Workplace Violence among Nurses: Contributing Factors and Resolution Strategies
In contrast to other professionals, the health care workers have four times risk of being exposed to workplace violence. Nurses form the largest workforce in healthcare and thus, are majorly predisposed to workplace violence. This is particularly seen in restricted settings where there is staff shortage and poor administration.
Defining, workplace violence is the physical violence against any professional, ranging from threatening gesture to intimidating actions. It may initiate as verbal abuse and extend up to harassment and physical assault. According to WHO, it is classified as physical and emotional violence (Havaei & Ma, 2020, pp. 98). Emotional violence is afflicted as psychological harm whereas physical violence is the use of force that leads to both physical and mental harm. The workplace violence also extends to bullying and sexual harassment of nurses in the workplace (Havaei & Ma, 2020, pp. 98).
This topic has great significance and is a point of detail discussion as nurses form the grounds of health care. Patients, doctors and the health care organizations depend directly and indirectly on nursing to ensure safe patient care, at the same time raising organization’s revenue via effective care (Canada. Parliament. House of Commons. Standing Committee on Health, & Casey, 2019). Despite the impeccable role of nurses in health care, they are subjected to violence both by consumers and producers. This topic holds utmost significance as it remains under reported majority of times causing physical and mental health deterioration in nurses, ultimately affecting their care giving efficiency (Canada. Parliament. House of Commons. Standing Committee on Health, & Casey, 2019).
Exposure to traumatic events like workplace violence in any form puts nurses at stake, paving way for physical and mental health issues. With increasing viscosity of workplace violence among nurses, there is higher prevalence of PTSD, anxiety, depression and burnout among nurses (Havaei, 2021, pp. 41). Among all, PTSD and burnout majorly affect the nursing professionals. It was reported that exposure of Canadian nurses to physical violence is proportional to their use of psychotropics. Workplace violence not only affects the mental health of the nurses but also derails their physical and emotional health and limits their performance and efficiency (Havaei, 2021, pp. 41).
In a comprehensive review measuring workplace violence among nurses, it was observed, nearly 32% of the nurses were globally victims of physical violence, whereas 63% suffered non-physical violence. Nearly half of the nurses (48%) experienced bullying and 18% were victims of sexual harassment. The nurse may be victimized through first hand involvement via direct exposure or by witnessing violence; indirect exposure. Canadian nurses have high prevalence of indirect exposure to workplace violence accounting to 77% (Havaei, 2021, pp. 41).
In order to determine the major contributing factors, it is important to denote the source of violence and the other factors like environment that contribute to workplace violence. The instigators of violence can be the patient or family of the nurse, coworkers, spouse, and even strangers coming to seek health care. The major contributors are the patient and the family (Spector & Che, 2014, pp. 72-84). Other than that, certain workplace factors namely; lack of health care resources, poor administration, lack of staff, increased workload and long waiting hours can instigate patient aggression leading to violence against nurses. Several studies pointed to the positive correlation between heavy nurse workload and patient complaints causing escalation of violence (Spector & Che, 2014, pp. 72-84).
Another contributing factor is the nurses working in urban care settings and involved in direct care have more risk of being inflicted with violence. Others include gender, Female nurses have been the majority of responders in studies related to workplace violence. Additionally, age group also contributes, with most violence reported by age group of 25-54 years old (Havaei & Ma, 2020, pp. 98).
The nurses working emergency department are most likely to be the victims. Similarly, mental health nurses are the second in line to face the maximum workplace violence from patients and caregivers, followed by nurses in long-term care. It has also been reported that nurses in psychiatric units are more likely to face sexual harassment as compared to general nurses (Havaei & Ma, 2020, pp. 98). Also, professional designation plays a role of the contributor where RN’s are at most risk to workplace violence in comparison to LPN and RPN. Education is also on contributor list where diploma nurses face the major violence from patients and administration. It has also been reported that a lack of experience precipitates workplace violence for nurses. Lastly, the changing demands in health care contribute majorly to workplace violence (Havaei & Ma, 2020, pp. 98).
Adding to this, The Canadian Institute of Health Information revealed that in 2014-2019, maximum patients witnessed more than average wait time which led to workplace violence against nurses in lieu of frustration and anger (Havaei & Ma, 2020, pp. 98).
From the critical review of available evidence, it is observed that nurse leaders have a major role to play in managing workplace violence. The nurse leaders must timely intervene when the nurse reports feelings of frustration and anxiety and is not able to oblige to standards of nursing care. It is also imperative for nurse leaders to practice effective leadership to allow engagement of nurses in policy and decision making. Also, evident support of a coworker or authority has been seen to effectively resolute violence effects (Pereira et al., 2019, pp. 1052-1060). The organization must do their bit by launching ‘zero tolerance policy’ against violence in workplace. Prevention campaigns must be launched in and outside hospital premises where the health care seekers understand the issue and consequences of indulging in any indecent behavior towards nurses (Pereira et al., 2019, pp. 1052-1060).
As a part of patient-nurse conflict, the nurse can resort to prevention strategies like client centered care. This will give the client information and decision-making power. The nurse needs to acknowledge feelings behind client’s behavior. The nurse must practice therapeutic communication asking open ended questions and engaging in active listening. As a part of management, the resolution strategy that can be implemented is critical incident management plan (College of Nurses of Ontario, 2018). The nurse must clearly state the behavior limits. Withdrawing temporarily from care service to the client is also helpful. In conflict with colleagues, the nurse can prevent the same by modeling professional behaviors. She integrates and mentor the new nurses to practice in settings. The nurse reflects on self-behaviors, acts on strengths and work up the cons (College of Nurses of Ontario, 2018).
As a conflict management strategy, the nurse must practice addressing rather than avoiding. The nurse focus on behavior rather than the colleague. The nurse initiates an open dialogue for clarification and discard of assumptions. Assembling a neutral party will also be beneficial (College of Nurses of Ontario, 2018). The workplace conflict can be prevented by strong policies that combat discrimination and violence. Effective collaboration and communication are strong prevention strategies. As a part of conflict resolution, free reporting of incidents and routinely assessment will help (College of Nurses of Ontario, 2018).
The one resource that can aid in conflict resolution is ‘The conflict Prevention and Management practice guideline by College of Nurses of Ontario’. The resources is available online and can be easily accessible to nurses. The guideline clearly states the significant factors tailed to conflicts in workplace. It offers prevention and management strategies for conflict resolution at the same time highlighting the role of nurse leaders (College of Nurses of Ontario, 2018). Another significant resource available for nurses is the Registered Nurses' Association of Ontario: Best practice guidelines on managing and mitigating conflict; tips and tools for nurses. This tool is readily available online and allows better understanding of prevention and management of conflict in workplace (Registered Nurses’ Association of Ontario, 2012).
Reflection on learning
The paper was an enlightening experience as it allowed me to choose a topic of concern in nursing. The topic of workplace violence holds great significance as nurses form the foundation of health care and must be safeguarded. On critical review of scholarly articles, I realized that the incidence of workplace violence is highest among nurses globally and in Canada. It exists in various forms like physical, emotional, harassment and sexual violations. I observed that both direct and indirect violence play a role in limiting nursing efficacy in health care settings. I comprehended that workplace violence not only is a mental stressor for nurses but can extend harm up to physical and emotional health, limiting their ability to perform. This is a direct blow to standards of care formulated in nursing to ensure optimal patient care.
I recognized the major contributor factors that propagate violence against nurses listing lack of health care resources, increase workload, lack of administration and policy. The nurse’s education, area of work and specialty have a major role in determine the level of violence. I also apprehended the conflict resolution strategies that can be applied in every setting to prevent and manage conflict. Interpersonal skills and behavior management are important stepping stones in conflict resolution. The role of nurse leadership cannot be undermined in managing workplace conflicts. As a nurse, I will need to have access to evidence based resources like ‘The conflict Prevention and Management practice guideline by College of Nurses of Ontario’ and Registered Nurses' Association of Ontario: Best practice guidelines on managing and mitigating conflict; tips and tools for nurses for better understanding of prevention and management of conflict in workplace.
In addition to this knowledge gained, I will have to expand my knowledge of client-centered care which is a primary strategy to prevent nurse-patient conflict. Also, I need to practice self-enhancement in order to be able to work upon my strengths and conquer my weakness. A better understanding of therapeutic communication skills will be extremely beneficial. As far as the future nursing practice is concerned, I will be able to apply the learned prevention and management strategies for effective conflict resolution. This will allow me to create a positive working environment for myself and co-nurses, enabling to work efficiently towards patient care. The in-time attempt of conflict resolution will prevent the mental and physical harm, allowing me to oblige to nursing standards or care and code of conduct.
Workplace violence remains an undermined topic of concern in health care. With increasing incidence of variety and severity of violence, it is important for the sector to realize the need for stringent measures to curb the same. Workplace violence can be physical or emotional and on account of age, gender, specialty, education and position with contribution from certain environmental factors. Resolution strategies like interpersonal communication and behavior management are important. It is important to apply the conflict resolution strategies learned to create strong workforce and ensure better patient outcomes.
Canada. Parliament. House of Commons. Standing Committee on Health, & Casey, B. (2019). Violence Facing Health Care Workers in Canada. House of Commons Canada= Chambre des communes Canada.
College of Nurses of Ontario. (2018). Conflict Prevention and Management. Toronto, ON: Author. Retrieved from http://www.cno.org/globalassets/docs/prac/47004_conflict_prev.pdf
Havaei, F. (2021). Does the type of exposure to workplace violence matter to nurses’ mental health? Healthcare, 9(1), 41. https://doi.org/10.3390/healthcare9010041
Havaei, F., MacPhee, M., & Ma, A. (2020). Workplace violence among British Columbia nurses across different roles and contexts. Healthcare, 8(2), 98. https://doi.org/10.3390/healthcare8020098
Pereira, C. A. R., Borgato, M. H., Colichi, R. M. B., & Bocchi, S. C. M. (2019). Institutional strategies to prevent violence in nursing work: an integrative review. Revista brasileira de enfermagem, 72(4), 1052-1060.
Registered Nurses’ Association of Ontario (2012). Managing and Mitigating Conflict in Health-care Teams. Toronto, Canada: Registered Nurses’ Association of Ontario.
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. https://doi.org/10.1016/j.ijnurstu.2013.01.010