A nurse emailed me about something she faces every day: harassment and verbal abuse by patients.
She stated her nurse manager does nothing to stop the nurse abuse and wonders how she can continue working in this facility if she is faced with this treatment on a regular basis. Violence against nurses in the workplace is nothing new. Nursing literature, news reports and nursing blogs contain copious amounts of information on nurse abuse and reactions to it. Workplace violence is generally defined by the National Institute of Occupational Safety and Health as an act or threat of violence, ranging from verbal abuse to physical assaults, directed toward persons at work or on duty. NIOSH has categorized four types of workplace violence:
- Type I: "Criminal intent" acts by persons having no relationship to the business or its employees
- Type II: Acts involving a customer, client or patient with a relationship to the business, who is violent while receiving services
- Type III: Acts involving a "worker-on-worker" relationship (lateral violence) in which an employee attacks or threatens another employee
- Type IV: Personal relationship acts between a perpetrator and the intended target in which the violent act or threat occurs at the victims workplace
Types II and III are the most common in healthcare, according to the American Nurses Association. Recent statistics support how common Type II violence is with nurses. A 2019 American Nurse Today survey of over 5,000 nurses showed 59% of nurses had been verbally assaulted by a patient.
Nurse abuse includes verbal abuse and harassment
Examples of nurse abuse by patients include:
- Bullying
- Ethnic insults
- Name calling
- Offensive teasing
- Questioning professional competency
- Requests for a date
- Sharing obscene photos
- Yelling
- Threatening verbal remarks
There are many underlying causes of such patient behavior, including financial concerns of loss of work and the cost of hospitalization, fear of a lack of control over the illness or diagnosis, anger at being hospitalized and personality characteristics or psychological problems.
Regardless of the source of patient abuse and harassment, it is unacceptable and clearly considered violence against its victims, according to the Joint Commission.
Effects of abuse
Nurses who have been victims of patient abuse and harassment are affected in a number of ways, including:
- Not wanting to care for patients
- Absenteeism
- Depression
- Anxiety
- Sleeping difficulties
- Fatigue
- Humiliation
- Fear
All these results not only affect the nurse, but also affect the provision of safe patient care, including the potential for an increase in medication errors and patient infections, according to OSHA.
Legislation in the works
The most promising response to the prevention of patient and other abuse and harassment against nurses is the November 2019 passage by the House of Representatives of the Workplace Violence Prevention for Health Care and Social Service Workers Act (H.R. 1309).
If it becomes law, H.R. 1309 would require the Department of Labor to create an occupational safety and health standard requiring certain healthcare and social service employers to develop and implement a comprehensive plan for protecting healthcare workers, social workers and other personnel from workplace violence.
It also will require employers to investigate workplace violence incidents, provide training and education to employees exposed to workplace violence hazards and risks, and prohibit acts of discrimination or retaliation against employees for reporting workplace "violence, incidents, threats or concerns." The Senate received the act and referred it to the Committee on Health, Education, Labor and Pensions. If it passes, H.R. 1309 would eliminate the current patchwork approach at the state level. Many states, including Illinois, Ohio and Maryland have passed laws protecting nurses and other healthcare workers from nurse abuse, but they are varied. Some require training of employees regarding workplace violence while others provide penalties to perpetrators of violence against healthcare workers. Lack of accreditation by The Joint Commission may occur if its Standard LD.03.01.01 is not met. That standard requires leaders in the healthcare facility to "create and maintain a culture of safety and quality throughout the organization," according to ANA.
How can you prevent nurse abuse?
You and your nurse colleagues play a pivotal role in preventing workplace violence. Here's how:
- Know your state law governing patient abuse and harassment of nurses and follow its mandates for reporting and notifying nursing administration.
- Follow your employer's policy concerning such violence.
- If your employer has no policy governing patient abuse and harassment against nursing staff, ask your facility's policy and procedure committee to draft one for consideration by administration.
- Contact your senator and ask for his/her support of H.R. 1309 and any other legislation that will help to end violence against nurses in the workplace.
- Support your professional associations in their efforts to end nurse abuse.
- Report any patient verbal abuse or harassment to nursing administration and risk management.
- Participate in educational and training seminars that focus on unacceptable patient conduct and how to immediately deal with it.
- If you are a nurse manager, nurse supervisor or CNO, be supportive to nurses who are victims of patient abuse or harassment.
- If you are a nurse staff member, be supportive of colleagues who have experienced this type of violence.
Take these courses to learn more about violence in various settings:
Preventing Violence in the Healthcare Setting (1 contact hr) Violence in healthcare settings reflects the chaos of a broader work environment. Experts not only agree on the extent of violence in the healthcare setting, but also concur on its best treatment: education and prevention. Nurses heighten their awareness and expertise in dealing with violence in their professional settings by learning to identify risk factors and warning signs, and by applying interventions that can shield their patients and themselves from harm. Domestic Violence Awareness for Healthcare Professionals (3 contact hrs) Domestic violence occurs in relationships among family members, partners, and people who share the same household or are dating; it includes child and elder abuse. The National Coalition Against Domestic Violence reports that 10 million people are physically abused by an intimate partner every year and that more than 20,000 calls are placed each day to domestic violence hotlines. The National Children's Alliance estimates that nearly 700,000 children are abused annually. Child Abuse (1 contact hr) In 2015, about 1,670 children died due to child abuse or neglect. While this number is upsetting, many practitioners and researchers think the actual number is much greater. Healthcare providers in all settings are presented with opportunities to identify families at risk for child abuse. Knowledge of risk factors, signs of abuse/neglect, and prevention strategies are necessary to disrupt the cycle of abuse. This course provides an overview of those risk factors, how to identify potential child abuse and neglect, and prevention interventions.
