Workplace Bullying Among Nursing Students: Prevalence, Consequences, and the Bullying-to-Attrition Cascade Framework

Aim To examine prevalence, perpetrators, and multidimensional consequences of workplace bullying among nursing students, and to propose the Bullying-to-Attrition Cascade Framework (BACF) as a theory-informed explanatory model. Background Workplace bullying, workplace violence, and incivility within clinical learning environments threaten students' wellbeing, skills development, professional identity, patient safety, and workforce retention. Design : A cross-sectional survey sampled 102 BSc Nursing students following a four-month clinical placement across eight Kenyan referral hospitals. Methods A validated, adapted Negative Acts Questionnaire-Revised (NAQ-R) was administered electronically. Descriptive and inferential statistics deployed R (v4.3.1). Results Workplace bullying prevalence was 79.4%, while 78.4% had witnessed another student being bullied. Qualified nurses/midwives were the most dominant perpetrators (72.8%), followed by patients/relatives. Predominant consequences: emotional/mental health impacts, impaired learning, reduced teamwork, perceived negative effects on patient care, and intention to leave nursing. Chronic bullying and female gender independently predicted adverse mental health outcomes (aOR = 4.08; 3.2). Conclusion Workplace bullying is highly prevalent within Kenyan clinical training environments. The BACF offers multiple intervention points for nursing education, policy reform, and health-system strengthening aligned with SDG 3.