Violence in the Healthcare Workplace ___________________________________________________________
538 nurses in an international university-based hospital. The nurses in the study reported that the responses from superiors were not always supportive. They also tended to believe that reporting was useless, with no formal reporting mechanism and no system for following up legally [123]. In an interesting qualitative study that sought to examine the process by which individuals, specifically women, label and identify workplace bullying, Lewis interviewed 10 women from a range of professional fields (e.g., teacher, counselor, nurse, police officer, university lecturer) [18]. Nine of the 10 participants reported being bullied by their managers. Lewis found that when they initially experienced various forms of workplace bullying, the victims tended to minimize the behaviors [18]. Although the study participants perceived the behaviors as stressful, they framed them as an interpersonal problem and did not recognize the patterns of bullying. All of the women acknowledged that the behaviors escalated. Because the definition of workplace bullying is ambiguous, the women felt they could resolve the problem on their own. In part, this was related to preserving their sense of self and sense of professional competence. Similar results were found in a qualitative study conducted by van Heugten [43]. The 17 social workers in the study who had experienced workplace bullying reported having attempted to minimize the seriousness of the bullying. Similar to Lewis’ study, these participants also did not recognize the negative behaviors they experienced as workplace bullying. When they were finally able to put a name to the behaviors, the shame gradually ebbed. Prior to the behaviors being identified as workplace bullying, the social workers reported experiencing negative physical health symptoms [43]. These studies are very small, and generalized conclusions about the profession should not be made based on the results. However, they do provide some insight into how individuals respond to and report perceived violence.
Lack of security is also a risk factor [154; 182]. In a focus group study with 22 nurses, the participants identified the presence of security as instrumental in preventing workplace violence [55]. The nurse participants emphasized the importance of security staff who were specifically hired by the organization (and not by an outside organization) and trained to the unique issues related to the grounds of the organization. Other security- related factors include unsecured doors, areas with poor vis- ibility or lighting, and non-functioning alarms [155]. Overall, environments that are vulnerable to patient-perpetrated workplace violence are those with easy public accessibility, high noise levels contributing to the perceived chaos of the environ- ment, fear and stress emanating from crisis situations, such as difficult diagnoses and prognoses, unexpected complications, and long wait times [91; 188]. Long wait times are another predictor to violence perpetrated by patients and family members. In one study, researchers found that freestanding emergency departments have fewer incidents of workplace violence compared with hospital-based emergency departments. Hospital-based emergency depart- ments take in more patients, which then creates longer wait times and leads to higher levels of patient anxiety and frustra- tion [156]. Inconsistent policies for patients can also trigger violence [182]. Finally, health and mental health professionals’ work often entails having one service provider solely assessing or providing a service to a client/patient. This in itself increases the risk of violence or assault [7]. ORGANIZATIONAL ENVIRONMENT The organizational environment can also act as a risk factor for workplace violence. For example, environments that are overcrowded, like residential wards or working environments experiencing budget cuts or freezes, are more vulnerable to workplace violence [46; 47]. Organizations that do not have clearly specified staff roles may also be a risk marker. In a study conducted by Gates et al., the researchers found that there was a relationship between frequency of experiencing assaults and role ambiguity, role insufficiency, and occupational strain among nursing assistants in residential care settings [26]. Nursing assistants, for example, who experience greater levels of vagueness about their work expectations and priorities, feel that their training is not appropriate to the job, and perceive occupational stress and strain were more likely to experience assaults from their patients than those who were confident in the expectations and training [26]. Experts have suggested that healthcare professionals may not be able to concentrate on caring for difficult and challenging patients when they feel unappreciated, overwhelmed, or stressed [26]. A 2015 study found that Finnish employees who reported higher levels of job demands were four times more likely to experience work- place bullying compared with those with low levels of job demands [124]. However, it is important to remember that the relationship between job strain and workplace violence may
RISK FACTORS FOR WORKPLACE VIOLENCE
OCCUPATIONAL SETTING Characteristics associated with a specific job are correlated to risk of experiencing workplace violence. Research indicates that employees who work nighttime hours (e.g., 3 p.m. to 11 p.m.) are more likely to experience all types of workplace violence than those working daytime hours (e.g., 7 a.m. to 3 p.m.) [44; 119; 153; 154]. Findings of another study of emergency departments in Turkey also indicated that working a night shift increased the risk for experiencing violence [28]. Periods of increased activities and less surveillance, such as visiting hours or mealtimes, are another risk marker. In a study conducted in a university hospital, units with greater turnover, downsiz- ing, and night shifts were associated with increased risk of workplace violence [187]. Working in a geographically isolated area is also a risk factor [155].
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