Almost a third of the nurses who took part in a large-scale study reported that they had been subjected to both physical and verbal abuse in the last 4 working weeks and a quarter had considered resigning as a result, according to research in the latest issue of the UK-based Journal of Advanced Nursing.
Two-thirds of the 2,407 nurses who took part in the survey, led by the University of Tasmania and supported by the Australian Nursing Federation, reported some form of abuse during the period covered.
This ranged from being sworn at, slapped and spat upon to being bitten, choked and stabbed. The abused nurses, who all worked in Tasmania, reported an average of four verbal incidents and between two to three physical incidents.
Sixty-nine percent of nurses who had been physically abused had been struck with a hand, fist or elbow and 34 percent had been bitten.
A further 49 percent said they had been pushed or shoved, 48 percent had been scratched and 38 percent said that someone had spat at them.
"We also discovered that that six percent had been choked and just under one percent had been stabbed" adds lead author Professor Gerald A Farrell, now based at La Trobe University School of Nursing and Midwifery in Victoria, Australia.
Verbal abuse was most likely to take the form of rudeness, shouting, sarcasm and swearing. Two percent said that their home or family had also been threatened. Patients and visitors were the most likely people to abuse nurses, but four percent of nurses who reported physical abuse said that it was carried out by another nurse and three percent by a doctor.
When it came to verbal abuse, that percentage rose considerably, with 29 percent reporting abuse from a nurse colleague and 27 percent from a doctor.
The results were collated from questionnaires sent to the 6,326 nurses registered with the Nursing Board of Tasmania in late 2002. Thirty-eight percent completed the survey, which was also supported by Tasmania's Hobart Clinic, but when this was adjusted for the number of registered nurses actually working during this period, the figure was nearer 55 percent.
"The present findings point to a work environment that is both distressing and dangerous for staff" says Professor Farrell.
"Eleven percent of nurses told us that they had left a post because of aggression and two percent had left nursing completely.
"Two-thirds of those who experienced aggression said that it affected their productively or led to errors in their work. Ten percent said it was the most distressing aspect of their work, after the 51 percent who cited workload as the biggest problem.
"Another key finding of this research was that although verbal and physical spreads across every branch of healthcare – from paediatrics to psychiatry and community services to critical care – few staff made their complaints official."
Workplace aggression is a world-wide problem and further research is needed to discover why levels are so high in modern healthcare settings, adds Professor Farrell, who was based at the University of Tasmania at the time of his research.
He and the other researchers believe that the restricted time frame of the study – four working weeks – and the fact that aggression was carefully defined, with clear distinctions between verbal and physical abuse, may have captured a greater range of incidents than previous studies.
"Our research shows that many nurses are working in environments in which they cannot provide the care that they think is best for patients. At the same time they have to contend with high levels of verbal and physical abuse" he says.
"It's not surprising that some nurses have left the profession altogether and many more are thinking about it.
"We live in an era when employers are constantly being told that they have a duty of care for employees. It's a sad reality that nurses who spend their lives caring for others and providing such a valuable service continue to feel so vulnerable in the workplace."
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Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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