By Susan Kreimer, MS, contributor
March 3, 2010 - Verbal and physical abuse continues to escalate in the whirlwind of healthcare change, compelling some nurses to question their calling.
A new survey found that the abuse nurses confront on the job often goes unreported. The survey appears in the February 2010 issue of the Journal of Clinical Nursing.
Although the research was conducted in Australia, nursing experts say it mirrors the concerns in this country, where assaults and under-reporting seem just as common. And while the incidents in the survey occurred at the hands of patients or their visitors, abuse also runs rampant among nurses and their supervisors.
“Enduring many types of workplace violence – coming from patients, family, peers and superiors – the passion and compassion for helping people and making a positive difference in lives gets lost. It becomes ‘a job’ and nothing more,” said Michelle Joy Johnston, RN, BSN, MSN, lead author of an article on bullying in the October/December 2009 issue of Critical Care Nursing Quarterly.
When violence erupts among peers, it reverses the strides that the profession has made in garnering respect for nurses. It also decreases the quality of care, distracting nurses from the needs of patients and families and creating difficult work environments with stress overload and large turnover.
“It is very much a domino effect. People need to be held accountable for their behavior,” said Johnston, who completed the bullying article in the University of Texas Health Science Center at San Antonio School of Nursing. Managers and directors should send a consistent message from an employee’s date of hire and beyond – that bullying won’t be tolerated.
Among the top occupational health issues for nurses--which include infectious disease, lifting and patient handling, workplace violence, and chemicals--workplace violence is the biggest blow to morale, according to Susan Wilburn, MPH, BSN, a technical officer with the World Health Organization (WHO). To arrive at solutions, she urges joint labor and management committees to meet regularly to review incident data, conduct staff surveys, walk through the healthcare setting to observe working conditions and potential risks, and take actions to make any needed improvements.
Wilburn added that a synthesis of general recommendations that apply to all of these occupational health issues for nurses can be found in WHO and International Labor Office (ILO) guidelines and conventions including the Joint WHO/ILO/Public Services International(PSI/)/International Council of Nurses (ICN) Framework guidelines addressing workplace violence in the health sector, Joint ILO/WHO guidelines on health services and HIV/AIDs and ILO Framework Convention on Occupational Safety and Health.
Among occupational health issues, workplace violence is the biggest blow to morale. To arrive at solutions, joint labor and management committees should meet regularly, conduct staff surveys, and walk through the healthcare setting to observe working conditions, said Susan Wilburn, MPH, BSN, an officer with the World Health Organization.
Research suggests that violence remains consistently under-reported by healthcare workers. The reasons are complex, ranging from management’s lack of support to workers’ perception that it’s “part of the job,” said Carole Farley-Toombs, MS, RN, NEA-BC, president-elect of the American Psychiatric Nurses Association, which developed a position paper on workplace violence.
“This would indicate that the significant numbers reported to date may represent only a fraction of the actual incidents,” said Farley-Toombs, associate director of nursing at the University of Rochester Medical Center’s Strong Memorial Hospital in Rochester, New York.
In the Australian survey, 52 percent of nurses in a community hospital reported being physically assaulted in the prior year and 69 percent mentioned being threatened with violence. Almost 92 percent of participants said they had encountered verbal abuse. Only half brought the incidents to the attention of senior staff or co-workers, and just 16 percent filed an official report, according to researchers at the Curtin University of Technology in Perth, Australia.
Informing nurses about the prevalence of workplace violence while equipping them with self-protecting strategies is part of the solution. Encouraging them to report incidents is also crucial, said Jeri A. Milstead, Ph.D., RN, NEA-BC, FAAN, chair of the Ohio Nurses Association’s Health Policy Council and dean emerita of the University of Toledo College of Nursing. Reporting mechanisms need to be realistic, with minimal paperwork and without time-wasting obstacles.
The association applauded the introduction of House Bill 450 in the Ohio Legislature on Feb. 11. The pending bill recognizes that violent acts against nurses in the workplace occur more often than in any other profession, and it would increase the penalty for assault.
A zero-tolerance policy would be the most proactive approach hospital leadership can take to combat negative attitudes and disruptive actions. The code of conduct must promote open and respectful communication among all healthcare providers, including physicians and management, said Joyce Benjamin, MSN, RN, executive director of the Arizona Nurses Association.
Accountability trickles down from the top. “Leaders must role-model what behavior they are expecting from staff and physicians,” Benjamin said, “and ‘put some teeth’ into what the consequences will be.”
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