Step Away From That Nurse! Violence in Healthcare Continues Unabated

Laura A. Stokowski, RN, MS


November 19, 2014

In This Article

Healthcare Settings: High-Risk Workplaces

Like the nurse who has gotten used to patients striking out at her, nurses are often heard to say that violent acts by patients and visitors are "just part of the job." Has violence become so prevalent in healthcare that it must now be accepted as "going with the territory?"

"We tell nurses that violence isn't part of your job," says Hartley, "but violence prevention should be. The risk factors for violence are more common in healthcare settings."

NIOSH divides the risk factors for violence into three categories: clinical, environmental, and organizational.[32] Clinical risk factors are those that relate to the patient, family member, visitor, or other individual, and include such characteristics as being under the influence of drugs or alcohol, having a history of violence, or being in the criminal justice system. Sometimes, a reaction to a healthcare provider who is perceived as being authoritarian or who used excessive force in the course of care can prompt anger. Some medical and psychiatric diagnoses are risk factors for violence, although most people with mental illness are not violent.

Environmental risk factors for violence are features of the layout, design, or amenities of the setting that might provoke frustration or anger, such as confusing signage, a lack of parking, or prolonged waiting. The environment can also elevate risk by providing such opportunities for undetected violence as unmonitored stairwells, insufficient lighting, or furniture and other items that could thrown or used as weapons. A lack of security systems, alarms, or "panic buttons" to call for help can restrict a staff member's ability to respond appropriately to a sudden threat.

Organizational risk factors include inadequate attention to the risk for violence in the workplace, a lack of staff training to prevent and manage violence, inadequate security and preparedness, and inadequate staffing.


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