Violence: Not in My Job Description

Laura A. Stokowski, RN, MS

Disclosures

August 23, 2010

In This Article

Scope of Violence Against Nurses

Reliable, objective data about violence against nurses are almost nonexistent. We are forced to cobble together a variety of data sources to gauge the degree and frequency of violence experienced by nurses. Between 1993 and 1999 (the last years for which data are available), an average of 1.7 million incidents of workplace victimization occurred each year in the United States,[14] according to the National Crime Victimization Survey. These episodes of nonfatal violence include simple assault, aggravated assault (use of a deadly weapon or with intent to rape, maim, or murder), sexual assault, rape, and robbery, although 94% of cases are simple and aggravated assault. Annually, 430,000 nurses were victims of these crimes.[14]

A report from the OSHA indicated that 48% of all nonfatal injuries from occupational assaults and violent acts occurred in healthcare and social service settings.[1]Nurses are the most likely of all healthcare workers to be assaulted. Gerberich and colleagues describe rates of violence of 13.2 physical and 38.8 nonphysical incidents per 100 persons per year.[15] In a study conducted in Alberta and British Columbia, Canada, comprising 8780 staff nurses from 210 hospitals, investigators found that 46% of nurses experienced one or more types of violence (emotional abuse, threat of assault, physical assault, verbal sexual harassment, sexual assault) in the past 5 shifts worked.[16]

Typically, the highest rates of violence are reported by ED nurses. In a recent survey of 3465 members of the Emergency Nurses Association, more than 50% of respondents reported that they had experienced physical violence (being spit on, hit, pushed or shoved, scratched, or kicked), and 70% had experienced verbal abuse (being yelled or cursed at, intimidated, or harassed with sexual language or innuendo) in the past year.[6]Another survey of ED nurses found even higher rates of assault – 82% had been physically assaulted in the ED during a single year, and 100% had been verbally assaulted.[17]

Recently, the Joint Commission reported that its Sentinel Event Database, which includes a category that combines assault, rape, and homicide, has received 256 reports of this nature since 1995, a number that is probably lower than the actual number of incidents, because violent crimes in healthcare facilities are known to be underreported. Even without accurate statistics, the category "assault, rape, and homicide" is consistently among the top 10 types of sentinel events, and the Joint Commission has seen steady increases in reports of these violent crimes in healthcare facilities, with the greatest number of reports in the past 3 years: 36 incidents in 2007, 41 in 2008, and 33 in 2009.[3]

Other than government statistics on violence, the most common research method used to ascertain the extent of workplace violence experienced by nurses has been voluntary surveys. A major limitation of these instruments is recall bias. What nurses remember and report on a survey, many months or years later, might not accurately reflect what happened.

When these attacks capture the attention of the newspapers, however, the details are there in black and white. Although assaults of this scale are rare, shootings and stabbings with intent to kill or maim do happen to nurses in the line of duty. In March 2010, a nurse in Connecticut was shot 3 times by an elderly patient.[18] In February 2010, an intensive care unit nurse was stabbed by a patient who wanted medication.[19] Both of these nurses survived the attacks, but not all are so lucky. In January 2010, a home healthcare nurse was shot and killed on a home visit to a patient in Detroit.[20]

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