Updated: Feb 6, 2022
Nurse Abuse, let's talk about it!
Abuse has many definitions; we will be focusing on physical, emotional, and discriminatory abuse. The prevalence of workplace violence in healthcare continues to increase; nurses are at a higher risk due to the nature of their work and involvement with patient care. Around 45%-94% of nurses experience abuse while working (Keller et al., 2018). Nurses are not only abused by patients; but also their employers and coworkers frequently abuse them. This is a cause for concern because it can affect patient outcomes, care provided to patients, cause a hostile work environment, and a high turnover rate. One research study indicates that workload is a direct correlation to workplace violence. Furthermore, the same research suggests that the higher the acuity of the patient's illness increases the risk of workplace violence (Havaei & MacPhee, 2020). As a nurse, I'm sure most of you have heard the saying "nurses eat their young". Verbal abuse amongst nurses can cause severe psychological effects on nurses. Furthermore, it should be recognized as causing anxiety, low self-esteem, humility, stress, low confidence, depression, and anxiety (Keller et al., 2018). Nurses and physician relationships are essential and having a healthy relationship and collaborating with physicians is necessary to provide patients with the best possible outcomes. Unfortunately, however, nurses and physician relationships, can be less than ideal. Abuse is higher for males, nurses who work with patients who have mental health disorders, nurses working on night shifts, have poor staffing, lack of support from managers, less experience as a nurse, and poor relationship with physicians.
Physical Abuse: 3/10 nurses experience physical abuse during their nursing career, and the percentage statistics are increasing. Physical abuse includes but is not limited to being spit on, hit, pushed, scratched, and kicked. More often than not, many nurses assume that abuse is a part of the job; let me be the one to tell you, this is not a part of nursing. I want to point out that the highest reported violence was amongst nurses working with patients with mental health disorders (Edward et al., 2016). In some instances, patients don't have the cognitive ability to control their actions; however, nurses need to know that any form of abuse is not acceptable.
Emotional Abuse: One study suggests that 47% of nurses experience some form of emotional abuse. Furthermore, nurses are less likely to report this form of abuse; the highest forms of abuse were from nurses themselves (You know the saying "nurses eat their young"), patients' families, followed by physicians, and lastly, patients themselves (Rowe & Sherlock, 2005).
Discriminatory Abuse: Discrimination, unfortunately, is a reality that many nurses face in the healthcare setting; this includes favoritism to a specific group, harsher punishment to a particular group, microaggression behaviors towards groups.
Why is abuse an issue? I mean, it's obvious, of course, that there should be zero tolerance for abuse but let's talk about how these forms of abuse affect nurses, patients, and healthcare companies. First, the psychological trauma that it takes on a person is irreconcilable; this causes nurses to be disengaged with the work, increases burnout, increases turnover rate, poor patient outcomes, tardiness, frequent callouts. Furthermore, the abuse increases the companies' cost, i.e., HAI health insurance companies are not paying for an infection that occurred in a hospital setting. What does that mean? Companies have to take that as a loss. Second, one review shows that patient care is affected and places the patient's health at risk due to lack of staff from nurses quitting, medication error, increased patient falls. Third, when companies hire a nurse, it's an investment. If that nurse quits, the company loses out on the acquisition and has to replace the nurse, costing the company thousands of dollars. Legal actions (my favorite). I tell all my nursing friends and coworkers to document everything your company does, just like they have you sign documents or write you up when something goes wrong; you do the same thing! I've taken a few employers to court; I just text myself or email myself when an event occurs that I feel is unsettling or uncomfortable; in addition, make sure that you email HR letting them know how you feel so that it's documented that you made them aware of this issue.
Ways to reduce workplace abuse: As a nurse, I pride myself on saying I do not know everything that encompasses nursing. We grow and evolve from novice nurses to experts, and as we continue our education, we can go from an expert to novice, i.e., RN expert to APN novice. As nurses, we need to help one another, take constructive criticism when providing feedback, do it positively, avoid berating or belittling other nurses. Documentation is your best friend. I always say CYA in all aspects of life. I have experienced abuse as a nurse; I documented everything that rubbed me the wrong way, seemed unethical, etc. I did this by either texting myself the situation or emailing myself. This technique has helped me tremendously in the past. If a patient is being verbally abusive I try to find out why i.e. is the patient in pain, if the patients pain is not managed that can be the reason why the patient is being abusive (still this is not an excuse however finding out why can cease the abuse). STOP normalizing abuse, abuse is not a part of the job, report the abuse to your manager and HR, if the nurse manager is the issue report it to HR. We do not support nor condone any forms of abuse!
Edward, K. L., Stephenson, J., Ousey, K., Lui, S., Warelow, P., & Giandinoto, J. A. (2016). A systematic review and meta‐analysis of factors that relate to aggression perpetrated against nurses by patients/relatives or staff. Journal of clinical nursing, 25(3-4), 289-299.
Havaei, F., & MacPhee, M. (2020). The impact of heavy nurse workload and patient/family complaints on workplace violence: An application of human factors framework. Nursing Open, 7(3), 731-741.
Keller, R., Krainovich-Miller, B., Budin, W., & Djukic, M. (2018). Predictors of nurses' experience of verbal abuse by nurse colleagues. Nursing Outlook, 66(2), 190-203.
Rowe, M. M., & Sherlock, H. (2005). Stress and verbal abuse in nursing: do burned-out nurses eat their young?. Journal of nursing management, 13(3), 242–248. https://doi.org/10.1111/j.1365-2834.2004.00533.x
Shields, M., & Wilkins, K. (2009). Factors related to on-the-job abuse of nurses by patients. Health reports, 20(2), 7–19.