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Nurses are not excluded
By: Marius Clifford R. Billedo

Initially, when we consider crime and violence most Filipinos may envision or think of
the inner city streets, area populated by “lower class status”, and poor neighborhoods. They may
even think of sub cultural conflict, or conflict overseas. Then when asked what causes violence,
they may consider poverty, racial disparity, ineffective families, substance abuse, and the list
goes on. In most cases they may be right, in their estimate of crime and violence.
However, we tend to avoid or exclude the issue of crime and violence in the workplace.
Workplace violence has become an issue that should be well thought-out, as a major concern or
problem, and a contributing force to the overall violence.
The Ontario Nurses Association defines workplace violence as “Violence, also known as
abuse, can be defined as any act of violence, including physical, verbal and sexual abuse,
harassment, including sexual harassment, threats, intimidation or anything that offends or
humiliates etc.” (ONA, 2003) Workplace violence can also include rumors, swearing, pranks,
arguments, vandalism, sabotage, pushing, rape, arson, anger related incidents and murder.
Workplace violence is one of the most complex and dangerous occupational hazards
facing nurses working in today’s health care environment. The complexities arise, in part, from a
health care culture resistant to the notion that health care providers are at risk for patient-related
violence combined with complacency that violence (if it exists) "is part of the job." The dangers
arise from the exposure to violent individuals combined with the absence of strong violence
prevention programs and protective regulations. These factors together with organizational
realities such as staff shortages and increased patient acuity create substantial barriers to
eliminating violence in today’s health care workplace. 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 health care providers.
Nurses are working under stress due to nursing shortages, higher patient acuity, and
staffing changes. These factors can lead to an increased incidence in burn out, which can cause
nurses to act out in a negative fashion towards other nurses and staff members.
Nurses are viewed by society as having a lower status in the medical profession. Many
nurses are also subject to daily verbal abuse from physicians. Nursing is a female dominated
profession in a society that devalues and sexualizes women which can cause oppression in
nurses. When people are oppressed, they feel a lack of control and use desperate measures to try
and regain control. This may be expressed by intimidation or abuse of their co-workers. There
are many factors why nurses are more exposed to violence. They work alone or in isolation when
dealing with patients. They have to interact with the public, be it patients, family or visitors.
Nurses work with valuables such as drugs that are a much sought after commodity, especially
narcotics. The hospital is an open concept facility in which people may enter and exit without
being challenged. These people can be intoxicated, depressed or angry and looking for someone
to blame.
The very nature of the business means that health care workers are required to deal with
people in distress; many angry and frustrated due to their illness and pain. Nurses also work
under vulnerable conditions such as downsizing, job loss and increased work load. Many are so
overworked that they do not have time to deal with small crisis before they escalate into actual
acts of violence
Physical violence has long been acknowledged and is being dealt with in many cases, but
psychological violence is now emerging as a priority issue. Violence generates distress in
victims, which can lead to long term health problems such as insomnia, headaches, allergies and
substance abuse but can easily progress to hypertension, depression and even suicide.
The suffering and humiliation the victim suffers can cause a lack of motivation, loss of
confidence and reduction in self-esteem. This can result in lost production and reduced efficiency
in the workplace.
Workplace violence is a large problem in the health care field and incidents need to be
dealt with when they occur. Staffs need to be trained and encouraged to report every incident and
management needed to support employees when incidents are reported. Over the past century
health and safety measures have helped reduce injuries for various types of accidents.
Workplace violence needs to be the next priority in Health and Safety. Workplace
violence is on the rise and now is the time to stop it. Provincial and Federal efforts are needed to
assist the Nursing profession’s journey to create a safe and healthy working environment.