UBC Reports | Vol. 50 | No. 3 | Mar. 4, 2004

Study Shows Nurses are Regular Targets of Violence

But 70 per cent of incidents go unreported

By Hilary Thomson

When she went on shift that day in May 1992, Dorothy Leslie thought it would just be another day at work. It turned out to be her last.

An emergency room nurse with 12 years' experience, Leslie was the victim of a violent assault -- kicked hard in the back by a patient high on drugs -- that severely aggravated a recent back injury and resulted in chronic disability.

"I still can't believe I'm not able to work -- it all happened in the blink of an eye," she says. She charged the man with assault and he was sentenced to two years plus probation.

This is the kind of situation UBC Nursing Assoc. Prof. Angela Henderson has explored in one of only a handful of qualitative studies ever done on nurses' experience of workplace violence. She interviewed about 50 nurses working in four different clinical departments in hospitals and clinics in western Canada and the U.K.

She found that nurses routinely encounter verbal abuse and physical violence in the workplace.

"Nursing is a physically dangerous job -- that's nothing new," says Henderson, whose research focus is women and violence. "Nurses expect a certain amount of abuse from dealing with patients and families who are stressed. However, they were profoundly affected by the level of 'unnecessary' abuse directed at them."

Henderson says these experiences not only have implications for nurses' ability to be effective in their work but may also make it difficult to attract and retain nurses, a key issue in the face of international nursing shortages.

Linda Silas, president of the Canadian Federation of Nurses Unions, agrees.

"This is a growing problem because violence at work is not being addressed, despite zero tolerance policies," she says, noting that few incidents result in charges being laid with police. "It's hard to focus on this issue when the nursing shortage issue is so acute. But when workplaces are understaffed it just adds to the pressure for both nurses and patients and aggressiveness builds."

Henderson's findings, recently published in the Canadian Journal of Nursing Leadership, were that nearly all the nurses interviewed had been personally threatened at work and several had been assaulted and disabled from work because of injuries.

One emergency room (ER) nurse was admitted on a stretcher to her own ER following an attack by a man angry at being kept waiting to have his sore throat examined. In addition to physical assaults, violent acts reported in the study included emotional abuse, sexual harassment and sexual assault.

Vickie Fowler, (not interviewed in the study) is an emergency room nurse with 25 years' experience. She was bitten by a violent patient who was being restrained by six people. The patient had hepatitis C and Fowler spent a year having blood tests to find out if she had contracted the disease.

"I was furious -- I was trying to save her life," says Fowler, who says she was pretty disappointed in the support she received from management. She charged the individual with assault and the woman was sentenced to six months' house arrest. "We have to stand up for our own rights. I tell my co-workers that. It's just not right to put up with the abuse."

Inadequate response by administrators was a common theme in the nurses' accounts. Supervisors often were unsupportive and some nurses who had been assaulted or threatened were discouraged from reporting the violation to supervisors, administrators or the police. An ER nurse who had been attacked was told to delay her police interview and go back to work.

In addition, some nurses' stories described a double standard where violence against nurses was accepted but violence against doctors was not.

"Interestingly, it's the situations where nurses felt they were held in contempt that bothered them the most -- not the lethal or dangerous ones," says Henderson. "When administrators tolerate verbal or physical violence against nurses, they send a message to the public and to nurses that they are not valued."

Despite descriptions of high levels of abuse, most nurses feel that no one other than nurses takes the threats seriously, says Henderson. As many as 70 per cent of incidents are unreported according to a 2001 study of nurses' experience of violence in Alberta and B.C. hospitals, reported in the Canadian Journal of Nursing Research. That study also reported that nearly half of the almost 9,000 nurses surveyed had experienced one or more types of violence in the last five shifts worked.

Henderson would like to see more reporting to bring the issue out into the open and allow for interventions. Most important, she says, is that health-care workplaces must exemplify safety.

"If nurses are to support others, they must feel supported and safe themselves. In particular, if we want nurses to work with female victims of violence, we need to demonstrate that nurses' safety is important and that they will be protected when they intervene in difficult situations."

To read the study, visit http://www.nursingleadership.net/NL164/NL164Henderson.html.