Physical violence against nurses is a concern in the United States; however, its prevalence is not well quantified.
Objective:
We sought to describe the prevalence of workplace violence against nurses in the United States over a 22-year period.
Methods:
A meta-analysis was performed following a literature search of English texts through Scopus, CINAHL Plus, and Ovid MEDLINE. Inclusion criteria included the following: (1) primary reports of workplace violence incidents in the United States against nurses, (2) perpetrator was a patient, family member, or visitor, and (3) publications between January 1, 2000, and June 21, 2022. Reports where prevalence rates for nurses could not be calculated were excluded. Study quality was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology checklist.
Results:
Thirty-seven studies met the inclusion criteria; 27 030 nurses were included. The pooled prevalence of workplace violence was 0.35 (95% confidence interval [CI]: 0.29-0.42; Q = 3189.40; I2 = 98.87). Pooled rates of workplace violence increased from 30% in 2000 to 2004 to 43% in 2020 to 2022; however, the overlapping CIs indicate that the increase may not be statistically significant. The mean prevalence of reported workplace violence among nurses who work in the emergency department, in corrections, and psychiatric mental health settings (pooled prevalence = 0.59, 95% CI: 0.46-0.71) was higher than that of nurses who worked in all other settings (pooled prevalence = 0.24, 95% CI: 0.18-0.30).
Conclusions:
Workplace violence is a significant and potentially increasing problem for nurses in the United States. This critical problem requires an effective response from nurse policymakers.
ArnetzJE.The Joint Commission’s new and revised workplace violence prevention standards for hospitals: a major step forward toward improved quality and safety. Jt Comm J Qual Patient Saf. 2022;48(4):241-245. doi:10.1016/j.jcjq.2022.02.001
2.
ArnetzJEHamblinLEssenmacherLUpfalMJAgerJLuborskyM.Understanding patient-to-worker violence in hospitals: a qualitative analysis of documented incident reports. J Adv Nurs. 2015;71(2):338-348. doi:10.1111/jan.12494
BrannMHartleyD.Nursing student evaluation of NIOSH workplace violence prevention for nurses online course. J Safety Res. 2017;60:85-91. doi:10.1016/j.jsr.2016.12.003
5.
GroenewoldMRSarmientoRFRVanoliKRaudabaughWNowlinSGomaaA.Workplace violence injury in 106 US hospitals participating in the Occupational Health Safety Network (OHSN), 2012-2015. Am J Ind Med. 2018;61(2):157-166. doi:10.1002/ajim.22798
6.
PompeiiLASchoenfischALLipscombHJDementJMSmithCDUpadhyayaM.Physical assault, physical threat, and verbal abuse perpetrated against hospital workers by patients or visitors in six U.S. hospitals. Am J Ind Med. 2015;58(11):1194-1204. doi:10.1002/ajim.22489
RosenthalLJByerlyATaylorADMartinovichZ.Impact and prevalence of physical and verbal violence toward healthcare workers. Psychosomatics. 2018;59(6):584-590. doi:10.1016/j.psym.2018.04.007
9.
ArnetzJHamblinLESudanSArnetzB.Organizational determinants of workplace violence against hospital workers. J Occup Environ Med. 2018;60(8):693-699. doi:10.1097/jom.0000000000001345
10.
DuncanJBrownNJLockC, et al. Increasing the rate of documentation of security interventions in the emergency department: Big Orange Security Sticker (BOSS) Project. J Nurs Care Qual. 2020;35(3):276-281. doi:10.1097/ncq.0000000000000433
11.
KafleSPaudelSThapaliyaAAcharyaR.Workplace violence against nurses: a narrative review. J Clin Transl Res. 2022;8(5):421-424.
12.
ByonHDLiuXCrandallMLipscombJ.Understanding reporting of type II workplace violence among home health care nurses. Workplace Health Saf. 2020;68(9):415-421. doi:10.1177/2165079920910758
13.
McPhaulKMLondonMLipscombJA.A framework for translating workplace violence intervention research into evidence-based programs. Online J Issues Nurs. 2013;18(1):4.
14.
PerkinsMWoodLSolerT, et al. Inpatient nurses’ perception of workplace violence based on specialty. J Nurs Adm. 2020;50(10):515-520. doi:10.1097/nna.0000000000000927
CopelandDHenryM.Workplace violence and perceptions of safety among emergency department staff members: experiences, expectations, tolerance, reporting, and recommendations. J Trauma Nurs. 2017;24(2):65-77. doi:10.1097/jtn.0000000000000269
18.
HollywoodLPhillipsKE.Nurses’ resilience levels and the effects of workplace violence on patient care. Appl Nurs Res. 2020;54:151321. doi:10.1016/j.apnr.2020.151321
19.
BlandoJDO’HaganECasteelCNoceraMAPeek-AsaC.Impact of hospital security programs and workplace aggression on nurse perceptions of safety. J Nurs Manag. 2013;21(3):491-498. doi:10.1111/j.1365-2834.2012.01416.x
20.
Al-QadiMM.Workplace violence in nursing: a concept analysis. J Occup Health. 2021;63(1):e12226. doi:10.1002/1348-9585.12226
21.
DaveyKRavishankarVMehtaN, et al. A qualitative study of workplace violence among healthcare providers in emergency departments in India. Int J Emerg Med. 2020;13(1):33. doi:10.1186/s12245-020-00290-0
22.
PageMJMcKenzieJEBossuytPM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. doi:10.1136/bmj.n71
23.
BorensteinMHedgesLVHigginsJPTRothsteinHR.Introduction to Meta-Analysis. John Wiley; 2009.
24.
BorensteinM.In a meta-analysis, the I-squared statistic does not tell us how much the effect size varies. J Clin Epidemiol. 2022;152:281-284. doi:10.1016/j.jclinepi.2022.10.003
25.
von ElmEAltmanDGEggerMPocockSJGøtzschePCVandenbrouckeJP.The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Int J Surg. 2014;12(12):1495-1499. doi:10.1016/j.ijsu.2014.07.013
26.
MonnaatsieMBiddleSJHKhanSKolbe-AlexanderT.Physical activity and sedentary behaviour in shift and non-shift workers: a systematic review and meta-analysis. Prev Med Rep. 2021;24:101597. doi:10.1016/j.pmedr.2021.101597
27.
AndersonC.Workplace violence: are some nurses more vulnerable?Issues Ment Health Nurs. 2002;23(4):351-366. doi:10.1080/01612840290052569
28.
BlountSAskinsPWellsNSandlinV. Preventing violence in the healthcare setting. In: Needham I, McKenna K, Kingma M, Oud N, eds. Proceeding of the Third International Conference on Violence in the Health Sector: Linking Local Initiatives with Global Learning. KAVANAH; 2012:445-446.
29.
BoivinJM.2018 nursing trends and salary survey results. Am Nurse Today. 2018;13(11):14-19.
30.
BurchillCNBenaJPolomanoRC.Psychometric testing of the personal workplace safety instrument for emergency nurses. Worldviews Evid Based Nurs. 2018;15(2):97-103. doi:10.1111/wvn.12265
31.
ByonHDSagherianKKimYLipscombJCrandallMSteegeL.Nurses’ experience with type II workplace violence and underreporting during the COVID-19 pandemic. Workplace Health Saf. 2022;70(9):412-420. doi:10.1177/21650799211031233
32.
CahillD.The effect of ACT-SMART on nurses’ perceived level of confidence toward managing the aggressive and violent patient. Adv Emerg Nurs J. 2008;30(3):252-268.
33.
CarpenterHDawsonJM.Keeping nurses healthy, safe, and well. Am Nurse Today. 2015;10(9):24-26.
34.
DeanLButlerACuddiganJ.The impact of workplace violence toward psychiatric mental health nurses: identifying the facilitators and barriers to supportive resources. J Am Psychiatr Nurses Assoc. 2021;27(3):189-202. doi:10.1177/10783903211010945
35.
DerscheidDJArnetzJE.Patient and family member violent situations in a pediatric hospital: a descriptive study. J Pediatr Nurs. 2020;55:241-249. doi:10.1016/j.pedn.2020.07.014
36.
EarlyMR.Recognizing and managing violence in the NICU. Neonatal Netw. 2004;23(1):31-34. doi:10.1891/0730-0832.23.1.31
37.
EarlyMRWilliamsRA.Emergency nurses’ experience with violence: does it affect nursing care of battered women?J Emerg Nurs. 2002;28(3):199-204. doi:10.1067/men.2002.124991
38.
El GhaziriMDuganAGZhangYGoreRCastroME.Sex and gender role differences in occupational exposures and work outcomes among registered nurses in correctional settings. Ann Work Expo Health. 2019;63(5):568-582. doi:10.1093/annweh/wxz018
FindorffMJMcGovernPMWallMGerberichSGAlexanderB.Risk factors for work related violence in a health care organization. Inj Prev. 2004;10(5):296-302. doi:10.1136/ip.2003.004747
41.
GatesDMRossCSMcQueenL.Violence against emergency department workers. J Emerg Med. 2006;31(3):331-337. doi:10.1016/j.jemermed.2005.12.028
42.
GerberichSGChurchTRMcGovernPM, et al. An epidemiological study of the magnitude and consequences of work related violence: the Minnesota Nurses’ study. Occup Environ Med. 2004;61(6):495-503. doi:10.1136/oem.2003.007294
43.
GershonRRPearsonJMShermanMFSamarSMCantonANStonePW.The prevalence and risk factors for percutaneous injuries in registered nurses in the home health care sector. Am J Infect Control. 2009;37(7):525-533. doi:10.1016/j.ajic.2008.10.022
44.
GillespieGLBreslerSGatesDMSuccopP.Posttraumatic stress symptomatology among emergency department workers following workplace aggression. Workplace Health Saf. 2013;61(6):247-254. doi:10.1177/216507991306100603
45.
GramlingJJMcGovernPMChurchTRNachreinerNMGauglerJE.Effectiveness of conducted electrical weapons to prevent violence-related injuries in the hospital. J Emerg Nurs. 2018;44(3):249-257. doi:10.1016/j.jen.2017.06.008
46.
KimSMayerCJonesCB.Relationships between nurses’ experiences of workplace violence, emotional exhaustion and patient safety. J Res Nurs. 2021;26(1-2):35-46. doi:10.1177/1744987120960200
47.
KowalenkoTGatesDGillespieGLSuccopPMentzelTK.Prospective study of violence against ED workers. Am J Emerg Med. 2013;31(1):197-205. doi:10.1016/j.ajem.2012.07.010
48.
MayDDGrubbsLM.The extent, nature, and precipitating factors of nurse assault among three groups of registered nurses in a regional medical center. J Emerg Nurs. 2002;28(1):11-17. doi:10.1067/men.2002.121835
49.
McPhaulKLipscombJJohnsonJ.Assessing risk for violence on home health visits. Home Healthc Nurse. 2010;28(5):278-289. doi:10.1097/NHH.0b013e3181dbc07b
50.
PriviteraMWeismanRCerulliCTuXGromanA.Violence toward mental health staff and safety in the work environment. Occup Med. 2005;55(6):480-486. doi:10.1093/occmed/kqi110
51.
RidenourMLanzaMHendricksS, et al. Incidence and risk factors of workplace violence on psychiatric staff. Work. 2015;51(1):19-28. doi:10.3233/wor-141894
52.
RidenourMLHendricksSHartleyDBlandoJD.Workplace violence and training required by new legislation among NJ nurses. J Occup Environ Med. 2017;59(4):e35-e40. doi:10.1097/jom.0000000000000973
53.
SmallCRPorterfieldSGordonG.Disruptive behavior within the workplace. Appl Nurs Res. 2015;28(2):67-71. doi:10.1016/j.apnr.2014.12.002
54.
SpaderC.2020 nursing trends and salary survey results. Am Nurse Today. 2020;15(11):17-22.
55.
SpectorPECoulterMLStockwellHGMatzMW.Perceived violence climate: a new construct and its relationship to workplace physical violence and verbal aggression, and their potential consequences. Work Stress. 2007;21(2):117-130.
56.
SpectorPEYangL-QZhouZE.A longitudinal investigation of the role of violence prevention climate in exposure to workplace physical violence and verbal abuse. Work Stress. 2015;29(4):325-340.
57.
SperoniKGFitchTDawsonEDuganLAthertonM.Incidence and cost of nurse workplace violence perpetrated by hospital patients or patient visitors. J Emerg Nurs. 2014;40(3):218-228; quiz 295. doi:10.1016/j.jen.2013.05.014
58.
WileyKK.2007 Nebraska nurses survey results. Making a world of difference: workplace violence and nursing. Nebr Nurse. 2008;40(4):14-19.
59.
Wright-BrownSSekulaKGillespieGZouchaR.The Experiences of registered nurses who are injured by interpersonal violence while on duty in an emergency department. J Forensic Nurs. 2016;12(4):189-197. doi:10.1097/jfn.0000000000000130
60.
SomaniRMuntanerCHillanEVelonisAJSmithP.A systematic review: effectiveness of interventions to de-escalate workplace violence against nurses in healthcare settings. Saf Health Work. 2021;12(3):289-295. doi:10.1016/j.shaw.2021.04.004
LimMCJeffreeMSSaupinSSGiloiNLukmanKA.Workplace violence in healthcare settings: the risk factors, implications and collaborative preventive measures. Ann Med Surg. 2022;78:103727. doi:10.1016/j.amsu.2022.103727
63.
D’EttorreGPellicaniVMazzottaMVulloA.Preventing and managing workplace violence against healthcare workers in Emergency Departments. Acta Biomed. 2018;89(suppl 4):28-36. doi:10.23750/abm.v89i4-S.7113
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