Skip to main content
  • Original research article
  • Open access
  • Published:

Association of quality of nursing care with violence load, burnout, and listening climate



Violence against nurses is common. Previous research has recommended further development of the measurement of violence against nurses and integration of the individual and ward-related factors that contribute to violence against hospital nurses. This study was designed to address these issues by investigating the associations between violence, the listening climate of hospital wards, professional burnout, and perceived quality of care. For this purpose, we used a new operationalization of the violence concept.


We sought nurses to participate in the study through social media which yielded 765 nurses working in various healthcare systems across Israel who volunteered to complete a self-administered online questionnaire. 80% of the sample were hospital nurses, and 84.7% were female. The questionnaire included validated measures of burnout, listening climate, and quality of care. Instead of using the traditional binary measure of exposure to violence to capture the occurrence and comprehensive impact of violence, this study measured the incremental load of violence to which nurses are subjected.


There were significant correlations between violence load and perceived quality of care and between constructive and destructive listening climates and quality of care. Violence load contributed 14% to the variance of burnout and 13% to the variance of perceived quality of care. The ward listening climate moderated the relationship between burnout and quality of care.


The results of this study highlight the impact of violence load among nurses and the ward listening climate on the development of burnout and on providing quality care. The findings call upon policymakers to monitor violence load and allocate resources to foster supportive work environments to enhance nurse well-being and improve patient care outcomes.


Workplace violence is a global ‘epidemic’ that affects all healthcare professionals [1, 2]. Workplace violence includes incidents of threats, assault, and other offensive behaviors (including physical beating, kicking, slapping, stabbing, shooting, pushing, biting, and pinching), as well as incidents of psychological violence like rudeness, yelling, interrupting, bullying, undermining, and ignoring [3, 4]. Such violence has been recognized as an occupational hazard, and its negative consequences are well-known [5, 6]. By the early 1990s, the recognition of workplace violence toward nurses as an occupational risk in psychiatric settings was extended to other types of settings [7]. Since then, the great increase in research into workplace violence has contributed to raising awareness of the problem [8,9,10]. The COVID-19 pandemic has seen an increase in workplace violence with higher numbers of incidents of physical violence and verbal abuse and more difficulty in reporting incidents to management [10,11,12,13].

Workplace violence often increases the levels of distress, anxiety, depression, dissatisfaction with work, exhaustion, poor well-being, and other negative consequences for individuals [10, 14, 15]. On the organizational level, workplace violence is linked to higher turnover, lower morale, poor or missed nursing care, and increased burnout [16,17,18]. This is of great importance because nursing stands out as the profession with the highest levels of professional burnout [19,20,21]. This manifests as a progressive psychological response to chronic work stress with three main dimensions: (1) emotional exhaustion, (2) depersonalization, and (3) decline in professional efficacy [22, 23].

Consequences of burnout in nurses include poor physical health, diminished mental health, decreased self-compassion, work–home conflicts, decreased job satisfaction, and impaired work performance. Furthermore, there are associations between burnt-out nurses with higher numbers of medical errors, suboptimal patient care, and lower levels of work involvement – all of which have adverse effects on patients, threaten nurse retention, and increase hospital costs [24,25,26,27].

Workplace violence occurs within an organizational climate, which can moderate the condition in either direction [28]. Organizations with a pervasive safety climate are firmly committed to protecting patients and nurses from harm. This commonly involves promoting open, non-punitive communication regarding adverse events, and commitment to learning from such events to avoid their recurrence [29]. An organizational climate may also moderate the relationships between workplace violence and workers’ engagement [30]. More specifically, an organizational climate that emphasizes the quality of the provider-patient relationship and the quality of listening may mitigate workplace violence against nurses [31,32,33,34].

Listening has three components: (1) attention (to the speaker), (2) comprehension (of the speaker), and (3) (positive) intention (e.g., being empathic and non-judgmental) [35,36,37]. A constructive listening climate is present when one perceives the other person as paying attention to him/her, understanding him/her, and relating to him/her positively (non-judgmental, empathic, etc.). The dysfunctional opposite is defined as destructive [38]. Studies suggest that the ward’s climate of constructive listening may reduce nurses’ exposure to workplace violence [38, 39].

Classically, workplace violence has been viewed by researchers as part of a hospital’s quality dashboard, with hospital management recommended to examine trends in workplace violence incidents over time, evaluate the effects of workplace violence across units, and implement prevention programs [40]. However, monitoring workplace violence requires data concerning the magnitude of workplace violence across hospital units [40]. Previous studies on violence against nurses reduced it to a binary measure (i.e., exposed vs. not exposed). This binary approach fails to establish a measurement of the extent of exposure to workplace violence. Notably, a high prevalence of exposure in all areas invalidates comparisons across units [10]. This perspective ultimately monitor the continuum of workplace violence towards nurses: from no exposure at all to high exposure to workplace violence (i.e., more continuous properties). To address this issue, we have extended the measurement of violence by considering the exposure load of workplace violence on a continuum, namely, “Violence Load.”

Although there has been extensive research focused on workplace violence towards nurses, burnout, and the effect on quality of care, very few studies have focused on the relevant factors at the organizational level. In line with the recommendations of eminent researchers, we studied both personal and context-related factors of workplace violence [41]. Thus, this study were to examine the (a) associations between violence load, burnout, and quality of care, b) associations between the ward’s listening climate, nurse’s burnout, and quality of care, and (c) the mediating effect of burnout on the relationships between ward’s listening climate and violence load to quality of care. The study model is shown in Fig. 1.

Fig. 1
figure 1

Path diagram with standardized regression coefficients (Beta). Notes. *p < .05, **p < .01, ***p < .001. Controlling for age, tenure, and gender. Coefficients in parenthesis are the direct (bivariate) association between variables. For Listening climate (as depicted in its rectangle): coefficients above the regression line reflect “Constructive” climate, while coefficients below the regression line reflect “Destructive” climate. The model boasts superior fit (Byrne, 2010): χ2(df) = 16.30 (2), p = .072; SRMR = .05; CFI = .96; NFI = .96; TLI = .92; GFI = .99; RMSEA (90% CI) = .08 [.05-.14], p-close = .058


Sampling method

The minimum a priori sample size for the study, with a standard α error probability of 5%, power of 95%, and a fixed effect size of 0.15, was estimated by G*Power (v. statistical software as n = 138 (and n = 204 for the effect size of 0.10). We therefore considered a sample size above 204 (as the stricter upper bound) as adequate for subsequent analysis.

A digital link to the anonymous online questionnaire was circulated among nurses via social network platform for specific nursing groups (Facebook and WhatsApp) from May to July 2020. We invited nurses to fill out the questionnaire with the following statement: “Staff nurses, please access a questionnaire that deals with violence towards nurses. We appreciate your time, and you can fill out the questionnaire using your preferred device.” This distribution method allowed us to reach out to nurses from different healthcare organizations and enabled the participants to respond anonymously to this sensitive topic. Before data collection, we conducted a pilot study among ten nurses to assess respondents’ understanding of the questionnaire.

Out of 1332 potential respondents who accessed the web link of the questionnaire, we excluded those with empty records and obtained a final sample of 765 nurses. Notably, this 58% response rate is above the response rate found in a meta-analysis on the adequacy of response rates in online surveys [42].


The study survey examined (a) exposure to violence load, (b) the ward climate of listening, (c) burnout, (d) quality of care, and (e) socio-demographic characteristics. The measures used in the current research were translated from the original English into Hebrew by the back-translation procedure [43]. All measures had adequate psychometrics. Four experts, two senior researchers, and two senior nurses who study violence at work reviewed the instruments for relevance and clarity. They suggested a few changes in wording, which were accepted and incorporated into the final version of the survey. The full questionnaire can be supplied upon a reasonable request.

Violence Load was assessed by a scale of nine items relating to verbal and physical violence in the last 6 months [3]. The types of violence are verbal violence, verbal threats, destruction of property, minor physical violence, severe physical violence, use of a weapon or a sharp object, sexual harassment, and social shaming (Additional file 1). The respondents were asked to rate their experience of violence as: (1) never, (2) yes, exposed to patient-perpetrated violence. This study exclusively examined patient-perpetrated violence. In order to acquire continuity and relativity for this binary construct, the overall score was derived as follows: (A) When the participant replied “yes” once, they were given a score of 1 for violence ; (B) when the answer “never” was selected, the score given as 0; (C) the responses were summed to obtain an incremental increase in Violence Load and create a continuous variable with higher statistical variability, instead of a dichotomous response construct, such that higher scores represent higher violence load, and vice versa (i.e., higher scores reflect “higher load,” or occurrence/frequency, of violence). The final variable can be regarded as continuous, although a reliability coefficient could not be calculated.

Quality of care was assessed by six items previously used to measure the reported quality of nursing care in the context of abusive behaviors [38]. For example, “In my ward, the treatment of patients who demonstrate violence behavior is incomplete” or “The level of care for violent patients, as compared to other patients in my ward, is low.” Respondents were asked to rate each item on a Likert scale ranging from 1 (strongly disagree) to 7 (strongly agree). The overall score was represented by the mean. A higher mean score indicated a lower quality of care (a higher impairment of the quality of care) of sexually harassing patients.

Respondents were asked to rate each item on a scale from 1 (strongly disagree) to 7 (strongly agree). One item was recoded. The overall score was represented by the mean of the construct, with a higher score indicating a higher quality of care. Reliability (Cronbach’s Alpha Coefficient) was adequate, α = 0.78 [44].

Burnout was assessed using the 14-item Shirom-Melamed Burnout Measure [45]. Participants were asked to rank the statements on a scale from 1 (never) to 7 (always). A high mean score reflects high burnout. The reliability (Cronbach’s Alpha Coefficient) was high α = 0.9. For example, “I feel physically fatigued” and I am too tired to think clearly.

Ward’s climate of Listening to Patients was assessed using measurements of both perceived “constructive” and “destructive” listening [35, 36]. Respondents were asked to rate nine items (six items for constructive listening climate, and three destructive listening climate) on a scale from 1 (never) to 7 (always). Example items are: “When nurses listen to patients, they listen carefully” and “When nurses listen to their patients, they try to understand what the patient is saying.”

The overall score was the mean value of the totals. The reliability (Cronbach’s Alpha Coefficient) for constructive climate was high, with α = 0.91, and was adequate for destructive climate, with α = 0.75.

Socio-demographic data included gender, age, institution, specialty, place of birth, seniority, profession, form of employment, and position.

Ethical considerations

The Institutional Review Board of Jerusalem College of Technology, the academic institution with which the first author is affiliated, granted ethical approval for this study (Approval #: 0313 − 17). The study adheres to Helsinki 1964 guidelines on ethics. Following the ethical approval, participants received a brief written explanation about the study’s aims. They were informed that the data collected would only be used for publication and statistical analysis. Completing the questionnaire served as consent to participate in the study.

Data analysis

After demographic frequency analysis to test the research model (see Fig. 1), zero-order Pearson correlations were calculated to assess the baseline associations between the research variables.

Structural equation modeling was employed to assess the study model and the prevalence of common-method bias [46, 47]. Common method variance exists when the shared variance among variables is not due to the true underlying interrelationships but rather due to the measurement itself, namely self-reported data. Common method bias is a systematic error that can arise when respondents consistently rate items in a certain way, regardless of the actual relationships between the items [47]. Structural equation modeling was used because it allows researchers to model and analyze complex relationships among variables, handle both observed variables (measured variables) and latent variables (unobserved constructs), with more than one criterion, making it suitable for capturing intricate relationships that go beyond simple correlations [46, 48]. In addition, Structural equation modeling addresses measurement errors by allowing researchers to model the relationships between latent variables and their corresponding observed indicators enhancing the accuracy of the estimation of the tested relationships between variables in cross-sectional studies [46].

Two methodologies were employed to test the possible impact of common-method variance on the results [ 49,50]. These are (a) Harman’s single-factor method (all items are loaded on one common factor) and (b) a common latent factor method (all items are loaded on two types of factors – their expected factors and one latent common method factor). Analysis by Harman’s single-factor model accounts for only 21.81% of the explained variance and is a good fit [11, 46, 48,49,50]. Indices were: χ2(2696) = 8,491.17; p = .000; χ2/df = 3.15; Comparative Fit index = 0.78, Normed fit index = 0.75, The goodness of fit index = 0.86, SRMR = 0.13, and the root mean square error of approximation [90% CI] = 0.18 [0.14-0.29], p-close = 0.004. In contrast, the common latent factor model explained 20.37% of the explained variance: χ2(2583) = 6,741.63; p = .000; χ2/df = 2.61; Comparative fit index = 0.81, Normed Fit Index = 0.80, The goodness of fit index = 0.88, the difference between the observed correlation and the model implied correlation matrix was = 0.10, and the root mean square error of approximation [90% CI] = 0.11 [0.05-0.16], p-close = 0.017. Notably, these findings do not exclude the presence of common method bias [47]. However, as previously reported [47], we note that if the variance explained by the first emerging factor is less than 50% (R 2 < 0.50), then, in conjunction with a poor model fit for each analysis, common method bias is an improbable explanation of our findings (see also Table 1).

Table 1 Pearson zero-order correlation matrix and descriptive statistics (n = 765)

Finally (Fig. 1), Structural equation modeling was also utilized [49] to test the mediation model, and full mediation analysis was employed with bootstrapping (95% bias-corrected confidence intervals and 5,000 re-samples; [46,47,48,49,50]. Bootstrapping can counteract any potential skew of the data from a normal distribution. In this case, the predictors are violence load and listening climate, while the mediator is nurses’ work burnout, and the criterion is the quality of care.

This study complied with STROBE guidelines [51].



The research sample comprised 765 nurses, with females accounting for 84.7% of the sample. The persons in the sample ranged in age from 24 to 68 years (M = 41.48, SD = 9.97). Hospital nurses comprised 80% of the sample. Seniority in nursing ranged from 1 to 42 years (M = 10.35, SD = 9.18). Additional data are presented in Table 2. It is paramount to note that although most respondents were hospital nurses, we analyzed the data with and without the non-hospital participants. Since the changes in statistical results were negligible, we decided to keep the non-hospital nurses in the final sample to improve the power considerations and external validity.

Table 2 Demographic and background characteristics of the sample (n = 765)

Correlational analysis

Table 1 presents the means and standard deviations of the study variables and the intervariable correlations. The modest strength of the correlations supports the notion that Common method bias is an improbable explanation for our findings.

Mediating effects

Table 3 presents the findings from the path analysis to test mediation effects, while Table 4 reports the indirect (mediation) effect tests. Finally, Fig. 1 illustrates the findings on a path diagram.

Table 3 Path analysis results with standardized regression coefficients (beta)
Table 4 Indirect (mediation) effect analysis

The findings indicate that violence load contributes 14% to the variance of burnout and 13% to the variance of perceived quality of care. Table 4 reveals that three out of the four tested mediation effects are statistically significant: (1) burnout partially mediates the association between violence load and quality of care, (2) burnout partially mediates the association between a climate of constructive listening and quality of care, and (3) burnout fully mediates the association between destructive listening climate and quality of care.


This study extends the standard measurement of workplace violence to assess the cumulative effect of violence load on nurses. The study findings expand the existing knowledge on workplace violence in the field of nursing research with a focus on the impact of violence load, listening climates, and nurse burnout on quality of care. The results should motivate policymakers to employ this measurement in health systems and monitor and compare workplace violence data in and across units over time. Such monitoring will identify the units that most require intervention and the groups of nurses who are subjected to higher violence loads, thereby risking their personal wellbeing and jeopardizing quality of care.

Targeted strategies must be identified and implemented to ensure a safe and supportive work environment for nursing professionals. Monitoring violence load in and across units can identify better-performing units and allow them to be studied. Thus, they can potentially contribute to spread of effective interventions to reduce workplace violence.

Analyzing mediation pathways and identifying the relationships between constructive and destructive listening climates and nurse burnout also highlights the importance of fostering a positive work culture that promotes effective communication and support. Addressing destructive listening climates can also positively affect nurse burnout and the quality of care provided. Our findings are in accordance with those of studies in other industries, where a constructive listening climate significantly affected exposure to workplace violence [35, 36]. Notably, a byproduct of this study is the identification of a clear linkage between a constructive or destructive listening climate and the violence load. These effects may be explained by the emotional intelligence capability that constructive listening generates, which has been found to mitigate abusive behaviors [32]. In addition, our findings concerning listening climate support reports in the literature that meeting psychological needs help to reduce bullying and improve employee functioning [52, 53], while burnout mediates the effects of workplace violence on patient safety [54].

We recommend policymakers allocate resources for nursing management training programs designed to: (a) raise awareness of workplace violence among all nurses, encourage them to report workplace violence incidents and allocate time to discuss the nature, specific characteristics, and rates of occurrence over time; (b) establish policies that foster a supportive work environment, encourage open reporting of violence incidents, and prioritize nurse well-being; (c) allocate resources to ensure adequate staffing levels and support services to manage the impact of violence load on nurses; (d) adopt a trauma-informed care approach by integrating trauma-informed care principles into healthcare practices to address the psychological effects of violence load on nurses; and (e) support research into the consequences of violence load on nurse burnout and patient outcomes to guide evidence-based policymaking.


The use of single-source data and a cross-sectional design restricts causal inferences. We have tried to indicate possible causality by using Path Analysis. In addition, cultural influences may have impacted the results [55], and constructive listening may represent only one facet of a broader societal issue. In this study, we focused on the new measure of violence load on nurses, however, future research should explore the model in high workplace violence settings like emergency medicine, aged care, and mental health and replicate the studies in diverse countries to provide external and construct validity [56]. It may be informative to extend this approach to other health professionals in different healthcare settings since workplace violence extends beyond nursing and cultures [56]. It may also be useful to conduct longitudinal or cross-lagged studies designed to examine the association between violence load and post-traumatic stress [57].


This study highlights the significance of the violence load and the ward’s listening climate as contributors to nurse burnout. The mediating role of burnout on the relationship between violence load, listening climate, and the quality of care provided by nurses underscores the importance of addressing workplace violence and promoting a supportive work environment in healthcare settings. Based on the findings of this study, we have developed a set of targeted strategies and policies, beginning with regular monitoring of violence load in units of health systems that would prioritize violence prevention and workplace support in order to improve nurse well-being and quality of care.

Availability of data and materials

The data supporting this study’s findings are available from the corresponding author [SST] upon reasonable request.


  1. Johnson J, Hall LH, Berzins K, Baker J, Melling K, Thompson C. Mental healthcare staff well-being and burnout: a narrative review of trends, causes, implications, and recommendations for future interventions. Int J Ment Health Nurs. 2018;27(1):20–32.

    Article  PubMed  Google Scholar 

  2. Fasanya BK, Dada EA. Workplace violence and safety issues in long-term medical care facilities: nurses’ perspectives. Saf Health work. 2016;7(2):97–101.

    Article  PubMed  Google Scholar 

  3. Shafran-Tikva S, Zelker R, Stern Z, Chinitz D. Workplace violence in a tertiary care Israeli hospital-a systematic analysis of the types of violence, the perpetrators and hospital departments. Isr J Health Policy Res. 2017;6(1):1–1.

    Article  Google Scholar 

  4. Zhao M, Jiang K, Yang L, Qu W. The big data research on violence against doctors: based on the media reports from 2000 to 2015. Medicine and philosophy (A). 2017(01):89–93.[]=citjournalarticle_545846_12

  5. Fottrell E. A study of violent behaviour among patients in psychiatric hospitals. Br J Psychiatry. 1980;136(3):216–21.

    Article  CAS  PubMed  Google Scholar 

  6. Lanza ML. The reactions of nursing staff to physical assault by a patient. Psychiatric Serv. 1983;34(1):44–.  7.

    Article  CAS  Google Scholar 

  7. Lipscomb JA, Love CC. Violence toward health care workers: an emerging occupational hazard. AAOHN J. 1992;40(5):219–28.

    Article  CAS  PubMed  Google Scholar 

  8. Liu J, Gan Y, Jiang H, Li L, Dwyer R, Lu K, Yan S, Sampson O, Xu H, Wang C, Zhu Y. Prevalence of workplace violence against healthcare workers: a systematic review and meta-analysis. Occup Environ Med. 2019;76(12):927–37.

    Article  PubMed  Google Scholar 

  9. Mento C, Silvestri MC, Bruno A, Muscatello MR, Cedro C, Pandolfo G, Zoccali RA. Workplace violence against healthcare professionals: a systematic review. Aggress Violent Beh. 2020;51:101381.

    Article  Google Scholar 

  10. Timmins F, Catania G, Zanini M, Ottonello G, Napolitano F, Musio ME, Aleo G, Sasso L, Bagnasco A. Nursing management of emergency department violence—can we do more? J Clin Nurs. 2023;32(7–8):1487–94.

    Article  PubMed  Google Scholar 

  11. Byon HD, Sagherian K, Kim Y, Lipscomb J, Crandall M, Steege L. Nurses’ experience with type II workplace violence and underreporting during the COVID-19 pandemic. Workplace Health Saf. 2022;70(9):412–20.

    Article  Google Scholar 

  12. Chirico F, Afolabi AA, Ilesanmi OS, Nucera G, Ferrari G, Szarpak L, Yildirim M, Magnavita N. Workplace violence against healthcare workers during the COVID-19 pandemic: a systematic review. Journal of Health and Social Sciences. 2022;7(1):14–35.

  13. Watson A, Jafari M, Seifi A. The persistent pandemic of violence against healthcare workers. Am J Manag Care. 2020;26(12):e377-9.

    Article  PubMed  Google Scholar 

  14. Bashir S, Cheema SM, Ashiq M. Impact of Workplace Violence on sustainable performance of nurses with the mediation of Social Well-being in the Pakistani context. J Manage Res. 2023;10(1).

  15. Cheung T, Yip PS. Workplace violence towards nurses in Hong Kong: prevalence and correlates. BMC Public Health. 2017;17(1):1–0.

    Article  Google Scholar 

  16. Gabay G, Shafran Tikva S. Sexual harassment of nurses by patients and missed nursing care—A hidden population study. J Nurs Adm Manag. 2020;28(8):1881–7.

    Article  Google Scholar 

  17. Sahiran MN, Minhat HS, Muhamad Saliluddin S. Workplace violence among healthcare workers in the emergency departments in Malaysia. J Health Res. 2022;36(4):663–72.

    Article  Google Scholar 

  18. Saleem Z, Shenbei Z, Hanif AM. Workplace violence and employee engagement: the mediating role of work environment and organizational culture. Sage Open. 2020;10(2):2158244020935885.

    Article  Google Scholar 

  19. Markwell P, Polivka BJ, Morris K, Ryan C, Taylor A. Snack and Relax®: a strategy to address nurses’ professional quality of life. J Holist Nurs. 2016;34(1):80–90.

    Article  PubMed  Google Scholar 

  20. Sabri B, St. Vil NM, Campbell JC, Fitzgerald S, Kub J, Agnew J. Racial and ethnic differences in factors related to workplace violence victimization. West J Nurs Res. 2015;37(2):180–96.

    Article  PubMed  Google Scholar 

  21. Zubairi AJ, Ali M, Sheikh S, Ahmad T. Workplace violence against doctors involved in clinical care at a tertiary care hospital in Pakistan. J Pak Med Assoc. 2019;69(9):1355–9.

    PubMed  Google Scholar 

  22. Maslach C, Leiter MP. New insights into burnout and health care: strategies for improving civility and alleviating burnout. Med Teach. 2017;39(2):160–3.

    Article  PubMed  Google Scholar 

  23. Tziner A, Shkoler O, Rabenu E, Oren L. Antecedents to burnout among hospital doctors: can they cope? Med Res Archives. 2018;6(10).

  24. Alotni MA, Elgazzar SE. Investigation of burnout, its associated factors and its effect on the quality of life of critical care nurses working in Buraydah Central Hospital at Qassim Region, Saudi Arabia. The Open Nursing Journal. 2020;14(1).

  25. Lebrón M, Tabak F, Shkoler O, Rabenu E. Counterproductive work behaviors toward organization and leader-member exchange: the mediating roles of emotional exhaustion and work engagement. Organ Manage J. 2018;15(4):159–73.

    Article  Google Scholar 

  26. Shkoler O, Tziner A. The mediating and moderating role of burnout and emotional intelligence in the relationship between organizational justice and work misbehavior. Revista De Psicologia Del Trabajo Y De las Organizaciones. 2017;33(2):157–64.

    Article  Google Scholar 

  27. Tavakoli M, Shokridehaki F, Marzband M, Godina R, Pouresmaeil E. A two-stage hierarchical control approach for the optimal energy management in commercial building microgrids based on local wind power and PEVs. Sustainable Cities Soc. 2018;41:332–40.

    Article  Google Scholar 

  28. Escribano RB, Beneit J, Garcia JL. Violence in the workplace: some critical issues looking at the health sector. Heliyon. 2019;5(3). e01283.

  29. Sorra JS, Dyer N. Multilevel psychometric properties of the AHRQ hospital survey on patient safety culture. BMC Health Serv Res. 2010;10(1):1–3.

    Article  Google Scholar 

  30. Hu H, Gong H, Ma D, Wu X. Association between workplace psychological violence and work engagement among emergency nurses: the mediating effect of organizational climate. PLoS ONE. 2022;17(6):e0268939.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Arnetz J, Hamblin LE, Sudan S, Arnetz B. Organizational determinants of workplace violence against hospital workers. J Occup Environ Med. 2018;60(8):693.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Hutchinson M, Hurley J. Exploring leadership capability and emotional intelligence as moderators of workplace bullying. J Nurs Adm Manag. 2013;21(3):553–62.

    Article  Google Scholar 

  33. Trépanier SG, Fernet C, Austin S, Boudrias V. Work environment antecedents of bullying: a review and integrative model applied to registered nurses. Int J Nurs Stud. 2016;55:85–97.

    Article  PubMed  Google Scholar 

  34. Olsen E, Bjaalid G, Mikkelsen A. Work climate and the mediating role of workplace bullying related to job performance, job satisfaction, and work ability: a study among hospital nurses. J Adv Nurs. 2017;73(11):2709–19.

    Article  PubMed  Google Scholar 

  35. Itzchakov G, Kluger AN, Castro DR. I am aware of my inconsistencies but can tolerate them: the effect of high quality listening on speakers’ attitude ambivalence. Pers Soc Psychol Bull. 2017;43(1):105–20.

    Article  PubMed  Google Scholar 

  36. Itzchakov G, DeMarree KG, Kluger AN, Turjeman-Levi Y. The listener sets the tone: high-quality listening increases attitude clarity and behavior-intention consequences. Pers Soc Psychol Bull. 2018;44(5):762–78.

    Article  PubMed  Google Scholar 

  37. Rogers CR, Roethlisberger FJ. Barriers and gateways to communication. Harvard Business Rev. 1991;69(6):105–11.

    Google Scholar 

  38. Shafran-Tikva S, Kluger AN, Lerman Y. Disruptive behaviors among nurses in Israel– association with listening, well-being and feeling as a victim: a cross-sectional study. Isr J Health Policy Res. 2019;8(1):1–9.

    Article  Google Scholar 

  39. Shafran Tikva S, Gabay G, Asraf L, Kluger AN, Lerman Y. Experiencing and witnessing disruptive behaviors toward nurses in COVID-19 teams, patient safety, and errors in care. J Nurs Scholarsh. 2023;55(1):253–61.

    Article  PubMed  Google Scholar 

  40. Hamblin LE, Essenmacher L, Luborsky M, Russell J, Janisse J, Upfal M, Arnetz J. Worksite Walkthrough intervention: data-driven prevention of workplace violence on hospital units. J Occup Environ Med. 2017;59(9):875.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Judge TA, Zapata CP. The person–situation debate revisited: Effect of situation strength and trait activation on the validity of the big five personality traits in predicting job performance. Acad Manag J. 2015;58(4):1149–79.

    Article  Google Scholar 

  42. Wu MJ, Zhao K, Fils-Aime F. Response rates of online surveys in published research: a meta-analysis. Computers Hum Behav Rep. 2022;7:100206.

    Article  Google Scholar 

  43. Brislin RW, editor. Handbook of cross-cultural psychology. Allyn and Bacon; 1980.

    Google Scholar 

  44. Cronbach LJ. Coefficient alpha and the internal structure of tests. Psychometrika Springer. 1951;16(3):297–334.

    Article  Google Scholar 

  45. Shirom A, Melamed S. A comparison of the construct validity of two burnout measures in two groups of professionals. Int J Stress Manage. 2006;13(2):176.

  46. Byrne BM. Structural equation modelling with or: Basic concepts, applications, and programming (2nd edition). 2010. Taylor & Francis Group.

  47. Podsakoff PM, MacKenzie SB, Lee JY, Podsakoff NP. Common method biases in behavioral research: a critical review of the literature and recommended remedies. J Appl Psychol. 2003;88(5):879.

    Article  PubMed  Google Scholar 

  48. Arbuckle J. Amos (Version 26.0)[Computer program] Chicago. IL, USA: IBM SPSS; 2019.

    Google Scholar 

  49. Shkoler O, Kimura T. How does work motivation impact employees’ investment at work and their job engagement? A moderated-moderation perspective through an international lens. Front Psychol. 2020;11:38.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Vasiliu C, Tziner A, Lebron MJ, Shkoler O, Rabenu E, Iqbal MZ, Ferrari F, Hatipoglu B, Roazzi A, Kimura T, Tabak F. Heavy-work investment: its dimensionality, invariance across 9 countries and levels before and during the COVID-19’s pandemic. Revista De Psicología Del Trabajo Y De las Organizaciones. 2021;37(2):67–83.

    Article  Google Scholar 

  51. Cuschieri S. The STROBE guidelines. Saudi J Anesth. 2019;13(Suppl 1):S31.

    Article  Google Scholar 

  52. Drory A, Shkoler O, Tziner A. Abusive leadership: a moderated-mediation through leader-member exchange and by organizational politics. Front Psychol. 2022;13:983199.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Trépanier SG, Fernet C, Austin S. Longitudinal relationships between workplace bullying, basic psychological needs, and employee functioning: a simultaneous investigation of psychological need satisfaction and frustration. Eur J Work Organizational Psychol. 2016;25(5):690–706.

    Article  Google Scholar 

  54. Liu J, Zheng J, Liu K, Liu X, Wu Y, Wang J, You L. Workplace violence against nurses, job satisfaction, burnout, and patient safety in Chinese hospitals. Nurs Outlook. 2019;67(5):558–66.

    Article  PubMed  Google Scholar 

  55. Hofstede G. Cultures and Organizations: Software of the Mind. McGraw Hill; 1991.

  56. Thomas DC, Peterson MF. Cross-cultural management: essential concepts. Sage; 2016. Dec 30.

    Google Scholar 

  57. Vandenberghe C, Panaccio A, Bentein K, Mignonac K, Roussel P. Assessing longitudinal change of and dynamic relationships among role stressors, job attitudes, turnover intention, and well-being in neophyte newcomers. J Organizational Behav. 2011;32(4):652–71.

    Article  Google Scholar 

Download references


Not applicable.


This research received no grant or funding.

Author information

Authors and Affiliations



All authors read and approved the final manuscript.  SST Conceptualization, Methodology, Writing Original Draft, Resources, Data collection, Writing - Review & Editing.  GG Conceptualization, Methodology, Writing Original Draft, Writing - Review & Editing.  OS Formal analysis, Data Curation, Review & Editing.  IK Conceptualization, Methodology, Data Curation, Writing - Review & Editing.

Corresponding author

Correspondence to Sigal Shafran Tikva.

Ethics declarations

Ethics approval and consent to participate

Approval was granted for this study by the Academic Institution with which the first author is affiliated - Approval #: 0313 − 17.

Anonymity was promised, and all data were coded without identifying details and were used for research purposes only. Completing the questionnaires was considered consent to participate in the study. All authors confirm that the protocol was performed in accordance with the ethical standards laid down in the Declaration of Helsinki and its later amendments or comparable ethical standards.

Authorship: We confirm that all authors meet the criteria of substantial contribution to all of the following: (1) the conception and design of the study, or acquisition of data, or analysis and interpretation of data, (2) drafting the article or revising it critically for important intellectual content, (3) final approval of the version to be submitted.

Consent for publication

Not applicable.

Reporting guidelines: STROBE reporting guidelines were used.

Competing interests

All Authors declare no conflict of interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article has been updated to correct an author name.

Supplementary Information

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shafran Tikva, S., Gabay, G., Shkoler, O. et al. Association of quality of nursing care with violence load, burnout, and listening climate. Isr J Health Policy Res 13, 22 (2024).

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: