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Time to End Nurse Abuse

Jasmine S. Pelfrey

Youngstown State University

NURS 6900: Healthcare Issues and Trends

September 20, 2021

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Abstract

The World Health Organization defines workplace violence as any incident where staff are

abused, threatened, or assaulted in the form of physical attacks, verbal abuse, bullying, and

sexual or racial harassment (Stephens, 2019). Health care workers, and nurses specifically, are at

an increased risk of encountering workplace violence. The Department of Labor (DOL)

estimates nurses are four times more likely to encounter workplace violence than any other

industry; however, very little incidences of violence/abuse are reported. The Occupational Safety

and Health Administration (OSHA) provides federal guidelines to employers for employee

health and safety, but it does not strictly enforce these guidelines. With the help of the American

Nurses Association (ANA), nurses around the world are calling for a change in regulation to

decrease the severity and frequency of attacks and to promote safer, more productive work

environments. It’s time to end nurse abuse.

Keywords: workplace violence, nursing, nurse abuse

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Time To End Nurse Abuse

According to the World Health Organization, workplace violence can be defined as any

incident where staff are abused, threatened, or assaulted (Stephens, 2019). Stephens (2019), goes

on to say that violence can be in the form of physical attacks, verbal abuse, bullying, and sexual

or racial harassment. McPhaul and Lipscomb (2004) identify four ways in which workplace

violence can occur; type one involves criminal intent and occurs when a criminal activity is

taking place, type two is when the offender is a customer or patient, type three is worker-on-

worker violence, and type four is when the offender has a personal relationship with an

employee. Although all forms of workplace violence are important to discuss, the American

Nurses Association (ANA) highlights violence against registered nurses (RNs) by patients,

patient family members and external individuals. Stephens (2019) solidifies the argument that

patients or their families are usually the main perpetrator in violence against nurses but warns not

to discredit the severity and prevalence of violence between staff members. High stress work

environments can easily create tension between coworkers, and Stephens (2019) goes on to

discuss this environment that nurses work in daily. Unfortunately, nurses often encounter people

on one of their worst days. Illness, pain, fear, and sadness elicit many mixed emotions. Patients

and their family members are vulnerable during their encounter with health care workers, and in

these times, anger and aggression are more likely to arise. For example, in a 2001 study, 46% of

sampled nurses had experienced one or more types of violence in their previous five shifts;

however, an alarming 70% of nurses in this study did not report the violence (McPhaul &

Lipscomb, 2004). The concept of nurses being exposed to more workplace violence than all

other professions combined, with extraordinarily little reports of such, should raise an eyebrow.
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Nurses must understand the implications of not reporting workplace violence. To do that, nurses

need to first question what barriers to reporting exist and second, how they can overcome these

barriers.

Historical Aspects

The Occupational Health and Safety Act of 1970 gave rise to the Occupational Safety and

Health Administration (OSHA). OSHA, a part of the United States Department of Labor (DOL),

aims to provide workers with safe and healthy working conditions by setting and enforcing

standards. OSHA helps employers and companies to achieve these standards by assisting them

with education and training. The agency may cite employers for failure to provide working

conditions free of serious hazardous conditions, but it does not require implementation of a

workplace violence prevention program. OSHA leaves power to the state; however, limited

states impose concrete laws that address workplace violence. Federal guidelines released in 1996

and 2004 highlight the increased risk of workplace violence for health care and social service

workers, which suggests an increased awareness of the growing problem with workplace

violence as related to nursing specifically. According to the DOL, from 2002 to 2013, health care

workers were four times as likely to fall victim to serious incidences of violence. Furthermore,

the amount of serious violent injuries in health care were almost equivocal to the violent injuries

in all other industries combined (U.S. Department of Labor). Lipscomb and Love (1992) present

a review that identifies violence as an emerging hazard in health care. A multitude of literature

exists to identify and explain the violence that health care workers experience, but few offer

solutions for the problem (McPhaul & Lipscomb, 2004). There is a lack of literature for

prevention of violence against health care workers; however, in 2015, OSHA and the DOL
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presented updated guidelines that added to the 1996 and 2004 literature in an increased effort to

prevent violence against health care workers.

Implications

To fix the problem of underreporting, it is important to understand why violence is not

being reported. In a 2019 issue brief by the American Nurses Association (ANA), several factors

are mentioned including, the notion that workplace violence in nursing is normal, part of the job,

not the patient’s fault due to their current illness or that an incident of violence lacked severity.

Even more concerning among the reasons listed for not reporting was a lack of support from

management, a belief that nothing will change after the report, or even worse, that the nurse will

face retaliation for reporting the event (Trossman, 2019). A lack of training and a lack of

understanding of the definition of workplace violence were briefly mentioned as well. To

eliminate these barriers, management, employers, and regulating agencies must continue to train,

educate, and encourage nurses to report every event, no matter how seemingly small.

The problem of nursing shortage is no secret to anyone that works in the health care field.

Trossman (2019) mentions the absurdity of it being commonplace to go into work and expect to

encounter some form of workplace violence each day. For most other professions, this is not

even fathomable. According to Fountain (2019), studies have shown that violence against

hospital nurses reduces their job satisfaction, self-esteem, health and well-being, engagement

levels, retention rates, and their ability to provide optimal levels of patient-centered care. Roche

et al. (2010) suggests that violence is a fact of working life for nurses. The encounters with

violence mentioned had direct relation to adverse patient outcomes, and job satisfaction was

certainly decreased (Roche et al., 2010). Trossman (2019) also mentions the increased reports of

PTSD among nurses who have experienced workplace violence. These feelings weigh on the
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compassionate and dedicated health care worker, and it becomes questionable if there really is a

nursing shortage or if nurses are leaving the bedside due to burnout and decreased morale from

frequent encounters with violence in all forms.

Unfortunately, there is little research and review that provides a comprehensive approach

to tackling the problem. The current studies lack the implementation of a risk/hazard assessment,

documentation of baseline risk factors for violence, assault experience and prevention strategies

(McPhaul & Lipscomb, 2004). Intervention studies including post intervention assault

experiences, pre-intervention risk factors, and inclusion of control workplaces are needed to

rigorously evaluate a comprehensive violence prevention program (McPhaul & Lipscomb,

2004).

Resolution

Since nurses are directly affected by the large disparities in workplace violence in their

field versus others, it is important to include what nurses find to be acceptable measures of

resolution. According to May and Grubbs (2002), nurses reported things such as providing

specifically trained staff on how to ease tension and aggression, metal detectors at emergency

room entrances, and availability of security or police officers for high-risk patients that are

hospitalized as specific measures believed to be helpful in combating violence and reducing

stress.

As stated, no national reporting system exists. OSHA only serves to provide guidelines

for workplace violence prevention. Trossman (2019) mentions that one strategy to combat the

frequency and severity of workplace violence is to call on OSHA to provide facilities with a

unified standard for all health care employers to follow. Trossman (2019) mentions the ANA-
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backed federal legislation, the Workplace Violence Prevention for Health Care and Social

Service Workers Act (H.R. 1309/S. 851), which does just that – it calls on the Secretary of Labor

to issue a final standard that is applicable to all health care employers.

Fountain (2019) highlights the three prevention strategies recommended by the ANA.

Primary prevention includes education and prompt identification of workplace violence,

secondary prevention includes screening, continued surveillance, and treatment of workplace

violence victims with quick interventions to mitigate negative outcomes, and tertiary prevention

seeks to provide rehabilitative programs and assistance to minimize long term limitations

(Fountain, 2019). Foutain (2019) also brings light to the desperate need for more research to

cultivate and sustain effective ways to improve the workplace for all health care workers,

especially nurses.

Conclusion

Since the development of OSHA in 1970, federal guidelines have existed to help prevent

workplace violence. Recently, health care workers have brought to light the major difference in

incidence of violent events in their facilities as opposed to the incidence of violence in all other

industries. Due to the relative immaturity of available research, the abundance of violent events

not reported by nurses, and the lack of trust between employers and employees, it has proven to

be difficult to quantify the need for change. Agencies and organizations, such as the ANA, are

working in accordance with nurses to gain mass attention and bring this problem to legislature.

In order to resolve the issues, nurses are calling for prevention through education programs,

screening, treatment and rehabilitation programs, along with a unified standard reporting process.

Workplace violence has many negative effects on nurses, including job dissatisfaction, burnout,

and even PTSD. For the health of those caring for us, it is pertinent to end nurse abuse now.
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References

American Nurses Association. (2019). ANA Professional Issues Panel, END RN ABUSE: Issue

Brief: Reporting Incidents of Workplace Violence.

Fountain, D. M. (2019). Strengthening workplace violence prevention. Colorado Nurse, 119(4),

19. https://link.gale.com/apps/doc/A669379220/AONE?u=ohlink104&sid=bookmark-

AONE&xid=11e608dd

Lipscomb, J., & Love, C. (1992). Violence toward health care workers - An emerging

occupational hazard. AAOHN Journal, 40(5), 219-228.

May, D. D., & Grubbs, L. M. (2002). The extent, nature, and precipitating factors of nurse

assault among three groups of registered nurses in a regional medical center. Journal of

emergency nursing, 28(1), 11–17. https://doi.org/10.1067/men.2002.121835

McPhaul, K., Lipscomb, J. (2004). Workplace Violence in Health Care: Recognized but not

regulated. Online Journal of Issues in Nursing, 9(3), 6.

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Roche, M., Diers, D., Duffield, C., & Catling-Paull, C. (2010). Violence toward nurses, the work

environment, and patient outcomes. Journal of Nursing Scholarship, 42(1): 13–22. doi:

10.1111/j.1547-5069.2009.01321.x

Stephens, W. (2019). Violence against healthcare workers: A rising epidemic. AJMC.

https://www.ajmc.com/view/violence-against-healthcare-workers-a-rising-epidemic
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Trossman, S. (2019). Time to end nurse abuse: Resources and efforts to prevent workplace

violence. American Nurse Today, 14(10), 32+.

https://link.gale.com/apps/doc/A616903444/AONE?u=ohlink104&sid=bookmark-

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U.S. Government Accountability Office (2017). Additional Efforts Needed to Help Protect

Health Care Workers from Workplace Violence. 10.

http://www.gao.gov/assets/680/675858.pdf.