Violence Against Nurses and its Impact on Stress and Productivity

Donna M. Gates, EdD, RN, FAAN; Gordon L. Gillespie, PhD, RN, FAEN; Paul Succop, PhD


Nurs Econ. 2011;29(2):59-67. 

In This Article



Prior to beginning the study, university institutional board review approval was obtained. A cross-sectional design was used to gather data from ED nurses who are members of the Emergency Nurses Association in the United States. A survey was sent to a randomized sample of 3,000 nurses of which 264 surveys were returned and completed for a return rate of 8.8%. The survey consisted of four sections. The first section asked the participants to describe in narrative a single recent workplace violent event that caused them the most stress.

The second section of the survey consisted of the Impact of Events Scale-Revised (Weiss & Marmar, 1997), which assesses the presence and magnitude of posttraumatic stress symptoms during the 7 days after a traumatic event. The participants responded to 22 Likert-type items which asked about their symptomatic responses to the violent event in three areas (subscales): intrusion (e.g., intrusive thoughts, nightmares, imagery, re-experiencing), avoidance (e.g., numbing, avoidance of feelings), and hyperarousal (e.g., anger, irritability, difficulty concentrating). Participants are asked to identify how distressing each item had been for them during the 7 days after the violent event ranging from not at all (0) to extremely (4). The Impact of Events Scale-Revised has been used extensively as a quick measure of a person's response to trauma and has been shown to have high internal consistency ratings (0.79–0.91) and strong sensitivity (74.5) and specificity (63.1). Scores 24 or more indicate that PTSD is a clinical concern, scores 33 and more represent the cutoff for probable diagnosis of PTSD, and scores 37 or more are high enough to suppress the immune system (Kawamura, Kim, & Asukai, 2001).

The third section consisted of the Healthcare Productivity Survey, a 29-item instrument with four scales developed to measure the perceived change in work productivity after exposure to a stressful event. The four scales include Cognitive Demands (e.g., concentration, keep mind on work), Workload Demands (e.g., complete your assignments on time, handle patient load), Sup - port and Communication Demands (e.g., provide emotional support, be empathetic), and Competent and Safe Care Demands (e.g., be attentive to asepsis, administer medications without errors). Participants were asked to rate their ability to perform the work activity after the violent event as compared to before the event. Responses ranged from decreased ability (-2) to increased ability (+2). The development and testing of the Healthcare Productivity Survey is described in detail in Gillespie, Gates, and Succop (2010). Psychometric analysis demonstrated strong content and construct validity for the four subscales, internal consistency reliability (0.871 - 0.945), and testretest reliability (r = 0.801, p < 0.001) with a sample of U.S. emergency nurses (Gillespie et al., 2010). Participants were asked in the fourth section, the demographic/occupational survey, to respond to questions regarding their age, gender, race, education, care population, the urbanicity of their ED, and whether their employer provides violence prevention training or critical incident stress debriefing.

Participants with missing data for the Impact of Events Scale- Revised or Healthcare Productivity Survey were excluded from analysis. Descriptive and bivariate statistics were calculated using version 17 of the Statistical Package for the Social Sciences (SPSS, Chicago, IL).


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