Linking Workplace Aggression to Employee Well-Being and
Work: The Moderating Role of Family-Supportive Supervisor
Behaviors (FSSB)
Nanette L. Yragui
1
, Caitlin A. Demsky
2
, Leslie B. Hammer
2
, Sarah Van Dyck
2
, and Moni B.
Neradilek
3
1
Washington State Department of Labor & Industries, SHARP Program, 243 Israel Rd SE, Bldg 3,
Olympia, WA 98501, USA
2
Department of Psychology, Portland State University, Portland, OR, USA
3
The Mountain-Whisper-Light Statistical Consulting, Seattle, WA, USA
Abstract
Purpose—The present study examined the moderating effects of family-supportive supervisor
behaviors (FSSB) on the relationship between two types of workplace aggression (i.e., patient-
initiated physical aggression and coworker-initiated psychological aggression) and employee well-
being and work outcomes.
Methodology—Data were obtained from a field sample of 417 healthcare workers in two
psychiatric hospitals. Hypotheses were tested using moderated multiple regression analyses.
Findings—Psychiatric care providers’ perceptions of FSSB moderated the relationship between
patient-initiated physical aggression and physical symptoms, exhaustion and cynicism. In addition,
FSSB moderated the relationship between coworker-initiated psychological aggression and
physical symptoms and turnover intentions.
Implications—Based on our findings, family-supportive supervision is a plausible boundary
condition for the relationship between workplace aggression and well-being and work outcomes.
This study suggests that, in addition to directly addressing aggression prevention and reduction,
family-supportive supervision is a trainable resource that healthcare organizations should facilitate
to improve employee work and well-being in settings with high workplace aggression.
Originality—This is the first study to examine the role of FSSB in influencing the relationship
between two forms of workplace aggression: patient-initiated physical and coworker- initiated
psychological aggression and employee outcomes.
Keywords
Workplace aggression; Family-supportive supervisor behaviors; Occupational stress; Health;
Conservation of resources theory
Correspondence to: Nanette L. Yragui.
HHS Public Access
Author manuscript
J Bus Psychol
. Author manuscript; available in PMC 2018 March 19.
Published in final edited form as:
J Bus Psychol
. 2017 April ; 32(2): 179–196. doi:10.1007/s10869-016-9443-z.
Author Manuscript Author Manuscript Author Manuscript Author Manuscript
Workplace aggression has emerged over the past 25 years as an important worldwide
research topic in occupational health psychology, and refers to physical and nonphysical
negative acts carried out against an organization or its members, which harms employees
(Neuman and Baron 2005). Limited prevalence estimates suggest that six percent of the U.S.
employees across all occupations have experienced physical violence at work in the previous
12 months, while 41.4 % of employees have experienced psychological aggression at work
within the past year (Schat et al. 2006). A recent review of workplace violence prevalence
acknowledges that much of the empirical research since 2000 has focused on employees in
professional and service occupations (e.g., nurses, social workers, police officers, etc.), as
these employees exhibit a higher likelihood of experiencing workplace violence (Piquero et
al. 2013).
Thus, while workplace aggression may be a concern for all employees, research has
indicated higher frequencies of physical and nonphysical aggression in the healthcare sector,
particularly in psychiatric settings (Gerberich et al. 2004). Recent data from the U.S.
Department of Justice suggest that those in government mental health occupations have one
of the highest levels of workplace physical violence at 7.8 %, second only to law
enforcement-security and teaching (Harrell 2013). However, these statistics should be
considered in the context of reporting practices. Healthcare workers experience patient
aggression as being “a part of the job” and subsequently underreport physical aggression
incidents to their employers (Findorff et al. 2005). More recent prevalence estimates in the
healthcare industry suggest that approximately 30 % of nurses report having experienced
some form of workplace aggression (Campbell et al. 2011). Those in psychiatric hospitals
report the highest levels of exposure to workplace aggression with 70 % of care providers
reporting patient physical aggression and 92 % reporting coworker verbal conflict (Kelly et
al. 2015). In a recent review of violence research, Spector et al. (2014) reported that in the
Anglo world region which includes the United States, 87.7 % of nurses and nursing
assistants were exposed to physical aggression from patients. In addition, 37.4 % of nurses
were exposed to nonphysical aggression from healthcare staff. While these statistics
emphasize the pervasive nature of workplace aggression for healthcare providers, some
important research gaps exist in understanding forms and sources of aggression as well as
processes that affect the impact aggression has on care provider health and work outcomes.
To address these gaps, our study examines two distinct forms (i.e., physical and
psychological) and sources (i.e., patient and coworker) of aggression—patient physical
aggression and coworker psychological aggression—in a sample of psychiatric hospital
workers. Patient physical aggression is an assault that may or may not result in injury (e.g.,
hitting, biting, etc.). Coworker psychological aggression is nonphysical aggression (e.g.,
yelling, insulting, excluding, etc.) from a hospital employee including coworkers and
supervisors (e.g., nursing, social work, psychology, etc.). While patient psychological
aggression does commonly occur in psychiatric settings, nursing staff adjust to this knowing
patients are mentally ill and are committed to the institution against their will (Chapman et
al. 2010). We chose to focus on patient physical aggression because it has greater
consequences for care providers in terms of physical harm. Prior research has documented
psychiatric hospital staff exposure to patient physical aggression (Kelly et al. 2015), and a
range of consequences may include injury (Spector et al. 2014), psychological distress
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(McKenna et al. 2003), post-traumatic stress symptoms (Gates et al. 2011; Gillespie et al.
2013), and fatality in rare circumstances (CDC 2012). In addition, coworker physical
aggression is a rare occurrence in healthcare settings; thus, we chose to focus on coworker
psychological aggression as it occurs with greater frequency (Lanza et al. 2006). Spector et
al. (2007) found that physical violence and verbal aggression were common in a hospital
setting with physical violence perpetrated primarily by patients and family members and
verbal aggression by staff members. Our choice to examine different forms and sources of
workplace aggression is in line with recent calls by researchers (e.g., Hershcovis and Barling
2010) in an effort to identify potential differential relationships with employee and
organizational outcomes.
In addition, we examine FSSB as a key element of the relational and social contexts in
which an individual is embedded at work. We propose FSSB has an influence on reactions to
workplace physical and psychological aggressions, work stressors that negatively impact
employee health, well-being, and work outcomes (Aquino and Thau 2009; Bowling and
Beehr 2006; Hershcovis and Barling 2010). We further propose that the contextual resource
of supervisor support is important in the context of psychiatric care settings where the
stressors of patientinitiated physical aggression and coworker-initiated psychological
aggression occur. In our formative research described below, psychiatric supervisors and
care providers reported on the challenges of managing employees’ work– family conflict.
Thus, family-specific supervisor support, or FSSB, is expected to serve as an important
resource for employees that creates a positive context where employees are valued and
respected and thus will moderate the negative effects of physical and psychological
aggressions on employee work and well-being outcomes. FSSB has been defined as “those
behaviors exhibited by supervisors that are supportive of families and consist of managerial-
initiated actions to restructure work to facilitate employee effectiveness on and off the job”
(Hammer et al. 2009, p. 839). The construct of FSSB is composed of emotional support,
instrumental support, role modeling, and creative work–nonwork management across the
two interrelated domains of work and nonwork.
The importance of the construct of FSSB in psychiatric settings emerged in our formative
research at the psychiatric hospitals in which we attended management meetings, conducted
direct observations on the wards as well as care provider focus groups and supervisor/
manager individual interviews (Yragui et al. 2009, 2011). We sought to learn about sources
and types of aggression as well as the context for aggression and its impact on employees’
health and work. The qualitative analyses revealed the importance of family-supportive
supervision for care providers among other themes related to social support and patient- and
coworker-initiated aggression. The results included several points: (1) care providers
reported that they wanted their supervisors to appreciate them as a whole person and
acknowledge their challenges in managing work–nonwork conflicts including assistance
with solving the problems they encountered in managing their time and effort across the two
spheres; (2) care providers took unscheduled absences as “mental health days” to cope with
stress from patient and coworker aggression; (3) care providers reported using unscheduled
sick leave to attend to nonwork responsibilities because on many units the supervisors would
not allow schedule flexibility and the hospital had no policy to support switching schedules
with another care provider. The unscheduled absences left wards understaffed which
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increased the risk of patient aggression; (4) some supervisors confirmed the lack of schedule
flexibility; however, other supervisors reported that they used their discretion to provide this
resource to their employees as a reward for reliable attendance and providing quality patient
care; 5) finally, supervisors also reported that this approach led to more satisfied staff and
therefore safer staff through reductions in patient aggression. These research results suggest
that supervisor support for employees’ work–nonwork management was variable. We found
that some supervisors provided resources to support employees’ effectiveness in both work
and nonwork domains through family-supportive supervision. These supervisors chose to
expand their support approach to include employees’ work and nonwork domains rather than
limiting their support solely to the work domain.
In sum, knowledge gained from our prior formative research informed our focus on FSSB in
the context of workplace aggression. The current study is the first to examine this particular
constellation of relationships in a setting that is understudied, namely psychiatric hospitals.
We therefore chose to examine direct effects of two types and sources of aggression as well
as supervisor support for the work–nonwork interface as a boundary condition for workplace
patient-initiated physical and coworker-initiated psychological aggression and care provider
well-being and work outcomes.
Prior research has shown FSSB improves both familyspecific and more general work and
well-being outcomes for employees (Hammer et al. 2011; Kossek et al. 2011). In validating
the FSSB measure, Hammer et al. (2009, 2013) found FSSB was significantly negatively
related to workto- family conflict, turnover intentions, and significantly positively related to
job satisfaction, over and above the effects of general supervisor support. In addition, Odle-
Dusseau et al. (2012) found significant relationships over time between employee
perceptions of FSSB and reduced turnover intentions, increased job satisfaction, and
increased supervisor ratings of employee job performance. We argue that FSSB provides
resources to employees in line with the conservation of resources theory (COR; Hobfoll
1989) and thus results in improved work, health, and well-being outcomes for employees
that are workrelated, nonwork-related, and more general, including support that leads to
increased personal resources for employees. Thus, FSSB provides employees a means to
better manage competing work and family demands and is especially relevant in the context
of the demands of workplace aggression. Supervisors that proactively provide work–
nonwork-specific support meet their employees’ need to replenish resources within and
outside the work domain (Hammer et al. 2015).
Furthermore, it is important to note that training supervisors to enact FSSBs has proven to be
effective in improving work and well-being outcomes for employees in several randomized
control trials (e.g., Hammer et al. 2011, 2015; Kelly et al. 2014; Olson et al. 2015). More
specifically, such FSSB training provides an organizational approach to improving work and
health outcomes for employees and thus provides a potential intervention for high stress
occupations such as that of psychiatric care workers who experience numerous stressors on
the job including workplace aggression.
To our knowledge, no studies have examined the role of FSSB in influencing the
relationship between workplace aggression and employee outcomes. Work–family research
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has shown that employees managing demands from multiple roles such as work and family
leads to reduced resources and increased strain (Grandey and Cropanzano 1999; Hammer et
al. 2013). In a psychiatric care context, work–nonwork support is a meaningful resource
emotionally and practically because care providers must manage work and nonwork
stressors in the context of workplace aggression. General supervisor support focuses solely
on employee performance in the work domain. Supervisor work–nonwork support facilitates
employees’ ability to effectively manage in both work and nonwork spheres (Hammer et al.
2009; Thomas and Ganster 1995). This is enacted through supervisor helping behaviors and
attitudes such as empathy with an employee’s motivation and need to balance work and
nonwork roles (Thomas and Ganster 1995).
Supervisor work–nonwork support is valuable in that it offers more than general support in
buffering stress from job demands (i.e., patient-initiated and coworker-initiated aggression)
and helps to conserve resources in the
two
domains of work and nonwork (Allen 2001). For
example, a supervisor may provide schedule flexibility and time off from work with the
understanding that an employee’s unaddressed strain due to patient physical aggression may
impact their ability to manage in the domains of work and nonwork as well as understanding
that it is in the nonwork domain that the care provider may find respite from workplace
physical aggression incidents. In the case of physical aggression, sick leave may be desired
for physical recovery and rest at home if injury occurred. In many cases, psychiatric care
providers return to work in the same ward with the same aggressive patient and time away to
regroup physically and mentally may be welcome.
In addition, psychological aggression has been documented as a stressor that depletes
personal resources and may be associated with exhaustion (Estryn-Behar et al. 2008). In this
case, resource replenishment in the nonwork domain is more likely to be achieved where the
target can separate from the source of aggression either through time spent with family, with
friends, or through leisure activities. Therefore, employees who experience psychosomatic
or psychological strain due to coworker psychological aggression, may value FSSBs as a
particularly important resource in buffering the negative effects of the aggression.
Supervisors may proactively provide needed emotional support to prevent exhaustion that
may occur in work and nonwork domains and schedule flexibility that allows for separation
or recovery should negative effects occur or to prevent their occurrence.
In sum, the current study provides two important contributions to the literature. First,
workplace aggression scholars have called for examining the source of workplace aggression
(Hershcovis and Barling 2010), and in response, we examine two distinct forms and sources
of aggression— patient physical aggression and coworker psychological aggression
experienced by a sample of psychiatric hospital workers. Second, the majority of workplace
aggression literature has focused on identifying the antecedents and outcomes of various
aggression constructs (e.g., Bowling and Beehr 2006; Hershcovis and Barling 2010).
However, we identify a trainable workplace resource (i.e., FSSB; Hammer et al. 2009, 2011,
2015; Kelly et al. 2014) that may reduce the negative impacts of workplace aggression and
we examine the moderating effects of FSSB on employees’ health and work outcomes. In
this study, we examine direct relationships that allow us to replicate prior research regarding
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