Table of Contents
Quality and Safety Initiative Focus
The safety of patients, patient’s families, and nursing staff should be a priority for every healthcare provider. There is a correlation between the work environment for nursing staff and the delivery of quality patient care, as well as the impact of workplace violence, whether that is nurse-to-nurse, management to nursing staff, nurse-to-patient, or patient and patient family to nursing staff. A healthy work environment in which workplace violence is not tolerated at any level enhances the quality of care as well as successful patient outcomes.
Given that nurses have the most direct interaction with patients and families, as well as with their co-workers, often under stressful working conditions, it is important for nurses to recognize and understand workplace violence and its impact on their health and well-being, as well as its impact on their patients and their perception of their care. With the review of the literature, this paper will examine workplace violence, including nurse-to-nurse, management to nurse, patient and patient family to nurse, nurse to the patient or patient family and the impact of workplace violence on the quality of patient care and safety of patients, families and nursing staff. This paper will also provide recommendations for policy change and implementation to address this issue on a system-wide as well as unit-specific level.
Rationale from Literature
Numerous studies have been conducted and peer-reviewed journal articles written on the importance of a healthy work environment, as well as the impact of workplace violence (WPV) on the well-being of nursing staff, patients, and patient’s families.
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As noted by the 2016 Quick Safety report from the Joint Commission, workplace safety and quality of patient care is not some new concept. In their 2004 report, Keeping Patient’s Safe: Transforming the Work Environment of Nurses, the Institute of Medicine (IOM) focused on the work environment of nurses and its impact of quality of care and patient safety (Joint Commission, 2016). The Joint Commission (2016) noted that a report by the Occupational Safety and Health Administration [OSHA] found that 21% of registered nurses and nursing students reported experiencing a physical assault; 50% reported experiencing verbal abuse, which includes bullying, all within a twelve-month period.
Additionally, this same report noted that within a seven-day period, 12% of emergency room nurses reported experiencing physical violence and 59% experienced verbal abuse. There are five recognized categories of workplace violence:
- Threat to one’s standing, such as insults, inappropriate teasing or name calling;
- isolation or withholding of pertinent information;
- threat to one’s professional status, such as public humiliation;
- destabilization which is defined as failing to give one credit when it is due and,
- overwork or unrealistic or impossible deadlines.
Bullying falls within these categories as it includes verbal abuse, as well as behavior that is threatening or humiliating, or it interferes with one’s ability to complete their tasks (Joint Commission, 2016). The 2016 Quick Safety report by the Joint Commission noted that 44% of nurses have experienced bullying and that in many instances nurses accept bullying as part of the job, especially new nurses coming onboard. Fasanya and Dada (2015) noted that workplace violence is an issue that must be addressed, especially when many states are now adopting stand your ground laws to promote workers protection. Their statistical data is consistent with that of the Joint Commission and OSHA with 65% of respondents reporting having experience with workplace violence. A significant issue that must be addressed on the findings in this study in which 41% reported that management showed little concern for their safety and 23% reporting that making a workplace violence report to their supervisor was an unsafe action.
National Nurses United (2018) noted that between 2011 and 2016, 58 hospital workers lost their lives due to workplace violence and that in 2016 the Government Accountability Office noted that healthcare workers at inpatient facilities were 5 to 12 times more likely to experience workplace violence than those working in other facilities. Fasanya and Dada (2015) stated in a report by Fidelity Brokerage Investment Services that the healthcare industry is notorious for workplace violence.
In March 2018 a bill was introduced in Congress that would mandate OSHA to develop national standards relative to workplace violence prevention and would require all health care facilities and organizations to both develop and implement both system-wide and unit-specific violence prevention plans. As noted by supporters of this bill, workplace violence impacts the safety of everyone, nursing staff, patients, and families. It impacts one’s ability to deliver quality care as well as successful patient outcomes (National Nurses United, 2018).
Workplace violence is an alarming issue that affects everyone who experiences it. It impacts not only one’s physical safety but one’s emotional and psychological well-being. It is an issue that takes a daily toll on one’s ability to perform the job effectively and is one of the most challenging security and personal safety issues an organization can face. Workplace violence plays a significant role in lower employee morale, employee turnover, absenteeism, and fear experienced by those who are on the receiving end.
