The intent of this position statement is to declare that there is a critical need for increased awareness of violence in the workplace. This position also seeks to assist registered nurses to prevent and manage violent incidents in their workplace.
It is the position of the New York State Nurses Association that:
Violence is a public health emergency that pervades all socioeconomic segments of society and is of growing concern in healthcare settings. According to the Bureau of Labor Statistics (BLS), in 2000, the injury rate for nurses is among the highest and 25 of every 10,000 full-time nurses were injured in workplace assaults. This rate is much higher than private-sector industries, which is 2 per 10,000. These statistics only reflect a portion of the incidents; the Occupational Safety and Health Administration (OSHA) has found that there is severe underreporting because many healthcare workers believe it is part of the job (Barthel, 2004).
Violent incidents are most common in hospitals, but are also on the rise in community practices, long-term care facilities, homecare settings and college campuses. There is no agreement in the literature on an operational definition of workplace violence. Smith-Pittman and McKoy (1999), developed a definition appropriate for healthcare which states, “an act of physical or psychological abuse against a healthcare provider designed to harm, injure, and/or damage; or as an act that a reasonable person should know would result in psychological or physical harm” (pg. 8).
According to Smith-Pittman and McKoy (1999), every violent situation contains at least the following four common elements: an offender, causative factors, an environment conducive to violence, and targets. Offenders in healthcare settings can be those who have no legitimate connection to the workplace and are there to commit criminal acts, recipients of services or their family members, or employees or relatives of employees (Barrett, 1997). Healthcare settings continue to be very stressful environments, with factors contributing to violent incidents consisting of increased workloads; decreased resources; healthcare reorganization; high population of women in the workplace; facilities open and accessible 24 hours a day, 7 days a week; and lack of policies and programs to prevent and reduce violent incidents, to name a few.
The consequences of violence in the workplace are serious for both an organization and the employee. Victims of workplace violence have an increased risk of long-term emotional problems and post-traumatic stress disorder (PTSD), a disorder which is common in combat veterans and victims of terrorism, crime, rape and other violent incidents. Symptoms experienced by victims include self doubt, depression, sleep disturbances, irritability, decreased ability to function at work, increased absenteeism, and disturbances in relationships with family, friends and co-workers (American Federation of State, County and Municipal Employees, n.d). Organizations are significantly affected financially due to low worker morale, increased job stress and turnover, reduced trust of management and coworkers, and hostile work environments (NIOSH, 2002).
The Occupational Safety and Health Actof 1970 mandates that, beyond compliance with hazard-specific standards, all organizations have a general duty to provide their employees with a workplace free from recognized hazards, that are likely to cause death or serious physical harm. The Act’s “General Duty Clause” can be used to cite employers who violate this clause because they have not safeguarded their organization from recognized harm and lack strategies to prevent or abate workplace violence (OSHA, 2004). The American Nurses Association (ANA) Bill of Rights for Registered Nurses states, “Nurses have the right to a work environment that is safe for themselves and their patients” (Know your rights: ANA’s Bill of Rights arms nurses with critical information, 2002).
Both healthcare organizations and RNs have responsibilities to create methods and organized programs to prevent and intervene appropriately to manage occurrences of violence. Research indicates that violence may be prevented if approached strategically. An intensive multidisciplinary approach is needed to manage violence (AACN, 2004). OSHA recommends that facilities develop a program for job safety and security, which should be incorporated into the facilities’ overall health and safety programs.
According to Gerardi (2004), a healthy work environment is just as important as mastering the newest technology. Organizations continually find it difficult in the complex and hectic world of healthcare to develop an environment with positive working relationships. Healthcare has a very unique culture, which lends to barriers that prevent effective resolution of conflict. Barriers to managing conflict in healthcare include time constraints, poor communication, difficulty in accessing information, ambiguous roles, diversity of education/experience of clinicians, power imbalances, emotionally-charged situations, and fatigue. It has been said that creating an environment that appropriately manages conflict, leading to a healthy work environment is the next evolution of healthcare delivery (Smith, Tutor & Phillips, 2004). Creating a culture of professionalism and mutual respect establishes an expectation that patients, visitors and healthcare team members will consistently interact with open communication and regard for basic human dignity.
Conflict that is unresolved in the facility leads to barriers for employees, teams, organizational growth and productivity, which leads to cultural breakdown within an organization. “Integrating collaborative conflict management strategies into the daily activities of clinical care can improve patient outcomes, improve retention of nursing staff, and create an environment that optimizes scientific advances through enhancement of effective working relationships” (Committee on the Work Environment for Nurses and Patient Safety, 2004).
Taking steps to improve healthcare environments will improve patient outcomes, improve retention and recruitment of RNs, and improve patient satisfaction. Registered nurses and the public advocate for safe and quality healthcare for patients, but without creating safe and healthy work environments for employees, the perpetuation of these issues will continue to erode healthcare delivery.
The New York State Nurses Association recommends that:
Approved by the Board of Directors on September 27, 1983.
Reviewed and revised by the expanded Council on Nursing Practice on January 21, 2005.
Approved by the Board of Directors on April 8, 2005.
This position statement replaces “Guidelines for Promoting Productive Communication and Resolution of Conflicts.”
Note: The use of the term “patient” anywhere in this document is intended to be generic and refers to the recipient of nursing care.
Other NYSNA position statements addressing violence include:
American Association of Critical-Care Nurses. (2004, April). (Available from AACN, 101 Columbia , Aliso Viejo , CA 92656 )
American Federation of State, County and Municipal Employees. (n.d.). Reacting to violence after it occurs (Chapter 7). In Preventing Workplace Violence. Retrieved February 15, 2005 from http://www.afscme.org/health/viol07.htm
Barrett, S. (1997). Protecting against workplace violence. Public Management, 79(8), 9-12.
Barthel, V. A. & Roman, L. (2004). We stop aggression before it starts. RN, 67(10), 33-36, 66-67.
Berry , K. (2000). Root Cause Analysis in Response to a “Near Miss.” Journal for Healthcare Quality,22(2), 16-18.
Committee on the Work Environment for Nurses and Patient Safety. (2004). Keeping patients safe: Transforming the work environment of nurses. Washington , DC : National Academies Press.
Gerardi, D. (2004). Using mediation techniques to manage conflict and create healthy work environments. AACN Clinical Issues, 15, 182-195, 296-298.
Know your rights: ANA’s Bill of Rights arms nurses with critical information. (2002, November/December). The American Nurse, 34, 16.
National Institute for Occupational Safety and Health (2002). Violence: Occupational hazards in hospitals (NIOSH Publication No. 2002-101). Washington , DC : Department of Health and Human Services.
Occupational Safety and Health Administration. (2004). Guidelines for preventing workplace violence for health care & social service workers (OSHA Publication No. 3148-01R). Washington , DC : U. S. Department of Labor.
Smith, S. B., Tutor, R. S., & Philips, M. L. (2001). Resolving conflict realistically in today’s health care environment. Journal of Psychosocial Nursing, 39(11), 36-47.
Smith-Pittman, M. & McKoy, Y. D. (1999). Workplace violence in healthcare environments. Nursing Forum, 34(3), 5-13.
For more information on nursing practice, contact NYSNA's Education, Practice and Research Program at 518.782.9400, ext. 282 or by e-mail.