Traumatized Nurses

Primary Traumatic Stress: Workplace Violence

Violence experienced by nurses is not a new phenomenon. However, experts believe that violence and the risks for being traumatized from violence are increasing. Several professional and regulatory organizations, [Page 770]including the American Nurses Association and the U.S. Occupational Safety and Health Administration, are recognizing the seriousness of the problem and are calling on employers to reduce and manage workplace violence (WPV). Recently, The Joint Commission, the organization that accredits health care organizations, brought attention to the problem and its effects on employees, employers, and patients.

Evidence shows that health care workers are at greater risk of WPV than all other workers. The Bureau of Labor Statistics reported that 60% of injuries from nonfatal assaults occurred in health care and social services, with most assaults committed by patients. Health care support occupations had an injury rate of 20.4 per 10,000 workers because of assaults, and health care practitioners had a rate of 6.1 per 10,000; this compares with the general sector rate of only 2.1 per 10,000. As significant as these numbers are, the actual number is much higher because of the gross underreporting related to the persistent perception that assaults are part of the job.

Although all nurses are at risk for WPV, those working in emergency, psychiatric, and geriatric settings experience violence at the highest rate. Emergency nurses are four times more likely to report being assaulted compared with nurses in other units with the majority of emergency nurses experiencing at least one assault every 6 months. Major risk factors for WPV include patient use of illicit drugs and alcohol; availability of guns and weapons; unrestricted access into the treatment area; patients, families, and visitors in stress, pain, and grief; long waiting times; isolated work areas; and patients with psychiatric, dementia, and other organic brain diseases.

Violence affects employees, employers, and patients. In addition to physical injury, disability, chronic pain, and muscle tension, nurses who experience WPV may suffer short- and long-term emotional reactions, including anger, sadness, frustration, anxiety, irritability, apathy, self-blame, helplessness, and psychological problems such as loss of sleep, nightmares, and flashbacks. Many at-risk workers suffer symptoms of posttraumatic stress disorder (PTSD) resulting from violence, with an estimated 17% of nurses having scores high enough to be considered probable for a diagnosis of PTSD. The psychological consequences of WPV may continue after a violent incident, affecting quality of life for several years. For the employer, WPV affects costs related to increased turnover, absenteeism, medical and psychological care, property damage, increased security, litigation, increased workers compensation, and decreased morale. The cost associated with assaults to nurses has been estimated to be approximately $31,643 per assault. Patients are affected negatively when the nurse's ability to provide safe and competent care is compromised after a violent event or when PTSD symptoms make it difficult to be emotionally and physically present at work.

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