15 Most Common Causes of Workplace Violence in Nursing + How to Prevent
Written By:
Darby Faubion
Darby Faubion RN, BSN, MBA
Darby Faubion is a nurse and allied health instructor with over 20 years of clinical experience. Darby lives in Louisiana and loves exploring the state’s rich culture and history. Darby has a passion for caring for veterans and a special interest in those affected by post-traumatic stress disorder. In her quest to make a difference for veterans, she founded a non-profit called “Operation Battle Buddy.” Read Full Bio »» RN, BSN, MBA
Violence in nursing is a major problem impacting nurses at all levels of healthcare. Some studies indicate that 25% of nurses have reported being physically assaulted by a patient, and over 50% reported experiencing verbal abuse. To combat workplace violence in nursing, we must first identify causes and understand measures to prevent it. That leads to the question, "What are the most common causes of workplace violence in nursing?”
I have witnessed other nurses be the victim of violence in the workplace and have also experienced violence directed toward me in healthcare settings. In this article, I will share the 15 most common causes of workplace violence in nursing + how to prevent them. While preventing every act of violence may not be possible, with education and awareness, we can help reduce the occurrence of violent acts and make healthcare safer for patients and nurses alike.
What are the Most Common Causes of Workplace Violence In Nursing?
(The following are the 15 most common causes of workplace violence in nursing + how to prevent them.)
CAUSE #1: Patients Under the Influence of Alcohol or Drugs
About the Cause:
One of the most common causes of workplace violence in nursing is having patients who are under the influence of alcohol or drugs. Drugs and alcohol often cause people to exhibit unpredictable behaviors, and when those behaviors become violent in a healthcare setting, nurses are the likely victims.
How to Prevent:
Preventing workplace violence in nursing when patients are under the influence is crucial for both patient and staff safety. Some strategies include performing a risk assessment by regularly assessing patients for signs of substance abuse or intoxication and applying trauma-informed principles to identify patients who may have underlying trauma leading to their behaviors. It is also important to be aware of environmental risks such as cluttered pathways and inadequate lighting, which could increase the risk of vulnerability and violent outbursts.
CAUSE #2: Delays in Patient Care
About the Cause:
Long wait times can lead to anger and frustration, especially in situations when people are sick or hurting. Unfortunately, when tensions build, it increases the risk of violent incidents occurring.
How to Prevent:
Some situations resulting in delays in patient care are unavoidable. However, there are some things you can do to help reduce the risk of situations getting out of hand due to anger and frustration. First, clinical judgment should be used to prioritize patient care and get patients seen as soon as possible. Second, if patients or their loved ones must wait, check in with them to give a status on their case and to make sure they are okay. It has been my experience that some of the most frustrated patients and their loved ones can be calmed by simple acts of kindness and concern from nurses.
CAUSE #3: Working in a High-Stress Environment
About the Cause:
Let’s face it: nursing can be stressful, no matter where you work. Some settings or work environments, such as critical care or emergency departments, are breeding grounds for elevated stress levels, and if we are caught off guard, these situations can lead to violence in the workplace.
How to Prevent:
One of the most important steps in reducing workplace violence due to working in a high-stress environment is to foster open communication among team members. Collaborate with peers to find ways to manage patient loads and destress effectively. Nurse leaders can work to promote a positive work environment and recognize nurses for their efforts and jobs well done, which makes them feel appreciated and may reduce work-related stress.
CAUSE #4: Understaffing
About the Cause:
Being short-staffed increases the nursing workload and can lead to increased stress and challenges in managing patient care and providing timely interventions. As a result, patients and/or staff may become overwhelmed, which can lead to outbursts of violence.
I remember working in the emergency room one weekend when the unit was terribly short-handed. One of the interns working with us became very upset because he did not have a nurse to assist him immediately, and he became increasingly agitated and aggressive toward the managerial staff. The situation ended in a physical altercation between the intern and one of the physicians, which cost the intern his job, leaving us even more understaffed.
How to Prevent:
Although understaffing is a cause of workplace violence in nursing, it is not always an easy fix. Today, there is a nationwide shortage of nurses and physicians. One thing you can do to help reduce the risk of violence because of understaffing is to show up for work when you are scheduled. If you are asked to work an extra shift and feel comfortable doing so, you may be able to help alleviate some of the stress other nurses feel due to being short-staffed.
CAUSE #5: Lack of Training on Crisis Prevention
About the Cause:
Sometimes, violence in the nursing workplace occurs simply because there is a lack of knowledge and understanding of how to prevent a potential crisis situation from escalating to an actual crisis event. A lack of staff training can lead to violent events that result in staff, patient, or visitor injuries.
How to Prevent:
While
crisis prevention is something we all can contribute to, significant changes must come from nursing administration. As a nurse and having worked in nursing leadership, I firmly believe that all nurse leaders and administrators have a duty to educate staff on how to respond to potentially violent situations. Providing training on how to identify possible aggressors and what to do if the situation is unmanageable is vital.
It is also important for nursing leaders to let staff know that it is okay to report situations that are concerning to them, even if it turns out to be something insignificant. Lack of concern from the administration is one of the main reasons nurses do not report potential risks, which leads to increased workplace violence in nursing.
CAUSE #6: Permissive Organizational Culture
About the Cause:
I would love to tell you that all healthcare facilities promote a culture of professionalism and that they implement measures to avoid violence. Unfortunately, that is not always the case. In situations where there is an organizational culture that is lax or permissive regarding poor behaviors, it can lead to cases of violence toward nurses.
How to Prevent:
Preventing workplace violence due to a permissive work culture requires everyone to be proactive. Leaders must prioritize safety for workers and patients and foster an environment where others feel safe and respected. It is also necessary to identify potential risks and vulnerabilities that could lead to increased risks for violence and encourage staff to report any behaviors that give them reason for concern. Finally, provide options for reporting incidents or concerns, even if the reporting person wishes to remain anonymous, and encourage open communication between management and staff.
CAUSE #7: Emotional Stress
About the Cause:
Several things lead to emotional stress for patients and their loved ones. At times, especially if they do not have healthy outlets for their stress, their emotions can erupt and result in violent outbursts.
How to Prevent:
It is not always easy to predict who will react violently, but knowing what to look for and learning measures to diffuse tense situations, when appropriate, can help. For example, when I worked for a hospice company, it was common for me to be present when family members were notified about a patient's terminal illness or death. There were many times that distraught loved ones reacted by throwing or hitting things. I once had a patient shove me to the ground in anger when I told him his brother had passed away.
You may be able to prevent this cause of workplace violence in nursing by being keenly aware of the people in your immediate vicinity. Look for signs, such as pacing, talking loudly, walking quickly toward you or someone else, or obvious threats. If you can talk to the person to de-escalate the situation without putting yourself in harm's way, that is okay. However, if you feel threatened and do not believe you can prevent an incidence of violence toward you, it is always best to remove yourself from the situation until help arrives.
CAUSE #8: Inflexible Visitation Hours
About the Cause:
Some hospitals and specialty units have restrictive visiting hours. Family members who insist on seeing patients outside of these hours can become angry and aggressive when denied access to visitation, sometimes leading to violent outbursts toward nurses.
One of my friends worked in a critical care unit that had very restricted visiting hours. One night, when she was returning to the unit from her break, a family member of one of her patients was standing outside the locked unit door, insisting on being allowed inside the unit. When she told him visiting hours were over, and she could not give him access to the unit, he became violent, shoving her and hitting her.
How to Prevent:
While inflexible visitation is not the main cause of workplace violence in nursing, it occurs much more often than it should. It is important for healthcare facilities to post visiting hours in places that are visible to all visitors. It is also essential that everyone follows rules. Finally, nursing supervisors should be readily available to help nurses when situations arise that may lead to frustration from potential visitors. Sometimes an encouraging word from a supervisor can help relieve the tension and keep situations from turning aggressive or violent.
CAUSE #9: Inadequate Security
About the Cause:
Another common cause of workplace violence in nursing is the lack of adequate security to address potentially volatile situations. Also, when there are inadequate security protocols, nursing staff are more vulnerable to violence.
How to Prevent:
I have worked in large hospitals that had several security officers on every floor, and I have worked in small healthcare facilities that had no official security staff. So, I understand what it is like to need additional security and have none. To prevent workplace violence in nursing due to inadequate security, it takes effort from the whole team. Build trust with staff, visitors, and patients, and treat everyone on your unit as part of your "community." Participate in and encourage violence awareness and prevention programs and contribute to developing safety policies and crisis plans. While you may not be able to stop every violence risk with security protocols, it is possible to reduce risks.
CAUSE #10: Patients Experiencing Mental Health Crisis
About the Cause:
Another common cause of
workplace violence in nursing is when patients experience a mental health crisis. Let me be clear; I am not saying every mental health issue leads to violence. However, there are some situations that increase the likelihood of a violent episode. For example, patients with paranoid delusions or antisocial personality disorder may act out aggressively, which could lead to violent behavior toward nurses.
How to Prevent:
The first and most important step in preventing workplace violence due to patients experiencing a mental health crisis is to prioritize safety for nurses and patients. It is also crucial to collaborate with mental health providers, such as social workers, psychiatrists, or mental health nurse practitioners, to develop plans that address critical patient needs and manage patient behaviors. Finally, nurses should be equipped with the skills to handle challenging behaviors calmly and rationally. Training in de-escalation techniques and conflict resolution is especially helpful in these situations.
CAUSE #11: Lack of Appropriate Training of Supervisory Staff
About the Cause:
Workplace violence in nursing often occurs because supervisory or management staff are not properly trained to identify and address potentially dangerous situations. Unfortunately, if leadership is ill-prepared to handle volatile situations, it is only natural to assume that staff will lack appropriate training as well.
How to Prevent:
One of the simplest ways to reduce the risk of workplace violence in nursing is to offer training to all facility staff, regardless of their position. By teaching staff and leaders what behaviors indicate the risk of violence and what to do when they observe these behaviors, we can head off some cases, reducing incidents of injury or harm. It takes a willingness from the administration to provide training and from staff to participate in training and apply what they learn.
CAUSE #12: “Revolving-Door” Syndrome
About the Cause:
Another common cause of workplace violence in nursing is often referred to as revolving door syndrome. This is a cycle that occurs when patient treatment is cut short due to pressure from insurance companies to discharge patients, which is often followed by inadequate or inappropriate community-based follow-up care. Then, when the patient's situation worsens, they return to the healthcare facility, and the cycle begins again. Revolving door syndrome leads to repeated crisis episodes and admissions, which cause increased frustration, fear, and anxiety, which often leads to violent outbursts.
How to Prevent:
In an ideal situation, nurses could take care of patients until they are completely well and no longer at risk for a relapse or new admission. That is not always the case, though. One thing we can do to prevent violence related to revolving door syndrome is to educate patients and caregivers about their illnesses or diseases, treatments, and any follow-up care or interventions they should follow upon discharge. It is important to realize that not all patients have the same level of understanding or the same resources outside of your facility. So, ensuring that case managers work with patients and families to prepare them before discharge is crucial.
CAUSE #13: Cultural Factors
About the Cause:
Cultural factors can significantly influence the risk of workplace violence in nursing. In some cultures, there is a belief that violence is inevitable and should be tolerated. In other situations, cultural differences in communication lead to misunderstandings, which increase tension, and miscommunication often leads to aggressive or violent behavior. Additionally, cultural hierarchies may influence how nurses and patients interact and could lead to power imbalances that cause aggressive or violent behavior.
How to Prevent:
The most effective way to combat cultural factors that lead to workplace violence in nursing is to create a counterculture that prioritizes nonviolence. Nursing leaders should create a culture where any threat or act of violence is taken seriously and prioritize the physical and psychological safety of patients, staff, and visitors. Violence should be clearly defined so that staff understand what constitutes violence and what actions they must take when threats of violence occur.
CAUSE #14: Increased Patient Morbidity
About the Cause:
In situations where nurses care for patients with complex health problems, they often experience higher stress levels. Stress can lead to frustration, which often manifests as physical or verbal aggression or violence toward colleagues or patients. Additionally, nurses who care for patients with higher morbidity rates may face making complex ethical decisions, which could lead to disagreements among providers about treatment options, resource allocation, and end-of-life care, all of which contribute to feelings of anger and frustration, which increases the risk of violence.
How to Prevent:
In most cases, nurses do not choose their patient assignments, which means that learning to deal with stressful situations, including caring for patients with complex problems, is required. What you can do, though, is reach out when you begin to feel overwhelmed. If your patient load is heavy and you have several patients with serious problems or co-morbidities, talk to your supervisor or team leader and ask for help before the situation gets out of hand. Also, if you are a nurse leader, consider patient assignments carefully, trying to spread complex patients among nursing staff to promote fairness and prevent overworking nurses.
CAUSE #15: Nurse Burnout
About the Cause:
Some research shows there is a connection between nurse burnout and workplace violence in nursing. When nurses experience burnout, it affects emotional well-being and their attitude toward work, which can lead to adverse effects on safety for patients and staff, especially if the nurse lacks good coping skills.
How to Prevent:
Educating nurses about symptoms of burnout and addressing the issue when it occurs is crucial for maintaining a safe work environment and preventing this cause of workplace violence in nursing. If you experience
symptoms of burnout, it is crucial that you report these symptoms to your supervisor before they get out of hand. If you are a supervisor or manager in nursing, it is vital that you create an environment where nurses feel safe to report feelings of burnout and where interventions are in place to protect patients and staff alike.
My Final Thoughts
Nursing is a wonderful career filled with fun, happy experiences. However, there are times when the unthinkable happens, and violence in the workplace occurs. As a nurse, it is crucial to know what constitutes violence in the workplace and what measures to enact when it occurs. With that in mind, it is necessary to ask, "What are the most common causes of workplace violence in nursing?”
Having been a nurse for more than 25 years, I have seen many situations where violence occurred in the workplace. In this article, I shared the 15 most common causes of workplace violence in nursing + how to prevent them. While one nurse cannot prevent every incidence of violence, if every nurse does their part, we can reduce the risks associated with violence and protect the safety and well-being of patients and staff in healthcare settings.
List Of Sources Used For This Article
1.
Crisis Prevention Institute
2.
The National Institute for Occupational Safety and Health: “Workplace Violence Consequences” (
Centers for Disease Control and Prevention)
3.
“Nurse Burnout: Risks, Causes, and Precautions for Nurses” (
University of St. Augustine for Health Sciences)
Darby Faubion, RN, BSN, MBA
Darby Faubion is a nurse and allied health instructor with over 20 years of clinical experience. Her work history includes clinical experience in pediatrics, mental health, addiction and behavioral disorders, geriatrics, wound management, and communicable disease. Darby has worked in hospitals, long-term care facilities, and home health and hospice agencies. Darby also has experience as a nursing and allied health educator at both community college and university levels. Her love for nursing and nursing education led to her becoming a test-taking strategist and NCLEX prep coach.