The National Institute for Occupational Safety and Health (NIOSH) defines workplace violence as any physical assault, threatening behavior or verbal abuse occurring in the workplace. Violence includes overt and covert behaviors ranging in aggressiveness from verbal harassment to murder. (NIOSH 1996)
How Widespread is Physical Workplace Violence in Healthcare?
- The healthcare sector leads all other industries, with 45% of all nonfatal assaults against workers resulting in lost work days in the US. (BLS, 2006).
- From 1993 to 1999 approximately 765,000 assaults occurred against healthcare workers resulting in days away from work (BLS, 2006; BLS, 2001)
- From 2003 to 2009, 8 registered nurses were FATALLY injured at work (BLS, 2011)
- 4 RNs received gunshot wounds (RNs) leading to their death
- 4 RNs received other fatal injuries
- 8 of 8 RNs were working in private healthcare facilities (not state or local government)
- 8 of 8 RNs were 35-54 years of age
Workplace Violence Reported by Registered Nurses
- In 2009 there were 2,050 assaults and violent acts reported by RNs requiring an average of 4 days away from work (BLS, Private Industry, State and Local Government, 2011)
- Of the 2,050 NONFATAL assaults and violent acts:
- 1,830 were inflicted with injuries by patients or residents
- 80 were inflicted by visitors or people other than patients
- 520 RNs were hit, kicked, or beaten
- 130 RNs were squeezed, pinched or scratched requiring days away from work
- 30 RNs were bitten
- In 2009, the Emergency Nurses Association reported that more than 50% of emergency center (EC) nurses had experienced violence by patients on the job and 25% of EC nurses had experienced 20 or more violent incidents in the past three years.
Lateral Violence and Bullying in Nursing
Lateral violence also called "horizontal violence" refers to acts that occur between workers and has been a long-term issue for nurses for decades, where nurses inflict psychological injury on each other. Horizontal violence also called bullying can be covert or overt acts of verbal and non-verbal aggression causing enough psychological distress to nurses to cause them to leave the profession (Dellasega, 2009).
What is the Impact of Lateral Violence and Bullying in Nursing?
- Low staff morale, increased absenteesism, attrition of staff, nurses leaving the profession
- Deterioration of the quality of patient care due to being distracted, unhappy, or intimidated
- Unmanaged anger leads to insomnia, hypertension, depression, and GI upset
(Hughes, 2008; Institute for Safe Medication Practices, 2004; Meyers, 2006)
How Widespread Are Lateral Violence and Bullying in Healthcare?
- Student nurses (53%) report they had been put down by a staff nurse Threatening body language and strong verbal abuse reported by up to 48% of nurses, pharmacists and others
- Nurses (56.9%) reported having been threatened or experienced verbal abuse at work
(ANA, 2001); Institute for Safe Medication Practices, 2004; Longo, 2007).
Workplace Violence Protection for Nurses by Accrediting Bodies
Although, there is no federal standard that requires workplace violence protections, effective January 1, 2009 The Joint Commission on Accreditation of Healthcare Organization created a new standard in the "Leadership" chapter (LD.03.01.01)* that addresses disruptive and inappropriate behaviors in two of its elements of performance:
- EP 4: The hospital/organization has a code of conduct that defines acceptable and disruptive and inappropriate behaviors.
- EP 5: Leaders create and implement a process for managing disruptive and inappropriate behaviors.
In addition, standards pertaining to medical staff (physicians) have been organized to follow six core competencies (see the introduction to MS.4) to be addressed in the credentialing process, including interpersonal skills and professionalism.
To learn about specific Joint Commission standards: www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea_40.htm
Workplace Violence Protection for Nurses at the State Level
Rather than wait for healthcare employers to volunteer to establish such programs, some states have sought legislative solutions including mandatory establishment of a comprehensive prevention program for healthcare employers, as well as increased penalties for those convicted of an act of violence against a nurse.
Enacted to Date
- Legislation calling for a employer run workplace violence programs, study of the issue or reporting of incidents has been signed into law in: CA, CT, IL, ME, NJ, NY, OR, WA and WV.
- States with laws that strengthen or increase penalties for acts of workplace violence affecting nurses include: AL, AZ, CA, CO, CT, HI, IL, NE, NV, NJ, NM, NY, NC, OH*, OK, TN, VT, VA, and WV.
*also authorizes hospitals to post warnings regarding violent behaviors
- HI passed a resolution urging employers to develop and implement standards of conduct and policies for managers and employees to reduce workplace bullying and promote healthful and safe work environments.
Last updated 6/2013