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Dealing with Workplace Bullying in Nursing and Healthcare

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Physical and verbal abuse against nurses is a serious problem in hospitals, clinics, and other healthcare settings across the country. The likelihood of healthcare workers being exposed to violence is higher than prison guards or police officers. One in 4 nurses has been assaulted at work. That’s not okay.

What Is Workplace Violence and Where Does It Occur?

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Workplace violence is any act or threat of physical violence, harassment, intimidation, or other threatening disruptive behavior that occurs on the job. It ranges from threats and verbal abuse to physical assaults and even homicide. It can affect and involve employees, patients, supervisors, and visitors. Workplace violence is a major concern for employers and employees nationwide.

In December 2017, the American Nurses Association (ANA) launched the #EndNurseAbuse initiative to increase awareness of the serious problem of physical and verbal abuse against nurses and to encourage individuals to stand with nurses and pledge to:

  • SUPPORT zero tolerance policies for violence against nurses.
  • REPORT abuse against nurses whenever safely possible.
  • SHARE this pledge and ask friends and family to sign.

While nursing is a profession dedicated to helping others, the highly charged nature of many of the environments in which nurses work can lead to situations where emotions boil over.

Incivility, bullying, and violence in the workplace are serious issues in nursing. Incivility is “one or more rude, discourteous, or disrespectful actions that may or may not have a negative intent behind them.” The ANA defines bullying as “repeated, unwanted, harmful actions intended to humiliate, offend, and cause distress in the recipient.” Such acts of aggression—be they verbal or physical—are entirely unacceptable whether delivered by patients or colleagues. These incidents not only have a serious effect on the wellbeing of the nurse in question but also their ability to care for their patients.

What Are the Types of Workplace Violence?

According to the National Institute of Occupational Safety and Health (NIOSH), there are four types of violence that nurses and other healthcare providers might face in their work environment:

  • Criminal intent. The perpetrator has no relationship with the victim, and the violence is carried out in conjunction with a crime.
  • Patient/client. This is the most common health care environment-based assault; the perpetrator is a member of the public with whom the nurse is interacting during the course of their regular duties.
  • Worker-on-worker. Commonly perceived as bullying, in these instances the perpetrator and victim work together, though not necessarily in the same role or at the same level.
  • Personal relationship. In these incidents, the victim has been targeted as a result of an existing non-work-related relationship with the perpetrator, with the violence taking place in the workplace.

It is important to remember that none of the scenarios above are restricted to physical violence; verbal and psychological abuse can be just as damaging to nurses and their ability to care for patients. All types of abuse fall within the scope of ANA’s anti-workplace violence agenda.

What Are the Costs of Workplace Violence?

Workplace violence in hospitals and other healthcare facilities has been shown to be very costly. For example, at one hospital, 30 nurses required treatment due to physical assault at a cost of $94,156 per nurse ($78,924 for treatment and $15,232 for lost wages in one year).

Violence can also lead to other less obvious costs, such as caregiver fatigue, injury, and stress, all of which are tied to a higher risk of medication errors and patient infections. Studies have found higher patient satisfaction levels in hospitals where fewer nurses are dissatisfied or burned out.

Injuries and stress are common factors that drive some caregivers to leave the profession. The estimated cost of replacing a nurse is $27,000 to $103,000. This cost includes separation, recruiting, hiring, orientation, and training. Some estimates also account for lost productivity while a replacement is hired and trained (OSHA, 2015).

Zero-Tolerance Policy for Workplace Bullying

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In the healthcare sector, persistent workplace violence has been under reported and, some may say, basically ignored. Lack of support from hospital administrations and the judicial system both present a major obstacles. Police and prosecutors do not necessarily feel that this is a big issue unless an individual is very severely injured, even though there are felony laws in place. Healthcare workers who report attacks often say that acceptance of and tolerance for violence runs through the administration, law enforcement, and the court system.

A study of emergency department nurses described supportive and sympathetic supervisors but passive hospital administrations. About half the nurses in the study said the hospital took no action after they were assaulted. In another 20% of cases, the perpetrator was only issued a warning. Ten percent of nurses said they were blamed for the incident. Other studies suggest that more than half of physical assaults on nurses and up to 80% of verbal abuse goes unreported (Speroni et al., 2014). Hospitals with mandatory reporting policies, on the other hand, experience half the rate of physical violence as those without such policies.

One of the best protections employers can offer their workers is to establish a zero-tolerance policy toward workplace violence. This policy should cover all workers, patients, clients, visitors, contractors, and anyone else who may come in contact with company personnel.

By assessing their worksites, employers can also identify methods for reducing the likelihood of incidents occurring. OSHA believes that a well-written and -implemented workplace violence prevention program—combined with engineering controls, administrative controls, and training—can reduce the incidence of workplace violence in both the private sector and federal workplaces. This can be a separate workplace violence prevention program or can be incorporated into a safety and health program, employee handbook, or manual of standard operating procedures.

It is critical to ensure that all workers know their facility’s policy and understand that all claims of workplace violence will be investigated and remedied promptly. In addition, OSHA encourages employers to develop additional methods as necessary to protect employees in high-risk industries.

One of the best protections employers can offer their workers is to establish a zero-tolerance policy toward workplace violence.

A Management Commitment to Reducing Violence

A key element of organizational policy is to take seriously all reports of workplace violence and to address them appropriately. Management should to be committed to:

  • The emotional and physical health of the employee
  • Appropriate allocation of authority and resources to responsible parties
  • Equal commitment to worker safety and health and patient/client safety
  • A system of accountability for involved managers and employees
  • A comprehensive program of medical and psychological counseling for employees experiencing or witnessing violent incidents
  • No employee reprisals for reporting incidents
  • Consideration of a “zero-tolerance” policy for intimidating and/or disruptive behaviors

Workplace Violence and Employee Involvement

Employee involvement in workplace violence policies is also an important element in addressing this problem and should include:

  • Understanding and complying with their facility’s workplace violence prevention program and other safety and security measures
  • Participating in employee complaint or suggestion procedures covering safety and security concerns
  • Reporting violent incidents promptly and accurately
  • Participating in safety and health committees or teams that receive reports of violent incidents or security problems
  • Making facility inspections and responding with recommendations for corrective strategies
  • Taking part in workplace violence trainings and a continuing education program that covers techniques to recognize escalating agitation, high-risk behavior, or criminal intent among patients, clients, and coworkers

Reporting Workplace Violence

Victims of workplace violence should report the incident to their supervisor or management immediately. They may also contact the following resources for further assistance:

To learn more about this important topic, take our 3-contact-hour CEU course on Workplace Violence.

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