Risk of Violence in Health Settings

Introduction

Workplace violence is a universal problem in health care settings across Canada. Health care workers have four times higher rate of workplace violence than any other profession. And yet, most of the violence experienced by health care workers goes unreported due to a culture of acceptance. The main thesis of discussion is about workplace violence among nurses. The definition of violence varies on practice settings or situations, there is an agreement that violence in the workplace is detrimental to the health and wellbeing of nurses and to the provision of quality nursing care. Workplaces include hospitals and long-term care facilities, primary care centres, outreach services and client’s homes. Nurses have the right to work in an environment that is free from all forms and sources of violence, bullying, harassment and verbal abuse by patients, families, doctors, colleagues, management. Violence in workplaces impacts both staff and patients. It minimizes the quality of care and impacts health outcomes. There are various implications and recommendations which aims to prevent violence among nurses will be discussed in this paper.

Background

The national comprehensive government survey to consider the health and wellbeing of nurses was conducted by Health Canada, Statistics Canada and the Canadian Institute for Health Information (CIHI, 2005). National Survey of the Work and Health of Nurses findings found that 19,000 nurses surveyed, about a third of hospital nurses had suffered physical abuse by patients and in long-term care homes 50% of nurses reported physical abuse by patients within 12-month period.

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The findings also revealed that in Ontario 28.4 percent of nurses had been physically assaulted by a patient in the period of twelve months and 2 per cent had been physically assaulted by someone other than a patient. In the same survey, the percentage of Ontario respondents who reported they had experienced emotional abuse at work, over the past 12 months was from a patient 44.9 per cent and minority of them were nurses, others and physicians. By looking into this survey results shows clearly that nurses are the immediate victims.

Definition

Workplace violence is the act or attempt to cause injury or abuse. Violence can be physical or psychological. It can be committed by anyone – employers, clients, co-workers or members of the public (WHSC). Workplace violence includes physical attacks or assaults, threatening behavior, verbal or written threats, abuse or assault and harassment, sexual abuse or statements, poisoned work environment and bullying behavior.

Scope

The workplace violence among nurses are not seen only particular province it is widespread. Nurses in every province of Canada were still facing the violence at workplace. A national survey of the work and health of nurse’s survey was conducted in 2005 report shows that majority 36.2% of physical assault was done by patients over 12 months period in Newfoundland and minority 26.5% seen in Quebec. Whereas, 58.6% of them were emotionally abused by a patient over 12-month period in Yukon, Nunavut and Northwest territories and minority 41.7% seen in New Brunswick. The survey had revealed violence among nurses at workplace in all the provinces.

Factors contributing violence

Several factors that contributes violence in health care. Some of them includes:

Benefits and challenges

The benefits to the nurses or health care system is nil where violence makes downfall of the service or destruction of the Canadian health care system. There are many challenges facing by the nurses mostly physical and emotional aspects. Physical aspects were headache, bruises, head injuries, fractures. Emotional aspects were anxiety, depression, fear, tension and sleep problems which all these leads to dissatisfaction of job, absenteeism, sick leaves. I like to discuss about two literatures which the studies mainly focused on workplace violence.

A descriptive study was conducted by Lucie Lemelin, Jean-Pierre Bonin, and André Duquette (2009) to determine the prevalence, origins, and forms of workplace violence reported among 181 nurses working in acute-care settings in Quebec. A workplace violence events questionnaire was administered in order to collect the data. Almost 87% of respondents reported being exposed to at least one of three forms of violence like physical, psychological, or sexual. The study results showed that 65.9% of respondents were victims of horizontal violence, while 59.6% had experienced vertical violence and 59.1% had been victims of violence inflicted by a doctor. The literature says about challenges faced by nurses due to violence at workplace either from patients or colleagues would result in unexpressed anger or passive-aggressive behaviour that is manifested in depression, workplace dissatisfaction, and violence-tinged behaviour.

A literature review was done by Abigail Mitchell, Areeg Ahmed, Catherine Szabo (2014) regarding workplace violence among nurses, why are we still discussing this? It is estimated that 50% of health care workers are physically assaulted during their professional careers and that nurses are three times more likely to experience violence than any other professional group. As victims of workplace violence, nursing students, new graduates, and novice faculty might remain silent out of fear and embarrassment. The direct or indirect negative behaviors associated with workplace violence might never be known to nursing students or graduate nurses unless they are empowered with knowledge and understanding regarding how to acknowledge and report workplace violence incidents. The literature says about challenges faced by nurses consequences of workplace violence include being labeled as a troublemaker; fear about loss of career advancement opportunities; fear about termination from the job; and experiencing psychosomatic symptoms such as nervous tension, headaches, eating disorders, sleep disturbance, and onset of chronic illness which leads to shortage because the nurses are leaving the profession due to experiencing workplace violence.

We have just seen how the two studies have been framed. Both the literatures showed common point about challenges faced by nurses due to violence at workplace. I want to argue for the view that in Lucie study, the author performed systematic approach of how the sample has selected and number of samples thereby, administered a survey questionnaire and collected the data which results had been discussed briefly. Based on the results the author has given recommendations and further studies to be done in other directions. But this literature is limited to the nurses who are volunteered by themselves only. It can be possible that most of the nurses who volunteered have faced violence once in a time. If most of them faced violence and are part of the sample, then most of them might have answered same. So, that the study results would come biased. Instead, the author could have gone through a quantitative approach and random sampling technique. In this approach the bias ratio will be less and could get an average percentage of violence noted.

Abigail literature the author hasn’t done the systematic approach of the study. The author has reviewed from other literatures and concluded. In the conclusion I disagree with the author where mentioned about profession of nursing consists primarily of females, nurses are at increased risk for workplace violence. I disagree with that argument because in every occupation men and women both are equally being assaulted at workplace. I believe women are stronger because they have a matured thinking ability in handling critical situations, they are running family, handling kids and dealing many roles which men can’t do. My view related to that passage of course most of the females were in nursing profession. It is not a matter of men or women because the violence is doing mostly by the patients or families. Since their state of mind is not stable, they are provoking for violence due to their disease’s conditions. For instance, Psychological condition patient is aggressive and attacks nurses or behave rudely which is common because of his/her condition and nurses are the immediate members who always deal with the patients are easily prone for violence by patients.

Impact and Implications

Workplace violence in nursing has effects on worker’s health as unstable health, mental health, and vitality scores as observed in nurses who felt threatened and increased levels of psychological distress related to bullying and verbal sexual harassment suffered by nurses. I have asked few of my friends who were working as a nurse about workplace violence.  One of them stated that:

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One day I am on night shift went to the patient room to give his medications. While I was talking to him, suddenly he grabbed my hand and holed tightly for a minute and laughed. I was really scared because that room was in corner of the floor and no one could hear my voice. From that day I am scared to go alone to patient rooms specially the corner rooms. (Friend)

This shows that not only physically but psychologically the nurses are affecting and not working comfortably. The impact on nurses are short term and long term which results in pain, sprain, palpitations, sleep disorders, stress, depression, fear of patients and/or visitors, and job dissatisfaction were the complains made by nurses exposed to violence. In extreme cases of physical violence, workers have been murdered while others may suffer bruises, cuts and broken bones. These same physical attacks may lead to psychological effects including depression, anxiety, sleep disorders, mental illness, post traumatic stress disorder and overall stress.

Effect on human resource management

Nurses are facing many challenges at workplace violence has an impact on the delivery of care results in staff shortages due to workplace injuries and high rates of burnout and workplace stress that affect quality of care and increase costs to the health care system. Nursing shortage resembles high demand of nurses the human resource management must recruit and pay more for nurses which results in time taking and financial burden. Workplace violence not only affects the health-care workers themselves; it negatively impacts the organization. There are huge costs involved when nurses are off work due to incidents of violence, including workers’ compensation claims and sick days.

Implications

Implications that I foreseen were

• Educate and train health care professionals in the de-escalation of violence
• Undertake violence risk assessments of health care organizations, departments and individual patients
• Provide personal alarms with emergency buttons to the staff
• Flagging system of patients who pose a risk for violent behaviour
• Voice activated communication devices
• Personal safety response systems that allow health care providers to call for help
• Security personnel and protocols to respond to violence
• Training for health care workers regarding violence prevention
• Organize workstations with high counters and wide desks.

Recommendations

  Policies and standards make some change but, I recommend nursing leaders should come forward and develop strategies at organisational levels for example, mock-up sessions of  how to handle during violent behaviour, improve awareness among staff- ensure nurses to speak up or raise their voice, educate about risk assessment, conduct monthly meetings about the issues, arrange complaint boxes at each unit. To prevent violent behaviours, develop colour-coded labels and pull-tabs on paper-based charts. Other visual cues may be colour-coded wristbands, coloured markers or a sticker on a mobility aid. These visual cues can relay safety concerns to members of the care team who do not have access to patient medical records, such as housekeeping, maintenance, volunteers or the dietary staff. Security personnel also plays an important role in health-care facilities. Heath-care staff need to be properly trained on handling violent and aggressive situations. All the staff should work as team to prevent the violence among nurses at workplace. The team includes manager, in charge nurse, nurse and personal support worker and security personnel. Studies need to be done not only among nurses but also why the violent behaviour is enacting.

The first literature states that nurses are strongly advised to denounce violence and refuse to tolerate it. They should be encouraged to speak out about the violence that they experience and to take action that will promote good relationships with their co-workers. A sense of solidarity should be developed in order to counteract the violence. Nurse managers might consider identifying key factors that favour the development and implementation of programs aimed at preventing workplace violence. Future research should focus on examining the origins of the psychological violence that is so common among colleagues and on identifying factors that are likely to defuse this type of violence

The second literature states the following actions are to be implemented in health care settings: continuously evaluate and review environmental and administrative controls and local crime rate records and statistics; establish and evaluate violence-prevention programs on an ongoing basis; pre screen job applicants by conducting background checks and by evaluating professional competence and conduct; establish procedures for disciplining and firing employees to minimize potential for violent reaction; mandate workplace violence staff education and training that includes workplace prevention strategies and staff encouragement to report workplace violence; establish policy and procedures for responding to and reporting workplace violence; educate supervisors that all suspicious behavior and reports of workplace violence be taken seriously and thoroughly investigated; and establish counseling programs for employees who are victims of workplace violence. Continuing research is needed in exploring these suggestions by the Joint commission to see the effectiveness of each than the other.

I agree with both the literatures because when violence happened to nurse firstly, the nurse must speak up or raise his/her voice about the incident or violence happened to her. In every hospital or organisation “Zero Tolerance” is there at workplace which provides measures for the protection of the nurses. But how many hospitals or care centers are using the preventive measures for instance, security personnel at each unit. If a nurse does a simple mistake in documentation or any error, there will be a course examination, report writings and incidence writing in some cases cancelling the license. If a patient does some violence, why don’t he/she get a penalty or charges. I feel that if any patient or family member does violence to nurse or any health personnel then the actions to be taken by law that cancelling the health card so that they pay all the expenses for their treatment from their own pockets. This may reduce the violence among nurses.

Conclusion

The violence is increasing in our health care settings. We know that nurses are more at risk and we have preventive measures of what works to help reduce violence against health care workers. As such, governments, employers, unions and other health care stakeholders must come together to take concerted action on the issue. Engage the staff in self-awareness and reflective practice ensures that leadership styles do not support the violent behavior in the healthcare organization. The nursing leaders need to take stand on issues, inspire challenges, listen, advice, coach, and guide the nurses in all the dimensions. A mock-up session at each hospital or care centres on how to handle a violent behaviour from patient or any other person would be beneficial for nurses. Nurses are there when patients need them most. It’s time to make sure nurses are safe at work by raising standards, improving health and safety measures for nurses.

References

• Abigail Mitchell, Areeg Ahmed, Catherine Szabo (2014). Workplace violence among nurses, why are we still discussing this? Journal of Nursing Education and Practice, 2014, Vol. 4, No. 4. Retrieved from  http://dx.doi.org/10.5430/jnep.v4n4p147.
• Bill Casey, Chair (2019). Violence facing health care workers in Canada; Report of the standing committee on health. House of Commons. Retrieved from https://www.ourcommons.ca/DocumentViewer/en/42-1/HESA/report-29.
• Canadian federation of nurse’s union (2017). Enough is enough putting a stop to violence in the health care sector. Retrieved from https://nursesunions.ca/wp-content /uploads/ 2017/05/ CFNU_Enough-is-Enough_June1_FINALlow.pdf.
• Registered Nurses Association (2008). Violence Against Nurses: ‘Zero Tolerance’ For Violence Against Nurses and Nursing Students. Retrieved from https://rnao.ca/policy/position-statements/violence-against-nurses.
• Statistics Canada (2006). Findings from the 2005 National Survey of the Work and Health of Nurses. Retrieved from https://www150.statcan.gc.ca/n1/en/catalogue/11-621M2006052.
• Lucie Lemelin, Jean-Pierre Bonin, and André Duquette (2009) Workplace Violence Reported by Canadian Nurses. CJNR 2009, Vol. 41 No 3, 152–167. Retrieved fromhttp://cjnr.archive.mcgill.ca/article/viewFile/2210/2204.
• Workers Health and Safety Centre. Workplace Violence; Predictable and preventable. Retrieved from https://www.whsc.on.ca/Files/Resources/Hazard-Resource-Lines/RL_WorkplaceViolence_V5-web.aspx.