Violence toward nurses, the work environment, and patient outcomes

Area of Science:

• Nursing Research
• Healthcare Management
• Patient Safety

Background:

• Workplace violence is a significant concern in healthcare settings.
• Nurses on medical-surgical units report experiencing emotional abuse, threats, and actual violence.
• The impact of workplace violence on the nursing environment and patient outcomes requires further investigation.

Purpose of the Study:

• To examine the relationship between nurses' perceptions of workplace violence and the nursing work environment.
• To determine the association between workplace violence and patient outcomes on medical-surgical units.
• To identify factors within the nursing environment that may mitigate or exacerbate workplace violence.

Main Methods:

• A cross-sectional study was conducted involving 2,487 nurses across 94 nursing wards in 21 Australian hospitals.
• Data were collected using surveys, including the Nursing Work Index-Revised (NWI-R), Environmental Complexity Scale (ECS) PRN-80, and a specific workplace violence questionnaire.
• Primary data on staffing, skill mix, patient acuity, and patient outcomes (falls, medication errors) were also collected over a one-week period.

Main Results:

• Approximately one-third of nurses reported experiencing emotional abuse, with 14% reporting threats and 20% reporting actual violence.
• Perceptions of violence were associated with increased ward instability, leadership issues, and difficult interprofessional relationships.
• Violence was linked to operational factors such as unanticipated patient mix changes, delayed tasks, and increased medication errors. Higher registered nurse (RN) skill mix and Bachelor of Science in Nursing (BSN) prevalence were associated with lower reported violence.

Conclusions:

• Workplace violence is prevalent and negatively impacts nurses' job satisfaction.
• Perceptions of violence are associated with adverse patient outcomes, mediated by a destabilized or negative working environment.
• Understanding the complex interplay between the nursing work environment, workplace violence, and patient outcomes is crucial for effective healthcare delivery and management.