Violence against emergency Department Nurses
The U.S. Department of Justice survey showed that health care sector led all other sectors in the incidence of non-fatal workplace assaults and that nurses were the most likely of health care workers to be assaulted. [23]Assault rates are particularly high among Emergency Department (ED) nurses. [24] A study of 125 nurses at a regional medical center found that 82 percent of ED nurses had been physically assaulted at work during 2001. [25]
In a survey of Workplace Violence across 65 U.S. Emergency Departments key informants reported more than 3,461 physical attacks over 5-year period. [26]
In 2009, the Emergency Nurses Association (ENA) surveyed ED nurses in U.S. nationwide and found that more than
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Paradoxically, the job sector with the mission to care for people appears to be at the highest risk of workplace violence. Nurses are among the most assaulted workers in the American workforce. Too frequently, nurses are exposed to violence – primarily from patients, patients’ families, and visitors. This violence can take the form of intimidation, harassment, stalking, beatings, stabbing, shootings, and other forms of assault. [24]
Psychological consequences resulting from violence may include fear, frustration, lack of trust in hospital administration, and decreased job satisfaction. Incidences of violence early in nurses’ careers are particularly problematic as nurses can become disillusioned with their profession. Violence not only affects nurses’ perspectives of the profession, but it also undermines recruitment and retention efforts which, in a time of a pervasive nursing shortage, threatens patient care.
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These features include, for example, decreased productivity, increased absenteeism, burnout, turn over, and financial losses; decreased staff morale and reduced quality of life; emotional reactivity such as anger, sadness, frustration, fear, self-blame; decreased job satisfaction; changes in relationship with the co-worker and family, and feelings of incompetence and guilt; leaving the profession; and direct/indirect financial burdens for the health economy and society as a whole.
Several databases including Academic Search Premier, JSTOR, CINAHL, MEDLINE, and Cochrane were accessed using the key words “workplace violence,” “nurses,” student nurses,” horizontal violence,” “bullying,” “oppression,” and “intergroup conflict.” The purpose of the literature search was to determine the predominance of horizontal violence among new nurses and nursing students.
The trauma related to negative behavior can afflict the healthcare environment on many levels, from creating a hostile work environment in which job performance is affected, by increasing job turnover and causing nurses to leave the profession altogether. The Joint Commission states that in the United States 65.6 million workers have experienced or witnessed bullying, psychological harassment affects 38 percent of healthcare workers, and 44 percent of nurses are impacted by this behavior (The Joint Commission, 2016). Inclusively, this behavior can influence the way nurses care for their patients, staffing levels, and the healthcare organization’s
Lateral Violence in Nursing Lateral violence is an act of aggression that occurs among nurses (Becher & Visovsky, 2012), many nurses are exposed to incidents of lateral violence two or more times weekly (Ceravolo, Schwartz, Foltz-Ramos, & Castner, 2012) (American Association of Nurse Anesthetists, 2014). Lateral violence which is also called bullying, incivility, disruptive behaviors and horizontal violence may be covert or overt acts of verbal or nonverbal aggressions (American Nurses Association, 2011). Lateral violence may be verbal, physical or psychological in nature (Blair, 2013). Victims of lateral violence may have profound psychological effects including fatigue, insomnia, stress, depression, shame, guilt, isolations, substance abuse,
Now a days, in the healthcare field the nurses are known to prevent, promote and improve the health and abilities of patients, families and communities. It is very heartbreaking to hear that in this honorable profession exists violence, bullying which is among not only nurses but also other healthcare professionals. According to the article, Reducing Violence Against Nurses: The Violence Prevention Community Meeting, violence is defined as any verbal or physical behavior resulting in, or intended to result in, physical or physiological injury, pain, or harm. In the healthcare field the term that is used when there is violence between coworkers is called horizontal violence. This is a term that is continued to be used but some hospitals have replaced it with the terms bullying or lateral violence. Horizontal violence is violence between nurses and it explains the behavior nurses have toward their coworkers and other healthcare professionals. This type of violence interferes with working together as a team and communicating between coworkers, which are things that are needed to promote and care for others.
Horizontal violence is not a topic that medical faculties discuss on a day-to-day basis, but it is an enormous problem within the health care system. In this research the author looks at bulling from a registered nurse (r.n.) aspect .The effects on patient centered care can be detrimental for patients and r.n.’s. The work place needs to be a safe place for not only the patients but also the employees. With the rise of new graduate nurses who are employed by the medical facilities, they too are starting to face horizontal violence within the first year on the job, which leads to retention of nurses in the medical field. Horizontal violence will continue to arise if nurses do not stand up to bullying and empower victims to speak up on horizontal violence.
The purpose of this paper is to discuss the issue of incivility in nursing and how this affects the work environment, the importance that this has in the microsystem and the nursing profession and how suggestions on how to create healthy work atmosphere through my advanced practice in the family nurse practitioner field.
This leads to decreased patient satisfaction, safety issues, and health care providers seeking a more professional work environment (Lachman, 2014). Despite the negative outcomes from disruptive behavior, it is still present in many health care facilities. One report states that 39% of graduates witnessed bullying in their first year of practice, and 31% said they were the victims of bullying (Lachman, 2014). The author also notes that 85% of nurses experience horizontal/lateral violence. Large numbers of health care professionals witness disruptive behaviors.
McNamara, S. A. (2012). Incivility in nursing: unsafe nurse, unsafe patients. AORN Journal, 95(4), 535-540. doi:10.1016/j.aorn.2012.01.020
Nurses continually strive to bring holistic, efficient, and safe care to their patients. However, if the safety and well-being of the nurses are threatened or compromised, it is difficult for nurses to work effectively and efficiently. Therefore, the position of the American Nurses Association (ANA) advocate that every nursing professional have the right to work in a healthy work environment free of abusive behavior such as bullying, hostility, lateral abuse and violence, sexual harassment, intimidation, abuse of authority and position and reprisal for speaking out against abuses (American Nurses Association, 2012).
This is largely due to nurses leaving their jobs and/or medical incidents involving patients. A nurse working in an environment lacking civility can create stress and anxiety for the nurse. This, in turn, will lead to poor attitudes, decreased productivity, increased absences, and higher job turnover rates (Kerber, 2015). While working in uncivil environments is unhealthy for the healthcare professionals, it has also been shown to greatly affect patient care. A nurse working in a hostile environment can feel stress and overwhelmed, which can lead to an altered emotional state. Blevins (2015) reports in Impact of Incivility in Nursing that nurses working in this type of environment can “experience stress-related disorders and physical illness” which can decrease work attendance. A nurse or healthcare provider providing patient care in this emotional state can turn their negative feelings into uncivil behavior toward the patient or miss something critical to patient care, leading to patient harm or death. For example, if a nurse is upset about being disrespected from a fellow healthcare worker the nurse might turn her emotions on the patent by not asking the right assessment questions, or writing off a critical detail the patient is reporting. Incivility can also reach the patient level when a nurse is afraid to ask questions regarding patient care to the charge nurse as a result of recent bullying. The opposite is also true; If a patient is being discourteous to a nurse who is being civil and helping to the patient, it might make the nurse unconcerned about patient care satisfaction. This can spiral into an incivility cycle that is hard to
“Nurses eat their young.” It is an aged saying in nursing which describes the hazing and lateral violence which frequently occurs in the workplace. The victims of this bullying are usually new graduate nurses or nursing students. New graduates start their careers at the bottom of the proverbial totem pole; spending much of their time trying to learn the ropes and gaining experience as nurses. To the more experienced nurses they may appear to be easy targets with their “deer in the headlights” faces; believing the newbies are too frightened to fight back. Certain nursing schools, which will remain anonymous, use similar boot camp- like mentality while training their student nurses. The students at these schools remain fearful of their nursing instructors at all times. This instinct is required to survive their harsh reality of nursing boot camp. These students remain fidgety throughout their time in nursing school and this same shell-shocked behavior carries over to the early months or even years of their nursing careers.
Throughout my career I have been threatened and even physically abused by patients with limited protection. In addition, I have witnessed physical altercations in the waiting room between patients waiting to be to be seen by Advanced Practice Nurses or a Medical Doctor. It is situations like these that have contributed to burnout and made me question if my safety were important to administration. It is these incidents of abuse that has caused me to consider leaving bedside nursing to work in a clinic setting.
The prevalence of incivility in the health care arena is of growing concern (Peters, 2015). According to Blake (2016), the last two decades have seen a rise in the incidence of incivility in the work place. The presence of incivility in the workplace has been associated with poor self-esteem, increased staff turn-over, and ultimately inferior patient outcomes (McNamara, 2012). Multiple national organizations have called for strategies to be utilized to decrease incivility and promote a healthy work environment (Blake, 2016). The purpose of this paper is to discuss the issue of incivility and its effect on nursing, demonstration of incivility through storytelling, strategies for the creation of a healthy
According to the Bureau of Justice Statistics (BIS), workplace violence affects 1.7 million people each year. The Bureau of Labor Statistics’ Census of Fatal Occupational Injuries (CFOI) reported 11,613 workplace homicide victims between 1992 and 2006. Averaging just under 800 homicides per year, the largest number of homicides in one year occurred in 1994, while the lowest number occurred in 2006 (CDC).
What is the Effect of Horizontal Violence on The Burn Out Rate of Registered Nurses?