Violence Among Emergency Nurses

Literature that investigates the rates of lateral violence has confirmed that LV has been and currently still is prevalent in the nursing profession. A survey taken during the Upstate AHEC Lateral Violence Among Nurses Project by Jacobs and Kyzer (2010) revealed that 93 percent of nurses have witnessed lateral violence among coworkers, while 85 percent have been a victim of lateral violence. As can be seen by these percentages, lateral violence in nursing is very real and affects many of those who are identified as a nurse. Although these statistics are informative, it is critical to remember that they do not capture all incidents of LV in the nursing profession. Since these statistics come from reported incidents of lateral violence in nursing, there may be additional incidents that were not reported. Therefore, the rates of

23). These actions are all negative, and it is obvious how horizontal violence can have damaging effects on its victims. In addition, with such a wide variety of acts that classify as horizontal violence, it is understandable why it is such an inescapable issue in the nursing profession.

money in recruitment and education. Moreover, bullying also affects continuity of care with patients and may result in sentinel events as well as legal action against the clinician, and facility

Workplace violence commonly occurs between nurses, between nurses and patient, between nurses and families, or even between nurses and physician. Violence from relatives and friends of patients may occur as a result of frustration with a perceived lack of care or communication (Roche et.al. 2010). According to Woefle and McCaffrey there two consequences of violence (physical and psychological) for nurses and organization. Physical by the mean nurses can possibly experience weight loss, cardiac palpitation, stress, hypertension and irritable bowel syndrome. Psychological by the means of being mentally drain of nurses that can cause danger in giving a quality care.

In reality, there are limited places that violence cannot happen, however, we are often surprised by some of the places violence does take place. One of the places many don’t expect violence to take place is in the hospital. Hospitals are designed to promote safety and provide medical care and nursing treatment for sick or injured people. Unfortunately, on January 12, 2016 a hospital security guard and a police officer endured near-fatal shootings by a drug-affected patient in Nepal. Rachel Olding, the author of an article written February 4, 2016 points out some concerns, thoughts, and ideas for improvement taken from hospital workers who have seen and experienced hospital violence firsthand. Hospitals need to be a place of safety for their patients, staff, and visitors.

Typically, when someone thinks of a bully, childhood memories of scuffles on the playground come to mind. Bullies are not usually people that are associated with adult life. However, nursing has changed this stereotypical view. For many nurses, bullying may be as great a threat every day at work as it was when they were in grade school. This threat is because of what is termed as horizontal or lateral violence in the workplace, and it is a surprisingly, prominent issue in the field of nursing. Furthermore, horizontal violence is a detrimental problem in nursing due to its damaging and negative effects on nurses and the nursing profession as a whole.

Civility in the work place, or the lack thereof, has been identified as a growing problem within many professions in today’s society. Often referred to as lateral violence, this occurrence is no exception in the nursing profession. It is also known as ‘horizontal violence’ or ‘workplace bullying (Coursey, Rodriguez, Dieckmann, & Austin, 2013). In this evidenced-based paper, information will be provided in an effort to identify causes of lateral violence in the workplace and how to encourage civility.

In 3 articles, survivors of healthcare worker directed violence admitted to knowingly spending less time with their patients after the attack.(8, 12, 16) Quality of care is also reduced as survivors admit to being fearful of their patients as well as being reluctant to care for specific patients or any patients at all.(8, 17, 19, 25) After an incident of workplace violence, survivors stated that they have decreased communication with their patients, patient families, and coworkers.(12, 27) Survivors also admitted to having reduced interest in being a part of patient care, as well as being in their current position.(8, 12, 14, 19) One article found that physiotherapists often reduced their expectations for their patients after experiencing an incidence of workplace violence from a patient.(8) Survivors also found that they had reduced empathy and gave reduced emotional support to patients and their families after returning to work.(15) After an attack by a patient, survivors admitted to lacking concentration that led to missed medication administration, increased falls, and increased errors in administration of care.(10, 15, 17, 27)

Moreover, another type of violence which nurses experience is horizontal violence. Horizontal violence is described as “hostile, aggressive, and harmful behavior by a nurse or group of nurses toward a co-worker or group of nurses via attitudes, actions, words, and behaviors” (Becher & Visovsky, 2012, p. 210). Horizontal violence not only involves nurse-nurse violence but includes nurse-physician and nurse-supervisor violence. The perpetrator displays behaviors associated with horizontal violence which may include refusing to lend assistance, criticizing, intimidation, gossiping, name-calling, and ignoring (Becher & Visovsky, 2012). The American Nurses Association sets the expectations for nursing standards. According to the American Nurses

The goal of this research was to quantitatively describe the occurrence of healthcare worker directed violence, describe how the violence is dealt with, and describe the consequences to the healthcare worker. This research was performed at a general hospital in Sweden using a cross-sectional survey that was dispersed to many types of healthcare workers ranging from physician to physical therapist to nursing assistant and midwife. The Survey of Violence Experience by Staff (SOVES-G-R) was given to 4,845 workers that had patient contact and 2,495 surveys were returned. Three categories are looked at using the SOVES-G-R including: individual characteristics, interactions, and organizational work environment. Results of these surveys showed that violence was seen by workers in all areas of patient care, often when medical or therapeutic interventions were taking place. The interventions used by the healthcare workers were also documented and found to be very inconsistent throughout the hospital, showing that the lack of education on avoidance of violence and de-escalation of violent patients was a problem that needs to be addressed throughout the healthcare

As the new RN was facing horizontal violence; no one stood up for her or take any actions regarding the situation. I believe that it was mostly due to the fact that most staff members on the unit did not have a clear sense of what behaviors were reportable and unfamiliarity to code of conduct or workplace violence policy. Nurses may have fear of reporting; “ if they report/complain, no one help him/her or he/she will make the situation worst and most importantly fear of being labeled. Overtime the staffs may believe that horizontal violence behaviors are normal and become a part of their work setting which will keep letting the HV continue in the future. Which leads to my next point that newly graduate nurses are especially at risk for the horizontal violence and how it affects them and the other nurses that are victim of it.

In today’s world violence can be expected anywhere at any time. This includes what was considered at one time a low risk area, the medical facility. Today the incidence of violence is increasing. There are two types of violence the first is lateral violence or aggression which is amongst hospital or medical personal. The other is external factors consisting of patients or visitors instituting violence or aggression among themselves or against healthcare workers. This is known as a code grey in my facility and all male staff not currently engaged in patient care are supposed to respond.

Pich, Hazelton, Sundin, and Kable (2010) research aimed to explore the concept of nurses in Australia being identified as the occupation at most risk of patient-related violence in the health care sector. The researchers found that patient-related violence against nurses was highest in emergency departments; 70% of nurses working there estimated to experience violence on a weekly basis and between 60-90% of nurses reported exposure to violence, both verbal and physical (Pich et al., 2010). Patients were consistently identified as the most common source of such violence, responsible for ≤89% of all cases (Pich et al., 2010). Verbal abuse, a form of psychological abuse, was reported by ≤82% of nurses across a range of clinical environments

Nurses continually strive to bring holistic, efficient, and safe care to their patients. However, if the safety and well-being of the nurses are threatened or compromised, it is difficult for nurses to work effectively and efficiently. Therefore, the position of the American Nurses Association (ANA) advocate that every nursing professional have the right to work in a healthy work environment free of abusive behavior such as bullying, hostility, lateral abuse and violence, sexual harassment, intimidation, abuse of authority and position and reprisal for speaking out against abuses (American Nurses Association, 2012).

In everyday language violence and aggression are usually interchangeable, but some researchers suggest that there might be a difference between what people in general mean under aggression and what a nurse would use the term for. Usually, people tend to connect intention to aggression when causing harm to someone. Violence is different, it may be accidental. That said, in hospitals most of the violent incidents carry an aggressive – intentional element. For these reasons it seems logical to use the definition for aggression and violence as it was determined by the HSAC. They think if a health worker or nurse is put at risk in an incident, that counts as violence. Also it is worth to mention the cycle of the assault process (trigger