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Workplace Violence:What Nurses Need to Know

Amanda J. Simonton, MSN, APRN, PMHNP-BCPhD Candidate

Conflicts of Interest

• There are no conflicts of interest to disclose

Objectives• Define Workplace Violence (WPV)

• Discuss the types of WPV nurses face

• Discuss the importance of understanding, identifying, and preventing WPV

• List warning signs an individual may exhibit of impending violence toward nurses and others

• Explain methods to promote safety from WPV

Defining Workplace Violence:Definitions

U.S. Department of Labor:“An action (verbal, written, or physical aggression) which is intended to control or cause, or is capable of causing, death or serious bodily injury to oneself or others, or damage to property.”

Centers for Disease Control:“Violent acts (including physical assaults and threats of assaults) directed toward persons at work or on duty”

Defining Workplace Violence:Types

• Verbal abuse:– Shouting or yelling– Swearing or cursing– Threatening physical assault

• Physical abuse:– Grabbing– Scratching– Striking

• Stalking or workplace confrontation

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Defining Workplace Violence:Examples

• Arm twisted• Hit by a thrown

object• Bitten• Hair pulled• Slammed against a

wall/hard surface

• Personal property destroyed

• Humiliated• Scratched• Pushed• Spat on • Slapped

Defining Workplace Violence:Statistics

• Underreported!

• 75% of all workplace assaults occurs in a healthcare setting

• Healthcare workers are 4-16 times more likely to experience WPV compared to other sectors

• 1 year prevalence rates:– ED nurses: >95%– Non-ED nurses: >70%

Recent Legislation

• HR 7141 Workplace Violence Prevention for Health Care and Social Service Workers Act (Federal)

• S 1374 Elise’s Law (Massachusetts)

• HB 1146 (Texas, Donna Howard): WPV prevention policies and plans at healthcare facilities

High Risk Areas

• Emergency department• Psychiatric• Inpatient • ICU• Nursing Homes

Factors

Hospital• Large volumes of patients• Chaotic• Overcrowded• Noisy• Nursing shortage• No or poorly enforced

visitor policies• Lack of pt privacy

Patient / Visitor• Dementia or Alzheimer's• Mental Health diagnosis• Drug-seeking• Under the influence• Stressed• Grieving• Misperceptions regarding

staff

Factors

• Stressful situations• Being given “bad news”• Lack of organizational

policies and training for staff

• Gang activity• Presence of firearms or

other weapons• Inadequate security or MH

staff on site

• Staff working in isolation • Environmental – restricted

vision• No access to emergency

communication• Unrestricted public access• Lack of community mental

health

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Effects of WPV

• Physical harm– Head– Back– Arms

• Psychological consequences– PTSD

• Direct and indirect

• Emotional consequences– Anger, sadness, fear disgust, and surprise

Effects of WPV Continued

• Work functioning consequences– Thoughts about quitting– Decreased productivity and performance

• Other consequences: relationship with clients/quality of care, social consequences, and financial consequences

Warning Signs• Change in behavior pattern• Swearing or emotional language• Forgetfulness or decreased concentration• Demanding

• More serious:– Pacing or restless movements– Clenched jaw or fists– Loud talking or yelling– Glaring or avoiding eye contact– Violating personal space

Motives and Histories of Gunmen

• Male• White• Mental health history– Paranoid– Resentful– Narcissistic

• Domestic Violence• Sense of grievance• Desire for notoriety

Promoting Safety• Be aware of your surrounding

– Position yourself with an escape route

• Make people aware of where you are or where you will be

• Address environmental risk factors– Isolated areas, lack of physical barriers, poor illuminations,

blocked visibility, loose furnishings

• De-escalate verbally

• Physical maneuvers to escape attack/hold

Promote Safety: Verbal Communication Tips

1. Be empathic and non-judgmental2. Respect personal space3. Use non-threatening non-verbal communication4. Avoid overreaction5. Focus on the emotions6. Ignore challenging questions7. Set limits8. Choose wisely what you insist upon9. Allow silence for reflection10.Allow time for decisions

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What Next

• Advocate for policy implementation or changes

• Educate others

• Be attuned to warning signs

• Consider a self-defense class

ResourcesHomeland Security Information –https://www.dhs.gov/school-and-workplace-violence

OSHA printout -https://www.osha.gov/Publications/OSHA3826.pdf

Free Tips to Diffuse Difficult Situations -http://resources.crisisprevention.com/CPIs-Top-10-De-Escalation-Tips.html?code=ITG006DT&src=Pay-Per-Click&gclid=EAIaIQobChMIwKbonbDf1wIVCZ7ACh0ShwYHEAAYAiAAEgKG__D_BwE

Questions? ReferencesCenters for Disease Control and Prevention. National Institute for Occupational Safety and Health

(NIOSH). Violence in the workplace. DHHS (NIOSH) Publication Number 96-100, Current Intelligence Bulleting 57. Atlanta, GA: DOL, July 1996.

Celik, S., Celik, Y., Agirbas, I., & Ugurluoglu, O. (2007). Verbal and physical abuse against nurses in Turkey. International Nursing Review, 54(4), 359-366. doi:10.1111/j.1466-7657.2007.00548.x

Esposito, L. (2017). Nurses face more violence from hospital patients. Retrieved from https://health.usnews.com/wellness/articles/2017-01-18/nurses-face-more-violence-from-hospital-patients

Hills, D., & Joyce, C. (2013). A review of research on the prevalence, antecedents, consequences and prevention of workplace aggression in clinical medical practice. Aggression and Violent Behavior, 18(5), 554-569. doi: 10.1016/j.avb.2013.07.014

Lanctôt, N., & Guay, S. (2014). The aftermath of workplace violence among health care workers: A systematic literature review of the consequences. Aggression and Violent Behavior, 19 (5), 492-501. doi:10.1016/j.avb.2014.07.010

ReferencesLongo, D. L., & Phillips, J. P. (2016). Workplace violence against health care

workers in the united states. The New England Journal of Medicine, 374(17), 1661-1669.

McMahon, S., Martinez, A., Espelage, D., Rose, C., Reddy, L., Lane, K., . . . Brown, V. (2014). violence directed against teachers: Results from a national survey. Psychology in the Schools, 51(7), 753-766. doi:10.1002/pits.21777

Nowrouzi-Kia, B., Isidro, R., Chai, E, Usuba, K., & Chen, A. (2019). Antecedent factors in different types of workplace violence against nurses: A systematic review. Aggression and Violent Behavior, 44, 1-7. https://doi/org/10.1016/j.avb.2018.11.002

Occupational Safety and Health Administration. Guidelines for preventing workplace violence for healthcare and social service workers (OSHA, 3148-04R). Washington, DC: OSHA, 2015.

ReferencesPhillips, J. P. (2016). Workplace violence against health care workers in the United

States. The New England Journal of Medicine, 374, 1661-1669. doi: 10.1056/NEJMra1501998

Roche, M., Diers, D., Duffield, C., & Catling-Paull, C. (2010). Violence toward nurses, the work environment, and patient outcomes. Journal of Nursing Scholarship, 42(1), 13-22. doi: 10.1111/j.1547-5069.2009.01321.x

Speroni, K. G., Fitch, T., Dawson, E., Dugan, L., & Atherton, M. (2014). Incidence and cost of nurse workplace violence perpetrated by hospital patients or patient visitors. Journal of Emergency Nursing, 40(3), 218-228. doi: 10.1016/j.jen.2013.05.014

U.S. Department of Labor. DOL Workplace Violence Program — Appendices. Definitions. Washington, D.C.: DOL, no date.

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https://www.dhs.gov/school-and-workplace-violencehttps://www.osha.gov/Publications/OSHA3826.pdfhttp://resources.crisisprevention.com/CPIs-Top-10-De-Escalation-Tips.html?code=ITG006DT&src=Pay-Per-Click&gclid=EAIaIQobChMIwKbonbDf1wIVCZ7ACh0ShwYHEAAYAiAAEgKG__D_BwE