Violence, Incivility, & Bullying
While nursing is a profession dedicated to helping others, the highly charged nature of many of the environments in which nurses work can lead to situations where emotions boil over.
Incivility, bullying, and violence in the workplace are serious issues in nursing, with incivility and bullying widespread in all settings. Incivility is “one or more rude, discourteous, or disrespectful actions that may or may not have a negative intent behind them”. ANA defines bullying as “repeated, unwanted, harmful actions intended to humiliate, offend, and cause distress in the recipient.”
Such acts of aggression – be they verbal or physical – are entirely unacceptable, whether delivered by patients or colleagues. These incidents not only have a serious effect on the wellbeing of the nurse in question but also their ability to care for their patients.
ANA seeks to protect nurses from all types of workplace conflict through various methods including advocacy, policy, and resources. We want nurses, employers, and the public to jointly create and nurture a healthy, safe, and respectful work environment in which positive health outcomes are the highest priority.
Types of violence
According to The National Institute of Occupational Safety and Health (NIOSH), there are four types of violence that nurses might face in their work environment:
- Criminal Intent. The perpetrator has no relationship with the victim, and the violence is carried out in conjunction with a crime.
- Customer/client. The most common health care environment-based assault, the perpetrator is a member of the public with whom the nurse is interacting during the course of their regular duties.
- Worker-on-worker. Commonly perceived as bullying, in these instances the perpetrator and victim work together – though not necessarily in the same role or at the same level.
- Personal relationship. In these incidents, the victim has been targeted as a result of an existing exterior relationship with the perpetrator, with the violence taking place in the workplace.
It is important to remember that none of the scenarios above are restricted to physical violence – verbal and psychological abuse can be just as damaging to both the nurse and their ability to care for patients. All such abuse comes within the scope of ANA’s anti-workplace violence agenda.
How ANA is taking action on workplace violence
Currently, there is no specific federal statute that requires workplace violence protections, but several states have enacted legislation or regulations aimed at protecting health care workers from its effects. We support these moves by individual states, and are actively advocating further, more stringent regulation.
In 2015, we convened a Professional Issues Panel on Incivility, Bullying, and Workplace Violence to develop a new ANA position statement. You can read the full position statement here, and below are some key points:
- The nursing profession will not tolerate violence of any kind from any source;
- Nurses and employers must collaborate to create a culture of respect;
- The adoption of evidence-based strategies that prevent and mitigate incivility, bullying, and workplace violence; and promote health, safety, and wellness and optimal outcomes in health care;
- The strategies employed are listed and categorized by primary, secondary, and tertiary prevention;
- The statement is relevant for all health care professionals and stakeholders, not exclusively to nurses.
In 2019 the #EndNurseAbuse Professional Issues Panel developed policy on barriers to reporting workplace violence. You can read the full Issue Brief here.
How you can make a difference
Tackling workplace violence will take a united effort. To that end, we have collated a series of promotional and educational resources that can help you and your colleagues reduce incidents in your workplace, and help create safe health care environments by advocating for change. Take the pledge to #EndNurseAbuse https://p2a.co/DQPJlDH
- Downloadable Graphics: Preventing Bullying poster and Civility Best Practices poster
- Tip Cards: Bullying in the Workplace
- Key Recommendations for Nurses and Employers Tri-Fold
Related ANA Position statements
- Bullying in the Workplace: Reversing a Culture
This book will enable nurses to understand and deal with bullying and its perpetrators and to counter the culture of bullying in their work environments.
- Not Part of the Job: How to Take a Stand Against Violence in the Work Setting
This book outlines the factors that create barriers to reduce violence against health care workers; and offers strategies and tools that can address them.
Below are some additional anti-bullying resources created by other health care organizations that you might find useful:
- AACN Standards for Establishing and Sustaining Healthy Work Environments
- AHRQ’s TeamSTEPPS
- APNA Position Statement: Workplace Violence
- CDC Workplace Violence Prevention for Nurses Course
- OSHA Safe + Sound Resources Factsheet
- OSHA’s Worker Safety in Hospitals website
- PACERS Civility Toolkit
- The Joint Commission - New and Revised Workplace Violence Prevention Requirements
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