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



Two hundred and thirty emergency nurses returned fully completed surveys of which 14% (n=32) were male and 86% (n=198) were female. Ninety-one percent were non-Hispanic White, while 9% represented Blacks, Asian-Pacific islanders, and Native Americans. Demographics are described in Table 1.

Healthcare Productivity Survey (see Table 2)

Thirty seven percent (n=82) of the participants had a negative total productivity score, demonstrating decreased performance after a violent event; the mean total productivity score for the group was -0.05. All scales except the Safe and Compassionate Care scale had a negative mean score, indicating a decrease in performance. Individual items with the highest frequency of participants reporting decreased performance included: (a) Cognitive Demand items "keep mind on work" (32%), "think clearly" (26%), "concentrate on work" (23%), "control emotional reactions while working with coworkers" (26%); and (b) Support and Communication Demand items "provide emotional support to patients" (25%), "provide emotional support to families" (22%), "be empathetic with patients and families" (25%), "control emotional reactions" (22%) Table 2.

Impact of Event Scale-revised (see Table 3)

Ninety-four percent (n=209) of participants had a total Impact of Event Scale-Revised score that indicated the presence of at least one stress symptom after a violent event; the mean score for the group was 18.67 (range 0–83). Twenty-five percent (n=58) had total scores of 24 or higher, 17% (n=39) had total scores of 33 and over, and 15% (n=34) had scores of 37 or higher Table 3.

The Intrusion Scale had the highest mean at 7.86 (range 0–32). The intrusion scale had the highest means with the following items having the highest percentage of nurses with symptoms: "any reminder brought back feelings about it" (82.5%), "I thought about it when I didn't mean to" (69%), "pictures about it popped into my mind" (67%), and "I had waves of strong feelings about it" (68%). The avoidance scale had the second highest mean with the following items with the highest frequency of those having symptoms: "I avoided letting myself get upset when I thought about it or was reminded of it" (65%) and "I tried not to think about it" (57%). Hyperarousal scale items with the greatest number of participants experiencing the symptom included: "I felt watchful and on guard" (73%), "I felt irritable and angry" (67%), "other things kept making me think about it" (67%), and "I was jumpy and easily startled" (48%). Items on the avoidance scale with the highest frequencies included "I avoided letting myself get upset when I thought about it or was reminded by it" (65%) and "I tried not to think about it" (57%).

Two intrusion scale items had results where almost a quarter of the participants responded they not only experienced the symptom but experienced it often and very often. This included 22% for the item "any reminder brought back feelings about it" and 22% for the item "watchful and onguard" after the violent event.

Correlation between Health Productivity Survey and Impact of Events Scale-revised scores

Table 2 shows the relationships between the group's Healthcare Productivity Scale and Impact of Event Scale-Revised scores. There were significant findings between the Impact of Events Scale-Revised scores (total and three subscales) and the Cognitive Demands and Support Communication Demands. Correlations between the two total scores (Impact of Event Scale-Revised and Healthcare Productivity Survey) was near significance (p=0.07).


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