Violence in the Healthcare Workplace ___________________________________________________________
This course will provide an overview of the different types of workplace violence, risk factors, emotional, social, and behavioral ramifications of workplace violence, and specific interventions and policies that have been implemented by organizations to address workplace violence and enhance practitioners’ safety. DEFINITIONS OF WORKPLACE VIOLENCE The definition of workplace violence is complex, multifaceted, and ambiguous. The challenges in establishing tracking and monitoring systems inevitably lead to an under-reporting of workplace violence, which can then have ramifications in developing clear policies in the workplace [4]. The terms used are confusing and can contribute to a lack of consensus regarding an overall definition. For example, terms used in the literature include: workplace bullying, workplace aggression, workplace abuse, workplace harassment, horizontal violence, and mobbing [5]. In this course, a workplace is defined as a location where an employee, whether employed on a tempo- rary or long-term basis, performs tasks related to his or her job description [5]. Although the general public usually equates aggression with violence, there are differences. Aggression constitutes inten- tional behavior, and the goal is to ultimately harm or injure another party physically or psychologically [139]. Some have further categorized aggression into two types: hostile aggres- sion and instrumental aggression [6]. Hostile aggression refers to aggressive behaviors triggered from feelings of anger or frustration. Instrumental aggression focuses around the intention to hurt someone psychologically or physically to achieve some goal, not merely to inflict pain [6]. The dilemma with these definitions is that nurses, social workers, and other human service professionals deal with clients or patients who may not be fully oriented. In these cases, the question about their intent is raised [6]. However, this does not mitigate the psychological and emotional consequences of the victims who experience workplace violence [6]. One definition of workplace violence includes physical assaults and threats of physical assault aimed at employees in their occupational setting or while on duty [7]. Other definitions address not only physical violence but also psychological violence, abuse, bullying, harassment (racial, sexual, and psychological), obscene phone calls, and/or verbal assault [7; 8]. The Occupational Safety and Health Administration (OSHA) defines workplace violence as “any act or threat of physical violence, harassment, intimidation, or other threaten- ing disruptive behavior that occurs at the work site. It ranges from threats and verbal abuse to physical assaults and even homicide. It can affect and involve employees, clients, cus- tomers, and visitors” [109]. The U.S. Department of Labor defines workplace violence as “an action (verbal, written, or physical aggression) that is intended to control or cause, or is capable of causing, death or serious bodily injury to oneself
or others, or damage to property” [110]. Other instances that may be overlooked are incidents in which there are unintended victims. Such a case, as described by Keyes and Keim, is one in which an employee who is berated in front of co-workers later sabotages equipment, resulting in personal injury and dam- age to property [4]. While many equate the term “violence” with physical force or physical injury, for the purposes of this course, workplace violence will refer to any act of aggression, physical or nonphysical, that takes place while the victim is working. This is consistent with a 2023 systematic review and meta-analysis in which investigators noted that studies generally defined workplace violence as any violent incidence in which there is a threat to an employee’s safety, well-being, or health at their location of work; it can include physical, verbal or psychological abuse [173]. The term “workplace aggression” is often used in the mental health literature, while the term “workplace violence” is preferred in the healthcare literature [139]. For the purposes of this course, the two terms are used interchangeably. Some experts have posited that workplace violence falls into three categories: internal violence (i.e., the perpetrator and victim are employees), external violence (i.e., the perpetrator is a stranger and the victim is an employee), and client initiated (i.e., the perpetrator is a patient and the victim is an employee) [87]. Of these types, client-initiated workplace violence is the most frequently encountered in the healthcare setting [91]. Overall, these incidences of workplace violence are character- ized as specific, time-limited, and unanticipated. They may also trigger feelings of loss of personal safety and emotional well- being [9]. Workplace violence ultimately consists of persistent, offensive, unwanted, and intimidating behaviors that are used to control or exert power over an individual [5]. OTHER TERMINOLOGIES As noted, the fact that various terminologies have been used complicates the process of coming to a consensus about the definition of workplace violence. Terminologies that are com- monly employed include [10; 11; 12; 111; 139; 174; 175]: • Bullying: Involves a series of incidences of overt and subtle forms of aggression that are usually non-physical in nature but can be characterized as controlling. Bullying behaviors include spreading rumors, withholding information, blocking an individual’s promotion, and using psychological abuse to exclude someone. Some experts have more specifically defined bullying as specific types of behaviors that occur at least twice per week for a minimum of six months. Bullying can be perpetrated face-to-face or via technology (e.g., cyberbullying). • Horizontal violence (or lateral violence): Nursing literature has utilized the term “horizontal
violence” to describe a specific form of bullying involving non-physical acts of aggression or hostility. It may be either blatant or covert.
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