Pediatric healthcare workers' primary and secondary experiences of patient behavioral events: A cross-sectional study

Patient behavioral events, defined as physically aggressive behaviors, are common experiences of healthcare workers. Most research focuses on direct experiences of high severity but low frequency (acute) events and less is known about indirect experiences of frequent (chronic) low- and high-severity events, especially in a pediatric setting. This study examines pediatric healthcare workers' primary (directly targeted) and secondary (witnessed/heard about) experiences with patient behavioral events, and associations with stress-related outcomes, work attitudes, and work behaviors.

Three children's hospitals (academic medical centers and free-standing hospitals) in the Midwest and South, United States, participated in the anonymous, cross-sectional survey. Of 2918 invited bedside healthcare workers (≥18 years), 521 responded. Respondents included nurses, ancillary staff, providers, and technicians/assistants (mean age = 37.76 years), predominantly female and white. The survey measured primary/secondary patient behavioral events, stress-related outcomes (work pressure, emotional demands, burnout), work attitudes (job satisfaction, engagement, hospital attachment), and work behaviors (withdrawal, turnover intentions).

Patient behavioral event frequency correlated positively with stress-related outcomes, negatively with work attitudes, and positively with most of the work withdrawal behaviors, for both primary and secondary events. Nurses and those in emergency departments or behavioral health units reported the highest frequencies of events.

Patient behavioral events are associated with pediatric healthcare professionals' well-being and work outcomes, whether they are directly targeted or witnessed/heard about.

Attending to the psychological effects of patient behavioral events for targets and their coworkers may be a key element in pediatric personnel retention.