Abstract
Background: Workplace bullying in clinical learning environments is a growing global concern in nursing education, adversely affecting nursing students' psychological health, clinical learning experiences, and future workforce sustainability. However, empirical evidence from Sri Lanka remains limited.
Objective: To determine the prevalence of workplace bullying and examine its associations with psychological distress and clinical learning outcomes among nursing students during clinical placements.
Methods: A cross-sectional study was conducted among second- and third-year nursing students at a government nursing education institution in Sri Lanka. Census sampling included all eligible students (N = 240), of whom 220 participated. Data were collected using a validated self-administered questionnaire. Ethical approval was obtained from the Ethical Review Committee of KIU University, Sri Lanka. Data were analyzed using SPSS version 25 with descriptive statistics and Spearman's rank-order correlation.
Results: Among the 220 respondents, 96.8% were female, 63.2% were second-year students, and 36.8% were third-year students. Overall, 75.9% experienced at least one form of workplace bullying during the previous year. Non-physical bullying was most common (75.5%), followed by physical aggression (15.9%) and sexual harassment (9.1%). Frequent psychological consequences included frustration (57.3%), stress (55.0%), reduced self-confidence (52.3%), and emotional distress (41.4%). Bullying also negatively affected clinical learning, including reduced quality of patient care (38.6%), fear while providing patient care (33.6%), intention to leave the nursing program (28.6%) and hesitation in performing clinical procedures (22.7%). Workplace bullying was strongly correlated with psychological distress (ρ = .736, p < .001) and impaired clinical learning outcomes (ρ = .638, p < .001).
Conclusion: Workplace bullying is highly prevalent in clinical nursing education in Sri Lanka and is significantly associated with psychological distress and impaired clinical learning outcomes. Implementation of institutional anti-bullying policies, confidential reporting systems, mentorship programs, and staff training is essential to create safe and supportive clinical learning environments.
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Copyright (c) 2026 B.A.M.S.N. Damayanthi Damayanthi, Senarath Jayasena (Author)