A survey of 8,080 critical care nurses found that 86% experienced at least one incident of verbal or physical abuse, sexual harassment, or discrimination in the past year, the American Association of Critical-Care Nurses (AACN) reports.1

Patients and their family members were the primary source of all categories of abuse. An AACN survey found these incidents are less likely to happen when verbal and physical abuse policies were in place.

However, only 48% of participants said their organizations had a zero-tolerance policy against verbal abuse of staff, with 62% reporting a zero-tolerance policy against physical abuse, says lead author Beth Ulrich, EdD, RN, FACHE, FAAN, professor at Cizik School of Nursing at the University of Texas Health Science Center at Houston.

“The data from the AACN study is clear — the existence of zero-tolerance policies against abuse is significantly related to the amount of verbal and physical abuse which the nurses in the study experienced,” she tells Hospital Employee Health. “All healthcare organizations should have zero-tolerance policies against the abuse of staff and enforce them. Organizations should educate their staff members on both the existence of the policies and on how to deal with and mitigate abusive behavior.”

In a finding seen in similar studies, only 42% of the nurses who had experienced verbal or physical abuse, discrimination, or sexual harassment reported the incident to facility management.

“Among those who reported an incident, 55% said there was some discussion but nothing was done or there was no follow-up, 30% said the problem was resolved satisfactorily, and 4% said they were blamed for the incident,” Ulrich and colleagues reported in the study.1

Work Environment, Lack of Staffing Are Issues

The responses were different depending on whether the unit had implemented the AACN healthy work environment (HWE) standards, which include principles of skilled communication, true collaboration, and appropriate staffing.2

“For example, in units that had implemented the HWE standards, 50% of the participants said the problem was resolved satisfactorily, compared with 24% in units where the HWE standards had not been implemented,” the researchers reported.

“As the evidence continues to mount on the relationship between the health of the work environment and patient and nurse safety and outcomes, many healthcare and nursing organizations and associations have increasingly addressed work environment issues,” Ulrich says. “In addition, nurses themselves are speaking up when environments are unhealthy.”

Overall, 60% of nurses responding cited a lack of appropriate staffing, which is a major driver of an intent to leave the job. One-third of respondents said they planned to leave their current job within the next year.

“Staffing is not just about the number of patients or the number of nurses,” she says. “There are many more variables that need to be considered. AACN asserts that appropriate staffing requires an effective match between the individualized needs of the patient and family and the knowledge, skills, and abilities of the nurse.”

AACN recommends that organizations involve nurses in all aspects of staffing, particularly planning and evaluation.

“Nurses who worked in healthier work environments were significantly less likely to express intent to leave,” she says. “The responses from the participants who said they intend to leave their current positions on what would get them to reconsider leaving are informative.”

The top response was better staffing (50%), followed by higher salary or improved benefits (46%), better leadership (44%), more respect from administration (42%), and more meaningful recognition (39%), she explained.

“In addition, intent to leave was significantly related to a nurse’s perception of the overall effectiveness of his or her manager,” Ulrich says.


  1. Ulrich B, Barden C, Cassidy L, et al. Critical Care Nurse Work Environments 2018: Findings and Implications. Crit Care Nurse. 2019;39(2):67-84. doi: 10.4037/ccn2019605. Epub 2019 Feb 6. Available at: https://bit.ly/2IVDvKH.
  2. American Association of Critical-Care Nurses. Healthy Work Environments. Available at: https://bit.ly/2IAZZl5.