Violence in the Nursing Workplace - Essay Example

Violence in the nursing Workplace America's health care sector is shifting rapidly. Today with new technological system patients can get better information about the quality and cost of their care, and there is competition to provide them with the best value. According to the current estimates, US healthcare spends approximately 15% of GDP, which is the highest in the world (WHO, 2006). After launching his Value-Driven Health Care Initiative, Secretary Leavitt announced that more than 100 million Americans will be served by health plans that are committed to providing consumers with transparent quality and cost information. In this movement the federal government; half of the states; about 775 employers, including almost half of the top 200 U.S. corporations; and numerous unions, communities, doctors and hospitals have joined (U.S. Department of Health & Human Services, 2007). In providing the high quality health care the challenges are significant, particularly in the highly decentralized health care system in the United States. The cost and quality of care in the United States are frequently the two major issues of discussion. According to statistics, the United States is below the average for developed countries in health measures such as infant mortality (CDC, 2007), maternal death (Hilts, 1995), and life expectancy (WHO, 2000). On the other hand access to advanced medical treatments and technologies is greater than in most other developed nations. One of the major challenges faced by the health care sector is the shortage of nursing staff. Recent national statistics show the average age of nurses rising while the rate of those entering the profession has slowed over the past few years. The reason for the nursing shortage includes the average age of nurses is 45 years, the image of the profession, work environment issues especially the high stress situations and the faculty shortage. Health care organizations increasingly depend on staff nurses to meet patient and organizational outcomes. In most of the cases, to achieve these outcomes, staff nurses must be willing to assume additional roles while providing exceptional job performance. In other words, it is not the case with other jobs where work is just restricted to the individuals' interest to grow and perform. Besides organizational commitment has been connected to a variety of desired organizational outcomes and work behavior including decreased turn-over, patient satisfaction, and exceptional job performance. Today with the increasing pressure on the nursing staff, it is estimated that first-year retention rates for new graduate nurses is only between 40% and 65%. In terms of numbers as many as 6 out of 10 new nursing grads leave nursing practice within one year of graduation (Rosebrough, 2005). One of the main reasons for them to leave the profession is the workplace violence they experience particularly in the initial years of their practice. Workplace violence is one of the most complex and dangerous occupational hazards facing nurses. It is a common that nurses experiences violence from both patients as well as co-workers. The dangers arise from the exposure to violent individuals together with the absence of strong violence prevention programs and protective regulations. These factors combined with organizational realities such as staff shortages and increased work pressure creates substantial barriers to eliminating violence. Statistics point out that more than 1.6 million people worldwide lose their lives because of violence every year (World Health Organization, 2002) and as many as 72 per cent of nurses do not feel safe from assault at work (International Council of Nurses [ICN], 2004). Health-care professionals are at the highest risk for being attacked at work, when compared to other professions such as prison guards, police officers, bank personnel or transport workers (Kingma, 2001). Workplace violence is a concept with ambiguous boundaries. The U.S. Occupational Safety and Health Administration (OSHA) and the U.S. Centers for Disease Control National Institute for Occupational Safety and Health (CDC/NIOSH) define workplace violence as "violent acts (including physical assaults and threats of assault) directed toward persons at work or on duty" (CDC/NIOSH, 1996). Workplace violence is also defined as those that includes physical and psychological violence, abuse, mobbing or bullying, racial harassment and sexual harassment (Cooper & Swanson, 2002; International Council of Nurses, 2000) and can include interactions between co-workers, supervisors, patients, families, visitors, and others. This kind of violence in the health care and social service sector has faced a significant risk of job-related violence. Physical attacks represent a serious safety and health hazard within these industries. It is important to note that violence does not always involve physical injury; it also includes any intense or extreme behavior used to frighten, intimidate, threaten, or injure a person or harm a person self image. The behavior may be physical, verbal, or nonverbal, such as a gesture. In addition any unwelcome physical contact from another person is battery. In other words, it is not necessary that a person has to be physically "hurt" to be categories as violence in work place. Victims of violence include direct victims i.e. the person to whom the violent act is directed and also those who witness it. Indirect victims are those whose personal relationship with the victim is damaged by the violent event. The National Institute for Occupational Safety and Health reports that 9,000 health care workers are assaulted at work each day. And according to the Bureau of Justice reports up to 429,100 nurses were victims of violent crimes each year from 1993 to 1999. In fact these are the only reported cases, there are a number of cases which goes unnoticed. Researchers of workplace violence believe that more than half of workplace violence incidents are not reported. In many cases a nurse may not even report a violent incident because she's not sure what constitutes violence. She is not aware about what she should report, or she doesn't know whom to inform. Certain environments in a facility are more conducive to violence than others; for instance, working in a high-stress department such as the emergency department or critical care unit, and working with a few co-workers in an isolated setting or a high-stress department (Lillian, 2003). What ever be the case, workplace violence especially in the health care sector needs more attention. According to the Bureau of Labor Statistics (BLS) report there were 69 homicides in the health services from 1996 to 2000. The vast majority of workplace violence consists of non-fatal assaults. BLS data shows that in 2000, 48 percent of all non-fatal injuries from occupational assaults and violent acts occurred in health care and social services. Most of these occurred in hospitals, nursing and personal care facilities, and residential care services (Occupational Safety & Health Administration, 2004). The following are some of the common factors that explain why nurses are at a greater risk of violence in the workplace: Insufficient staffing levels and supervision that may create stress and contribute to violence; Frequent shift work, including commuting to and from work at night; Lack of good security measures in health facilities and unrestricted movement of the public in clinics and hospitals; Interventions demanding close physical contact; Lack of privacy, which violates people's sense of personal space; Home visiting and its associated isolation; and Long waits in emergency departments or clinics, which increase patients' stress (ICN, 2000). Horizontal violence Horizontal violence is defined as "hostile and aggressive behavior by individual or group members towards another member or groups of members of the larger group" (Hastie 2000). It may also be referred as inter-group conflict, and it may be overt or covert (Leap 1997). Horizontal violence is focused mainly to mould, shape and dictate the behavior and practices of those within a workplace. In other words, it mainly functions to socialize new members into the workplace culture (Hastie 2000). The existing group within a workplace perceives anyone new and different as change, which is threatening and may damage their power base (Hastie 1996). If we look into what constitutes horizontal violence, it can be clearly said that those behaviors that include sabotage, scapegoating, backstabbing, lack of openness, undermining, failure to respect privacy, infighting, unwillingness to help out, failure to keep confidences, lack of support, discourtesy, lack of cohesiveness, intimidation, derisiveness, dismissing, and frequent fault-finding all can be categorized under single heading of horizontal violence (Leap 1997; Hastie 2000). In addition, horizontal violence can also take the form of actions or body language. This can include mocking gestures such as rolling eyes, folding arms, raising eyebrows, and turning away (Leap, 1997). Horizontal violence can also be carried out in words. This may take the form of comments that devalue, freezing out of conversations/silent treatment, nicknaming, threatening, put-downs, and dismissing (Hastie 2000). As early as the 70s and 80s it was recognized that in some situations staff themselves were the instigators of aggression and violence against other staff through bullying and harassment which was first investigated systematically amongst nurses and was referred to as horizontal violence (Smythe 1984, Hockley 2002). Horizontal violence is most often seen in hospital environments were conditions are stressful and workers have limited control over their work. This is often the case with nurses and midwives who are dominated by a patriarchal system managed by doctors, administrators, and nurse managers. This patriarchal hierarchy is both a power player in the issue of horizontal violence and one of the key stakeholders. Nurses and midwives have no power in decision-making and have no autonomy within their workplace, and are left feeling oppressed/powerless (Hastie 2000). Unable to direct their dissatisfaction and frustration at the cause, they direct it toward each other (Leap 1997). Victims of horizontal violence often experience a range of physical and psychological symptoms such as sleeplessness, depression etc. Above all horizontal violence can also have an impact on the victim's employment, the way he/she works, and on the team within which the violence is occurring. All of these effects can be progressive if not addressed (Hastie 2000). Nurses subjected to horizontal violence in their workplace can experience symptoms including sleep disorders, elevated blood pressure, low self esteem, eating disorders, nervous conditions, apathy, depression, disconnectedness, impaired personal relationships and even suicide (Griffin 2004). In the nursing profession it is often reported that the younger nurses or students encounter problems from hostile and unsupportive older nurses. The main contributing factor to the problem of horizontal violence is that nurses need to feel better supported within the hospital system, which presently seems to perpetuate the problem. There needs to be more participative management so that nurses have a voice in the organizational decision making. Adequate role preparation for managers and clinical supervisors is seen as integral to reducing horizontal violence and other system sources of aggression. Impact of workplace violence Violence in the workplace especially among the nursing staff can have serious impact on patients, clients, families and also their coworkers. Additionally such incidence can also have a greater impact on the entire organization. Registered nurses may have greater impact in the form of anxiety, fear and apathy. They may take frequent leave and will not be willing to go back to work. Violence can have an impact on the job performances, sleep pattern disturbances that may result in headaches, feeling of guilt and shame. In fact it is not only the nurses who are the victims that suffer, but also the coworkers who are the witnesses to the violence may be affected. For instance, they will have thoughts that similar violence may occur to them or they may also be victimized one day or the other. In many cases the coworkers will have to share the work load of the victim as they may be on long leave, which may cause greater stress. Patients who were receiving care from the nurse who is victimized may also feel the difference or discomfort with new nurses replacing them. This may also result in communication gap between the families and the nurses. Organizations also have a major impact. For instance, the number of patients returning for treatment will reduce gradually as the quality of service decreases. Nurses who have to work overtime will have to be paid extra but the performance will only decrease with more work and stress. Violence can also result in increasing number of nursing staffs quitting the profession or changing the organizations. This will put increasing pressure on the present nursing staff and also on the organizations as they will have to divert their time and resources to appoint new staff and also train them to accustom to the organizational culture (Registered Nurses' Association of Nova Scotia, 1996). Preventing violence It is important to prevent horizontal violence from occurring. Management need to produce a statement outlining appropriate/desired workplace behaviors and attitudes and display this statement prominently around the workplace (ACMI 2002). Managers need to be seen to support and encourage students, new staff and staff generally to foster an attitude of accepting behavior (Hastie 2000). Managers need to encourage nursing staff autonomy and initiative and monitor staff morale. Education plays an important role in reducing horizontal violence in the workplace especially in the hospital environment. For newly registered nurses and midwives understanding how horizontal violence is practiced can allow them to view the behavior in the appropriate context (Griffin 2004). Education programs need to be developed within workplaces on the subject of horizontal violence (ACMI 2002), which should include how to deal with being victimized (Hastie 2000). It is important to prevent the increasing rate of workplace violence. It is the responsibility of the entire staff including the heads of the organization, registered nurses, managers and clients and families to maintain a congenial environment and reduce the workplace violence. Besides it is also important to monitor such violence and bring in stringent laws to prevent and punish such acts of violence. Employers need to implement policies that support a violence free environment. They should also provide support to the victim and create more awareness among the staff, clients, other employees and families. It is the responsibility of the registered and senior nurses to support the junior staff. They need to take leading step to prevent violence in workplace. In conclusion, it is important that US health care sector have to improve especially in developing a violence free health care sector. Organizations, registered nurses, employees, clients and families all together play major role in preventing violence in workplace and each one should be responsible to conduct themselves according to their roles and responsibilities. Nursing is a stressful profession, and on-the-job assaults are not new. Emergency rooms and psychiatric units have always witnessed violence. What is new is that violence now pervades the hospital. Robbery, verbal abuse, physical attack, sexual harassment, rape and even murder occur in hospitals. Workplace frustration from the many causes outlined above, as well as the nature of the work for instance dealing with mentally ill people often in volatile and emotive situations has resulted in major occupational health and safety matters in nursing, including workplace injuries, violence and stress. Workplace violence is recognized as a growing problem for nurses, which is almost certainly affecting the retention of nurses in the workforce. Advance practice nurses are one of the most important ways in which these situations can be handled. It is important to use of stress education and management strategies; balancing priorities; enhancing social and peer support; team-building strategies; flexibility in work hours and planning shifts more appropriately; policies to deal with violence; and retention and attraction of nursing staff strategies. These strategies need to be empirically evaluated for their efficacy in reducing role stress. References Australian College of Midwives Inc. (2002), ACMI Philosophy and Position Statements-Horizontal Violence in Midwifery, Canberra. Centers for Disease Control and Prevention (CDC), (2007) Eliminate Disparities in Infant Mortality, Retrieved on 24 June 2006 from http://www.cdc.gov/omhd/AMH/factsheets/infant.htm Centers for Disease Control and Prevention/NIOSH. (1996). Current intelligence bulletin 57: Violence in the workplace, 2004, Retrieved on 23 June 2006 from the world wide web at: www.cdc.gov/niosh/violence.html Cooper, C. L., & Swanson, N. (2002). Workplace violence in the health sector: State of the art. International Labour Organization. Griffin, M (2004), 'Teaching cognitive rehearsal as a shield for lateral violence: An intervention for newly licensed nurses', The Journal of Continuing Education in Nursing, vol. 35, no. 6, pp. 257-263. Hastie, C (1996), Dying for the Cause, Retrieved June 25, 2007, from http://www.acegraphics.com.au/articles/hasties01.html Hastie, C (2000), Horizontal violence in the workplace, Retrieved June 23, 2007, from http://www.acegraphics.com.au/articles/hasties02.html Hilts, P. J. (1995) In a Ranking of Maternal Health, U.S. Trails Most Developed Nations, Retrieved on 24 June 2006 from http://query.nytimes.com/gst/fullpage.htmlsec=health&res=990CE3DF1338F935A15754C0A963958260 Hockley, C (2002) Silent Hell: workplace violence and bullying Peacock Publications Norwood South Australia. International Council of Nurses. (2004). Violence: A world-wide epidemic [Fact sheet]. Geneva: Author. International Council of Nurses. (2000). Abuse and violence against nursing personnel [Position statement]. Geneva: Author. International Council of Nurses. (2000). Position statement: Abuse and violence against nursing personnel, Retrieved on 24 June 2006 from the world wide web at: www.icn.ch/psviolence00.htm Kingma, M. (2001). Workplace violence in the health sector: A problem of epidemic proportion. International Nursing Review, 48(3), 129-130. Leap, N (1997), 'Making sense of 'horizontal violence' in midwifery', British Journal of Midwifery, vol. 5, no. 11, p. 689. Lillian, D. (2003) Defusing workplace violence, Springhouse Corporation, Retrieved on 23 June 2006 from http://findarticles.com/p/articles/mi_qa3689/is_200308/ai_n9285817 Occupational Safety & Health Administration, (2004) Guidelines for Preventing Workplace Violence for Health Care & Social Service Workers, Retrieved on 25 June 2006 from http://www.osha.gov/Publications/OSHA3148/osha3148.html Registered Nurses' Association of Nova Scotia, (1996) Violence in Workplace: A resource guide, Retrieved June 23, 2007, from http://www.crnns.ca/documents/violence.pdf Rosebrough, C. (2005) Healthcare Management: Challenges and Issues, Retrieved on 25 June 2006 from http://crosebrough.typepad.com/ Smythe, E (1984) Surviving Nursing, Addison Wesley California, and Farrell G. 2000 Danger! Nurses at Work Australian Journal of Advanced Nursing vol 18, no 2, pp. 6-7. U.S. Department of Health & Human Services, (2007) News Release: U.S. Health Care Sector Moves Rapidly To Provide Consumer Information on Value- May 9, 2007, Retrieved on 24 June 2006 from http://www.hhs.gov/news/press/2007pres/05/pr20070509a.html WHO, (2000) Press Release: WHO Issues New Healthy Life Expectancy Rankings: Japan Number One in New 'Healthy Life' System, Retrieved on 23 June 2006 from http://www.who.int/inf-pr-2000/en/pr2000-life.html World Health Organization. (2002). World report on violence and health. Geneva: Author. World Health Organization (WHO), (2006) Working Together for Health, Retrieved on 23 June 2006 from http://www.who.int/whr/2006/whr06_en.pdf Read More