Understanding the Issue of
Workplace Violence
Workplace Violence Defined1-6
• Behaviors in the work setting that cause physical or
emotional harm
– Physical Assault
– Emotional or verbal abuse
– Threatening , harassing, or coercive behavior
Possible Reasons for Increased Risk
in the Hospital Environment5,7-11
• Lack of violence prevention programs
• Low staffing levels
• Lack of effective staff training in recognizing and
coping with potentially dangerous situations
• Inadequate security in some hospitals
• The tendency for some to view hospitals as sources
of money or drugs
• The presence of guns and other weapons among
hospital patients and visitors
Which Nurses are at Increased Risk?1,12-13
• More likely to be experienced by
– Male nurses
– Nurses under the age of 55
• Violence occurs most frequently to in
–
–
–
–
–
Emergency departments
Geriatric units
Psychiatric wards
Waiting rooms
Large urban areas
Factors That May Increase
Emotional Tension4-5,11,14
• Patients in pain
• Patients and visitors dealing with fear of the unknown,
especially related to the patient’s condition
• Anger directed at the hospital or healthcare system
– Cramped physical space
– Long waiting times
Violence Reporting is Inconsistent5-7,9,14-18
• The employee doesn’t know HOW to report an
incident
• Some employees have the perception that it is part
of the job
• Some employees don’t believe that reporting will
benefit them or correct the situation
• Employee concerns that assaults by patients or
visitors may be viewed as poor performance or
negligence caused by the employee
Analyzing the Issue
and Recommending Solutions
7,19-20
• Emergency Nurses Association
• Occupational Safety and Health Administration (OSHA)
• The Joint Commission
ENA 2007 Violence Study21
• Conducted to investigate emergency nurses’
experiences and perceptions of workplace violence
• Collect information on the types and frequencies of
assaults
• Understand contributing factors to workplace
violence
ENA 2007 Violence Study: Key Findings21
• More than half of emergency nurses report
experiencing physical violence on the job, including
as being “spit on,” “hit,” “pushed or shoved,”
“scratched,” and “kicked.”
• One in four has experienced such violence more than
20 times in the past three years.
• Just as alarming, one in five nurses have experienced
verbal abuse more than 200 times during the same
period.
Emergency Department Violence
Surveillance (EDVS) Study13
Purpose of EDVS study is to examine:
•
•
•
•
•
Types of workplace violence
Extent of under-reporting
Reporting mechanisms
Facility’s response to violence
Trends in violence over time
EDVS Study: Key Findings13
• 95.9% of emergency nurses believed that the level of
workplace violence in their emergency department had
remained the same or increased over the past year.
• 38.5% of workplace violence incidents occurred while
the nurse was triaging a patient.
• 76.9% of workplace violence incidents occurred in a
patient’s room.
• 26.6% of emergency nurses had considered leaving
their department for another unit or leaving the
hospital altogether due to the level of violence
ENA Position Statement19
• Acknowledges responsibility to provide safe
environment
– Environmental controls
– Relationship with law enforcement
• Highlights the importance of a violence prevention
program
• Advocates for legislation and research
• Stresses importance of supporting employee victims
through the reporting and recovery process
Three-Step Initiative
• Prevent (pre-event)
• Respond (event)
• Report (post-event)
Predictive Phases of Violence22-23
ASSAULT
PHASE
PRE-ASSAULT
PHASE
CALM
PHASE
Normal
behavior
prior to
disturbance
Individual
displays
threatening
verbal and
nonverbal
behaviors
Individual
displays out of
control verbal
and physical
behavior
Cascade of Violence23-25
Incivility
Non-physical
Violence
Physical
Violence
• The intent to harm is ambiguous and subject to varying
interpretation
• Intentional behavior
• Examples: harassment, intimidation, name calling, obscene
phone calls, stalking, use of profanity, verbal threats
• Intentional behavior
• Examples: spitting on person, pushing, grabbing, beating,
stabbing, shooting, homicide
Prevent
• Acknowledge intolerance of all workplace
violence and necessity of prevention measures
• Raise awareness of the culture of acceptance
• Promote the importance of recognizing escalating
situations
• Intervene early to diffuse the cascade of violence
• Understand the barriers to an effective
prevention program
Respond
• Identify the barriers to swift, effective and
safe response to an occurrence
• Educate the following groups on appropriate
response policies, procedures and skills to
minimize the likelihood of harm to a patient or
staff member
– Emergency department staff
– Patients/families
– Hospital administration
Respond
• Your zero tolerance policy includes responding
100% of the time
• Administrative support
– Fair and consistent procedures
– Culture of support, not punishment, for
victims of violent occurrences
Report
• Acknowledge that occurrence reports hold
valuable information for future improvements
• Filing a report should never generate a
punitive response for the employee
• Staff culture and attitudes have an impact on
whether a report is filed
• Lack of reporting can impede an initiative to
improve the safety of the emergency dept
Our Project Plan
• Slides 20-24: Suggested topics; modify and
insert slides specific to your institution/project
plan or staff education program
Project Team
• Slides 20-24: Suggested topics; modify and
insert slides specific to your institution/project
plan or staff education program
Goals for Our Emergency Department
• Slides 20-24: Suggested topics; modify and
insert slides specific to your institution/project
plan or staff education program
Staff Involvement
• Slides 20-24: Suggested topics; modify and
insert slides specific to your institution/project
plan or staff education program
Resources
• Slides 20-24: Suggested topics; modify and
insert slides specific to your institution/project
plan or staff education program
References
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9.
Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health.
(2002). Violence: occupational hazards in hospitals. Retrieved from
http://www.cdc.gov/niosh/pdfs/2002-101.pdf
Anderson, C. (2002). Workplace violence: are some nurses more vulnerable? Issues in Mental Health
Nursing 23(4), 351-366.
DelBel, J.C. (2003). Deescalating workplace aggression. Nursing Management 34(9), 30-34.
US Department of Justice, Federal Bureau of Investigation. (2004). Workplace violence: issues in
response. Retrieved from http://www.fbi.gov/stats-services/publications/workplace-violence
McPhaul, K.M., & Lipscomb, J.A. (2004). Workplace violence in health care: recognized but not
regulated. The Online Journal of Issues in Nursing 9. Retrieved from http://www.nursingworld.org/ojin/
Lipscomb, J., Silverstein, B., Slavin, T., Cocy, E., & Jenkins, L. (2003). Perspectives on legal strategies to
prevent workplace violence. The Journal of Law, Medicine, and Ethics 30(3),166-172.
US Department of Labor, Occupational Safety and Health Administration. (2004). Guidelines for
preventing workplace violence for health care & social service workers. Retrieved from
http://www.osha.gov/Publications/OSHA3148/osha3148.html
Gilmore-Hall, A. (2001). Violence in the workplace: are you prepared? The American Journal of
Nursing 101(7), 55-56.
Kowalenko, T., Walters, B.L., Khare, R.K., & Compton, S. (2005). Workplace violence: a survey of
emergency physicians in the state of Michigan. Annals of Emergency Medicine 46(2), 142-147.
References
10. Gerberich, S.G., Church, T.R., McGovern, P.M., Hansen, H., Nachreiner, N.M., Geisser, M.S., et al. (2005).
Risk factors for work-related assaults on nurses. Epidemiology 16(5), 704-709.
11. Presley, D., & Robinson, G. (2002). Violence in the emergency department: nurses contend with
prevention in the healthcare arena. Nursing Clinics of North America 37(1), 161-169.
12. US Department of Justice, Bureau of Justice Statistics. (2001). National crime victimization survey: violence
in the workplace. Retrieved from http://www.ojp.gov/bjs/pub/pdf/vw99.pdf
13. Emergency Nurses Association. (2010). Emergency Department Violence Surveillance Study. Des Plaines,
IL: Author. Retrieved from http://www.ena.org/IENR/Pages/WorkplaceViolence.aspx
14. May, D.D., & Grubbs, L.M. (2002). The extent, nature, and precipitating factors of nurse assault among
three groups of registered nurses in a regional medical center. The Journal of Emergency Nursing 28(1),
11-17.
15. Love, C.C., & Morrison, E. (2003). American Academy of Nursing expert panel on violence policy
recommendations on workplace violence. Issues in Mental Health Nursing 24, 599-604.
16. Sofield, L., & Salmond, S.W. (2003). A focus on verbal abuse and intent to leave the organization.
Orthopaedic Nursing 22(4), 274-283.
17. Bradley, D.B., & Moore, H.L. (2004). Preventing workplace violence from negligent hiring in healthcare.
The Journal of Nursing Administration 34(3), 157-161.
References
18. Clements, P.T., DeRanieri, J.T., Clark, K., Manno, M.S., & Kuhn, W.D. (2005). Workplace violence and
corporate policy for health care settings. Nursing Economics 23(3), 119-124.
19. Emergency Nurses Association. (2010). Position Statement: Violence in the emergency care setting. Des
Plaines, IL: Author. Retrieved from http://www.ena.org/about/position/position/
20. The Joint Commission. (2010). Sentinel event alert, issue 45: Preventing violence in the health care setting.
Retrieved from
http://www.jointcommission.org/sentinel_event_alert_issue_45_preventing_violence_in_the_health_care_setting_/
21. Gacki-Smith, J., Juarez, A.M., Boyett, L., Homeyer, C., Robinson, L., & MacLean, S. (2009). Violence against
nurses working in US emergency departments. The Journal of Nursing Administration, 39, 340-348.
22. Distasio, C. (2002). Protecting yourself from workplace violence. Nursing, 32(6), 58-63.
23. Gallant-Roman, M.A. (2008). Strategies and tools to reduce workplace violence. The American Association
of Occupational Health Nurses Journal, 56(11), 449-454.
24. Andersson, L.M., & Pearson, C.M. (1999). Tit for tat? The spiraling effect of incivility in the workplace.
Academy of Management Review, 24(3), 452-471.
25. Hutton, S. A. (2006). Workplace incivility: State of the science. The Journal of Nursing Administration,
36(1), 22-28.