A rising epidemic
Health workers are at high risk of violence all over the world. Between 8% and 38% of health workers suffer physical violence at some point in their careers. Many more are threatened or exposed to verbal aggression. These are alarming statistics that are increasing every year. It’s safe to assume that the vast majority of nurses did not get into the field out of a desire to fight people, so why all the fighting? A study in the US performed by the Emergency Nurses Association (ENA) detailed contributing factors of healthcare associated violence in emergency departments across the country. Most factors were directly related to patient conditions such as an increase in the frequency of mental health disorders and patients or their family being under the influence of drugs or alcohol, while other factors were related to facility shortfalls like under staffing and the lack of safe visitor policies.
Australian studies show that more nurses experience occupational violence than allied health providers and GP’s. In the period (August 2001 to July 2002) 68 percent of nurses compared with 47 percent of allied health providers and 48 percent of GP’s reported violence. And, just like the ENA study, all three professional groups indicated that the most distressing occupational violence was perpetrated by patients, followed by patients’ relatives. The most frequent form of occupational violence being verbal abuse, followed by threatening behaviour, physical violence, and obscene behaviour.
The Effect on Moral and Burnout in the Field
Violence against health workers is unacceptable. It has not only a negative impact on the psychological and physical well-being of health-care staff, but also affects their job motivation. As a consequence, this violence compromises the quality of care and puts health-care provision at risk. It also leads to immense financial loss in the health sector.
The effect that frequent acts of violence against employees can have on their morale is of great concern. “Emergency care is one of the specialties that does have a high burnout rate. How many other places do you go to work, and it’s commonplace and almost accepted that people are going to swear and scream at you?
Eighty percent of the emergency physicians say that patients threaten them or threaten to return to the emergency department to harm them. The cumulative effect of both kinds of violence does wear and it creates burnout and may be contributing to nurses leaving the profession.”
Who is responsible?
WHO has stated, “An integrated approach should be actively pursued at all levels of intervention based on the combined and balanced consideration of prevention and treatment.” Therefore, WHO holds employers accountable for both ensuring the safety of their employees and acting to treat them after an act of violence has occurred.
Efforts to Reduce Acts of Violence
Ensuring that healthcare settings have an ample number of employees can help reduce acts of violence. Hospitals must provide safe staffing, which they do not in most cases. Most employers are failing to listen to direct input of the care staff, the people who are there who understand how violence is occurring. These are the people who understand what’s happening in their unit.
The surveillance and monitoring of the right amount of staff and intervening before a patient becomes too agitated is the single best intervention to preventing violence in the workplace. Having the time to teach people, talk to them, educate them so that they don’t become anxious or upset, this is the best type of intervention.
Nurses, however, don’t have time for this type of care because they don’t have enough people around to provide that kind of care. When nurses aren’t safe, patients aren’t safe. When a work environment is not safe, the hospital is not safe. Workers and patients have the right to know what measures are being taken and if this facility is safe or not. It must include fines for the failure to comply. It must include mechanisms for remediation.
Nurses must refuse to accept the status quo. The profession needs to mobilise for action by working actively in hospitals and communities to institute best practices. We should all be clear that allowing healthcare workers to be victims of violence isn’t acceptable.
1. Occupational Violence in an Australian Healthcare Setting: Implications for M… Christian Alexander; John Fraser; Richard Hoeth Journal of Healthcare Management; Nov/Dec 2004; 49, 6; ABI/INFORM Global pg. 377
2. Nursing 2013: April 2013 – Volume 43 – Issue 4 – p 58–62 doi: 10.1097/01.NURSE.0000428329.78235.6f Feature: PROFESSIONAL GROWTH
3. Violence and Injury Prevention https://www.who.int/violence_injury_prevention/violence/workplace/en/
4. Framework guidelines for addressing workplace violence in the health sector. Geneva, Switzerland: International Labour Office (ILO), International Council of Nurses (ICN), World Health Organization (WHO), Public Services International (PSI); 2002. who.int/violence_injury_prevention/violence/activities/workplace/en/. Accessed May 3, 2019.