Nursing and Workplace Violence: What You Need to Know

While interacting with patients, hospital employees sometimes find themselves on the receiving end of violence, ranging from verbal insults to physical violence. While many employees dismiss the seriousness of such cases, studies have established that violence against hospital employees is rampant and sadly, on the rise. This text aims at empowering nurses, health care, and social services workers to stop such violence. According to Locke, Bromley & Federspiel, (2018) , the spectrum of violence against hospital workers ranges from verbal offensives to homicidal levels. Workplace violence is defined as violence (including threats of assault such as yelling, hostile sarcasm, verbal harassment) and actual physical assaults such as slapping, biting, punching) on persons considered to be on duty in the working environment ( Locke, Bromley & Federspiel, 2018) . Cases have been reported of patients sexually assaulting hospital workers. 

Factors That May Contribute To Violence in Health Care Settings 

Violence at the workplace is more likely in healthcare organizations as compared to other industries ( Spector, Zhou & Che, 2014) , with the common perpetrators being patients. Studies have established that the most predisposed of hospital employees to violence by patients are emergency and psychiatric nurses. According to Emergency Nurses Association, twenty-five percentages of nurses in psychiatric care sustain disabling injuries inflicted by patients ( Locke, Bromley & Federspiel, 2018 ). According to Locke, Bromley, and Fedespiel, (2018), inexperienced nurses are more subjected to violence, while the experienced nurses perceive workplace policies on violence as ineffective. What causes this violence? First, when patients direct such violence to the nurse, the nurse considers such as symptoms of the patient’s illness. Rarely do they report the incidences, nor do they seek treatment even after sustaining injuries. A common outcome of physical and physiological violence is that the nurse becomes distracted, increasingly making errors in medication and thus lowering patient outcomes. The nurse also may experience damaging consequences such as moral distress, job dissatisfaction, and burnout. Such cases are attributed to the hospital management’s lack of encouraging the nurses to report such incidences. It has been shown that many organizations, when conducting induction of new employees, rarely focus on violence against employees, leaving them vulnerable. 

Components of OSHA's Workplace Violence Prevention Guidelines 

The Occupational Safety and Health Act (OSHA) offer guidelines on comprehensive violence prevention in healthcare settings and non-hospital workplaces. OSHA guidelines, though not exhaustive, provide policy recommendations with practical corrective proposals to assist in preventing workplace violence, by eliminating worker’s exposure to situations that lead to violence. These guidelines serve across the continuum of health care providers whose employees provide health care and social services. The guidelines also serve to reduce risks for the ancillary personnel working in health care organizations. OSHA (2015) advices employers to form multidisciplinary committees to establish the risk factors and develop ways of reducing them. According to OSHA (2015), employers are required to provide employees with hazard-free workplaces. The Act further stipulates that employees should not be intimidated for reporting incidents, injuries, illnesses, or fatalities at workplace. Though OSHA does not compel employers to have workplace violence prevention programs, it provides guidelines for violence prevention in the workplace. OSHA recommends reporting of violence incidences, establishing laws that penalize assault on nurses. OSHA authorizes hospitals to provide warnings on violent behavior. 

OSHA proposes four main components to effective health programs. The first is commitment of the management, augmented by the involvement of employees in safety and health policy-making processes. The second involves worksite analysis, where a systematic process is employed to assess the potential health and safety hazards present in the workplace environment. The third is implementation of hazard control and prevention mechanisms. This is followed by training the workers on issues of health and safety, with focus on prevention of violence at the workplace. 

Position of the American Nursing Association on Violence in the Workplace 

According to the American Nursing Association (ANA), workplace violence consists of verbal or written threats, physical and verbal harassment, physical assault and homicide. According to ANA, registered nurses (RNs) and the employers should provide and sustain a workplace environment that does not condone bullying, incivility and violence at the workplace. Further, it is the moral, legal, and ethical responsibility of RNs and the employers to create a safe, healthy work environment for all care team members inclusive of colleagues, employees, coworkers and students and their clientele. ANA insists on the importance of treating all involved in health care and the clients with dignity and respect. According to ANA, workplace violence is classified into four, where Type I involves a criminal intent, Type II involves persons with relationship to the business, Type III involves workers on workers, and Type IV involves parties with employee’s personal relationships. ANA requires that organizations provide employees, clients with a safe, quality environment, in addition to implementing a system for managing behavior considered to undermine the safe, and quality workplace environment. With regard to this, all RNs and employers ought to collaborate in creating the culture of respect envisioned by ANA, through application of evidence-based practice to promote RN health, Patient safety and to enhance RN career progression ( American Nurses Association, 2015 ). 

Safety policies and protocols for preventing and responding to violence against health care workers 

To reduce cases of violence against hospital workers, healthcare organizations need to implement a violence prevention program incorporated into the organizations’ health and safety policies ( Spector, Zhou & Che, 2014) . Such programs must commit both the management and the employees, detailing worksite analysis, hazard identification, prevention, and control, offer training in health and safety, and outline clear reporting, evaluation and record keeping mechanisms. In addition, the program should be evaluated regularly. The organization should allocate authority and resources required to ensure all the involved understand their responsibilities and accountabilities to ensure safety of all workers and patients. Further, it is the responsibility of the organization to support the implementation of recommendations by health and safety committees (Ahmad, Al-Rimawi, Masadeh & Atoum, 2015) . Employee involvement in drafting of safety and health policies is fundamental as their diversity can bring to light a broad array of information, experience, and skills useful in designing, implementation, and evaluation of such programs. In addition, employees from different levels and departments should be involved in safety and health committees responsible for drafting of health policies. 

Worksite Analysis and Hazard Identification 

This process involves establishing on a step by step basis existing and potential hazards that may act as a predisposing factor to workplace violence. This requires cooperation between the workers and the management. The workers contribute their knowledge based on familiarity with the physical environment as well operations, process activities and the potential threats within their areas (ANA, 2015). The analysis should identify hazards, draft prevention measures, and assist in providing necessary training to avert violence incidents from occurring. Review of incidence records is vital in establishing possible patterns in violence related cases. This is important in establishing appropriate control measures. This should include OSHA logs, records of incidences and near-miss logs. After the analysis, hazard prevention and control should follow to ensure that all systems are working to minimize or eliminate incidences that were identified. This process involves identifying and evaluating options to control workplace hazards, followed by selection of the most effective options to reduce or eliminate the hazards. The organization then provides necessary management resources necessary to implement the chosen option, while carrying out follow-up activities to ensure the controls are being effected appropriately (OSHA 2015). 

Conclusion 

Advocating for a safe working environment is the duty of all employees. Hospital workers should influence the organization to install safety infrastructure for both patients and workers. Such a system should design mechanism of Incident reporting, human resource empowerment to identify and curb violence under a violence prevention and safety policy with proper support for victims and proper directives on rapid response in emergency cases. Early clinical interventions can be used to alleviate patient violence against hospital workers. Noting and reacting professionally to a patient has continued agitation has registered success among the methods employed to avert violence by patients. Recognizing common triggers is helpful in reducing volatile interactions and hence prevents violence. In addition, establishing predisposing factors to violence works to minimize conflicts with the patient. These may include a history of violence or abuse, drug withdrawal, stress and trauma. Trauma-informed care helps the nurse establish patient’s trauma experience, recognize the signs, respond competently, and prevent re-traumatization. In addition, effective therapeutic communication is fundamental in preventing occurrence of violent incidences by patients, as it establishes rapport, builds trust, meets patient expectation to validate their sentiments, and allows the nurse to respond effectively. Further, efforts should be made to identify and remove items that may provoke or aid violence by patients. 

References 

Ahmad, M., Al-Rimawi, R., Masadeh, A., & Atoum, M. (2015). Workplace violence by patients and their families against nurses: Literature review.  International Journal of Nursing and Health Science ,  2 (4), 46-55. 

American Nurses Association. Professional issues panel on incivility, bullying, and workplace violence. 2015. New position statement. 

Guidelines for Preventing Workplace Violence for Health Care and Social Services Workers  . OSHA Publication 3148, (2015). Retrieved from https://www.osha.gov/SLTC/healthcarefacilities/violence.html 

Locke, L., Bromley, G., & Federspiel, K. A. (2018). Patient violence: It’s not all in a day’s work.  Am Nurs Today ,  13 (5), 10-3. 

Spector, P. E., Zhou, Z. E., & Che, X. X. (2014). Nurse exposure to physical and nonphysical violence, bullying, and sexual harassment: A quantitative review.  International journal of nursing studies ,  51 (1), 72-84.