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Consequences Of Interrupted Tasks

May 20 2010 - Research from Curtin University of Technology in Perth, Western Australia published in the Journal of Clinical Nursing found that three-quarters of nurses working in both the private and public sectors had experienced violence at work, but only one in six incidents were officially reported.

Lead author, Dr Rose Chapman said:

"Many of the nurses who took part in the research said that they did not report incidents because they felt that workplace violence was just part of the job."

The study was based on 113 nurses, the majority of whom were female, in their early 40s and with an average service of about 18 years (ranging from six months to 40 years). Nearly two-thirds worked part-time. Respondents reported 2354 incidents of which 92 per cent involved verbal abuse, 69 per cent physical threats and 52 per cent physical assault. Nurses faced an average of two to 46 incidents a year.

Researchers found that the number and type of incidents varied depending on the health care setting involved: 25 per cent experienced incidents on a weekly basis, 27 per cent about once a month, 25 per cent about once every six months, and the remaining 23 per cent had not experienced violence in the course of their work.

The majority of incidents were reported by nurses working in the emergency department (an average of 46 each in the last 12 months) and mental health (an average of 40 each). The fewest incidents were encountered by those working in midwifery (an average of two each) and in surgery or paediatrics (an average of four each).

Incidents involving a weapon were reported by 40 per cent of respondents including hospital equipment (32 per cent) guns (6 per cent) and knives (3 per cent). Again, the most common settings were emergency (weekly) and mental health (monthly) with 3 per cent of respondents reporting a weekly incident involving violence.

The greater experience of violence was not reflected in official reporting figures. Nurses working in the emergency department were much less likely to report incidents (42 per cent) compared to colleagues working in other specialities (76 per cent).

Overall, only 16 per cent of incidents were reported. About half of those responding had reported incidents verbally to line managers (29 per cent) other senior nurses (14.5 per cent) and/or to friends or colleagues (6 per cent). Half said that senior managers had failed to take effective action when they had reported an incident, 30 per cent did not report because they regarded such events as an inevitable part of their job.

Nearly three-quarters (70 per cent) said they would report an incident that involved injury, the possibility of charges against the perpetrator or a claim for compensation.

Rose Chapman said:

"The nurses in our study were reluctant to report episodes of workplace violence unless they considered the event to be serious. This finding was supported by a retrospective audit of the hospital's formal incident reports, which showed that 96 per cent of the reporting nurses had received one or more injuries as the result of a violent incident in the workplace.

"Understanding why nurses do or do not report incidents is very important as it can help educators and administrators to develop programmes that help to reduce workplace violence. Further research on how individuals adapt to violence in the workplace is also warranted."

Roger Watson, editor of the Journal of Clinical Nursing commented:

"Workplace violence is never acceptable and it is a very sad indictment of society today that so many of the nurses in this study saw these incidents as part of their job. Many of the studies published by the nursing media have focused on public facilities, but this study shows that violence is also an issue when patients are receiving private health care. It is vital that workplace violence is tackled to ensure that healthcare systems are able to retain good quality, trained staff. Any studies that provide an insight into how staff cope with violence, and what influences their decision to report incidents, are to be welcomed."

Previous study

Almost one-third of nurses who took part in a large-scale Tasmanian study reported that they had been subjected to both physical and verbal abuse in the previous four working weeks and a quarter had considered resigning as a result, according to research published in the September 2006 issue of the UK-based Journal of Advanced Nursing.

The survey was conducted by researchers from the University of Tasmania and was supported by the Australian Nursing Federation. Questionnaires were sent to the 6326 nurses registered with the Nursing Board of Tasmania in late 2002. Some 38 per cent completed the survey, but when this was adjusted for the number of registered nurses actually working during this period, the figure was nearer 55 per cent.

Some form of abuse in the previous four working weeks was reported by two-thirds of the 2407 nurses who took part. This ranged from being sworn at, slapped and spat upon to being bitten, choked and stabbed. The abused nurses described an average of four verbal incidents and between two to three physical incidents during the period covered.

Of nurses who had been physically abused, 69 per cent had been struck with a hand, fist or elbow and 34 per cent had been bitten. A further 49 per cent said they had been pushed or shoved, 48 per cent had been scratched and 38 per cent spat at. In addition, 6 per cent reported that they had been choked and just less than 1 per cent stabbed.

Verbal abuse was most likely to take the form of rudeness, shouting, sarcasm and swearing. However, 2 per cent said that their home or family had also been threatened. Patients and visitors were the most likely people to abuse nurses, but 4 per cent who reported physical abuse said that it was carried out by another nurse and 3 per cent by a doctor. Of those reporting verbal abuse, 29 per cent said that the perpetrator was a nurse colleague and 27 per cent a doctor.

Lead author Professor Gerald Farrell, now based at La Trobe University School of Nursing and Midwifery in Victoria, Australia said:

"The present findings point to a work environment that is both distressing and dangerous for staff. Eleven per cent of nurses told us that they had left a post because of aggression and 2 per cent had left nursing completely. Two-thirds of those who experienced aggression said that it affected their productivity or led to errors in their work. Ten per cent said it was the most distressing aspect of their work, after the 51 per cent who cited workload as the biggest problem.

"Another key finding of this research was that although verbal and physical spreads across every branch of healthcare from paediatrics to psychiatry and community services to critical care few staff made their complaints official."

The researchers believe that the restricted time frame of the study and the fact that aggression was carefully defined, with clear distinctions between verbal and physical abuse, may have captured a greater range of incidents than previous studies. The study concludes that workplace aggression is a world-wide problem and further research is needed to discover why levels are so high in modern healthcare settings

Gerald Farrell continued:

"Our research shows that many nurses are working in environments in which they cannot provide the care that they think is best for patients. At the same time they have to contend with high levels of verbal and physical abuse. It's not surprising that some nurses have left the profession altogether and many more are thinking about it.

"We live in an era when employers are constantly being told that they have a duty of care for employees. It's a sad reality that nurses who spend their lives caring for others and providing such a valuable service continue to feel so vulnerable in the workplace."

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