Workplace violence in Alberta and British Columbia hospitals

Abstract

Workplace violence is a significant and widespread public health concern among health care workers, including nurses. With growing awareness of how practice environments influence patient outcomes and the retention of health professionals, it is timely to consider the impact of workplace violence in hospitals. Registered nurses in Alberta and British Columbia, Canada were surveyed on their experiences of violence in the workplace over the last five shifts. Our results suggest that nurses are experiencing many incidences of violence in a given work week, particularly in the emergency, psychiatric, and medical–surgical settings. Most violent acts are perpetrated by patients, but there is also a significant portion of violence and abuse committed by hospital co-workers, particularly emotional abuse and sexual harassment. Our results also indicate that the majority of workplace violence is not reported. We suggest that using the Broken Windows theory might be a useful tool to conceptualize why workplace violence occurs, and that this framework be used to begin to develop new violence prevention policies and strategies.

Introduction

Media reports of crowded waiting rooms, labour strife, and critical shortages of health professionals continue to draw public attention to the quality of practice environments in the Canadian health care system. Policy-makers are more conscious of the critical link between the quality of practice environments in hospitals and patient outcomes, such as mortality and complication rates. This link has been demonstrated in several research efforts [1]. Researchers have also studied the emotional health of health care organizations [2]. Workplace violence has been linked to decreased job performance and job satisfaction, as well as increased absenteeism and mental health issues among doctors, nurses, and other health care professionals [3], [4], [5]. As awareness of the importance of practice environments to both patient care outcomes and the retention of health care professionals grows, increased attention is needed on factors affecting the physical, emotional, and social well-being of all clinicians in the hospital setting.

Canadian researchers have studied the extent of workplace violence among nurses and physicians, primarily through the use of survey research and the analysis of secondary data, including incidence reports and Worker's Compensation Board (WCB) claims [4], [6], [7], [8]. Drawing comparisons between studies is difficult, however, due to the varied definitions of violence. Some only include assault resulting in injury, while others cite epidemiological measures, such as incidence and prevalence for which the denominators are inconsistently derived [9]. However, three things are clear: (1) nursing and medicine are high-risk occupations compared with other jobs, including law enforcement; (2) most nurses have experienced some form of violence during the course of their career; and (3) nurses and physicians rarely report violent incidences [4], [6], [7], [10], [11], [12]. For the purposes of this paper, we will use the term violence to refer to all types of violent acts (including emotional abuse), but reserve use of the term abuse to refer only to emotional abuse.

Health services restructuring has been identified as a factor that can make hospital workplaces vulnerable to violence [13], [14]. The incidence of health professionals’ experiences of violence is an important marker of the quality of practice environments in hospitals. In this post-restructuring period, there is a need to consider the influence of workplace violence on the quality of patient care and work environment for health professionals. As nurse and physician shortages become more acute in Canada, violence and abuse issues in hospitals require increasing attention because they may influence the ability to attract and retain health service providers [15], [16].

The results reported here are one part of the International Hospital Outcomes Study, in which researchers investigated the connections between hospital restructuring, nursing organization, and nurse and patient outcomes [17], [18]. A survey of registered nurses was completed in five countries, and included three Canadian sites: Alberta, British Columbia, and Ontario. The questions related to violence in the workplace were explored only in Alberta and British Columbia. The purpose of this paper is to: (1) examine the occurrence, sources and reporting of workplace violence among nurses in different clinical hospital settings, (2) to examine and address some corollary issues, including the link between violence and job satisfaction, and (3) to make suggestions for new ways of conceptualizing violence prevention.