Nursing students' bullying experiences from instructors and nurses in the clinical practice: A qualitative systematic review and meta-synthesis

Objectives: Nursing students are more prone to bullying from clinical instructors and registered nurses during clinical practice than on campus. This bullying has physical and psychological effects on them, but it receives less attention. This review integrated qualitative studies of bullying by instructors or nurses experienced by nursing students during their clinical practice. Design: A qualitative systematic review and meta-synthesis. Data sources: The articles were sourced from PubMed, Cochrane Library, Embase, Web of Science, CINAHL, CNKI, Wanfang, and the retrieval time setting spanned from the inception to November 2023. Review methods: Published original studies of any qualitative research methods focused on bullying experienced by nursing students in clinical practice were included in this review. Two researchers independently screened titles and abstracts, assessed full-text articles for eligibility, and extracted data. The JBI Critical Appraisal Checklist for Qualitative Research (2024 edition) and meta-syntheses were used to assess, analyze, and interpret the methodological quality and findings from included studies. The Confidence in the Output of Qualitative Research Synthesis (ConQual) approach was used to assess confidence in the synthesized findings. Results: A total of 21 articles were included, yielding 110 research findings, which were integrated into 5 groups of results including 16 categories: the forms of experiencing bullying from the instructors and nurses in clinical practice of nursing students; the reasons nursing students experience bullying; the reactions and responses of nursing students to bullying; the negative impact of bullying on nursing students; the appeals of nursing students after experiencing bullying. Conclusion: This review shows the bullying experienced by nursing students in clinical practice, including forms and causes of bullying, responses when faced with bullying, as well as the impact on physical and mental health, self-efficacy, and sense of professional identity. Hospital managers and educators must collaborate to effectively reduce bullying incidents and consider future research on long-term impacts. Prioritizing comprehensive training programs and management mechanisms, strengthening supervision of departments and instructors, enhancing interactions between schools and hospitals, and paying attention to the physical and mental health of interns are urgent and necessary.