Violence in the Healthcare Workplace ___________________________________________________________
some form of physical violence from a patient, with more than 25% having experienced 20 or more incidences of violence at work in the last three years [23]. Emergency departments are inherently at higher risk of workplace violence due to the use of these services by patients having mental health and substance use issues. The crisis nature of the issues presented in emergency departments, often accentuated by long wait times, makes heightened emotions a regular occurrence [173]. The most common root causes of sentinel events such as rape, assault, and homicide in the healthcare workplace are failures in communication, inadequate patient observation, noncom- pliance with workplace policies, and lack of or inadequate behavioral assessments [134]. Patients are the source of 80% of violent incidence, followed by other client/customer (12%), students (3%), and coworkers (3%) [20]. Homecare/Residential Care Settings Studies have not yielded definitive conclusions about the mag- nitude of workplace violence when service workers provide care in the homes of patients. It is believed to be more prevalent than other sectors because, although workplace violence is a hidden problem in general, it is even less visible for caregiv- ers working in residential care settings or in private homes. It has been estimated that nursing home workers experience more aggressive incidents while caring for their patients, leading to more lost workdays compared with human service professionals in other sectors [24]. The “behind closed doors” nature of the work for homecare workers can exacerbate the sense of isolation, fear, and anxiety for those who experience workplace violence, and working in patients’ homes offers no immediate organizational structure or available support [6; 25]. In one study, approximately 28% of home healthcare workers experienced workplace violence during the lifetime of their work, most often verbal abuse perpetuated by a patient [178]. However, a study conducted by Büssing and Höge in Germany offered a different picture [6]. A total of 1,314 surveys were mailed out to 105 home care services. From this initial contact, 721 questionnaires were returned from 97 home care services, which represented a response rate of 55%. Compared with studies conducted among other healthcare sectors, the majority did not rate high agreement to experiencing general workplace violence and aggression. The authors speculated that perhaps their definitions of workplace violence affected the results. Furthermore, there is a possibility that the higher degree of autonomy among patients living at home compared with a hospital or residential setting might minimize the amount of violence perpetrated. In residential facilities, workplace violence may be over- looked. In some cases, aggressive behaviors are minimized or overlooked because the violence is unintentional and/or the perpetrators are patients who have dementia or other cognitive disorders [26]. In a study with 87 social workers in residential care facilities, 81% stated they had been either threatened or assaulted by clients in the facility in the past year [114]. In another study, researchers found that 34% of nursing assistants
PREVALENCE OF WORKPLACE VIOLENCE
HEALTH CARE It has been estimated that healthcare workers are sixteen times more likely to experience an incident of workplace violence compared with other employees, including prison guards, police officers, bank staff, retail employees, and transport workers [19; 20]. In total, 12,390 workplace assaults occurred in healthcare settings and 2,160 assaults occurred in social assistance settings in the United States in 2019 [135]. An estimated 19% of all traumatic occupational injuries sustained by healthcare workers are the result of workplace violence [133]. In an international study, researchers found that the majority of perpetrators of workplace violence were patients, and the victims were usually nurses and other staff working in contained environments [112]. In a study with 61 primary care physicians, participants reported that verbal abuse was com- mon [113]. The most common type of verbal abuse was being bullied to write a prescription, which was reported by 60.7% of physicians. Approximately 40% of the respondents indicated they had called security or the police to have a patient removed from their office [113]. In a study of New York City hospitals, 66% of residents reported experiencing at least one incident of physical violence during their shift in the emergency depart- ment. In addition, 52% experienced sexual harassment and 97% stated they experienced verbal threats [141]. Other studies have indicated that nurses may be at higher risk compared with other caregivers in the helping professions [21]. Rates for past-year workplace violence range from 24.7% to 88.9% [142; 177]. Nurses are often in the forefront of service delivery and tend to have direct interactions with patients and their family members. They are also exposed to patients deal- ing with issues related to substance abuse, domestic violence, human immunodeficiency virus (HIV), mental illness, and other social problems that place them in situations that are potentially more dangerous [14]. A survey of 762 practicing registered nurses sought to examine incidents of violence in the nursing workplace [14]. The nurses who participated worked in a variety of clinical settings and were diverse in age and work experiences; however, they were primarily female and White. Findings indicated the most common form of work- place violence experienced in the past year was verbal abuse by patients, experienced by 54.2% of respondents. Nearly 30% had experienced some sort of physical abuse by patients. It is important to note that differences in reported perpetrators or types of violence may arise as a result of the implied or given definitions of “aggression” and “violence.” Nurses in certain settings may be at higher risk given the popu- lation they serve. A multinational study of psychiatric nurses found that 75% reported that they had been assaulted at least once during their nursing career [22]. In 2009, the Emergency Nurses Association published a survey that indicated more than 50% of emergency department nurses had experienced
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