Workplace violence: Nursing

Workplace violence is an undesired consequence that can sometimes occur when working with people in stressful situations such as in healthcare settings. Workplace violence can range from threats, harassment, intimidation, and verbal abuse to physical assaults that could even result in homicide. Now, there are four major types of violence that nurses might face in their work environment. The most common type is violence that’s perpetrated by a client that’s receiving care from the nurse. This can also include family members or friends of the client the nurse is interacting with.

Then there’s worker-on-worker violence, also known as bullying or lateral violence, where the perpetrator and the nurse work together. There is also violence that can occur from personal relationships, where the nurse has an existing exterior relationship with the perpetrator. This could include acts of domestic or intimate partner violence that are committed in the healthcare setting. Finally, there’s violence that’s associated with criminal intent. This is where the violence is carried out during the commission of a crime in the healthcare setting, which can include, trespassing, robberies, active shooters, and terrorism.

Now, violent behavior can occur anywhere on a hospital, but there are some high-risk areas, such as psychiatric units and the emergency department. Other risk factors that can lead to violence include working with individuals under the influence of drugs or alcohol, or who have a history of violence or certain psychiatric disorders. The risk is also greater when working alone or when the unit is understaffed. The environment of the workplace can also result in some violent behaviors. This includes poor environmental design, lack of security, long wait times, and uncomfortable waiting rooms.

Other risk factors include, lack of staff training on personal safety and de-escalation techniques, lack of institutional violence prevention programs or policies, as well as access to firearms and other weapons, unrestricted movement of the public and poorly funded mental health and social services in the community. Finally, nurses who work in highly stressful and violence-prone areas can become desensitized to verbal and other forms of aggression. Moreover, they may consider reporting violent incidents to be a waste of time out of fear that they could be perceived as weak or incompetent if they report violent incidents.

Okay, there are some clinical manifestations that can predict imminent violence, including confusion, or not being oriented to person, place, or time; irritability, where the person is easily annoyed or angered; and loud, boisterous behavior, which can include yelling or slamming doors. These may be accompanied by threatening behaviors, such as verbal threats, which are aggressive verbal outbursts that can include verbal attacks or name-calling aimed at intimidating others; attacks on objects, including banging, kicking, or smashing objects; and physical threats, such as taking an aggressive stance or making a fist. Now, when 2 or more of these are present, the risk of violence is high, and measures should be taken to de-escalate the situation and prevent violence.

Okay, the priority nursing goal in potentially violent situations is to promote safety. Now, if your client is irritable, confused, and showing signs of threatening behaviors, your first priority is to ensure the safety of yourself, the client, visitors, as well as other members of the healthcare team. First, assess your environment, making note of any exits, as well as the location of any panic buttons or alarms that call for assistance. Also, ensure that you are not standing directly in front of the door, but rather off to the side, to prevent blocking anyone from exiting the room.