Professional Documents
Culture Documents
Workplace Violence in Nursing
Workplace Violence in Nursing
Katherine L. Stear
Abstract
The healthcare industry remains one of the leading industries to experience workplace violence.
decreased job satisfaction and performance. Incidences greatly contribute to the ever-expanding
nursing shortage. Patient care is diminished leading to decreased patient satisfaction. Hospital
reimbursements are affected, and a growing cost related to prevention and reaction to workplace
workplace violence can help minimize the negative implications and create a better environment
for all.
Workplace violence is an unfortunate risk in most, if not all, professions. However, this
risk can be significantly greater for nurses. According to multiple researchers, the healthcare
industry has one of the highest incidences of workplace violence, with the most common forms
being patient-to-nurse violence and nurse-to-nurse violence (Demming & O’Neil, 2020; Nevels
et al., 2021). Workplace violence is on the rise. Healthcare settings accounted for 75% of the
incidences throughout 2011-2013 (Nevels et al., 2020). A lack of understanding of what exactly
constitutes workplace violence or the lack of support and intervention by organizations may lead
to under-reporting which inhibits correction and prevention of future incidences. If we are unable
to determine incidences that lead to workplace violence, there are negative implications for the
profession. According to the World Health Organization, workplace violence is “the intentional
use of physical force or power, threatened or actual, against oneself, another person, or against a
group or community, that either result in or has a high likelihood of resulting in injury, death,
psychological harm, maldevelopment or deprivation” (Al-Qadi, 2021, para 5). Nurses are at risk
of workplace violence every day and can experience multiple episodes of violence in a single
day. With a clear definition, we can investigate past instances of workplace violence to identify
root causes, allowing us to determine interventions to recognize and prevent, or lessen the
Historical Aspects
Patient-to-Nurse Violence
Nursing staff spends a considerable time with the public. As the frontline interface for
patients and families, we are at increased risk of bearing the brunt of their frustrations and in turn
violence (Busnello et al., 2021). Patients are responsible for 69-80% of violence (Busnello et al.,
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2021 & Nevels et al., 2020). A study over 12 months revealed nearly 80% of the participants
experienced workplace violence where 75.7% of violence was verbal aggression (shouting,
swearing, and/or cursing), 4.1% racial discrimination, and 2.3% physical aggression, most
commonly pushing and/or hitting (Busnello et al., 2021). Those working with mental health
patients, drug dependency units, or those providing life-saving care are at the highest risk of
exposure (Al-Qadi, 2020 & Nevels et al., 2020). Mental health and drug dependent patients may
experience hallucinations or delusions that increase their risk of becoming violent. Drug
dependency can lead the person to commit violent acts to satisfy their addiction. Working in
emergency departments or intensive care units where the risk of patient death is greater can lead
to increased aggression from family members. Lack of communication with family members can
lead to lack of understanding of the patient’s condition or perceived notion that not enough is
being done for their loved one. Fear in the family member can evoke verbal or even physical
violence or aggression.
Nurse-to-Nurse Violence
It has been coined that “nurses eat their young.” Perpetrators of nurse-to-nurse violence
(also known as horizontal violence) are often full-time female workers (Houston, 2020). Some
theorize the root cause of horizontal violence extends from oppression by male dominance and
this is an attempt for the individual to assert dominance among those they feel are less powerful
than themselves (Houston, 2020). Incivility may be the result of the perpetrators desire to control
technology, may lead older nurses to be fearful of appearing inadequate if they are unable to
master new technology. An increase in educational requirements, with a move towards the
standardization of the baccalaureate nurse, may incite feelings of fear in the diploma nurse that
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she could be replaced by a younger, inexperienced nurse. These perceived threats of job
insecurity may be the cause of nurses to lash out to diminish the abilities of another as well as
Barriers to Reporting
Although healthcare workers are more likely to experience workplace violence, many
incidences are not reported for various reasons. Lack of intervention from the organization in
response to workplace violence claims with lack of policies providing justice to claims, nurses’
belief that violence comes with the job, empathy for patients, fear of humiliation, or pride all
If an employee has submitted a claim for workplace violence and the organization failed
to recognize or support the employee, the employee is likely to not report additional claims as
Lack of training and education on workplace violence may prevent nurses from
recognizing an incident and taking steps to reduce the risk or severity. Risk-reduction measures
are commonly an afterthought and only provided after the nurse has experienced an assault
Nurses often empathize with instances of workplace violence when patients are confused,
and they feel the patient would not have used physical aggression if they were in their right state
of mind. It is common for demented or otherwise confused or disoriented patients to believe they
are being attacked or held against their will and the fight response is activated. Even if patients
are in their right state of mind, nurses often shrug off verbal aggression as they understand the
patient’s frustration and feel they would be just as upset if they were in the patient’s situation.
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Cultural norms may reduce the perceivability of workplace violence. Most of the nursing
workforce is women. Women are accustomed to dealing with sexual harassment in our culture
and may lead to underreporting as they are conditioned to this behavior. Instances of horizontal
claims of bullying. Once again, our culture outside of the workplace has conditioned us to accept
a form of violence as it is common throughout our lives. Acts of racial discrimination are also
underreported as those individuals are exposed to racial discrimination daily in and out of the
workplace and history has proven that reporting such discrimination does not lead to any
resolution or any satisfactory results. Our culture may be likely to humiliate the individual
Workplace violence incidences may be diminished as nurses do not perceive any harm
has been done because they feel as if they can handle the psychological aspect and no physical
harm has been inflicted (Al-Qadi, 2021). Nurses may feel that reporting instances of workplace
violence will lead to them being viewed as incompetent and fear loss of employment (Nevels et
al., 2020). Some are fearful that making claims will lead the institution to be apprehensive of the
individual filing lawsuits and, to prevent this, will terminate the employee.
Patient satisfaction may be perceived as more important than employee satisfaction with
the move towards hospital reimbursements and federal funding linked to patient satisfaction
scores. While the intention of the Hospital Consumer Assessment of Healthcare Providers and
Systems (HCAHPS) was to ensure accountability of institutions, but many nurses have reported
their lack of reporting workplace violence was due to the institution valuing these scores more
Implications to Nursing
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Nurses can be greatly impacted by workplace violence. The second most common fatal
event in the United States is due to workplace violence (Al-Qadi, 2021). Lasting psychological
and physical harm has led to more than 50% of healthcare workers using medications to treat
depression or anxiety and even hypertension in response to the increased stress, anger, or loss of
sleep associated with job dissatisfaction (Busnello et al., 2021). Medications taken by healthcare
workers are not necessarily prescribed medications, and some nurses turn to alcohol and
Implications to Patients
Workplace violence attributes to nursing shortages. This affects every patient, not just
those directly involved in violence, as decreased staff leads to increased workloads, diminishing
the quality of care that can be provided. When a patient or a family member is aggressive, the
nurse may feel less compelled to enter the room, or to spend less time in the room, due to fear of
repetition or escalation of violence. This could lead to negligence of the patient or lack of
Professional Implications
nurses to leave the profession (Al-Qadi, 2021). This leads to increased turnover as well as a
decreased desire for recruitment to the profession. Workplace violence is expanding the nursing
shortage leading to a lack of expertise, decrease in the quality of care, and increased
Organizational Implications
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Organizations have a moral obligation to their employees to prevent them from harm, but
they also face incredible costs related to prevention and response to workplace violence.
Workplace violence costs businesses more than $130 billion a year, with hospitals attributing
$2.7 billion in prevention and response (Nevels et al., 2020) and over $400 million on insurance
Proposal to Resolve
standardize rules preventing workplace violence (Nevels et al., 2020). These include risk
treatment interventions, workplace prevention programs, and communication and training for
employees.
presence, or use of the buddy system in high-risk visits. If situations escalate, the nurse needs
prosecute violators to the full extent of the law (Demming & O’Neil, 2020). Identifying patients
or family members as aggressors can allow the nurse to prepare herself for a situation and be
defensive rather than reactive. The use of lethal weapons occurs more at night as there may be
increased wait times due to decreased staff (Al-Qadi, 2021). To reduce the risk of injury, metal
detection at entry points and limiting public access as well as visitation during night hours can be
established. The ability to lockdown entry points and units when there is an armed assailant in
Committees dedicated to investigating events and determining the cause and identifying
trends would help members to understand what led to an event and how to prevent future events
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(Demming & O’Neil, 2020). These committees could also be responsible for following up with
the employing and providing needed support. Support of the organization leads to an increase in
reporting of incidences, which is the most important action after an incident (Demming &
O’Neil, 2020).
Education for employees would include defining workplace violence, how to identify it
as well as factors leading to it, how to respond to it, and how to report it. By identifying factors
leading to violence, nurses can take steps to prevent the situation from escalating and prevent the
violence. If the nurse is unable to prevent violence, she should be trained in de-escalation as well
coined “verbal judo” that calms patients and reduces conflict (Nevels et al., 2020). This
prevention of violence.
Conclusion
Compared to other industries, healthcare remains one of the top industries experiencing
injuries related to workplace violence (Nevels et al., 2020). Psychological and physical harm can
have long-term negative effects on the individual as well as the organization and the profession.
There are serious implications at every level. It is nearly impossible to eradicate workplace
measures, we can greatly reduce the risks for nursing leading to improved outcomes for
employees, patients and their families, the organization, and the profession.
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References
Busnello, G. F., de Lima Trinidade, L., Pai, D. D., Colome Beck, C. L., & Pimenta Lopes
2020-0427
Huston, C. J. (2020). Professional issues in nursing: Challenges and opportunities (5th ed.).
Wolters Kluwer.
Nevels, M., Tinker, W., Zey, J. N., & Smith, T. (2020). Who is protecting healthcare