TAN Issue: September/October 1998: News: Workplace Violence Affects One-Third of Nurses

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Survey of nurses in seven SNAs reveals staff nurses most at risk

By Victoria Carroll, MSN, RN, and Karen H. Morin, DSN, RN

More than 30 percent of nurses recently surveyed in seven states reported having been the victims of workplace violence in the previous year. Most had been assaulted by patients. Initiated by the Colorado Nurses Association (CNA) Task Force on Workplace Violence, the survey was returned by 586 nurses in Alabama, Colorado, Delaware, Hawaii, Illinois, Kansas and Missouri. Of these nurses, 93.7 percent are female, 51 percent are staff nurses, 80 percent have been nurses for more than 10 years, and 55 percent have worked more than 10 years at their present agency. The survey was adapted from one used in the 1995 ANA grant project by the Kansas State Nurses Association: Violence Assessment in Hospitals (Carroll and Sheverbush 1996).

Since only 5 percent of the nurses who responded are emergency department nurses, it's possible that the number of nurses assaulted on the job is actually much higher than revealed in the survey. Some studies have shown that emergency department nurses are at the highest risk for being assaulted at work (ENA 1994; Mahoney 1991; Stultz 1993).

Seventy-two percent of those nurses who reported having been assaulted are staff nurses, with 60 percent of these reporting that support services were made available to them in the aftermath of the assault. Thirteen nurses said they were assaulted with weapons, including knives, scissors, chairs and guns.

More than 90 percent of all the nurses surveyed defined "workplace violence" to include physical violence such as kicking, pushing and slapping; physical violence with a weapon; sexual assault; and verbal abuse. Sexual harassment was included in the definition of workplace violence by 78 percent of the nurses. In addition, when given the opportunity to add other types of workplace violence, nurses most frequently referred to "intimidation," described as an implied threat when someone, for example, hit a wall, threw an object, or glared at another person in the immediate area.

Fifty percent of the nurses indicated that violent incidents were reported where they worked with another 26 percent indicating that they were "sometimes" reported. Nurses surveyed pointed to a need for more policies in some workplaces to enhance safety, such as hostage and weapon possession policies, and restriction-of-visitor policies. More than 70 percent of the nurses called for training on the prevention and management of assaultive behavior, with 55.6 percent highlighting the need for involvement of all employees in creating a safer workplace and 50 percent indicating the need for hospitals to place more emphasis on reporting violent incidents.

The survey is CNA's first step in establishing a violence reduction plan. The next step is to report the complete results to all Colorado nurses and to work with the CNA's Congress on Nursing Practice and Workplace Issues Committee to educate nurses statewide about workplace violence. CNA will work with the ANA's Congress on Nursing Practice to provide information and education on workplace violence to nurses nationwide.

Nurses offer invaluable resources to each other, their clients and their workplaces. Through effective planning and problem-solving, we can collaborate with other nurses and other disciplines to enhance the future of health care and develop safer workplaces. Just as we are advocates for safe and quality health care for our clients, we must be champions for creating a safe work environment for ourselves.


Emergency Nurses Association (1994). Prevalence of Violence in Emergency Departments. ENA: Park Ridge, IL.
Carroll, V., and Sheverbush, J. (1996). KSNA Violence Assessment in Hospitals Provides Basis for Action. The American Nurse, 28(6):18.
Mahoney, B.S. (1991). The Extent, Nature, and Response to Victimization of Emergency Nurses in Pennsylvania. Journal of Emergency Nursing, 17:282-294.
Stultz, M.S. (1993). Crime in Hospitals 1986-1996 Ð The Latest IAHSS Surveys. Journal of Healthcare Protection Management, (2):1-25.

Victoria Carroll is a clinical instructor at the University of Northern Colorado, and president of Carroll Consulting. She was director of the Kansas State Nurses Association Violence Assessment in Hospitals project, and is chairperson of the Colorado Nurses Association Task Force on Workplace Violence. Karen H. Morin is an associate professor at Widener University in Pennsylvania and president of the Delaware Nurses Association. She tabulated the survey data.