Violence against nurses may be underreported

Nurses are experiencing a high number of violent acts in the workplace — but not just from patients; much of the abuse comes from co-workers as well. A University of Alberta (Canada, U of A) study that investigated workplace violence in hospital settings found the majority of the acts are not reported, and that tolerance might be contributing to the problem.

Researchers from the faculty of nursing at the U of A drew on data they collected for an earlier study. They surveyed more than 9,000 nurses in Alberta and British Columbia, asking if they had experienced any of the five types of violence — physical assault, threat of assault, emotional abuse, verbal sexual harassment, or sexual assault — within the past five shifts worked. They also were asked to indicate the sources of violence: patient, family or visitor, physician or nursing co-worker.

One in five nurses experienced more than one type of violence in a five-shift period. While patients still represented the largest proportion of perpetrators overall, hospital co-workers were responsible for 56.7% of all emotional abuse and 53.6% of all verbal sexual harassment in the critical care setting. Nurses tended not to report violent episodes in general, but were even less likely to report violence if a co-worker was the abuser.

In this latest study, published in the March issue of the journal Health Policy, the researchers tried to determine why this behavior continues in hospital settings. One theory that might explain the violence is the "Broken Windows" theory of criminal behavior, says Katie Rickers, the lead author of the paper. "There is nothing else out there in the literature on how to treat violence in health care organizations, so we turned to a theory in criminal behavior," she reports.

In the Broken Windows theory, tolerating lesser criminal acts — such as vandalism — in a community creates an environment where more crime takes place. Petty crime in a neighborhood is a signal of social disorder and that criminals sense little resistance to their illicit activities. The same explanation can be applied to hospital settings, says Rickers. "Part of the problem is that if co-workers are abusing each other and that is seen as OK, patients are more likely to commit violent acts," she notes.

Taking a Broken Windows approach to violence prevention would require an immediate visible response to all incidents, no matter how serious. Considering the current difficulty in retaining health professionals and the link between violence in the workplace and lowered job satisfaction, investigating the impact of workplace violence in hospitals is even more timely, says the U of A.