Workplace violence in health care: recognized but not regulated

Workplace violence is one of the most complex and dangerous occupational hazards facing nurses working in today's health care environment. This article includes critiques of the conceptual, empirical, and policy progress of the past decade, a discussion of the need for methodologically rigorous intervention effectiveness research, and a description of a joint-labor management research effort aimed at documenting a process to reduce violence in a state mental health system. The development of a typology of workplace violence has advanced our understanding of the relationship of the perpetrator of the violence to the victim and provided a foundation for conceptual frameworks linking etiology and prevention. Even though health care workers may be exposed to four types of violence in the course of their work, the overwhelming majority of threats and assaults against caregivers come from patients (Type II), justifying emphasis on this type of violence. Individual nurses and direct care providers have very little influence over the level of violence in their workplaces, but through collective action are poised to influence policies designed to protect the health care workforce.