HYBRID EVENT: You can participate in person at Singapore or Virtually from your home or work.

4th Edition of

Singapore Nursing Research Conference

March 21-23, 2024 | Singapore

Nursing 2023

Victoria Grimes Holsinger

Speaker at Singapore Nursing Research Conference 2023 - Victoria Grimes Holsinger
Improving Healthcare Culture and Nursing, United States
Title: Non-sexual harassment and bullying in the workplace.


Background:  Addressing the issue of non-sexual harassment, workplace bullying (WPB) of minority nurses and non-minority groups who reported either being harassed or bullied. A review of the literature in concert with the findings of the grounded theory study and interventional interviews revealed several categories of issues that illustrate the causes of this phenomenon.  These categories were further delineated into specific sub-headings and organized in a fishbone flow chart. The fishbone made it possible to understand the influences of WPB in terms of the groups and the broader concepts of the major groups. The team created a list of specifically cited issues or problems. These were referred to as “line items.” These concepts were combined where appropriate into fourteen subgroups. These subgroups were incorporated into four significant groups based on their overall concept: Environment, Process, Policy, and People. An algorithm was developed illuminating several barriers to resolution.  Barriers include the time and energy of the individual, action from those receiving the report, and commitment from senior leadership to support the resolution.

The Data: A hazard analysis was performed on each of the 44 items in the Fishbone Diagram. Each line item was given two scores—one score for probability and one score for severity.  The probability score was rated based on multiple stakeholder sessions, literature, and study findings, of what was the likelihood a minority nurse would experience this item.  Scores were determined based on the reported results from the stakeholder sessions and the conclusions of the literature regarding severity.  The score was based on how severe the consequences would be to the target. A score for each item of 1 – 4 was assigned.  One being lowest probability or severity and four being highest.  These two scores were multiplied to give an overall score for the item.  Hence the range of overall scores could be between 1 and 16.  A score of 12 or more is given the highest priority. A score of 8 to 11.5 is given medium priority, and under 8 is the lower priority.  Items with a score under eight are not dismissed, however.

Recommendation: Accountably and trust of leadership were a reoccurring finding.

There was the sense that there were two standards of behavior toward staff and supervisor. That management and their friends were not held accountable. Another common reoccurring theme was that some abusive managers get a promotion or are rewarded when they target selective individuals. Finally, the AES’s recurring concern is that it is not reflective, and many did not trust how the findings were tabulated accurately. Suggesting a need to look at the variation within a department would allow the VA to intervene when that group culture was unhealthy.

Conclusion: Assessing the elements that create a hostile environment can be achieved through ongoing study and dialogue between staff and management. An outside group’s intervention would ensure fair and equitable outcomes.


Victoria Grimes-Holsinger is a registered nurse Retired from the Department of Veterans Affairs in Boston, Massachusetts, she works with colleagues to found Nursing Health Culture Alliance (NHCA) and Improving Healthcare Culture (IHC). She received her Doctor of Nurse Practice (DNP) in the area of Population Health from Quinnipiac University. Dr. Grimes-Holsinger’s work focuses on the impact of stress on the health of nurses, developing an intervention that addresses workplace stress and improved workgroup psychological safety. She created a workbook to accompany her intervention. She is an active member of the American Nurses Association (ANA) policy committee as well as the End Workplace Violence Coalition.
Dr. Grimes-Holsinger graduated with honors and was inducted in the Sigma Tau-Rho honor society as well as receiving acknowledgment for her academic achievement from the VA. She received an invitation to serve with the local Sigma chapter working on succession planning and on their research committee. She is also an active member on VA committees. She is a peer reviewer for the Infusion Nurses Society (INS), active in ANA, Secretary of Nurse Organization of the Veterans Affair (NOVA) and sits on the VA’s Best Practice committee and Nurse Profession Standards Board.
Dr. Grimes-Holsinger has a diverse array of hobbies and interest.  She enjoys painting in watercolors, gardening, and creating outfits for friends and family. She keeps her native heritage folkways (Lakota/Lenape) along with her daughter and keeps many of the traditions she was taught in her youth. She has the belief that resilience comes from the ability to face adversity without losing one’s integrity and grace.