___________________________________________________________ Violence in the Healthcare Workplace
Examples of horizontal violence, also referred to as inter-group conflict, are criticizing, insulting, infighting, scapegoating, sarcastic comments, ignoring, undermining, withholding information, and bickering. This type of violence usually occurs between colleagues in a similar hierarchal position, typically when both parties have experienced a situation in which they perceive they have been oppressed. Instead of dealing with it on an organizational level, feelings of anger and resentment are internalized and ultimately manifested in aggressive behavior. • Mobbing: The term “mobbing” was first coined by Konrad Lorenz, an animal psychologist. He observed a smaller group of animals attacking a single animal and termed this phenomenon “mobbing.” Later, the term was used to refer to children’s destructive behavior toward a single child. Nursing literature utilizes the term to describe the negative behaviors of a group directed at a single employee. In some cases, the perpetrators may be those who have more professional power (i.e., doctors, nurse supervisors) than the victim. Mobbing usually takes the form of psychological abuse in the workplace, involving an individual who is bullied by colleagues or supervisors through rumors, intimidation, and humiliation. • Insidious workplace behavior: A broad term used to signify dysfunctional behaviors that may or may not be aggressive FORMS OF WORKPLACE VIOLENCE It is important to identify the different types of workplace violence. Lipscomb et al. highlighted four distinct types of workplace violence perpetrators [13; 14]: • Stranger: The perpetrator is not known to the victim(s) and has no reason to be at the workplace. An example of this type of workplace violence is robbery. • Customers: The perpetrator is an individual who has been provided some sort of service; the victim may be the individual or caregiver who has provided the service. A patient who assaults the nurse conducting rounds is an example of this type of violence. • Colleague or former worker: The perpetrator is a current or former employee. This type of violence is often the result of a perceived injustice, and the violence committed is in retaliation for that injustice. An example of this type of violence might involve a former staff person who was laid off
and returns to hurt the employer. Physicians who verbally abuse the nursing staff would be another example of this type of violence. • Personal relationship outside of the workplace: The perpetrator is known to the victim outside of a work or professional relationship. The aggressive act is usually motivated by perceived difficulties in the social relationship. An example of this type of workplace violence would be a boyfriend who comes to his girlfriend’s workplace to hurt her and/or others (i.e., domestic violence or intimate violence). These perpetrator types parallel the categories identified by OSHA. OSHA has differentiated workplace violence perpe- trated by strangers (Type I), co-workers (Type II), or service recipients (Type III) [7]. In a meta-analysis study, workplace violence was most likely to be perpetrated by patients and their family members, colleagues, and superiors [176]. In addition to perpetrator types, workplace violence may also be categorized by the quality of the behaviors. Workplace vio- lence may be classified according to the type of behavior and manner in which harm is inflicted [16; 140; 176]: • Physical or Verbal: On one end of the continuum, there are acts or behaviors that involve a physical component, such as shoving, pushing, or kicking. Conversely, violence may be verbal, involving behaviors that utilize words to threaten or imply harm. In fact, verbal abuse is the most common type, followed by physical assault. • Active or Passive: In some cases, harm may be produced using some form of active (or overt) behavior, whether it is physical or verbal. The opposite end of this continuum is the passive dimension, consisting of harm produced by withholding, such as not releasing important information that would inevitably affect an employee’s performance or failing to act in assistance of the victim. • Direct or Indirect: In cases of direct workplace violence, the intent to harm is perpetrated directly at the target. Indirect aggressive acts are inflicted through roundabout means, such as spreading rumors. Part of the difficulty in developing a consensus regarding the definition of workplace violence, or even the related terms, is that the criteria for acceptable behavior are based on implicit and unwritten assumptions that vary across organizations, con- texts, and individuals [17]. These perceptions are influenced by a host of factors on individual, organizational, cultural, and social levels [18]. The challenge of establishing a definitional consensus is problematic for policy makers, researchers, and workers [139].
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