The moral dilemma of interpreting workplace violence

Workplace violence is a significant problem in healthcare. It was believed that in the context of patient violence nurses faced a moral dilemma regarding conflicting duties to self and patients. A qualitative study was conducted with nurses who experienced physical violence perpetrated by a patient. The aim was to examine the ethical decision-making process nurses used to determine the "right" course of action. Nurses did not perceive the conflict between these two duties as the primary dilemma they faced. They appreciated their patients' vulnerability and the power differential inherent in the RN-patient relationship and maintained that their primary responsibility was patient safety. Interpretation of the event was the primary dilemma they described. Patient violence was framed as a dichotomous experience: an expected part of the job or a crime. The middle space between these two choices was bounded by a fuzzy, porous, extremely difficult to interpret line. The dichotomous interpretation resulted in a perception of dichotomous responses: do nothing or file criminal charges. Violence in the context of the RN-patient relationship is a complex phenomenon involving a host of factors. We need to direct more attention to this complexity, to individualized responses to workplace violence, and to depolarizing this issue.