Environement, health, and safety

Workplace violence is a growing concern and one of the most dangerous hazards facing nurses. It is also a serious threat to safety in healthcare work settings. Nurses have a right to work in healthy environments that are free of abusive behaviors. To ensure safe workplaces, there must be zero tolerance for any form of workplace violence.

To be able to talk about workplace violence, it is necessary first to define the terms we use when discussing it. The International Council of Nurses (ICN) defines workplace violence as “behavior that humiliates, degrades, or otherwise indicates a lack of respect for the dignity and worth of an individual.” This, of course, includes bullying.

Bullying is the fastest growing type of workplace violence. The International Labour Organization (an agency of the United Nations) says bullying constitutes “offensive behaviour through vindictive, cruel, malicious, or humiliating attempts to undermine an individual or group of employees.”

There are different kinds of bullying and workplace violence. Lateral violence, sometimes referred to as horizontal violence, is described by ICN as “any inappropriate behavior, confrontation or conflict ranging from verbal abuse to physical and sexual assault” that is directed toward those on the same level in a hierarchical structure.

But because the perpetrator of psychological violence is most often (although not always) a supervisor or manager, the term relational aggression may be a more accurate description of this type of workplace violence. A term less limiting than lateral or horizontal violence, relational aggression better reflects the perpetrator-to-target relationship. It occurs between people on different hierarchical levels, such as a nursing supervisor and a new graduate, or a senior nurse and a newly hired nurse. It is a form of bullying typified by psychological abuse. According to Cheryl A. Dellassega, professor at Pennsylvania State University, examples of this type of behavior include calling a co­worker incompetent, gossiping, withholding information, and ostracizing him or her from the group. She reports that this type of bullying can be indirect or covert and can occur in person or in cyberspace. It can occur either at work or after work.

The ANA Code of Ethics for Nurses with Interpretive Statements states that RNs are “required to respect the inherent worth, dignity, and human rights of every individual; maintain compassionate and caring relationships with colleagues and others with a commitment to the fair treatment of individuals, to integrity-preserving compromise and to resolving conflict; be responsible for creating, maintaining, and contributing to environments that support the growth of virtues and excellences, and enable nurses to fulfill their ethical obligations.” Further, ANA’s 2006 Workplace Abuse and Harassment of Nurses resolution resolves that nurses should report in­cidents of abuse and advocates that no employee who experiences and reports workplace abuse should face reprisal.

The first step in stopping workplace violence is to interrupt it. The senior management team must be involved in solving this problem and interrupting the violence. As there are no generally accepted standard definitions of workplace violence, it is imperative that the team fully and openly discuss how it is defining workplace violence to ensure that everyone speaks a common language.

Difficult encounters, including high-stakes conversations, must occur to ensure that everyone involved understands they are working toward a common goal. Nurses should look at their own interactions to see if they are exhibiting undesirable behaviors and intervene quickly in any workplace violence situation so it does not escalate.

When bullying or other workplace violence has occurred or is found to be occurring, the employer may offer the services of an employee assistance program that can help support the target of the abuse.

By working together, nurses and management can end this often silent and secretive problem—one that continues to harm nurses and the nursing profession and negatively impact the quality of patient care.

Nancy L. Hughes is the director of ANA’s Center for Occupational and Environmental Health.

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