High stress during clinical practicum placement is associated with bullying among nursing students: A mixed-method study.

Background: Nursing students are often subjected to bullying during their clinical practices, but few study has examined associations of bullying with psychological status among these groups, and how they cope with the bullying.

Objectives: This study aimed to evaluate the experience and psychological status of clinical placement setting bullying among nursing students attending clinical practices, and explore students' coping strategies when bullied.

Design: A mixed methods.

Settings: Six tertiary hospitals in Northwest China.

Participants: A total of 687 nursing students completed the questionnaire survey, of which 18 nursing students participated in the qualitative interview.

Methods: A two-phase hybrid study was produced. During first phase, data were collected by using the Bullying Behavior Scale in Nursing Education (BNEQ) and the Depression, Anxiety and Stress Scale (DASS-21). Subsequently, those who have experienced bullying in the workplace were invited to participate in a face-to-face interview (second phase) which focused on exploring students' deeper insights.

Results: Of the 687 students involved, 72.19 % had experienced various types of bullying. Of them, 92.11 % experienced implicit violence. Those with higher education levels and from rural were more likely to experience bullying. Students were prone to greater psychological stress when exposed to bullying. "Pretending not to see" (33.16 %), "reporting to superiors" (30.10 %), and "doing nothing" were the most common ways students responded. Four themes were obtained from the qualitative interviews: (a) impaired self-esteem; (b) career rejection; (c) psychological stress; and (d) the decline of humanistic care.

Conclusion: Our findings suggest that senior nursing students experience multiple types of bullying during the clinical practices, leading to a high level of psychological stress, which further effect students' professional approval and self-esteem. To prevent such incidents, we need to call on university and hospitals' support to help students successfully cope with bullying.