1

Workplace Violence in Nursing

Emily Rittenhouse

Delaware Technical Community College

NUR 340 Nursing Research

Dr. Kathleen Heacock

July 30, 2023

 2

Introduction

There are several issues in healthcare today that would benefit from nursing research.

Workplace violence in nursing is a current issue that has a negative impact on healthcare

providers, patients, and organizations. Nurses and other healthcare workers are identified to be

more at risk for workplace violence than other professionals that experience violence (Bernardes

et al., 2020). Workplace violence can be defined as the physical or verbal use of aggression

toward a nurse from a patient, visitor, or even another coworker (Somani et al., 2021). It can also

be entailed as sexual harassment (Ross et al., 2019). This research paper will address the

significance of this nursing problem, different methodologies behind the research, further

exploration of workplace violence, and implications for the nursing profession.

Statement of the Problem

The research question used to guide this research involves looking for the best strategies

for preventing and coping with workplace violence in nursing. Workplace violence in nursing

can be divided into four types of violence. Type I is viewed as an attack with a criminal

objective, type II involves a patient becoming aggressive while being treated, type III is known

as violence between coworkers, and the last type is defined as violence found in a relationship

(Somani et al., 2021). Ross et al. (2019) indicate that all four categories of violence need to be

addressed and eliminated to ensure a safe and healthy work environment. The nurse is affected

by the physical and emotional stress resulting from workplace violence. One article mentions

that nurses who experience violence are more likely to struggle with burnout and feel present at

their place of employment (Wirth et al., 2021). The nurse may also struggle with depression,

anxiety, post-traumatic stress, or even loss of confidence and fulfillment in caring for patients
 3

(Somani et al., 2021). Wirth et al. (2021) further discuss that patients are affected due to the

quality of care they are receiving, as well as the result of nurses feeling less proactive and

productive at work.

Literature Review

Several articles were collected to determine the best strategies for preventing and coping

with workplace violence. A total of six articles were collected for the study. The articles will

further be broken down into their methodology in the next section. Somani et al. (2021) wrote an

article discussing the best interventions to address workplace violence. The article begins by

identifying workplace violence as a problem and begins to define violence and discuss the

consequences for employees that endure violence without effective coping strategies. It was

identified that maintaining control of the environment, such as security locks, formulation of

safety policies, and utilization of staff training, has been effective (Somani et al., 2021).

Bernardes et al. (2020) begin an article by reviewing the specific types of violence, including

bullying, sexual harassment, verbal, and physical violence, as well as identifying the increased

risk nurses face, especially in the emergency department. This study also addressed the

prevalence in regard to the findings that females tend to experience violence more, and verbal

violence is the most experienced type of violence (Bernardes et al., 2020). Wirth et al. (2021)

wrote an article that discusses the best interventions for addressing workplace violence,

specifically with patients being aggressive or violent toward nurses in the emergency room. The

authors found that due to the increased risk, staff training and education are very important, as

well as support from management. Wirth et al. (2021) also encourage safe staffing ratios to
 4

prevent nurses from being secluded, as well as proper conditions such as good lighting, security

cameras, and alarm systems.

Jakobsson et al. (2020) discuss the experiences of nurses and other healthcare providers

that have experienced workplace violence. It was found that nurses perceived aggression from

patients with dementia or delirium to be less threatening as opposed to specific verbal attacks or

being threatened with a weapon. The authors also mention how a patient with substance abuse or

sustained harm from gang activity can cause alarm due to the unpredictability that comes with

these patients or their visitors (Jakobsson et al., 2020). The consensus from the article is that

these nurses felt unprepared or avoidant when handling workplace violence. Pierre et al. (2023)

discuss the benefit of implementing a behavioral response team that would decrease staff

injuries, promote a healthy work environment, and limit restraints on patients. It was encouraged

that staff receive de-escalation education and training regarding behavioral health. Once

implemented, the behavioral response team was proven successful due to the decreased staff

injuries as well as the decreased incidence of restraint use. Ross et al. (2019) describe that sexual

harassment can be displayed when someone in authority requests sexual favors or if someone

endures sexual hints or jokes from patients or employees. Though sexual harassment goes

against human rights, many victims do not report the incident because they fear consequences to

their personal or professional well-being (Ross et al., 2019). Many organizations are known to

have a no-tolerance policy in regard to sexual harassment. However, the question is whether this

standard of no tolerance is being implemented and upheld (Ross et al., 2019).

Analysis
 5

Each of the six articles have been broken down into different methodologies that each

add a different type of research to be considered. The articles can be categorized as qualitative,

quantitative, and quality improvement. The article “The face of workplace violence: Experiences

of healthcare professionals in surgical hospitals wards” is a good example of a qualitative

research article. The authors gather experiences and perspectives from healthcare workers

through interviews conducted in four focus groups (Jakobsson et al., 2020). That data was then

analyzed into the main themes, including workplace violence characteristics, prediction factors,

strategies, and the consequences associated with workplace violence (Jakobsson et al., 2020).

The article “Evaluating a behavioral response team in an acute hospital” is a quality

improvement article that advocates for the introduction of a behavioral response team to be

implemented. The authors discuss a six-step process to introduce the behavioral response team to

a hospital and determine the response to this intervention through pre and post-implementation

surveys (Pierre et al., 2023). “Sexual harassment in nursing: ethical considerations and

recommendations” discusses the terms, definitions, and ethical considerations surrounding

sexual harassment, a form of workplace violence (Ross et al., 2019). The authors search the

literature to support the ethical obligations organizations have to protect human rights (Ross et

al., 2019).

Three articles collected involved quantitative data. The article “A systemic review:

Effectiveness of interventions to de-escalate workplace violence against nurses in healthcare

settings” is a quantitative article that utilizes a quasi-experimental approach. The authors of this

article find twenty-six articles through reliable, creditable databases. They use a statistical

process called a PRISMA flow diagram to analyze the data and ultimately determine which
 6

interventions are the best for preventions and coping (Somani et al., 2021). The article

“Workplace violence among nursing professionals” is another quantitative research article. The

authors distributed a set of fifty-four questions to be distributed to healthcare professionals and

the results were categorized, analyzed, and interpreted (Bernardes et al., 2020). The article

“Interventions for workplace violence prevention in emergency departments: A systemic review”

also is a quantitative research article uses a quasi-experimental approach to gather sources from

several credible databases and also use the PRISMA flow diagram for analysis (Wirth et al.,

2021). A total of fifteen articles were utilized for the final recommendations in this article.

Recommendations

All these collected research articles utilize many different methods to offer support and

prevention of workplace violence in nursing. Bernardes et al. (2020) identify several ways to

prevent or cope with violence. It was suggested that everyone is treated with respect and

encouraged to listen to those involved in the incidents. Bernardes et al. (2020) also emphasize

that employee education needs to be continuously included, as well as ensuring appropriate

systems for reporting and handling workplace violence. The creation of a healthy work

environment was indicated in multiple articles in order to create an environment that prevents

workplace violence. Jakobsson et al. (2020) encourage consistent training activities and exercises

with specific instructions on handling workplace violence when it occurs. Ross et al. (2020) state

that it is the ethical obligation that healthcare establishments to protect the safety of their

employees and further employ that policies and environment should be in place to dictate that

safety is, in fact, a right. Somani et al. (2021) suggest ways that the individual and the

organization can prevent and cope with violence. It is established that the individual needs to be
 7

active in learning and adopting strategies to combat workplace violence. The responsibility for

the organization lies in the creation of a safe environment, a dedication to ending violence,

established policies, and leadership support (Somani et al., 2021). Wirth et al. (2021) determine

that staff need to learn self-defense and de-escalating tactics, and the environment needs to be

evaluated for any potential risks that can be addressed toward prevention. Pierre et al. (2023)

endorse having a behavioral response team available all hours of the day and night as a resource

to help the staff feel more supported. Hospitals should be proactive as opposed to reactive in

their response to handling workplace violence.

This research is extensive and comprehensive, but there are still some identified gaps or

places for future exploration. Several studies reported that workplace violence was not always

reported for various reasons. Ross et al. (2019) suggest that more research is needed regarding

sexual harassment. It was also identified that there was limited research on institutional as well

as environmental strategies (Wirth et al., 2021). For a future research question on workplace

violence, it would be essential to identify what interventions organizations provide for workplace

violence and how effective these interventions are. Another question would be regarding how

organizations support employees experiencing sexual harassment. Quantitative research would

be very beneficial to catch a wide range of data. However, it would be helpful to identify from

the nurses through quantitative data what they are experiencing. Due to the sensitivity of the

topic of sexual harassment, the rights of the victim would need to be protected (Ross et al.,

2019). Any type of workplace violence can be a sensitive issue that needs to be handled with

empathy and respect. Nieswiadomy and Bailey (2018) discuss that before proceeding with
 8

nursing research, participants clearly understand the benefits and risks of participation, give

consent, and understand they can withdraw from the research anytime.

Research is an important component of nursing that the nurse needs to keep as part of

their practice. It is imperative that the nurse stays up to date on the current practices and

evidence-based solutions to become a better nurse and improve patient care. Nurses can initiate

change in their hospitals and communities by presenting solutions to problems that are backed up

by research. Nurses need to be sensitive to vulnerable populations and ensure that the rights of

their patients and coworkers are protected. In conclusion, nurses are responsible for their growth

and learning and should find ways to incorporate their findings into their practice.
 9

References

Bernardes, M. L. G., Karino, M. E., Martins, J. T., Okubo, C. V. C., Galdino, M. J. Q., &

Moreira, A. A. O. (2020). Workplace violence among nursing professionals. Revista

Brasileira de Medicina Do Trabalho, 18(03), 250–257.

https://doi.org/10.47626/1679-4435-2020-531

Jakobsson, J., Axelsson, M., & Örmon, K. (2020, May 28). The face of workplace violence:

Experiences of healthcare professionals in surgical hospital wards. Nursing Research and

Practice. https://www.hindawi.com/journals/nrp/2020/1854387/

Nieswiadomy, R. M. & Bailey, C. (2018). Foundations of Nursing Research (7th ed.). Pearson.

ISBN 13:9780134167213

Pierre, P. E. Loeb, S. J., & Bansby, K. A. (2023). Evaluating a behavioral response team in an

acute care hospital. MEDSURG Nursing, 32(1), 46-61.

https://web-s-ebscohost-com.libproxy.dtcc.edu/ehost/pdfviewer/pdfviewer?vid=12&sid=

1a506402-747c-4d78-95f9-502351c60c00%40redis

Ross, S., Naumann, P., Hinds-Jackson, D., & Stokes, L. (2019). Sexual harassment in nursing:

Ethical considerations and recommendations. OJIN: The Online Journal of Issues in

Nursing, 24(1). https://doi.org/10.3912/ojin.vol24no01man01

Somani, R., Muntaner, C., Hillan, E., Velonis, A. J., & Smith, P. (2021). A systematic review:

Effectiveness of interventions to de-escalate workplace violence against nurses in

healthcare settings. Safety and Health at Work, 12(3), 289–295.

https://doi.org/10.1016/j.shaw.2021.04.004
 10

Wirth, T., Peters, C., Nienhaus, A., & Schablon, A. (2021). Interventions for workplace violence

prevention in emergency departments: A systematic review. International Journal of

Environmental Research and Public Health, 18(16), 8459.

https://doi.org/10.3390/ijerph18168459