WORKPLACE VIOLENCE

In a national survey of registered nurses conducted by American Nurses Association (ANA) in 2001, 88% of working nurses reported that health and safety concerns influence their decisions to continue working in the field of nursing as well as the kind of nursing work they choose to perform. Hospitals are perceived as places of safe haven, but in reality they are potential breeding grounds for many types of incidents, ranging from disruptive staff, patients, and families to chemical and infection exposure. Nurses have a right to a safe workplace. In fact, a safe workplace is necessary for the provision of patient care (ANA, 2007). Hazardous material exposure was covered in Chapter 7. This chapter deals with issues of concern for the nurse dealing with potentially explosive workplace situations.

Workplace violence ranges from offensive or threatening language to homicide. The National Institute for Occupational Safety and Health (NIOSH) defines workplace violence as violent acts (including physical assaults and threats of assaults) directed toward persons at work or on duty. Workplace violence can be divided into four categories: violence by strangers, clients (patients), coworkers, and personal relations (AACN, 2004). It has been reported that 82% of nurses surveyed had been assaulted during their careers and that many assaults go unreported (Erickson & Willams-Evans, 2000; ICN, 2001).

More than 5 million U.S. hospital workers from many occupations perform a wide variety of duties. They are exposed to many safety and health hazards, including violence. Recent data indicate that hospital workers are at high risk for experiencing violence in the workplace. According to estimates of the Bureau of Labor Statistics (BLS), 2637 nonfatal assaults on hospital workers occurred in 1999—a rate of 8.3 assaults per 10,000 workers. This rate is much higher than the rate of nonfatal assaults for all private-sector industries, which is 2 per 10,000 workers.

Employee assaults may be from patients, families, and coworkers. Assault can range from minor to major assaults. Outbursts of violence can affect the employee with disability, psychological trauma, or death. Several risk factors may lead to violence in the health care setting (Tomey, 2006):

Hospitals are microcosms of society and, as such, are socialized to violence.

Workplace violence is a multifaceted event with the potential to increase in frequency and scope (Ehrmann & Zuzelo, 2007). As a nurse and manager, you need to have a basic understanding of the risk for workplace violence to intervene in effective, efficient, and meaningful ways. You have already earned about potentially violent patients and how to handle them, but you need to be able to transfer some of this knowledge to the potentially violent employee. Boxes 17-1 and 17-2 provide warning signs of physical violence.

While there is no universal strategy to prevent workplace violence, all hospitals have developed security plans to protect the employee from an unsafe workplace. The risk factors vary from hospital to hospital and from unit to unit. You have learned many ways of assessing individuals for altered levels of dealing with stress as well as intervening in such situations. These are important to remember.

Maintain behavior that helps diffuse anger.

Be alert.

Take these steps if you cannot defuse the situation quickly.

When you are dealing with potential staff violence or patient and family violence, it is important to maintain the safety of the patient care situation. If possible, remove the potentially violent individual from the patient care area.

CONFLICT MANAGEMENT

In managing the conflict, you will need to determine the cause of the conflict. First, determine the basis of the conflict. Is there difficulty between two shifts (intergroup) or two individuals (interpersonal)? Often, there is conflict between shifts that spill over to stressful situations. Some of these conflicts may relate to perceptions of work left undone by one shift or other work-related concerns. Second, you will need to analyze the source of the conflict. Conflict management techniques stress the importance of open and honest communication and assertive dialogue. It is important that during conflict situations the nurse manager views the total situation and uses positive communication. Conflict resolution techniques are described in a variety of ways by a variety of authors (Tomey, 2004; Yoder-Wise & Kowalski, 2006). The following is a list of strategies for conflict resolution, the third step of conflict management (Huber, 2006, p. 528):

Box 17-3 provides a model for managing conflict.

HORIZONTAL VIOLENCE IN THE WORKPLACE

Many of the issues that interfere with workplace safety arise from the interactions that routinely occur between staff members. In times of stress, there is often miscommunication among colleagues. Most of these conflicts can be resolved with open communication. There is, however, a growing concern among health employees about horizontal violence between staff members. Horizontal violence is an act of aggression toward another colleague (Box 17-4). It may range from verbal or emotional abuse or extend to physical abuse. Subtle acts of horizontal abuse may include belittling a fellow staff member, withholding information, or freezing a colleague out of group activities. As a nurse, the challenge will be to identify behaviors that could be considered horizontally violent. Some of this behavior occurs between physicians and nurses. Two thirds of nurses say that they have experienced such abuse at the hands of physicians (Cook, 2001; Rosenstein, 2002).

Horizontal conflict is based on differences between colleagues. Vertical conflict relates to differences between managers and staff associates. These differences are often related to inadequate communication, opposing interests, and lack of shared attitudes. If staff members continue with horizontally violent behavior, the outcome is low morale and stress (Rosenstein, 2002). As a new nurse leader, it will be your responsibility to stop such behavior. The following steps are recommended to stop the cycle (Longo, 2007, p. 36):

SEXUAL HARASSMENT

Some instances of abuse may be forms of sexual harassment. Sexual harassment can result from collegial interpersonal conflict. Sexual harassment is a form of sex discrimination that violates Title VII of the Civil Rights Act of 1964. It is defined as unwelcomed sexual advances, request for sexual favors, or other verbal or physical conduct of a sexual nature when this conduct explicitly or implicitly affects an individual’s employment, unreasonably interferes with an individual’s work performance, or creates an intimidating, hostile, or offensive work environment (The U.S. Equal Employment Opportunity Commission, 2009).

All employment agencies are required to have sexual harassment policies and reporting procedures. This will be part of your new hire and mandatory annual education. When exposed to an incident of sexual harassment, it is important to remember that it needs to be confronted immediately. Confront the harasser with a statement such as, “I want you to know that I do not want you telling me sexual jokes.” If the behavior continues, inform your immediate supervisor.

While incidences of interpersonal conflict are inevitable in any workplace, it is the responsibility of both staff and leadership to recognize concerns and then intervene appropriately if the workplace is to be conducive to a satisfying and professional workplace.

As a nurse and nurse manager, you must do the following (AACN, 2004, p. 2):

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