UBC Reports | Vol. 50 | No. 3 | Mar.
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
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
"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
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.