Workplace assaults on nursing assistants in US nursing homes: a multilevel analysis

We examined risk factors for injuries to nursing assistants from assaults by nursing home residents at both the individual and the organizational level.

We analyzed data from the 2004 National Nursing Assistant Survey that were linked to facility information from the 2004 National Nursing Home Survey by use of multilevel modeling that accounted for the complex survey design effect.

Thirty-four percent of nursing assistants surveyed reported experiencing physical injuries from residents' aggression in the previous year. Mandatory overtime (odds ratio [OR] = 1.65; 95% confidence interval [CI] = 1.22, 2.24) and not having enough time to assist residents with their activities of daily living (OR = 1.49; 95% CI = 1.25, 1.78) were strongly associated with experiencing injuries from assaults. Nursing assistants employed in nursing homes with Alzheimer care units were more likely to experience such injuries, including being bitten by residents.

Reducing mandatory overtime and having a less demanding workload may reduce the risk of workplace violence. In particular, prevention activities should be targeted at those nursing homes that care for cognitively impaired patients.