Workplace Violence in the Nursing Profession

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WorkplaceViolence in the Nursing Profession

WorkplaceViolence in the Nursing Profession

Workplaceviolence has been for a long time been a serious problem. There havebeen numerous definitions of workplace violence according to manyorganizations. Workplace violence is defined by the NationalInstitute for Occupational Safety and Health (NIOSH) as violent actswhich include threats of assault and physical assault which have beendirected towards people on duty or at work. Police officers usuallyfocus on threats and physical attacks that can result or that lead tophysical harm. However, there are many forms of workplace violenceaccording to scholars and practitioners such as verbalviolence-threats, hostility, harassment, and verbal abuse (Baron,&amp Neuman, 2014).These types of violations cause psychological stress and trauma eventhough there are no physical injuries that happen. There areinstances where verbal assaults results to physical violence. Nursinghomes, hospitals, and areas of healthcare provision are possiblesources of violence mostly perpetrated by visitors, coworkers,patients, and intruders. Some of the examples of violence in theseplaces include physical attacks and verbal threats by patients or afamily member who is distraught who can be an active shooter orabusive, domestic dispute, coworker bullying, gang violence in thehealthcare emergency department. This paper will discuss the variousforms of workplace violence in the nursing practice and what aretheir causes as well as programs and approaches to mitigate againstsuch practices.

IncreasedRisk for Workplace Violence for Nurses

Inthe years 2002 to 2013, there has been severe workplace violence,most of them involving the likelihood of the involved parties toreceive off days, and for those injured, recuperation. The numbersrecorded during these years were four times more prevalent inhealthcare, as compared to in the private industry at large. In 2003,the comprehensive ‘healthcare and social assistance’ segment had7.8 instances of adverse workplace violence for every 10,000full-time healthcare practitioners. It is worth to note that insectors such as manufacturing, construction, and retail had fewerissues regarding the workplace conflict for every 10,000 full-timeworkers (Serrette, Anna &amp Lipscomb, 2015).

Sourcesof Workplace Violence

OccupationalSafety and Health Administration (2015) notes that the largest sourceof violence in healthcare settings is the patients. However, patientsare not the only source of violence, as coworkers and visitors allcontribute to it. Patients account for approximately 80% of theviolence, colleagues 3%, students 3%, and other customers account for12% (McPhaul et al.,2015). Scholars in the profession have providedthese percentages, but they only include occurrences that resulted ingetting time off from the workplace. Despite the fact that data forother violence has been availed, studies show that several incidentsare never reported, even in healthcare facilities which have formalsystems for reporting. For instance, the results of one survey showedthat people said only 71% of non-physical assaults and 69% ofphysical assaults to managers (McPhaul et al., 2015). Another onecarried out in a medical center showed that physical and verbalassaults by patients to the nurses have never been reported inwriting (Occupational Safety and Health Administration, 2015).

Someof the reasons for underreporting include the fear of stigma orretaliation from other nurses and colleagues, lack of faith in thesystems of reporting, and a lack of reporting systems (McPhaul etal., 2015). There are some cultural factors in the healthcareprofession which contribute to acceptance of workplace violence, orthe underreporting of it. For instance, nurses feel that they have anethical and professional duty to protect patients, and not harm themin any way whatsoever. Some of then go to the extent of risking theirhealth and safety to help patients, hence some nurses have acceptedworkplace violence to be part of their jobs.

Nursesalso know that when patients hurt them, it is not usuallyintentional. Hence, the nurses either accept them and take them asunavoidable circumstances. One other issue is that the nurses avoidstigmatizing the perpetrators of violence, because of theirimpairment or illness. There is an evolution of healthcare, a factorwhich further increases the challenge. For instance, due to adecreased funding for mental health services, patients who mostlystir up violence are using emergency departments as opposed toutilizing treatment facilities that are specialized (OccupationalSafety and Health Administration, 2015).

Typesof Workplace Violence

Thereexist four types of workplace violence such as physical, verbal,horizontal, and sexual abuse (Sofield &amp Salmond, 2013). Severalreports have shown that in the healthcare setting, nurses experienceall these types of workplace violence, whereby most of the cases gounreported. Among the types listed above, there are subtypes whichhave been explained further. Physical workplace violence entails ofassaults, which are defined as attacks that range from slapping,homicide, rape and so on. Battery, physical harassment, mugging, andmurder are all part of physical violence, sexual workplace violenceconsists of fondling and rape, while verbal violence entails ofthreats, and verbal abuse which consists of demeaning, intimidating,yelling and so on. Horizontal violence mostly involves verbalharassment, hostility, and bullying as well. Violence alsoincorporates the aspect of manipulation in the workplace setting,which includes setting deadlines that are not reasonable, withholdingrequired information, the partial change of work schedules, beingexcluded from important meetings and so on (Serrette, Anna &ampLipscomb, 2015).


Duringone interview conducted that involved an expert in the nursingprofession, the prevalence of workplace violence was quite evident.One of the most common forms of violence in the healthcare professionwas regarding people being excluded from attending importantmeetings. The main reason for this is that the nurses threatened someof the members of the management team at lower levels. They thoughtthat these nurses would be vocal and may get noticed for theirefforts and that they may be promoted to reach their levels. In orderto solve this problem, the management issued a notice that beforeconducting meetings, the nurses in the lower levels should be emailedpersonally, so that they can know about it. On asked whether therewere other forms of violence, he stated that patients mostly gotinjured by rowdy patients. The problem with this is that the nursesseemed to condone this behavior. So as to solve this, most healthcarefacilities create awareness of the issue, and advice nurses to becareful and to avoid situations which put them at risk.

Factorsthat Impact Workplace Violence

  1. Shortage and Mal-distribution of Health Professionals

Criticalshortage and mal-distribution of health professionals increaseworkplace violence, particularly when patients harm the nurses. Inparticular, some patients may be in need of faster medical care fromthe nurses, and a shortage or mal-distribution would result in thepatients` increased level of anxiety this can, in turn, cause themto be violent against the nurses who are busy elsewhere (Sofield &ampSalmond, 2013).

  1. Quality of Healthcare

Impeccablequality of healthcare reduces workplace violence because both thenurses and patients are satisfied/ the nurses are satisfied withtheir working environment, hence they will provide the best servicesto the patients (Serrette, Anna &amp Lipscomb, 2015). Similarly,there will be fewer cases of agitation and anxiety from patients,which translates to a reduction in the prevalence of workplaceviolence.

  1. Payment, Insurance, and Reimbursement Plans

Thelack of coverage means that patients have to cash out and makepayments to the available healthcare facilities this makes patientsfeel as if they have to receive the best services and any mistakefrom the nurses may cause them to engage in violence against thenurses McPhaul et al., 2015).

  1. Quality of Workplace Settings

OccupationalSafety and Health Administration (2015) states that when themanagement has invested in ensuring that workplace settings are ofthe best quality, then workplace violence is reduced. Workplacesettings dictate the overall functioning of the healthcare facility,and as such, the management team should dedicate themselves. Anenvironment which does not have quality workplace settings harborsviolence, as the workplace conditions do not satisfy both thepatients and nurses.

ViolencePrevention Programs

Aprogram that has been written for the prevention of workplaceviolence and incorporated to all healthcare institutions for theiroverall health and safety would be significant as this wouldeliminate or reduce the risk of violence in the workplace. Some ofthe building blocks of coming up with a workplace violence preventionprogram that is effective include employee participation, managementcommitment, hazard control and prevention, program evaluation andrecordkeeping, worksite analysis, health, and safety training. Thereshould be clear objectives and goals for preventing violence in theworkplace regardless of where it arises from (Barling,2014).The components programs of preventing workplace violence are highlyinterdependent therefore they require regular reassessment andreadjustment so that they can respond to changes within thehealthcare profession such as the change in procedures andmanagement. These programs should be reassessed and evaluatedregularly and check for state requirements that are applicable.Several states in the country have developed requirements and passedlegislation that has addressed violence in the workplace.

WorkerParticipation and Management Commitment

Themanagement of health institutions should be at the forefront in thedevelopment and spearhead of the program in conjunction with theinvolvement of nurses and the staff in the department would result ina huge success in the program. There should be approaches which aredeveloped in such a way that the nurses and the management of thehealth institution are involved in the operation and creation of aprogram that prevents workplace violence through meetings which areheld regularly. The leadership of these establishments should firstrecognize that workplace violence is a health and safety hazard. Themanagement should allocate the appropriate resources and authority toall the relevant parties so that these places are safe and in theevent, patients are abusing either verbally or physically they arerestrained and reported to the police who would take appropriateaction against them. There should be a task-force in the institutionwhich has the responsibility of restraining people who are involvedin perpetrating workplace violence. The resources that people will beallocated with should go beyond catering for financial obligationsfor employing people who would restrain patients and coworkers whoare abusive. These resources should be assigned to training programsthat make all the workers in the health institutions the impacts ofworkplace violence and the adverse effects this kind of behavior hason people`s well-being.

HazardControl and Prevention

Afteranalysis of the workplace, this information should be reviewed then aresponse plan can be developed, which would ensure nurses working inhealthcare profession in the hospitals are safeguarded. Theprotection is done by installing video monitoring, education,changing workflow, fixing broken locks, policy development,implementation of drills, staffing changes (Baron,&amp Neuman, 2014).These policies would see to it that rogue patients are punishedseverely through severe fines which would be added to their medicalbills in a bid to discourage this kind of behavior.


Workplaceviolence is a great concern for nurses in the healthcare setting.Patients are the largest source of violence, despite the fact thatthere are other sources such as students, other customers, andcoworkers as well. These cases, however, are underreported because ofvarious reasons such as the fear of being stigmatized for makingreports. The nurses are also reluctant in reporting the perpetratorsbecause they feel that they have a duty to care, and they know thatthe injuries caused by the patients are unintentional. Overall,management teams should ensure that the quality of the setting isimpeccable so that both patients and nurses are satisfied. Inessence, this will lead to a reduction in the prevalence of workplaceviolence.


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Baron,R. A., &amp Neuman, J. H. (2014). Workplace violence and workplaceaggression: Evidence on their relative frequency and potentialcauses.&nbspAggressiveBehavior,&nbsp22(3),161-173.

McPhaul,K. M., London, M., Murrett, K., Flannery, K., Rosen, J., &ampLipscomb, J. (2015). Environmental evaluation for workplace violencein healthcare and social services.&nbspJournalof safety research,&nbsp39(2),237-250.sis.Maryland Safe Care Initiative.

OccupationalSafety and Health Administration. (2015). Workplace Violence inHealthcare. Retrieved from

Serrette,Anna &amp Lipscomb, J. (2015). Workplace Violence in Healthcare.Maryland`s Silent Crisis. Maryland Safe Care Initiative.

Sofield,L., &amp Salmond, S. W. (2013). Workplace violence: A focus onverbal abuse and intent to leave the organization.&nbspOrthopaedicNursing,&nbsp22(4),274-283.