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Confronting Workplace Violence in Nursing

More than 50% of nurses surveyed by ANA had been threatened or verbally abused at work.

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Violence can happen anywhere at any time. It's an unfortunate sign of our times, and the healthcare setting sees its fair share.

In fact, the Bureau of Labor Statistics found in 2006 that the healthcare sector led all other industries in workplace violence, with 45% of nonfatal assaults leading in loss of work days committed against registered nurses.

According to the American Nurses Association, workplace violence is one of the most dangerous occupational hazards facing nurses working in today's healthcare environment.

In a 2011 health and safety survey of more than 4,600 nurses, ANA found 11% of respondents had been physically assaulted in the previous 12 months while just more than 50% said they had been threatened or verbally abused. Additionally, about 1/3 listed on-the-job assault as one of their top three safety concerns.

"We now know that workplace violence is a prevalent issue," said Adam Sachs, communications and public relations representative for the ANA.

Protecting your Staff

Safe Haven

Don't wait for a nurse to be confronted with a violent incident to talk about the possibility one might occur.

Prevalence & Settings

An article released in 2004 by the ANA in its Online Journal of Issues in Nursing - "Workplace Violence in Health Care: Recognized But Not Regulated" - noted the prevalence of workplace violence can be attributed to the exposure to violent individuals combined with the absence of strong violence prevention programs and protective regulations. Staff shortages and increased patient acuity further facilitate the problem.

And who are the aggressors?

"Agitated clients in mental health facilities and the emergency department, demented elderly patients in medical and geriatric wards, nursing homes and rehabilitation centers, and any patient with a history of assault in mental health, hospital care, and community health are common sources of verbal and physical violence against nurses and other healthcare providers."

Sachs told ADVANCE one of the riskiest settings for violence is the emergency department. The Emergency Nurses Association agrees, stating emergency nurses are particularly vulnerable to workplace violence.

A 2006 survey of 1,000 ENA members found 86% had been the victim of workplace violence in the preceding three years, with family members and visitors as likely to perpetrate abusive behavior as patients. Nearly 20% reported that they experience workplace violence frequently.

"In general, nurses should not be expected to accept or tolerate violence on the job as part of the job," Sachs said. "Maybe in the past it was accepted that certain patients will act out, but that should not be a part of the job and employers should take steps to ensure that the chances for violence are minimized."

Steps Toward Prevention

According to Sachs, there are a number of things employers can do to prevent violence, including:

• Provide training and education for nurses on how to avoid situations for potential violence.

• Take environmental and security measures - have lockable areas for staff only (lounges, lockers rooms, bathrooms), adequate lighting both inside and outside, and have security guards in certain areas such as the emergency department.

• Have a good policy in place and laid out for the reporting of incidences and suspicious behavior. Employers need to be held accountable for studying the reports, analyzing the information and taking action.

• Flag the medical charts, or ID in some way, patients' records if they have past incidents.

Additionally, there are precautions nurses can take to ensure their own safety. Nurses need to:

• Make sure they aren't working alone, especially in certain areas such as the emergency department.

• Be aware of their surrounding environment.

• Be aware of their patient's history.

• Avoid being physically trapped in a room; keep themselves between the patient and the door.

• Have someone on staff nearby and aware that they are with a patient.

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Legislative Solutions

As a result of increased risks to healthcare workers, Sachs said, there has been over recent years an increase in state laws designed to protect healthcare workers against violence. "About one-third of the states have laws now," he added.

HCA Healthcare shared with the ENA a state survey in 2006 of all the statutes for workplace violence and criminal laws that address the penalty for assaulting a healthcare worker. The survey showed that 39 states currently have criminal laws protecting health professionals.

Additionally, Sachs explained there are laws in nine states requiring employers to have workplace violence programs and report violence.

"Workplace violence in healthcare is being recognized in state legislators around the country as an issue that needs to be addressed legally," Sachs concluded.

Jessica LaGrossa is on staff at ADVANCE. Contact: JLagrossa@advanceweb.com.


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I am scared to death of my night shift coordinator. Two years ago when I started working, her friend yelled at me for asking a question when I had just come off of orientation. I asked her manager to help me deal with this, as I needed this nurse to be a resource. During the next few weeks, the nightshift head nurse tried to sabotage me. Then she retold the story making me look like a buffoon. In other words, she lied and stated that I did not hold to the standards of the hospital. I was nearly fired over that incident but instead was put on probation and publicly humiliated by being put back on orientation. I did not do anything that warranted that writeup and can honestly say after working for two years that everyone in that unit could be written up the same way over incidentals that are retold from a slant with a conclusion that they don't hold to the standards of the hospital if we are using that standard as a benchmark. This incident set a chain of events in motion to where I have been on the defensive proving myself since day one. Not one other person has had to go through this. A few people did stand up for me miraculously, which is why I wasn't fired. However, I have felt the need to bend over backward to keep their friendships as not to have them against me. So for example, when one of them is not offering to help during a busy time, there is not one thing I can say. Since that day, I have proven to the hospital that these allegations weren't true by receiving the CPN and a BSN. Nevertheless, this lady has never ceased with her campaign to use lateral violence and passive aggression to discourage me and force me to quit. I have tried having courageous conversations with her. She rolls her eyes and uses these as a means to belittle me. For example, when I tell her that I have a BSN degree she says, "Oh, didn't you get that at one of those online degree programs." Like she knows anything about the extent of work that we do in those programs. I have repeatedly told her supervisors what she is like to no avail. Her manager sees the problem but seems powerless to deal with her. The director is a no-nonsense kind of business woman that wants people to figure it out and just get the work done right. Yet, because this woman has a position of leadership, she is able to do things to me that nobody sees but me. I have gone home and cried and distressed over going back to work. I am sometimes so exhausted from lack of sleep because of her. Plus, she has people more than willing to do her bidding. Some of the things they do are petty. Others interfere with my ability to take care of my patients especially because we have to rely on each other at times. It has been a nightmare and the only solution that has ever been offered to me is to move. Why should I have to move when she is like this? Why can't this be dealt with in some way?

Vera ,  RNJuly 20, 2013
South , FL



I did floor nursing for many years, mostly MED-SURG. The hospital where I worked had a special number to call SECURITY quickly.

Joan ,  RNMarch 13, 2013
New York, NY



As a long-term career nurse (more than 25 years) I have received and witnessed workplace violence. My incident involved physician to nurse violence, and by that time in my career, I decided to be pro-active and post the news of the incident in the break areas of all nursing staff in our division. I also asked administration to have the physician apologize to the nurse. I threatened to send this story to the local news in order for the community to be aware of how wives, mothers, daughters, and sisters were addressed while at work. Though a few months in the happening, the hospital did act and the apology was given and the physician fined. I think that if nurses first curtail violence within our workplace and give each other support and respect, that will be the start of persons outside of our ranks giving that same respect.

Carol ,  Nurse EducatorFebruary 23, 2013



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