A Reflection on: Byon et al. (2021) “Nurses’ Experience With Type II Workplace Violence and Underreporting During the COVID-19 Pandemic”

Dear Editor,

I read with great interest the recent paper “Nurses’ Experience with Type II Workplace Violence and Underreporting During the COVID-19 Pandemic” (Byon et al., 2021). This paper reports a cross-sectional study on prevalence of Type II workplace violence among nurses during the pandemic and their reporting of these events. The results revealed that a significant proportion of nurses suffered physical violence and verbal abuse and had greater difficulty reporting the abuse to managers. I applaud the efforts of the authors and believe this paper will be a valuable reference for nurses seeking expert guidance in this emerging field.

According to the World Health Organization (2021), levels of violence and aggression against health care workers were already significant prior to the pandemic, with 8% to 38% of health care professionals suffering physical violence at some point in their careers. The rapid spread of COVID-19 triggered a wave of violence in many countries against health care workers who have reported incidents of violence, discrimination, ostracism, harassment, and stigmatization as carriers of infection (Antão et al., 2020; Bitencourt et al., 2021; International Labour Organization [ILO], 2020; Larkin, 2021; Vento et al., 2020). Several precipitating factors implied that frontline workers (especially nurses providing long-term care; Organisation for Economic Co-Operation and Development, 2020) were among the professionals most negatively affected by the pandemic, including intensive and long work schedules, increased workload, adaptation to new working protocols, risk of infection and transmission to their relatives, disruption of family and personal life, mental stress and trauma, permanent health deterioration, and death (ILO, 2020; Özkan Şat et al., 2021). Moreover, other inciting reasons of occupational violence include refusal by health care authorities “to admit COVID-19 patients due to limited space, the death of relatives in the hospital, and refusal to hand over deceased patient bodies without the results of a COVID-19 test” (Bhatti et al., 2021, p. 2). At this point, the fear of contagion and the coronavirus misinformation lead the public to see health care workers as a representation of the disease which may explain the intensification of violence (Muñoz Del Carpio-Toia et al., 2021).

The evidence reinforces that underreporting workplace violence is a worldwide phenomenon on health care professionals (Byon et al., 2021; Song et al., 2021). Significantly, many incidents are unreported because nurses recognize violence as “part of the job” (Hogarth et al., 2016; Song et al., 2021). Another rationale was that nurses believe that reporting would not lead to any positive change, such as preventive measures, due to lack of a reporting policy, lack of faith in the reporting system, fear of blame and retaliation, and job insecurity (Hogarth et al., 2016; Song et al., 2021). Professionals with high levels of psychological distress “are more prone to errors and poorer interpersonal communication with patients and their families, which put them at higher risk for violence” (Yang et al., 2021, p. 6).

Workplace violence negatively affects the psychological health and well-being of nurses, other health care workers, patients, and their families (Al-Qadi, 2021; European Agency for Safety and Health at Work, 2013; Havaei, 2021). This can be destructive and has a profoundly negative impact on those directly involved in the incident, as well as observers, who may experience physical and psychological effects ranging from mild to severe. The effects of workplace violence can extend beyond the workplace, affecting the family and social life of victims and contributing to the deterioration of one’s work–life balance, with adverse impact on mental health of workers (ILO, 2020). A universal and pervasive phenomenon, violence poisons the workplace and the lives of victims.

Future work should explore comprehensive models of workplace violence, examine how risk factors vary across facilities, and address the effectiveness of violence intervention programs. In-service education programs should be a priority to combat workplace violence. Such programs should include the development of communication skills and how to understand and respond appropriately to clients’ needs, training on how to deal with aggression and defuse hostile situations, and stress management and self-care strategies. Nurse training institutions should also teach strategies to deal with workplace assaults, as incoming nurses may be exposed to this behavior (ILO, 2020; Sisawo et al., 2017).

Finally, workplace safety and health management systems should include measures to protect the mental health of workers and to guarantee that all events of violence are reported and then evaluated, providing reliable evidence.