identify the best nursing practice in the management of patient hostile behaviour and violence
Nursing and Workplace Violence Research Paper

Nurses are on the front lines and the back bones in the health sectors . Workplace violence is becoming an important issue that all organizations, these behaviors , especially that of bullying are detrimental and effect staff , patients , and outcome. Violence are defined as ( an incident that results in physical injury).(Duncan, Hyndan 2001 as cited in Denise,2009). Regarding to many research I found that nurses in emergency department and in mental health sectors are the most high risk staff who are facing violence form patients , their families and visitors because of many factors that I will discussed on my paper .Nursing and Workplace Violence Research Paper

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The aim of my research is review background of workplace violence . In addition to, identify situations and specific patient groups susceptible to being involved .Furthermore , identify the most health care sectors that are more susceptible to violence and factors leading to violence in these sectors depend on research articles to support my paper .Besides, identify the best nursing practice in the management of patient hostile behaviour and violence because nurses play a major role and the most staff dealing with different type of patient and cases. Finally, identify the role of health sector to minimize the risk of violence against nurses and the recommendation need it to prevent violence in health sectors .

Violence against Nursing in Health sectors
Work place violence is a serious occupational risk towards nursing.(International Council of nurses 2002 , Mc paul and Moore 2004 as cited in Jessica, Altair ,Lara, Cathy, Linda and Susan,2009).In hospital violence occurs most frequently in psychiatric wards, emergency departments ,waiting room ,and geriatric units.(Sofield and Salmond 2003 as cited in Jessica et al., 2009) they conducted studies and found that 35% to 80% of hospital staff suffering from violence either if its verbally or physically..Nursing and Workplace Violence Research Paper

The causes of work site violence are multifaceted and diverse .In hospitals ,clinics, health home setting, co-workers ,family members, patients or visitors may cause or contribute to violent events.(Maggie&Terriy,2005).The escalating risk in emergency department environment are reflective of patient under influence of drugs and alcohol abuse are often associated factors in patient-initiated violence on nursing staff , miscommunication and low staff levels leads to anger and long waiting times for patient.( Chalermrat , Virasakdi ,Suparnee ,Teem &Rassamee,2008 ).Beside, related to emergency situation and increasing number of patient with dementia and psychosis .Other risk factors are prevalence of guns and weapons that being carried by patients and their family or friends. (Gordan,Donna,Margret&Patricia,2010).In addition , lack of staff training or visible security ward. For instance, patients illnesses and unpleasant feeling ,as well as, the anxious and stress by patients and their family member and also visitors are often escalated by not enough space All these factors contributing and may incite physical and verbal abuse against emergency department staff.

On the other hand, nurses working in psychiatric setting have a higher risk for becoming victims of violence too. According to Gordon and Donna and Margared and Patricia,2010 was conducted a research about Workplace Violence in Health care Setting : Risk factors and protective Strategies and identify the risk factors in to perpetrator ,worker and setting environment risk factors. The perpetrator risk factors such as patient with mental health disorder like dementia, schizophrenia and alcohol and drug abuse have been associated with risk for workplace violence .However, setting and environmental factors that were related to increase risk for violence included day time versus evening and nighttimes hours .Equally important, work factors that were associated with violence include workers’ gender , the research show that women experienced a higher risk of verbal violence ,in contrast, men experienced physical violence.Besides,other characteristics of worker factors are number of hours worked per week and marital status.Nursing and Workplace Violence Research Paper

Employees in health care settings can’t prevent all violent events,however,they can use vary strategies to protect themselves against consequence of workplace violence.

Management of patient violence Nurses
Violence against nurses can be dangerous aspect of one’s nursing career. By providing the greatest amount of direct services to patients. nurses play a very great degree valuable role in the quality and efficiency of care and curative services.(Myduc,Stephen,Jay,Carri,Kenneth,2009).

Violence can be prevented and avoided by nurses who are aware ,well trained and in control .Nursing care should be in corporate activities within the domains of providing physical, psychological and emotional support through assess physical and emotional and psychological needs for violent .In addition to maintain privacy and personal safety. Besides physical and emotional support , the nurses should enhance safety of the patient and their family by focusing on the needs of family as a whole ,also full assessment for patient and family . In addition , a calm environment and greeting can stop noisy arguments ..(Maggie and Terry,2005). Moreover, good communication skills and proper intervention are more important to reduce the effects on mental health people and performance because some patient who are violence under the influence of drugs and alcohol even the visitors of patient.(Chalermrat et al.,2008). Finally, promote self efficacy by provide patient care plan ,health education and provide information about local and national help and support and available opinion. Further-more ,encourage safety planning and recognizing the patient’s experience regarding their situation and respecting and support patient and their family decision.(Gordon,2008).Nursing and Workplace Violence Research Paper

Violence preventing training for hospital is one step in reducing the incidence of violence in hospital emergency rooms. Potentially, violence patients and visitors can be recognized by the hospital staff by attending training in violence prevention .Also, alert supervisors to any concerns about safety and report all incident immediately in writting.(Tessa,Sue,Maureen,John,Martha,Sabina,Sandra,Greg,2010). Staffs work together or with a professionally trained individual to provide an open atmosphere in which to discuss the critical violent incident and need to learn don’t meet aggression with aggression.

Role of health care sector
All of the government initiatives in arrangement in light fixture and making the manager responsible to ensure well-being of their staff and put place reporting and monitoring systems ,but more emphasis is need in identity of the trigger factors to patient behaviour and appropriate management.

Similarly, the nurse play major role with violent patient ,of course the health sector play a major role to protect their staff and preventing violence .Facility administrator should provide a culture of support to those person who experience violence exposures in the work. In addition , can use a conventional and a credible system data to develop programs that increase staff safety and reduce the occurrence of violence exposure.Nursing and Workplace Violence Research Paper

To prevent and avoid violence , staff need to understand both violent activities and their development in the workplace . Education the staff regarding the function , role and responsibilities of the emergency nurse and the department may reduce the tension between staff. Also, education and training staff in the administration regarding the appropriate response to aggression behaviour if necessary. Moreover, close relationship with the police to tackle violence against staff to deal with the abuse behaviour once occurs.(Magie,2005). Equally important, provide enough staff member including nursing, medical officer support and security staff , besides , reduction of waiting time and the development policies and procedures to deal with the situation in case of emergency. Finally, provide video camera in emergency department to be used as evidence if necessary.(Ontario Nurses association,2008).

Conclusion
Nursing is a hard profession its physically and intellectually demanding. It requires patience and ability to relate to diverse types of patients ,communication skills and flexibility.

Violence at work place is a complex problem which demand multi functional actions and cooperation even with safety policies and procedures in place ,hospital and other health care setting can be dangerous places ,filled with individuals who are under stress .Part of nurses job to raise awareness in the health and aged care sectors and the community about the incidence of violence and its unacceptability as a workplace hazard are beginning to empower nurses to report violent incidents, to act to minimize risk , and to ensure their employers accept their legal obligations to provide a safe place for nurses to work and to provide care for the community.

Work place violence is unacceptable not only in nursing place ,but also in all workplace .

An important planning ,systematic assessment and effective responses strategies are necessary to deal with mental health illness and violent patient in any sectors ,some times its difficult, but by training sessions and copying strategies it could help to prepare nurses for violence in workplace.Nursing and Workplace Violence Research Paper

Violence against health workers
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. Most violence is perpetrated by patients and visitors. Also in disaster and conflict situations, health workers may become the targets of collective or political violence. Categories of health workers most at risk include nurses and other staff directly involved in patient care, emergency room staff and paramedics.

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.

Interventions to prevent violence against health workers in non-emergency settings focus on strategies to better manage violent patients and high-risk visitors. Interventions for emergency settings focus on ensuring the physical security of health-care facilities. More research is needed to evaluate the effectiveness of these program mes, in particular in low-resource settings.

A group of House Democrats introduced a bill on Friday to help protect millions of nurses and other health care workers from the high rates of violence they experience on the job.Nursing and Workplace Violence Research Paper

The new bill, called the Workplace Violence Prevention for Health Care and Social Service Workers Act, would require hospitals, nursing homes, rehab centers, mental health providers, and jails to develop a workplace safety plan to protect their workers from violence they experience at the hands of patients — a surprisingly common phenomenon. The bill would also require employers to record and investigate all complaints of violence, and prohibits retaliation against employees who call 911.

In 2016, health care and social service workers suffered 69 percent of all workplace violence injuries, according to the Bureau of Labor Statistics, and were nearly five times more likely to experience violence on the job than the average US worker. They are more likely to get injured at work than even police officers and prison guards. Nurses suffer in particular.

“Registered nurses are often threatened, punched, kicked, beaten, and assaulted on the job, sometimes with deadly consequences,” said Jean Ross, a registered nurse and co-president of the National Nurses United labor union, in a statement to Vox. The union has been pushing for federal legislation for years.

The bill, which is sponsored by Rep. Joe Courtney (D-CT), would essentially turn into law current guidelines from the Occupational Safety and Health Administration at the Department of Labor. A hospital’s violence prevention plan could involve hiring more security guards, installing surveillance cameras, and training staff in how to respond to violent incidents.Nursing and Workplace Violence Research Paper

The rule covers all employees, whether hired directly by a hospital or employed as subcontractors.

Violence against health care workers is a national problem
There are currently no federal rules that require that hospitals attempt to protect nurses from violence in the workplace, though some states have passed them on their own. In October 2016, California passed the toughest rules in the country, requiring health care employers to develop tailored violence prevention plans for each workplace with employees input. But the problem is not unique to California.Nursing and Workplace Violence Research Paper

Between 2005 and 2014, there was a 110 percent spike in the rate of violent incidents reported against health care workers. In one informal survey, as many as one in four nurses suggested that they had been attacked at work between 2013 and 2014 alone. Patients often kick, scratch, and grab them, and in rare cases, even kill them.

I also spoke to several nurses about their experiences for the Atlantic in 2016:

Rose Parma, a registered nurse in California’s Central Valley, says … patients have spit on her, slapped her, and even threatened her life during the five years she has worked as a hospital nurse. But it reached an intolerable level about a year into her career, when a delirious patient kicked her so hard in the pelvis that she slammed into a glass wall and fell to the ground. She was two months pregnant. The pain was not as shocking as her supervisor’s response when she reported the incident. “The manager seemed so surprised and said ‘Has this never happened to you? Is this really the first time?’ As if it weren’t a big deal,” Parma says. The manager then told Parma she would see her the next day at work. “I literally thought I was going to die [during the attack], and they didn’t even offer me counseling.” (Her baby survived.)Nursing and Workplace Violence Research Paper

Nurses say that not only do employers expect them to put up with violence on the job, but they often get punished if they call the police.

And it keeps happening. In 2017, health care and social service workers were still more likely to experience violent injuries than those in any other industry. Which is why Reps. Courtney and Ro Khanna (D-CA) and some of their colleagues decided congressional action is needed.

Nurses don’t expect their jobs to be a cakewalk. Stress, hard labor, fatigue, and working daily with sights, sounds, and smells that would make many average adults queasy—all of these go with the job, and nurses everywhere make the best of them. But if there is anything that a nurse does not have to accept, it is violent behavior from the people that they serve. Assaults on nurses by patients, visitors, and others are an unfortunately common problem, but it’s a problem that medical associations across the country are working together to solve. Through public campaigns, professional forums, and internal memos, they are making it clear to nurses and patients everywhere: Physical attacks do not go in a nurse’s job description.Nursing and Workplace Violence Research Paper

“Violence has been going on for a long, long time in emergency departments. And nurses have been told in the past that this is just a part of your job,” said JoAnn Lazarus, president of the board of directors for the Emergency Nurses Association. “Now we’re raising the awareness that it’s not just a part of your job. You don’t have to be assaulted. You can do something about it.”

A Milestone Reached
Last June was a milestone for Lazarus association, when Texas became the 34th state to raise the penalties for assaulting emergency-department nurses. The bill, which both houses of the Texas legislature unanimously approved and Governor Rick Perry signed into law, designated such assaults as “third-degree felonies.” They had previously been “Class A misdemeanors.”

JoAnn Lazarus, MSN, RN, CEN, and current president of the Emergency Nurses Association board of directors Nursing and Workplace Violence Research Paper
Up until now in Texas, it’s been a third-degree felony to assault firefighters or police officers, but not emergency-room nurses. The new law gives nurses the same legal protection as their crime-busting and firefighting counterparts.

The Emergency Nurses Association had worked over the previous four years to raise the issue with Texas lawmakers and see the law through to enactment. Representatives from the association and several partner organizations, including the Texas emergency physicians association, continuously met with state lawmakers and advocated to them for action.

“It was a group that came together to highlight the fact that violence is a problem in emergency room settings that was the impetus,” said Lazarus. “That’s pretty much what happens across the country. Nurses bring it to elected officials attention.

A Rising Concern
Violence against emergency-room personnel had been a rising concern in the Lone Star state and continues to be a problem throughout the country. Incidents run the full range from actions such as pinching, slapping, or kicking, to throwing nurses against walls or down flights of stairs, and in extreme circumstances, to severe beatings or sexual assaults. In a few cases, nurses have even been murdered.Nursing and Workplace Violence Research Paper

Coworkers, strangers, and individuals who personally know the nurses all account for some of the assaults. But the patients are the perpetrators 48% of the time, according to the American Association of Critical-Care Nurses.

An Emergency Nurses Association survey in November 2011 found that in just one seven-day period, nearly one in ten emergency-room nurses had suffered some form of physical violence. And those numbers only include the violence that gets reported. Even more incidents could be occurring but never being added to the final tally because the nurses fear that they could face repercussions for reporting them.

“Some have put up with dysfunctional behaviors for so long that they do not even recognize it as workplace violence. The culture is such that it does not get addressed in fear of retaliation,” said one Temple, Texas, nursing officer, speaking only on condition of anonymity. “For those that don’t admit it happens, I feel they are walking around with blinders on.”

She recalls an American Association of Colleges national conference several years ago, in which she delivered a presentation on workplace violence. Most attendees, a large share of them from military or veterans hospitals, stayed fairly mum during the presentation when she asked them as a group if violence was a problem at their facilities. But quite a few opened up to her in private afterwards.Nursing and Workplace Violence Research Paper

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“During the week I had several people come up to me one- on- one and told me that it does exist. Many were military or nurses that worked in the VA (Veterans Administration) system. Several broke down in tears as they described some of the behaviors exhibited along with what was tolerated by their administration,” she said.

Health Facilities Management surveys nearly 900 health-care facility management professionals yearly in its annual Hospital Security Survey. The most recent, in 2012, found that 25% of respondents were reporting more incidents of violence at their facilities from just one year prior; another 7% saw fewer such reports.

Why the Rise in Incidents?
Some of this is simply more nurses coming forward to report incidents. But there is, to a degree, also more violence taking place. Reasons why are many. The magazine cites as some factors the recent changes on the ground stemming from growing populations of patients, many of whom are uninsured and therefore require more time to process all their paperwork, combined with the squeezing of those populations into fewer hospitals as many health-care facilities close under tight state and local budgets. Wait times for care consequently increase, which leads to tensions in hospital wards and waiting rooms running even higher than they normally would.Nursing and Workplace Violence Research Paper

“Now we’re raising the awareness that it’s not just a part of your job. You don’t have to be assaulted. You can do something about it.”
It seems like hospitals everywhere are under pressure to keep doing more with less and less: treat growing populations of patients, including many with acute problems or lack of insurance, while many specialized facilities close or merge. Many hospitalized patients may be kept waiting for treatment due to short staff and too many other patients also needing care. And while this doesn’t excuse patients assaulting nurses, it appears to be a contributing factor.

“Emotions run high when patients in crises or pain must wait longer for care, creating situations ripe for violent incidents — often targeting hospital staff,” writes Beth Burmahl in Health Facilities Management.

Naturally, some hospitals have bigger problems than others. Any facility that treats large numbers of patients who have psychiatric or substance-abuse problems, for instance, may be more likely to see violence. According to the Emergency Nurses Association’s latest annual Violence Surveillance Study survey, which polled more than 3,200 nurses across the United States in 2011, patients who were drunk accounted for 54.7% of the assaults, while 45.9% were under the influence of drugs and 43.1% were psychiatric patients.

Emergency-room admissions of patients exhibiting psychiatric disorders or drug and alcohol-abuse-related episodes climbed rapidly after 2006, according to Kaiser Health News, due to the closure or consolidation of many specialized psychiatric and substance-abuse rehabilitation centers as tough economic times prompting many state and federal cutbacks in funding for mental-health and addiction-treatment programs.Nursing and Workplace Violence Research Paper

Making Changes
In a 2010 commentary in the American Journal of Nursing, emergency-department nurse Jessica Leigh Taylor of St. David’s South Austin Hospital in Austin, Texas, encouraged nursing associations everywhere to make deterring violence a “top priority” and hospital directors to institute and enforce “zero-tolerance policies” at their facilities. Hospital staff at all levels could also form committees to assess violence and violence prevention, encourage nurses to report any incidents, and make sure that nurses who experience violent incidents get the support and solidarity that they deserve.

The issue is an especially poignant one to Taylor. As she related in her commentary, she herself was once attacked by a patient.

“I’m not a victim anymore. I’ve declared that it’s not acceptable to abuse or harm me at work, and every nurse should make the same pledge,” Taylor wrote.

Hospitals around the country have been boosting their own internal security in the last few years. In many facilities, the in-house security teams are collaborating with the IT departments on upgrades to the ward monitoring equipment. These include new video surveillance to keep an eye on hospital rooms and electronic RFID tags that track where any patient is at any given time. Facilities are also setting up wireless panic alarm systems, remote-access controls that only open doorways to those with the designated bar-coded name tags, and computer software that accesses every patient’s record and notifies staff in advance if he or she has committed violent or disruptive behavior in a hospital in the past.

“I’m not a victim anymore. I’ve declared that it’s not acceptable to abuse or harm me at work, and every nurse should make the same pledge.” ~ Jessica Leigh Taylor, RN
Some non-technological solutions are also going into use. Emergency rooms are increasingly utilizing spare hallway and waiting-room space to see more patients in less time. Some are also converting select ward rooms as secured “safe rooms” for holding patients that present clear dangers to themselves or others. Management teams are also working with their hospitals staff on ways to streamline the patient-registration process, fast-track the less-acute injuries and illnesses, and better coordinate the inpatient floor nurses.Nursing and Workplace Violence Research Paper

“We have to work together to find ways to more effectively move patients through the system the less people we have to hold the lower the waiting times and the less violence you’re likely to have the happier everyone is likely to be,” says Lazarus.

The most critical piece of the solution, however, is the nurses themselves. Lazarus stresses the importance of every nurse observing patients and visitors and recognizing cues—be they verbal, body language, or something in the situation itself—that suggest a violent incident may be about to occur. Then that nurse can take steps to de-escalate the situation or, if necessary, eject himself or herself from it.

“They need to know when to call for help. Felony laws are great if something happens but they’re not necessarily going to be the deterrent the deterrent is going to be keeping that from happening in the first place,” Lazarus said.

Nurses can find violence-prevention courses that train them in de-escalation techniques. These courses can be very worthwhile, according to Lazarus. Some states even require them.

“A key challenge for nurses is learning to evaluate those situations and developing the awareness to deal with those situations or in some cases to just walk away. You have to make sure that the scene is safe,” Lazarus said. “As nurses we can’t refuse to treat a patient. But we can make sure that the environment is safe for us to do that.”

Workplace violence is more than physical assault — it is any act in which a person is abused, threatened, intimidated, harassed, or assaulted in his or her employment. Swearing, verbal abuse, playing “pranks,” spreading rumors, arguments, property damage, vandalism, sabotage, pushing, theft, physical assaults, psychological trauma, anger-related incidents, rape, arson, and murder are all examples of workplace violence. The Registered Nurses Association of Nova Scotia defines violence as “any behavior that results in injury whether real or perceived by an individual, including, but not limited to, verbal abuse, threats of physical harm, and sexual harassment.” As such, workplace violence includes:Nursing and Workplace Violence Research Paper

threatening behavior — such as shaking fists, destroying property, or throwing objects;
verbal or written threats — any expression of intent to inflict harm;
harassment — any behavior that demeans, embarrasses, humiliates, annoys, alarms, or verbally abuses a person and that is known or would be expected to be unwelcome. This includes words, gestures, intimidation, bullying, or other inappropriate activities;
verbal abuse — swearing, insults, or condescending language;
muggings — aggravated assaults, usually conducted by surprise with intent to rob; or
physical attacks — hitting, shoving, pushing, or kicking.
Workplace violence can be brought about by a number of different actions in the workplace. It may also be the result of non-work related situations such as domestic violence or “road rage.” Workplace violence can be inflicted by an abusive employee, a manager, supervisor, co-worker, customer, family member, or even a stranger. The University of Iowa Injury Prevention Research Center classifies most workplace violence into one of four categories.Nursing and Workplace Violence Research Paper

Type I Criminal Intent — Results while a criminal activity (e.g., robbery) is being committed and the perpetrator had no legitimate relationship to the workplace.
Type II Customer/Client — The perpetrator is a customer or client at the workplace (e.g., healthcare patient) and becomes violent while being assisted by the worker.
Type III Worker on Worker — Employees or past employees of the workplace are the perpetrators.
Type IV Personal Relationship — The perpetrator usually has a personal relationship with an employee (e.g., domestic violence in the workplace).
2. Effects of Workplace Violence

The healthcare sector continues to lead all other industry sectors in incidents of non-fatal workplace assaults. In 2000, 48% of all non-fatal injuries from violent acts against workers occurred in the healthcare sector. Nurses, nurses aides, and orderlies suffer the highest proportion of these injuries. Non-fatal assaults on healthcare workers include assaults, bruises, lacerations, broken bones, and concussions. These reported incidents include only injuries severe enough to result in lost time from work. Of significance is that the median time away from work as a result of an assault or other violent act is 5 days. Almost 25% of these injuries result in longer than 20 days away from work. Obviously, this is quite costly to the facility as well as to the victim.

A study undertaken in Canada found that 46% of 8,780 staff nurses experienced one or more types of violence in the last five shifts worked. Physical assault was defined as being spit on, bitten, hit, or pushed.

Both Canadian and U.S. researchers have described the prevalence of verbal threats and physical assaults in intensive care, emergency departments, and general wards. A study in Florida reported that 100% of emergency department nurses experience verbal threats and 82% reported being physically assaulted. Similar results were found in a study undertaken in a Canadian hospital. Possible reasons for the high incidence of violence in emergency departments include presence of weapons, frustration with long waits for medical care, dissatisfaction with hospital policies, and the levels of violence in the community served by the emergency department.Nursing and Workplace Violence Research Paper

Similar findings have been reported in studies of mental health professionals, nursing home and long-term care employees, as well as providers of service in home and community health.

Violence in hospitals usually results from patients, and occasionally family members, who feel frustrated, vulnerable, and out of control. Transporting patients, long waits for service, inadequate security, poor environmental design, and unrestricted movement of the public are associated with increased risk of assault in hospitals and may be significant factors in social services workplaces as well. Finally, lack of staff training and the absence of violence prevention programming are associated with elevated risk of assault in hospitals. Although anyone working in a hospital may become a victim of violence, nurses and aides who have the most direct contact with patients are at higher risk. Other hospital personnel at increased risk of violence include emergency response personnel, hospital safety officers, and all healthcare providers. Personnel working in large medical practices fall into this category as well. Although no area is totally immune from acts of violence it most frequently occurs in psychiatric wards, emergency rooms, waiting rooms, and geriatric settings.

Many medical facilities mistakenly focus on systems, operations, infrastructure, and public relations when planning for crisis management and emergency response: they tend to overlook the people. Obviously, no medical facility can operate without employees who are healthy enough to return to work and to be productive. Individuals who have been exposed to a violent incident need to be assured of their safety.

The costs associated with workplace violence crises are not limited to healthcare dollars, absenteeism rates, legal battles, or increased insurance rates. If mishandled, traumatic events can severely impair trust between patients, employees, their peers, and their managers. Without proper planning, an act of violence can disrupt normal group processes, interfere with the delivery of crucial information, and temporarily impair management effectiveness. It may also lead to other negative outcomes such as low employee morale, increased job stress, increased work turnover, reduced trust of management and co-workers, and a hostile working environment.Nursing and Workplace Violence Research Paper

The article, “The Bullying Aspect of Workplace Violence in Nursing” by Michelle Johnston, BSN, RN, Phylavanh Pahnhtharath, BSN, RN, and Brenda S. Jackson, PhD, RN discusses a kind of workplace violence, nurse bullying, that is considered to be one of the most prevalent types that occur in healthcare organizations not only on a national, but also an international level. The article focuses on its existence and proposes ways to address and prevent it. Thus, a healthy workplace environment for nurses can be established and maintained.

Many in the healthcare field, not only nurses, have heard the phrase, “nurses eat their young” repeatedly. The authors discuss various theories that show that this workplace violence has been a part of nursing history and has created a toxic environment whereby new nurses and students are the usual victims of this abuse who “may internalize it as a norm within the profession and eventually become bullies in their own right (Johnston, Phanhtharath, & Jackson, The Bullying Aspect of Workplace Violence in Nursing 2009, p. 288).” Furthermore, The Joint Commission has recognized that this is an issue of interest they want to be involved with, because “there is mounting evidence that unhealthy work environments contribute to medical errors, ineffective patient care, interdisciplinary conflict, and stress among healthcare professional(Johnston et al., 2009, p. 290).”

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The authors have set out to provide recommendations that may attack nurse bullying. Through a statistical survey conducted in the United States and 17 other countries, nurses were questioned about aspects of nurse bullying and how it affected their workplace environment. Furthermore, the authors illustrated the significance of nurse bullying, defined what nurse bullying is, gave a background or historical origin of nurse bullying, and provided interventions that could address this type of workplace violence.

They recognize specific theories that need to be considered when attempting to stamp out this kind of behavior. Among the various theories, the theory of human behavior is considered to be very relevant. Also, one “must also understand the context in which human behavior is occurring and how “it,” in this instance the environment of healthcare influences human behavior (Johnston et al., 2009, p. 290).” Another important theory that is referenced is Madeline Leninger’s culture care diversity and universality theory. In the promotion of positive behavioral norms, the author discusses Parsons’ Health Promoting Organizations model. Also, it is recognized that nurses consist of a diverse group of people with different personalities, values, and cultural and ethnic origins. In summary, these various theories and model produce the desired outcome of attacking nurse bullying and very likely could produce positive results.Nursing and Workplace Violence Research Paper

Nurse bullying has unfortunately been a part of the profession of nursing for a long time. Things will only get better when nurses bring this issue to the forefront. However old or deeply ingrained this workplace violence is a part of nursing; it is something that all nurses from anywhere in the United States as well as around the world see as something that should not be tolerated. Nurses need to no longer be victims.

Workplace Violence
Many companies today are dedicated towards creating an environment that is conducive to its employees to work in. this is in their struggle to make sure that they maximize resources and that the company heads towards its set goals. Such an environment can only be achieved by get rid of all forms of violence in the work place. This is because such vices only eat in to a lot of the employee’s time and create bad relationships among employees which in return reduce production. To have a good group of employees working together as a team may be difficult to realize. Still is one major thing that an employer should adequately invest in as it is directly proportional to the kind of results that your company will get.Nursing and Workplace Violence Research Paper

Forms of Workplace Violence
Many people believe that work place violence is only associated to incidents that occur on site of the business premises. It is good to note that any ugly incident that involves your employees is a form of work place violence regardless of where it happens. Workplace Violence is also not limited to physical violence or assault. There are other forms that are worse than the physical assault and have even a greater negative impact to a company’s output. The most common form is the use of written or verbal threats so as to annoy or inflict fear or harm to ones feelings. Verbal abuse is also very common in the work place and in most of the times it goes unnoticed yet some people remain hurt but may be afraid to speak. Another form is behaviors that are threatening like hallowing objects and destruction of property. Behaviors that intimidate, annoy, humiliate, embarrass and demean others are also not welcome at the work place. Last form is the one that is common to all and it the physical attacks that include pushing, kicking and hitting. All these forms no matter how inoffensive they look should be avoided at the work place.

Prevention of Workplace Violence
The employer should be very strict to individuals that getting implicated in work place violence. However punishment may never work always as you are not sure of getting at the bottom of these cases, it is thus good to prevent them by trying to create good working environments. This can be done by having bonding sessions that will allow employees to know each other well and enhance team work among them. This will also boost your company performance. The hiring process should also be thorough and you should wary of candidates that exhibit traits of violence.Nursing and Workplace Violence Research Paper

Workplace violence is defined as any incident or situation in which a person is abused, threatened, or attacked at the workplace and/or conditions related to it [1]. Workplace violence affects the people’s self-esteem and quality of work and causes inequality, discrimination, disorder, and conflict at work [2].

Despite the fact that violence occurs in all work environments, health workers are more exposed to workplace violence [3]. Statistics show that annually 70–80% of physicians, nurses, emergency medical personnel, and public service staff experience one or more cases of violence [4].

With regard to the nature of the work of the PEMTs, they are always at risk of confronting violence by the patient or their companions. PEMTs often encounter patients in critical situations that require immediate medical attention. In such stressful cases, they must provide emergency services and medical first aid to the patients at the scene of the accident and on the way back to health centers, and they should transfer the patients to hospitals and other health centers for performing specialized cares as soon as possible [5]. The results of a previous study showed that 83.3% of the employees had experienced workplace violence at least once a year [6].Nursing and Workplace Violence Research Paper

The rate of workplace violence is constantly increasing, the reason of which is the absence of preventive strategies and effective reporting system. The reports resulting from a survey that examined the extent of exposure to violence among emergency medical personnel showed that 25% of the personnel were exposed to physical attacks and physical injuries [7, 8]. The results of a study conducted by Gormley et al. on violence against US emergency medical personnel showed that 69% of the personnel experienced various kinds of violence over the previous year, and the rate of verbal violence had been more than any other physical violence [9].

A survey from the emergency medical personnel in two Canadian provinces showed that 75% of the respondents had experienced violence in the past year [10]. Verbal violence is the most common type of violence reported by the emergency medical personnel [11]. In a study, Maguire et al. showed that work-related harms among the emergency medical personnel were three times higher than the global average for other occupations [12].

Unfortunately, acts of violence cause many physical and psychological complications, such as physical injuries, tension headaches, anger, fear, depression, anxiety, feeling of guilt, decreased self-esteem, undesirable effects on the quality of patient care, reduced work morals, occupational burnout, frustration, and negative attitudes towards work. Additionally, disturbances such as the loss of working days, constraints on activity or work, termination of employment, job change, and even death are serious complications of occupational violence [13–16]. Research shows that there is a relationship between the incidence of occupational accidents and absenteeism and this relationship has a negative impact on the employees’ job satisfaction. In addition, violence can affect the whole healthcare team and affect the quality of services provided to patients [17, 18].

Most cases of violence in the hospitals have been caused by patients, patient’s relatives, physicians, personnel working in the hospital, and visitors [19, 20]. Unfortunately, despite the great importance of workplace violence and its destructive effects, this problem has not yet been taken seriously in our country’s healthcare system, and various studies have examined this problem only in a single province and in a small area. Therefore, with regard to the importance of this issue, as well as the lack of research performed on PEMTs, the present study was conducted aiming to investigate the workplace violence against PEMTs in Fars, Kohgiluyeh and Boyer-Ahmad, and Bushehr provinces, Iran.

Nurses work in a caring profession, helping patients heal from their illnesses and injuries and working toward positive changes in healthcare. In doing their jobs, however, nurses may also face workplace violence.Nursing and Workplace Violence Research Paper

Healthcare and social service workers, including nurses, face the risk of being injured as a result of job-related violence, the safety-focused Occupational Safety and Health Administration (OSHA) said. While federal regulators and accrediting agencies have been cracking down on medical facilities that fail to protect employees from violence, many say more work needs to be done. Many states do not have laws that specifically protect healthcare workers.

Nurse organizations are among the many groups hoping to change state and federal laws to protect workers. The groups want medical facilities to take a proactive role in protecting employees.

“Abuse is not part of anyone’s job and has no place in healthcare settings. Time’s up for employers who don’t take swift and meaningful action to make the workplace safe for nurses,” American Nurses Association (ANA) President Pam Cipriano said in American Nurse Today.

Registered nurses (RNs) are among the many healthcare workers who are lobbying for policy changes that may help reduce job-related violence. RNs who undertake RN to BSN programs learn the skills needed to become leaders. At Duquesne University, the RN to BSN online program provides opportunities for all nurses to take steps to stop workplace violence.

Types of Aggression and Violence
Acts of aggression take many forms, including bullying, spitting, punching, incivility, intimidation and yelling. The ANA said incivility and bullying are serious issues in nursing and can include rude, disrespectful, discourteous actions. The ANA further defines bullying as actions and comments meant to humiliate, offend and cause distress.

Overall, the National Institute for Occupational Safety and Health Administration (NIOSHA), a research-focused entity governed by the Centers for Disease Control and Prevention, said nurses might encounter four types of violence in the workplace:Nursing and Workplace Violence Research Paper

Criminal intent – A perpetrator with no relationship with the victim commits an act of violence. An example includes a nurse being assaulted in a hospital parking lot. This kind of incident is rare in a healthcare setting.
Customer/client – A perpetrator who is a member of the public assaults the on-duty nurse. An example includes a nurse being assaulted in a waiting room or a psychiatric ward. This is most common in a healthcare setting.
Worker on worker – Commonly called bullying or lateral/horizontal violence, this type of aggression usually includes a perpetrator in a supervisory role. This can include verbal and emotional abuse.
Personal relationship – The perpetrator has a relationship with the victim and violence spills over to the workplace. This can include instances of domestic violence.
Nationwide, workplace violence costs an estimated $4.3 billion annually and fuels staff turnover, recruitment and retention expenses and workers’ compensation claims, the New York State Nurses Association said. The heightened stress in the workplace leads to increased absences and more stress on those left to do the work, further eroding staff morale.

“This environment erodes what trust exists between management and nurses, which may lead to higher incidences of patient complaints and greater risks of stress in patients,” the association said.

At the same time, however, violence against healthcare workers is underreported. About 30 percent of nurses do not report violence because they believe acts of violence are part of the job, they fear repercussions or they believe assailants are not responsible for the violence because of their mental states.

Nurses Preventing Violence
With the growing focus on workplace violence in healthcare, organizations have taken notice and are taking action. In June 2018, The Joint Commission released an alert outlining seven steps healthcare organizations should take to address workplace violence.

The commission, which accredits more than 21,000 healthcare organizations in the United States, released its Sentinel Event Alert to help healthcare organizations recognize and address workplace violence, better prepare staff to handle violence and protect nurses from workplace violence.

The commission said all acts of violence, whether physical, emotional or verbal, warrant notification to leadership and, if needed, law enforcement.Nursing and Workplace Violence Research Paper

The commission’s seven steps are:

Define workplace violence and put systems in place that allow employees to report incidents of violence, including verbal abuse.
Track all workplace violence incidents, including verbal abuse and attempted assaults.
Support victims, witnesses and others impacted by the violence by providing psychological counseling and trauma care.
Determine the factors and worksite conditions that may have contributed to the violence.
Develop plans to reduce workplace violence, including physical changes to the workplace and to work and administrative practices.
Train staff in de-escalation and self-defense.
Continually analyze and review violence-reduction initiatives.
The commission said healthcare workplaces (including hospitals, nursing care centers, office-based surgery centers and home healthcare) are required to provide safety and security measures for their employees.

Workplaces that do not have the measures in place to prevent and respond to acts of violence could jeopardize their accreditation and may receive a citation from OSHA.

Nurses Taking a Stand Against Workplace Violence
Many nursing organizations think the threat of a citation or accreditation loss is not enough. Organizations that include the Silent No More Foundation have proposed that all states enact laws that make violence against healthcare workers a felony.

Other lobby groups have encouraged employers to take a tougher stance in protecting nurses from workplace violence. Through the efforts of the California Nurses Association/National Nurses United (CNA/NNU), all acute-care hospitals and skilled nursing facilities in California must develop and implement workplace violence prevention plans. The medical facilities face fines if they do not enact the protections.

At the same time, federal lawmakers are reviewing a bill that would require all healthcare employers to adopt comprehensive workplace violence prevention plans. The Health Care Workplace Violence Prevention Act has been in review with the House Subcommittee on Health since March 2018.

On a local level, nurses themselves can take action in their workplaces to encourage employers to enact protections. RNs who are seeking a Bachelor of Science in Nursing (BSN) degree have the opportunity to grow as nurse leaders who can lead changes for safer workplaces.

Through Duquesne University’s RN to BSN online program, RNs take foundational leadership and ethics coursework that can help them become catalysts for positive change.Nursing and Workplace Violence Research Paper

When Gordon Gillespie got his start in nursing, he expected to be a health care provider—not a patient. Yet that is the position he sometimes found himself in as an emergency nurse in Ohio, where he was assaulted dozens of times during nearly two decades on the job. On one occasion, he was beaten so badly that he suffered a wrist injury requiring treatment. “I was the only male in the department,” he says. “Any time patients became aggressive, I was told to jump in.”

The abuse, he says, came from people with mental illness and substance abuse problems, elderly patients with dementia, family members and caregivers who were under extreme stress, and others.

Gillespie, PhD, RN, FAEN, is now working to change a culture that he says tolerates and even dismisses violence against nurses and other health care providers. As an associate professor at the University of Cincinnati College of Nursing and a Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholar, Gillespie is studying interventions to protect health care workers from abuse and promote resilience among victims. “This is not something that should be part of the job,” he says. “People can go to jail for hitting a police officer or talking back to a judge, so why are they free to abuse nurses?”

Increasingly, they are not. In June, Colorado became the 32nd state to enact a law making it a felony to assault or batter emergency nurses or other emergency medical providers, according to the Emergency Nurses Association.

Epidemic Levels of Violence

Violence against nurses is at epidemic levels. In 2014, three in four nurses experienced verbal or physical abuse—such as yelling, cursing, grabbing, scratching or kicking—from patients and visitors, according to a January study in the Journal of Emergency Nursing. Three in 10 nurses reported physical abuse, the study found.

Between 2012 and 2014, nurses and nurse assistants experienced higher rates of workplace violence injuries than other health care sector workers, according to an April study by the U.S. Centers for Disease Control and Prevention. The problem is getting worse, the study found. Nurses and nurse assistants rates of workplace violence injuries rose steadily over the two-year period.

Nurses are especially vulnerable to violence because they are the largest sector of the health care workforce, spend more time with patients than other health care providers, and interact with almost all patients who come through the door—regardless of their condition when they arrive, says Charlotte Mather, MBA, BSN, RN, chief nursing officer at Sheridan Memorial Hospital in Wyoming and an alumna of the RWJF Executive Nurse Fellows program. “It has to do with face time,” Gillespie adds. “The longer you are sitting in a room with someone, the greater chance you have of being victimized.”Nursing and Workplace Violence Research Paper

Mather has witnessed the problem at Sheridan Memorial, and says it’s getting worse due to insufficient support for people with mental health conditions or substance abuse problems. “As we see more mental health patients in the emergency room, we also see the number of injured nurses go up,” she says.

Despite its prevalence, violence against nurses is often considered “part of the job,” warns Jane Lipscomb, PhD, RN, FAAN, a professor at the University of Maryland School of Nursing. She recently wrote a book about violence against nurses after a close friend—a nurse—was killed at work. “This topic is personal for me,” she said in a news release about the book.

But Gillespie is optimistic about curbing the rate of violence in health care. For his RWJF-funded research project, he asked nurses and other emergency department workers and administrators about strategies to prevent this violence and help victims recover. He used the findings to develop a series of interventions, which include raising awareness about violence in health care settings and training hospital registration and security staff to identify potential perpetrators and take preventive action. He hopes to test them in the near future.

Even so, Gillespie concedes that violence against nurses will never completely end, in part because many patients lack the cognitive ability to control themselves, especially in stressful environments like emergency departments. That’s why health care workers and administrators need to take universal precautions to prevent violence—much like they do to prevent contracting infectious diseases, he says. “If we take the stance that everyone has the potential to be violent, then nurses will interact with people differently and be more likely to protect themselves.”

Unfortunately, violence in the hospital setting is nothing new, and two recent nurse stabbings at two different facilities in Los Angeles have caused the health care community to take an even deeper look at safety programs and the technology in place.Nursing and Workplace Violence Research Paper

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Surveillance systems, metal detectors, alarms and other high-tech security measures are installed at hospitals throughout the country, but Deena Brecher, MSN, RN, APN, ACNS-BC, CEN, CPEN, president of the Emergency Nurses Association (ENA), explained that technology may not be the definitive answer when it comes to thwarting violence against nurses and other clinicians.

“There’s only one environmental control measure that we found that actually makes a difference in the amount of violence in a department, and that is a panic button or silent alarm,” Brecher said, citing a 2011 study conducted by the ENA. One of the technological advantages of panic buttons is that they can be mobile, instead of being limited to panic buttons in triage or the nurses’ station.

According to the ENA research, 82 percent of incidents of physical violence actually happen inside a patient’s room, and most exam rooms are not outfitted with emergency alarms or panic buttons. Brecher noted that mobile panic buttons that can be physically worn on the nurse might provide another level of protection.

“In our study, we looked at all kinds of things including the presence of security and metal detectors, and we found that those things did not lower the odds of physical violence against nurses.”

Wearable devices may have more promise.

Security Management recently published a case study on the Radius Enterprise Mobile Duress (EMD) system from Inovonics, a mobile panic button for health care providers. It offers the ability to locate alarms activated by the wearer, provide notification of the alarm, and then direct responders to the duress event. The product launched last year at Denver’s Exempla St. Joseph’s Hospital and several other facilities.Nursing and Workplace Violence Research Paper

Exempla’s security director, Eric Smith, CPP, was pleased to find that the EMD system “takes about 20 seconds from the time the button is pushed to security hearing the call,” and that it could be used to overcome radio “dead spots” for the security officers posted in the ER. A new St. Joseph’s hospital is due to open at the end of 2014, and Smith hopes to expand the system to more units in the new building.

Taking a holistic approach to reducing violence

The Bureau of Labor Statistics estimates that 900 deaths and 1.7 million nonfatal assaults occur each year due to workplace violence across industries, and The Center for Personal Protection and Safety reports that health care professionals are 16 times more likely to be attacked on the job than any other type of service professional.

In light of these statistics and the growing reports of violence, safety experts are urging hospitals to take a more holistic approach to security, one that encompasses technology, training, policies and drills.

Marilyn Hollier, CHPA, CPP, president of the International Association for Healthcare Security and Safety (IAHSS) and director of hospitals and health centers security at the University of Michigan, said that addressing workplace violence requires a multifaceted approach, and technology is just one piece of the puzzle.Nursing and Workplace Violence Research Paper

“Mobile duress signals, cameras and emergency alert systems have the ability to lock down an area electronically; and these are all important tools in helping keep a hospital safe. But standing alone, these wouldn’t be effective. I really focus a lot more on education and training,” Hollier said.

“We focus here on early identification and early intervention,” she continued. ”We emphasize and train nurses to report any kind of threat or gut feeling that they have that a person may act out. We do CPI [Crisis Prevention Institute] training and try to get all of our nurses trained on non-violent crisis intervention where they recognize early warning signs and learn things to say to try and keep the situation calm until security can get there.”

Many hospitals are also now utilizing a security risk code in their EMRs that is used to flag a high-risk patient or family member who has acted out in the past.

Hollier encourages staff nurses to seek out training to help improve their verbal de-escalation skills and to partner with the hospital security department to help further minimize risk.Nursing and Workplace Violence Research Paper

The ENA study found that the presence of reporting policies, especially zero-tolerance policies, was associated with lower odds of physical violence and verbal abuse. Brecher added that it is essential for hospitals to promote a culture where violence is not accepted or tolerated. “Hospitals that are able to do that are able to see a decrease in violence events.”

Organizations are also taking concrete steps to legally enforce policies specifically aimed at workplace violence. Just last week, three bills sponsored by the California Nurses Association/National Nurses United that would enhance patient safety, increase access to care and promote workplace violence prevention advanced in the California legislature.

The workplace violence prevention bill, SB 1299, sponsored by Sen. Alex Padilla, says that the California Occupational Safety and Health Standards Board must adopt standards requiring hospitals to establish workplace violence prevention plans that protect health care workers and other facility personnel from aggressive and violent behavior. Hospitals would also be required to document and report incidents of violence to Cal-OSHA.Nursing and Workplace Violence Research Paper