
identified. Jordan et al. (2010) argued that nurses’ perception of WPV is subjective;
therefore, it may be interpreted in different ways. Howard (2011) found that participants
perceived some acts as more representative of WPV than others. Nurse Leader
Communication Skills CharacteristicsThis is consistent with the current study findings,
which showed the participants’ varied perceptions of the definition of WPV and their lack of
understanding of the term. Almost all the nurses regarded WPV as verbal abuse and
verbal/written threats. In the present study, nurses who had experienced violence defined
it as verbal abuse, while those who had not experienced violence perceived it as a physical
attack. Most participants did not perceive violence as a serious problem in their work
setting. Thus, nurses are not fully aware of the violence occurring around them. This result
is consistent with that of Mueller & Tschan (2011), who found that nurses usually perceived
violent incidents by the patients as less serious than violent incidents by the employees.
They also found that workers in healthcare institutions often bear with the patients’ violent
behaviours in clinical settings. In the present study, the participants who had experienced a
violent incident were asked about its causes. The most commonly reported causes were
miscommunication and anger. Miscommunication was a frequently cited cause because
most of the participants were non-Arab nurses and most patients and their families did not
speak English, which created a communication barrier. Additionally, interpersonal
communication between the staff members was occasionally ineffective because the nurses
belonged to different nationalities and had different cultural backgrounds, principles,
values, attitudes and experiences. This cultural diversity can increase the risk of
interpersonal conflict, leading to violence. Hahn (2010) also found that impaired verbal
communication about therapeutic planning is associated with an increased risk of WPV.
Nursing professionals should know that the patients and their visitors could show
inappropriate emotions, aggressiveness and violent behaviour at the time of treatment.
These factors are the leading causes of WPV (Bowie et al. 2002). Taher (2010) suggested
that thorough and respectful communication with patients and their companions must be
initiated in the early stages of treatment. Communication with patients should include
clarifying expectations and explaining standard procedures, which would lessen frustrating
situations. Nurses are one of the professional groups who are at risk of WPV (Gates et al.
2011). In the current study, approxi- © 2016 International Council of Nurses mately half of
the subjects suffered from at least one form of WPV in the year prior to data collection. This
result is consistent with those of many studies conducted in Arab and foreign countries. The
incidence rate of WPV in these studies ranged from 50% to 86% (Almalki et al. 2012; Lim et
al. 2010; Newman et al. 2011). The findings of this study revealed that patients and their

7. families were the most frequent perpetrators of violence against nurses. This finding is
inconsistent with the findings of other studies examining WPV in healthcare settings (Al-
Omari 2015; Cashmore 2012; Fujishiro et al. 2011; Pai & Lee 2011; Taher 2010). Fujishiro
et al. (2011) revealed that nursing colleagues, seniors, managers and doctors were the
primar …Nurse Leader Communication Skills Characteristics