Workplace violence has become a major topic in the United States within the last decade, and healthcare providers, including nurses, are directly affected. The American Nurse Association (ANA) describes it as an "epidemic" and reports that 1 in 4 nurses are assaulted, 13% of missed work days are due to work place violence, and many incidents are not actually reported (https://www.nursingworld.org/practice-policy/work-environment/end-nurse-abuse/).
Violence includes incivility and bullying, not just physical, psychological, or verbal attacks. The American Nurses Association (ANA) proposes that incivility occurs within the context of derogatory actions that are rude, discourteous, or disrespectful, whether or not the intent is negative towards another individual. Bullying, on the other hand, is "repeated, unwanted, harmful actions intended to humiliate, offend, and cause distress in the recipient" (https://www.nursingworld.org/practice-policy/work-environment/violence-incivilit). Violence occurs as either a threat or actual act of physical, sexual, or psychological harm; harassment; intimidation; or any other threatening, disruptive behavior (https://www.nursingworld.org/practice-policy/work-environment/end-nurse-abuse/). When I first begin to think about this topic as a young nurse, I conceptualized workplace violence as always involving patient aggression directed toward nurses within the context of patient care delivery. However, it became clear after further reading and exploration, workplace violence can also exist between colleagues; does not necessarily always occur during care delivery, but is occurring in the work environment; and healthcare workers experience 50% of all reported workplace injuries related to violence (https://www.osha.gov/Publications/osha3148.pdf).
Having had experiences with combative patients in the intensive care setting in my early career, I viewed patient "demonstrations of aggression" as a "normal" part of providing nursing care to patients who were sedated or confused. I was very hesitant to use the term "violence." In my thinking, the negative outcomes of physical or verbal aggression were not personal and just came as part of caring for hospitalized patients. I thought the injuries that resulted, no matter whether minor or serious, were just part of the job. Thankfully, my naivety and nursing's stance on workplace violence has become much more informed. We have now identified that individuals experiencing workplace violence can experience post-traumatic stress, vigilance, irritability, and sleep disorders (University of Montreal, 2014), as well as impact the individual's finances, productivity, morale, and trust of safety in the work setting (Lowers & Associates, 2016).
When you really think about it, addressing workplace violence is embedded within promoting a culture of safety. And that responsibility falls on every individual in the healthcare system-not just nurses or support staff, but administrators and managers, as well as patients and family. Perhaps the greatest negative impact of workplace violence in healthcare is the negative impact upon patient care. Staff are either absent or not at their best when workplace violence occurs, regardless of whether the insult is physical or psychological, deliberate or unintentional.
As a specialty, we have not directly addressed workplace violence in the gastroenterology setting. But statistics suggest, it is happening. I encourage you to talk with your peers, be honest about experiences with workplace violence, and then contact me (mailto:[email protected]) if you would be willing to assist in establishing the incidence of workplace violence in our specialty setting. Identifying the problem, working collaboratively to identify effective ways for preventing or managing workplace violence, and evaluating our outcomes related to staff and patients can assist us in effectively minimizing the impact workplace violence has on our overall wellness, satisfaction, and delivery of care. Consider signing the #EndNurseAbuse pledge supported by the ANA. Just text ANA to 52886 or go to https://www.nursingworld.org/practice-policy/work-environment/end-nurse-abuse/ to pledge your commitment. Let's start the dialogue about workplace violence in the gastroenterology setting.
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