Rural hospital general ward nurses' experiences of workplace violence by patients and visitors: a scoping review

Workplace violence (WPV) is increasing globally, and nurses are disproportionately affected. While WPV has been studied in high-risk units such as emergency departments and mental health units, less is known about violence in general medical and surgical hospital wards, where most nurses work. WPV exacerbates nursing workforce shortages, especially in rural hospitals, which already face staffing challenges. In rural areas, previous research indicates that nurses' familiarity with patients and visitors makes patient-initiated violence more complex, and limited resources may mean a lack of on-site security and reduced local police presence. This study aimed to describe generalist nurses' experiences of WPV by patients and visitors in acute hospital wards, with particular attention to rural settings where reported.

A scoping review using PRISMA-ScR guidelines identified relevant peer-reviewed studies via CINAHL, Cochrane Library, MEDLINE, Google Scholar, and Scopus.

Of 165 records, 12 met the inclusion criteria. No included studies directly reported rural hospital generalist nurses' experiences of workplace violence, and evidence for this cohort could not be isolated. Four themes emerged: high prevalence of violence, underreporting, contributing factors, and negative impacts. Most generalist nurses reported experiencing WPV, with increased risk when inpatients were awaiting care-facility beds. These negative outcomes both result from, and contribute to, workforce shortages.

Despite recognition of the issue, there is little evidence on patient-/visitor-initiated violence in rural hospital general wards. Further research is needed to understand how such violence affects nurses' safety, patient care quality, and workforce sustainability in rural areas, to inform policies.