Workplace violence is one of the nursing profession's challenges that can reduce the quality of working life and job satisfaction. Nurses give so much direct care to the patient and have an essential responsibility in the quality of service offered to the sick persons. Even though nurses' role is significant, healthcare systems and particularly hospitals have not guaranteed nurses' safety against workplace violence. It can be psychological, mental, or physical, including mobbing, bullying, verbal abuse, and racial and sexual abuse. Workplace violence can affect nurse’s attitude towards their occupation and their level of satisfaction with the job.
Workplace violence leads to a reduced level of productivity and efficiency in a healthcare setting. It harms the nurses' enthusiasm to stay in the job, level of job satisfaction, and quality of working life, resulting in increased absenteeism and stress levels. Increased fear of exposure to workplace violence reduces commitment and job satisfaction. Violence is associated with work strain and stress. Increased stress levels raise the potential for burnout, violence, murder, and even suicide (Tee et al., 2016). There are substantial costs of workplace violence on nurses, society, and the work environment.
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Workplace violence encompasses not just happenings of active shooters or other dramatic actions of physical violence but also daily incidences like verbal abuse that are often disregarded. These occurrences have negative repercussions for patient safety, nurse turnover, burnout, and healthcare system finances. Caregiver burnout, stress, and fatigue contribute to a greater risk of medical errors and patient infections ( Monte et al., 2020) . The healthcare organization also incurs costs such as insurance costs, more extensive building security requirements, property damage, absenteeism, and employee compensation claims ( Lenaghan et al., 2018) . The incidents of workplace violence among nurses increase and challenge healthcare executives with the primary concern in public health and safety. The psychological effects of workplace violence among nurses could lead to health deterioration and, in some instances secondary trauma, and post-traumatic stress disorder.
Health executives are in a position to address the violence inflicted upon nurses at their workplaces effectively. They have a professional role in treating and proceeding with steps to diminish workplace violence and advocate for safety in the healthcare setting. Violence in health facilities and hospitals manifests in many ways, and moderating it requires a complex approach because it is a multi-faceted issue (Jobe, 2019). Healthcare executives should make efforts to ensure they place workplace violence prevention plans in their facilities. Also, employers should work towards preventing workplace violence on nurses by having security measures in place.
Additionally, the healthcare system can work together to diminish workplace violence in the nursing profession. First, the staff should believe that the organization's leadership team will address their reports of unacceptable behavior. Thus, they should report any occurrences of violence at the facility. Next, the healthcare organization can implement and broadcast zero-tolerance policies for any intimidating behaviors. Lastly, the organization should ensure that staff is trained and regularly refreshed on de-escalation practices, including using empathetic language, which is likely to reduce violent incidents. The organization needs to work towards managing difficult circumstances, being prepared, investigating each incident and near-miss situation, and constantly reporting happenings to OSHA to trace any trends ( d’Ettorre et al., 2018) . The healthcare organization always needs to improve in creating a safe and sustainable environment for nurses and other healthcare teams.
The nursing profession, through the nursing organization, can undertake these programs to prevent increased workplace violence. First, evaluation of the workplace is required. Workplaces are different, and the organization should analyze them to find out the unique violence vulnerability. They can develop a plan to control and prevent hazards by adjusting the working environment, changing job practices, and making effective responses to violent incidents. They can then make health and safety training, including training workers at every level, publicizing policies, and enlightening patients ( d’Ettorre et al., 2018) . Analysis of the workplace ought to be a constant process evaluating the program efficacy to make any necessary change. Nurses have fundamental training in workplace matters that makes them best to research, advance, administer, and assess programs to reduce workplace violence in their profession.
Next, use a top-down methodology. The nursing organization should address workplace violence beginning at the top downwards. OSHA's general work clause guarantees the employer's right to offer a safe working place for the employees. The role of safety eventually belongs to the employer. If the management does not endorse any prevention program, it will have no remote opportunity to succeed. The healthcare management has the power to address any aggression and bullying towards nurses. Most nurses fail to report workplace violence because the perpetrator is their supervisor (Kvas & Seljak, 2014). It is vital to stop this kind of intimidation so that the absolute number of violent incidents can be determined and employees know that the conduct will never be accepted.
The nursing organization should also empower nurses. Many forces have shaped the nursing culture. A challenging and generally dominant personality implies that the weaker personality surrenders and might even leave the field. People consider nurses part of an oppressed set, and they perceive themselves as powerless in the healthcare system. Efforts to regain their self-efficacy, especially towards one another, are demonstrated as negative behavior (Jobe, 2019). Time frame also affects nurses, making them view their job as a host of tasks and rules or time obligations. More patients with more complex needs and higher acuity make nurses feel overwhelmed. Therefore, it is imperative to eliminate those blocks and make nurses feel powerful in the healthcare setting.
Moreover, the nursing organization should institute zero tolerance for workplace violence. Consider the OSHA guidelines for the prevention of workplace violence as a zero-tolerance program. The organization should create nonverbal and verbal threats towards zero tolerance and related action policies on workplace violence and disseminate them among all employees, supervisors, managers, visitors, patients, and clients. Zero tolerance specifies that risks of aggression bounce from external forces and expects that the violence ascends from internal intimidations of violence between colleagues and addresses own personnel's supervision ( d’Ettorre et al., 2018) . There should also be a team of nurses to assess zero-tolerance responsible for revising programs and policies.
The nursing profession through professional nursing organizations should also provide education. An effective education program geared to preventing workplace violence should be an existing document, reformed with the organization's necessities to pinpoint and diminish the risks involved at work. Nurses should write these programs because they know the potential of violent circumstances caused by external and internal sources. Violence on nurses can come from coworkers, supervisors, physicians, strangers, patients, or their families. Stress often fuels an occurrence that would not have happened under different situations. The nursing profession should understand stressors and decrease them on time. The whole education program should surround the idea that workplace violence will never be tolerated ( d’Ettorre et al., 2018) . The healthcare management must support the education program, policies must reveal the support, and all patients and personnel must know of it. All healthcare facilities' employees should get an education and begin with supervisors whose support is vital in the program. Every worker should learn how to identify workplace violence's warning symbols and the appropriate steps to report possible problems. The organization should make the training annually.
The nursing organization should also predict high-risk happenings. Violence is a process that involves three behavioral stages; baseline, preassault, and assault. An individual begins with a calm phase with a typical demeanor after disturbance; they then get disturbed. They show nonverbal and verbal behaviors that threaten violence, and eventually, they play physical and verbal behavior (Jobe, 2019). The nurse profession and organization aim to identify when an incident has got at the pre-assault stage and intervene, leaving a twisting of violence. It is necessary to make a thorough evaluation of particular behaviors and diagnoses since some are too prone to violence. Violent behaviors may be found in persons with psychiatric diagnoses such as dementia from any cause, paranoid delusions, affective disorders, chemical dependency or abuse, and personality and impulse control disorders. Other factors that may show a high risk of violence are failure to take psychiatric medications, treatment for violence with a court order, and a violent history against property, pets, or people (Chang et al., 2018). There are many other behaviors that nurses should watch out for in their workplace. If a violent incident cannot be prevented or predicted, the employer should provide appropriate and immediate treatment to the victimized nurses.
To address workplace violence in the nursing profession more effectively, nurses operating in risky regions should undertake compulsory de-escalation training. It will help to head off the individuals who might be showing signs of violence. Outcomes can be improved when staff is trained on how to use non-threatening language and what factors to look out for. Nurses should also have a good attitude and handle their surroundings appropriately. They should address all circumstances with safety for themselves, patients, and their families in mind. During their shift huddles, nurses should review safety guidelines and attend safety committee meetings where employers share previous happenings to make everyone learn and be cautious. A nurse should adequately assess every situation, coworkers, patients, and their family members as they enter the room. For instance, if it is an elderly or a disabled person, the nurse should ask the family member if there is anything they need to be concerned about, like hitting, biting or anything that could upset or frighten the patient.
Moreover, the nurse should learn tips for managing psychiatric patients in the healthcare facility to avoid being assaulted. The nurse should be consciously aware of their surroundings, the patient's mood and behavior, and their psychiatric history (Niu et al., 2019). The nurse ought to assess the environment for any vulnerabilities that could be potentially hazardous to themselves, the security staff, the patient, or their family member. When taking the sick person to the restroom, the nurse should walk a few feet behind them, not at the side or in front of them. A nurse should always keep some arm's length away from the patient when giving care or delivering their meals. They should also keep some space when they assess the patient's mental status and their capacity to be educated and understand what they should expect while under the nurse's care and what is expected of them while with the nurse in the emergency department (Niu et al., 2019). Besides that, the nurse should never put themselves at a corner or turn their back, mainly if there is any form of alarm for violent behavior. If the patient begins to be violent, the nurse should call for help and not handle the situation independently.
In conclusion, workplace violence in the nursing profession is more significant than other average employees, and it comes from all corners, including those who should legally protect them. Nurses are stressed and overworked, and they do not get the employer's support. Workplace violence against nurses affects them, reducing their commitment to work and job satisfaction. Healthcare executives and organizations should work towards the safety of nurses at their facilities. They should engage nurses in efforts that reduce workplace violence to ensure they are prepared and ready to provide quality care to the patients. Nurses should also be consciously watching the patients from when they arrive at the lobby, in waiting areas, in emergency and care areas, and everywhere else around them.
References
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d’Ettorre, G., Mazzotta, M., Pellicani, V., & Vullo, A. (2018). Preventing and managing workplace violence against healthcare workers in emergency departments. Acta Bio Medica: Atenei Parmensis , 89 (Suppl 4), 28. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6357631/
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Kvas, A., & Seljak, J. (2014). Unreported workplace violence in nursing. International nursing review , 61 (3), 344-351. https://www.researchgate.net/profile/Janko-Seljak/publication/262532461_Unreported_workplace_violence_in_nursing/links/5f36ab5992851cd302f447d0/Unreported-workplace-violence-in-nursing.pdf
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