Running head: STRATEGIES TO DECREASE WORKPLACE VIOLENCE 1

Strategies to Decrease Workplace Violence

Katherine Sellards, RN

Western Washington University

NUR301- Information Literacy to Support Academic Discourse

Julie Samms MN, RN

November 28, 2016

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Strategies to Decrease Workplace Violence

When beginning a career in nursing, nurses expect that daily job tasks will include

providing exceptional care and education to patients, offering support to families, and

maintaining a safe environment for healing. However, it is not expected that it will become

common practice for nurses to be in jeopardy of experiencing violent acts in the workplace. For

the purpose of the paper, the term violence is not limited to just physical violence, but also

emotional and verbal as well. One example of how verbal abuse effects nursing in the workplace

begins with a patient, that was well known to the facility in which this nurse is employed. At the

beginning of the shift, she greeted the patient and was immediately faced with hostility from not

only the patient, but also the patients girlfriend. The altercation escalated quickly to the patient

standing approximately one foot away from the nurse on one side and the girlfriend on the other

side. The patient was yelling and using derogatory terms and vulgar language while the

girlfriend was also raising her voice and using threatening gestures with her arms. Luckily, this

nurse was close to the door and was able to leave the room quickly. Upon exiting the room,

several male staff approached and entered the patient room to try and diffuse the situation. At

the same time, the housekeeper had been outside of the patients room and witnessed the verbal

altercation and was trying to call a Code Grey, however because the yelling was so loud, the

voice activation system used to call other staff and departments could not recognize what she

was calling for. Fortunately, the patient left against medical advice shortly after the incident and

this nurse was relieved to know that she would not be faced with such hateful behavior for the

remainder of the day. Nevertheless, the thoughts of knowing there will be more hospital admits

in which this nurse will have to care the this particular individual and even worse, the possibility

of an accidental public encounter generates fear and uneasiness to an overwhelming degree.

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Workplace violence has been and continues to be an existing problem within the

healthcare setting, placing healthcare workers in uncertain circumstances while on the job.

Exposure to repeated events of workplace violence pose a variety of difficulties on the nurse that

affect how standard duties are performed on a day-to-day basis. Such difficulties include

increases in stress, decrease in work performance and decrease in job satisfaction. This paper

will explore how education, training, and institutional support decreases the impact of violent

interactions with patients leading to a reduction of stress, better work performance, and increased

job satisfaction in nursing staff.

Search Process

I began my search process by utilizing CINAHL through the Western Washington

University library research and writing website. From there, I performed general searches on

workplace violence in healthcare. Because some articles that I was interested in were not

available in PDF, I had to request them using Interlibrary loan. I had gathered 13 articles in total

from my searches. At that point, I began reading the articles and chose which ones were more

appropriate for the topics that I wanted to highlight in my paper.

Incidents of Workplace Violence

In a study from Gates, Gillespie, and Succop (2011), the authors cite a report from the

Bureau of Labor Statistics on how the healthcare industry has one of the highest rates of

workplace violence. Further, it is stated that the seriousness of the occurrence was four-times

greater in the healthcare field than in other industries (OSHA issues tools, 2016). According to

multiple sources analyzed by Gates et al. (2011), reports of workplace violence are in all

probability much higher, but due to underreporting because of lack of support from employers

and the perception of these acts as being part of the job, statistics do not accurately reflect the
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rate of incidences.

Stress

Under certain situations, individuals are capable of withstanding stressful workplace

encounters to some degree. However, when workplace violence is the cause of these stressful

events and are frequently repeated, stress can have a negative impact on physical and

psychological wellbeing. Gates et al. (2011) surveyed 264 emergency room nurses to collect

details on personal experiences of workplace violence and from that survey they were able to

determine how workplace violence can have negative health effects ranging from physical

impairments, anxiety, fear, impact on job performance and in some cases, met criteria for PTSD.

The prevalence of study participants with post-traumatic stress symptoms during the 7

days after a violent event is significant. Seventeen percent had scores high enough to be

considered probable for a diagnosis of PTSD and 15% had scores associated with

suppressed immune system functioning. (Gates, et al., 2011, p. 63)

Lanctt and Guay (2014) conducted a systematic review of the outcomes related to

workplace violence. The results were divided into several categories, one of which was the

psychological effects impacting the nurse after a violent event and from the review of data, it

was determined that there is a significant level of an increase in anxiety and stress. They also

concluded that, from reviewing multiple sources, high exposure to aggression in the workplace

more than doubled the odds of psychological distress, as compared with workers who are less

exposed (Lanctt & Guay, 2014, p. 496). The common theme from both studies mentioned is

that there is a lack of data on the long-term health outcomes of workplace violence in the

healthcare field and in order to provide more accurate information additional research should be

conducted.
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Work Performance

It is understandable that when faced with emotional, verbal, and even physical abuse

repeatedly from patients that the nurses increase in stress and anxiety could alter work

performance. From the research available, Gates, et al. (2011) were able to conclude that a

significant number of nurses had a decrease in work performance in the areas of focusing and

concentration on tasks, emotions, and providing support to patients and families. For instance, if

the nurse is plagued by thoughts of previous violent acts, it seems to reason that focus and

concentration is decreased, which in turn leads to a patients worsening signs and symptoms of a

condition being overlooked. Also, if the nurse were unable to control their own emotions, it

would be difficult for them to provide emotional support and assist with interventions to relieve

patient and family anxieties. What was interesting is that even though the nurses felt they were

experiencing a decrease in these areas, they were still able to manage the workflow and maintain

safety while caring for patients. Nevertheless, there is a need for further research on violent acts

and how it affects work performance in all areas of nursing

Literature reviews establish that approximately 45% of nurses were found to have a

decrease in work performance after a violent event and over 50% decrease in work productivity

(Lanctt & Guay, 2014). The nurses experienced a lack of interest, enthusiasm and confidence

in job related duties after their exposure to acts of violence.

Decrease in Job Satisfaction

In regards to job satisfaction, Gates et al., (2011) gather from their research that after

episodes of workplace violence, healthcare workers experienced such feelings of dissatisfaction

that some considered leaving their job and their nursing career altogether. It makes one consider

that if healthcare employees felt less intimidated and fearful of reporting events and more
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supported by management, that the level of being dissatisfied would decrease. Most nurses do

not report violent incidents believing that reporting does not make any difference since violence

is expected and tolerated, that incidents are seen as a sign of their incompetence, or that they

might encounter retaliation by ED management and hospital administration (Gates, et al., 2011).

Lanctt and Guay (2014) also report that employees either quit or were thinking of quitting their

job after experiencing workplace violence.

Interventions to Reduce Workplace Violence

Gillespie, Gates and Fisher (2015) evaluate multiple studies that offer several

recommendations for reducing episodes of workplace violence including screening assessment

tools, universal precautions, and facility mandated violence prevention programs. A violence

screening assessment tool gathers data of patients past violent behavior and severity of the event

and also obtains input from family regarding the patients cognitive abilities. In knowing that if

a patient has a history of past violent events, nursing staff can be more aware of a potential

threat. Suggested universal precautions to protect against violent acts include being

accompanied by another staff member when rounding on the patient and making sure to have a

clear pathway to an exit if needed (Gillespie et al., 2015). Nursing staff should also be aware of

the patients verbal, non-verbal, and body language cues to help diffuse a potential violent

situation. Gates, et al. (2015) cite multiple research studies suggesting facilities to have a zero-

tolerance policy and workplace violence prevention education programs to help reduce the

occurrences of violent acts.

The Online Journal of Issues in Nursing (2013) examines how most states have now

enacted laws to protect against individuals who assault healthcare providers. Washington state

law RCW 9A.36.031 states that an assault against a healthcare provider while performing their
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duties is a third degree assault and is a class C felony (Assault in the third degree, 1988). OJIN

also advocates for enforcement of zero-tolerance policies against workplace violence and

education and training to help healthcare workers identify behaviors that could pose a potential

risk to safety.

Conclusion

Although there is strong evidence showing that nurses who experience workplace

violence suffer from negative health effects, altered work performance and a decrease in job

satisfaction, the evidence is limited and more research needs be conducted to evaluate the long-

term effects in these areas. From this research, it can also be concluded that the use of violence

assessment tools, support from administration to encourage healthcare workers to accurately

report incidences, and being aware of particular patient cues promote for a safer work

environment. It should also be noted, that it is crucial for administrative personnel to follow up

on the rate and circumstances of incidences to determine if the existing violence prevention

policies are effective. Ensuring the effectiveness of workplace violence policies and prevention

measures will promote for a less stressful working environment, increase the healthcare workers

job satisfaction and work performance, which in turn leads to improved patient outcomes.

Nevertheless, there does not seem to be much hard data on if the recommended interventions are

successful and if the numbers of incidences are indeed decreasing. In saying that, this is yet

another area that deserves more extensive research in order to discover more ways in protecting

and providing safety to nurses in the workplace.

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References

Assault in the Third Degree, Wash. Rev. Code 9A.36.031 (1988)

Gates, D. M., Gillespie, G. L., & Succop, P. (2011). Violence against nurses and its impact on

stress and productivity. Nursing Economic$, 29(2), 5967

Gillespie, G.L., Gates, D. M., & Fisher, B. S. (2015). Individual, relationship, workplace, and

societal recommendations for addressing healthcare workplace violence. Work, 51(1),

6771. https://doi.org/dx.doi.org/10.3233AVOR-141890

Lanctt, N., & Guay, S. (2014). The aftermath of workplace violence among healthcare workers:

A systematic literature review of the consequences. Aggression and Violent Behavior,

19(5), 492501. https://doi.org/10.1016/j.avb.2014.07.010

OSHA issues tools to help prevent workplace violence. (2016 January/February). American

Nurse, 48(1), 6.

Workplace Violence in Healthcare: Strategies for Advocacy. (2013). Online Journal of Issues in

Nursing, 18(1), 1. https://doi.org/10.3912/OJIN.Vol18No01Man05