Who would want to be a nurse? Violence in the workplace--a factor in recruitment and retention

Nursing management of emergency department violence-Can we do more?

BACKGROUND

Emergency departments are the services with the highest risk of violence for nurses. Reports of violence in health care have increased exponentially in the last decade. Front line hospital services are more at risk, and worldwide there are attempts to quantify, manage and prevent episodes of violence, but no consistent solutions have yet been identified.

AIMS

To stimulate reflection on causal factors of violence against nurses in emergency departments and discuss potential solutions and strategies for aspects that largely remain unresolved.

DESIGN

A position paper underpinned by experiences and evidence reported in the literature.

METHODS

A search of Scopus and CINAHL using the term 'violence' provided information concerning the prevalence of the term 'violence' in contemporary literature and enabled to capture a general overview of contributing factors of violence and current approaches to its management and prevention.

CONCLUSIONS

However, while risk factors have been identified, there is a tendency to over accentuate the extent of their contribution. The main risk factors present conditions related to or accompanied by mental illness and the impact of overcrowding and long waiting times.

RELEVANCE TO CLINICAL PRACTICE

More is needed in terms of implementation of more far-reaching, holistic, practical and effective management solutions to promote nurses' safety and adequately support vulnerable patients.

What Goes Around Comes Around: How Perpetrators of Workplace Bullying Become Targets Themselves

In this study, we investigated whether and how perpetrators of bullying become targets themselves. Building on the notion of bullying as an escalation process and the Conservation of Resources Theory, we hypothesized that following enactment of bullying, people would experience increased relationship conflicts with colleagues, diminishing their sense of control and making them more likely to become exposed to bullying themselves. We tested this idea using longitudinal sequential mediated Structural Equation Modelling in a sample of 1420 Belgian workers. Our results confirmed that enactment of bullying lead to more exposure to bullying 18 months later. Relationship conflicts partially mediated this effect, meaning that bullying enactment can lead to increased tensions with others at work, increasing one’s vulnerability to bullying exposure. Although perceived control also mediated the enactment-exposure relationship, relationship conflicts did not lead to perceived loss of control, suggesting a missing link in this relationship. Furthermore, the effect from perceived control to exposure to bullying was small and did not replicate in post-hoc analyses. Our findings suggest that people may experience a backlash from others in their work environment following engagement in bullying behavior at work and invite further exploration of the processes that may account for this relationship.

Caregivers facing violence in long-term care setting: A cross analysis of incident reports and caregivers speech

BACKGROUND

Workplace violence is frequent, especially in long-term care, but often unreported.

AIMS

The aim of this study is to identify workers experiences and coping strategies when they face physical aggression from residents and assess the value of incident reports for violence follow-up.

METHODS

This mixed method study is based on incident reports collected over 3 years from two different long-term care geriatric facilities in France and thematic analysis of 20 semi-structured interviews of nurses and nursing assistants.

RESULTS

The reported frequencies of physical aggression among respondents range from none to daily aggression. Only 76 incident reports were submitted. Aggressions were under-reported by caregivers who often felt guilty for not having avoided them. Coping strategies included banalization and seeking support from colleagues. Incident reports can constitute a warning signal for the management team but are not a reliable tool for workplace violence follow-up.

CONCLUSIONS

Our study emphasizes the complexity of workplace violence prevention in long-lerm care settings. Proposals can be formulated to train and support caregivers, but a shift from a task-oriented organisation to a patient-centred approach seems necessary to reduce violence.

IMPLICATIONS FOR NURSING MANAGEMENT

Situations to be reported should be better defined, aggression reporting encouraged and judgmental attitudes toward reports discouraged.

What is the impact of patient violence in the emergency department on emergency nurses' intention to leave?

AIM

To examine the impact that patient violence, experienced in the emergency department, has on emergency nurses' intention to leave their job.

BACKGROUND

Emergency departments have become known for their overcrowding, chaos, unpredictability and violence. Emergency nurses are at high risk of experiencing workplace violence, which is cited in the literature as having a direct effect on general nurses' intention to leave. A high rate of nursing turnover may lead to short staffing, jeopardize the quality of patient care and increase overcrowding and wait times.

EVALUATION

A systematic review was undertaken in CINAHL, Medline and Psych INFO databases using published data until November 2021. Six articles were included, and PRISMA guidelines were adhered it.

KEY ISSUES

Workplace violence in the emergency department had a direct impact on emergency nurses' intention to leave and decreased their job satisfaction. Verbal abuse is the most experienced form of workplace violence.

CONCLUSIONS

Workplace violence experienced by emergency nurses in the emergency department had a direct positive impact on their intention to leave and subsequently negative impact on their job satisfaction.

IMPLICATIONS FOR NURSING MANAGEMENT

This review may inform clinical decision-making and aid in the development of clinical practice guidelines for a workplace violence prevention programme, specific to the emergency department.

Working intentions of medical students in response to healthcare workplace violence and descending resources reform in China

BACKGROUND

In order to curb healthcare workplace violence (WPV) and better allocate healthcare resources, China launched the descending resources reform in 2013 and tightened the anti-violence legal environment simultaneously. Medical students are expected to reconsider their working intentions of entering the medical market (inter-market effect) and choosing high- or low-level hospitals (intra-market effect) in response to the evolving WPV. The goal of this study was to explore the link between the perceived WPV incidence and medical students' willingness to practice medicine in the context of China's descending resources reform.

METHOD

Medical students were selected with cluster sampling from 8 medical colleges in Zhejiang Province, China, and 1497 valid questionnaires were collected by using a five-point unbalanced scale, to perform cross-sectional empirical research using the ordered logit model (OLM).

RESULTS

The perceived WPV incidence negatively correlate with the willingness of medical students to practice medicine but positively correlate with their willingness to practice in low-level hospitals, indicating the existence of inter- and intra-market effects. The anti-violence legal environment has no direct link with working intention but contributes to the perceived decline in the incidence of violence. Descending resources reform has simultaneous opposite effects on medical students, with the coexistence of prudent motives driven by reform costs and optimistic expectations of sharing external benefits.

CONCLUSIONS

Safety needs and risk aversion motive play an important role in medical students' career choice when facing severe WPV. Tightening of the anti-violence legal environment and the descending resources reform could drive medical students to low-level hospitals.

‘You live and breathe it…’: Exploring experiences of workplace cyberbullying among New Zealand nurses

Cyberbullying presents a new workplace issue with initial research demonstrating strong links to negative outcomes for individuals and organisations across a range of sectors. Yet, detailed accounts of target experiences of cyberbullying remain largely unexamined. To address this crucial research gap, this study explores nurses' experiences of workplace cyberbullying – a profession with high rates of workplace bullying. Adopting a work environment perspective, this paper provides an in-depth examination of eight cases of workplace cyberbullying that emphasise the practical and theoretical complexities associated with this emerging workplace hazard. Specifically, workplace cyberbullying is often experienced within a broader pattern of bullying behaviours, leading to a potentially wider scope of harm for those involved. A new typology of cyberbullying based on the source of perpetration is also presented that contributes to our growing understanding of the issue while extending the knowledge base for the effective management of workplace cyberbullying.

Abuse and Neglect in Nursing Homes: The Role of Serious Mental Illness

BACKGROUND AND OBJECTIVES

Nursing homes (NH) are serving a large number of residents with serious mental illness (SMI). We analyze the highest ("High-SMI") quartile of NHs based on the proportion of residents with SMI and compare NHs on health deficiencies and the incidence of deficiencies given for resident abuse, neglect, and involuntary seclusion.

RESEARCH DESIGN AND METHODS

We used national Certification and Survey Provider Enhanced Reports (CASPER) data for all freestanding certified NHs in the continental United States from 2014 to 2017 (14,698 NHs; 41,717 recertification inspections; 246,528 deficiencies). Differences in the number of deficiencies, a weighted deficiency score, the deficiency grade, and the facility characteristics associated with deficiencies for abuse, neglect, and involuntary seclusion were examined in High-SMI. Incidence rate ratios (IRR) and odds ratios (OR) were reported with 95% confidence intervals.

RESULTS

High-SMI NHs did not receive more deficiencies or a greater weighted deficiency score per recertification inspection. Deficiencies given to High-SMI NHs were associated with a wider scope, especially Pattern (IRR:1.03;[1.00, 1.07]) and Widespread (IRR:1.07;[1.02, 1.11]). High-SMI NHs were more likely to be cited for resident abuse and neglect (OR:1.49;[1.23, 1.81]) and the policies to prohibit and monitor for abuse and neglect (OR:1.18;[1.08, 1.30]) in comparison to all other NHs.

DISCUSSION AND IMPLICATIONS

Although resident abuse, neglect, and involuntary seclusion are rarely cited, these deficiencies are disproportionately found in High-SMI NHs. Further work is needed to disentangle the antecedents to potential resident abuse and neglect in those with mental healthcare needs.

Workplace Violence and Turnover Intention Among Psychiatrists in a National Sample in China: The Mediating Effects of Mental Health

BACKGROUND

Workplace violence (WPV) in healthcare has received much attention worldwide. However, scarce data are available on its impact on turnover intention among psychiatrists, and the possible mechanisms between WPV and turnover intention have not been explored in China.

METHODS

A cross-sectional survey was conducted among psychiatrists in 41 tertiary psychiatric hospitals from 29 provinces and autonomous regions in China. A stress-strain-outcome (SSO) model was adopted to examine the effects of WPV on mental health and turnover intention. The association and mediation by burnout and stress were examined by multivariate logistic regression (MLR) and generalized structure equation modeling (GSEM).

RESULTS

We invited 6,986 psychiatrists to participate, and 4,520 completed the survey (64.7% response rate). The prevalence of verbal and physical violence against psychiatrist in China was 78.0 and 30.7%, respectively. MLR analysis showed that psychiatrists who experienced verbal violence (OR = 1.15, 95% CI = 1.10-1.21) and physical violence (OR = 1.15, 95% CI = 1.07-1.24) were more likely to report turnover intention. GSEM analysis showed that burnout (β = 4.00, p < 0.001) and stress (β = 1.15, p < 0.001) mediated the association between verbal violence and turnover intention; similarly, burnout (β = 4.92, p < 0.001) and stress (β = 1.80, p < 0.001) also mediated the association between physical violence and turnover intention.

CONCLUSIONS

Experience of WPV is a significant contributor to turnover intention among psychiatrists. Mental health status, such as burnout and stress level significantly mediated the association. Policy makers and hospital administrators need to be aware of this association. Action is needed to promote mental health among the psychiatrists to improve morale and workforce sustainability.

Australian nurses' perceptions about workplace violence management, strategies and support services

AIMS

This study ascertained nurses' perceptions about workplace violence management, strategies and support services.

BACKGROUND

Nurses regularly encounter verbal and physical violence in their workplace. Workplace violence has long-term consequences on nurses' personal lives and professional work ability. However, more needs to be known about nurses' perceptions of violence management and interventions used.

METHODS

Ninety-eight nurses from a regional public hospital in Queensland, Australia, completed a survey about workplace violence. Nurses worked in the Emergency Department, Intensive Care Unit or Mental Health Department.

RESULTS

Ninety-five per cent of nurses stated that all violence should be reported, but 18% would take no action, and 22% would not complete an incident from. Perceptions and preferred responses differed for verbal and physical violence. Low-level interventions and aggression management training were preferred by nurses. Nearly all nurses felt that they should be involved in the development of workplace violence policies.

CONCLUSIONS

Nurses rate aggression management training highly, and they desire more input into violence policies. The under-reporting of violent incidents remains an issue for future management.

IMPLICATIONS FOR NURSING MANAGEMENT

Understanding nurses' perceptions of workplace violence management enables the identification of gaps when applying policy and adopting practical approaches to reduce the incidence and severity of workplace violence.

Psychological adjustment in care providers following restraint of psychiatric patients

Mental healthcare providers face many difficult interactions with patients that can be emotionally demanding and have adverse effects on their well-being. Recent theoretical models suggest that the interpretation of stressful episodes may be more important for psychological adjustment than the nature of the episodes. This study examined whether care providers' interpretations of mechanical restraint episodes were related to their adjustment. We asked 80 mental healthcare providers to recall mechanical restraint episodes and to rate them on centrality to identity and positive and negative influence on self-understanding. They also completed scales measuring current symptoms of post-traumatic stress, depression, life satisfaction, and well-being. The results showed that care providers who interpreted mechanical restraint episodes as having a central negative influence on their identity experienced more symptoms of post-traumatic stress. Care providers who gave higher ratings of positive self-change following episodes reported more well-being. Our findings suggest, that considering care providers' subjective interpretations of episodes and not merely the objective facts surrounding them is critical if we wish to mitigate the negative emotional impact of episodes.

Bullying in the clinical setting: Lived experiences of nursing students in the Central Region of Ghana

INTRODUCTION

Nursing students are confronted with bullies in the classroom and during clinical placement. Acquisition of the necessary psychomotor skills intended during clinical placements may be impeded when workplace bullies intimidate students. This study aimed to describe the various bullying behaviours experienced by nursing students and their effects during clinical placement in the Central Region of Ghana.

METHODS

A qualitative phenomenological descriptive approach using a semi-structured interview guide was employed to collect data from nursing students in focus groups. Overall, six (6) focus groups were used, with five (5) students in each group comprising males and females. The sample size was based on data saturation and was saturated on the six focus group discussions giving a sample size of 30. Purposive sampling was used to select students who had been on the ward at least three clinical placements and had experienced bullying in the clinical setting. In-depth interviews were conducted, recorded, transcribed verbatim and analysed using content analysis.

RESULTS

The study revealed that nursing students had experienced bullying practices such as shouting, isolation, humiliation and being assigned tasks below their competency level. In addition, findings showed that bullying led to a loss of confidence and caused stress and anxiety in nursing students.

CONCLUSION

Therefore, it is recommended that nursing students are mentored holistically in a caring and accepting environment where they will be supported to achieve their learning goals, build their confidence, and develop their personal and professional identity.

A Study Into the Severity of Forensic and Civil Inpatient Aggression

Aggressive incidents occur frequently in health care facilities, such as psychiatric care and forensic psychiatric hospitals. Previous research suggests that civil psychiatric inpatients may display more aggression than forensic inpatients. However, there is a lack of research comparing these groups on the incident severity, even though both frequency and severity of aggression influence the impact on staff members. The purpose of this study is to compare the frequency and severity of inpatient aggression caused by forensic and civil psychiatric inpatients in the same Dutch forensic psychiatric hospital. Data on aggressive incidents occurring between January 1, 2014, and December 31, 2017, were gathered from hospital files and analyzed using the Modified Overt Aggression Scale, including sexual aggression (MOAS+). Multilevel random intercept models were used to analyze differences between forensic and civil psychiatric patients in severity of aggressive incidents. In all, 3,603 aggressive incidents were recorded, caused by 344 different patients. Civil psychiatric patients caused more aggressive incidents than forensic patients and female patients caused more inpatient aggression compared with male patients. Female forensic patients were found to cause the most severe incidents, followed by female civil psychiatric patients. Male forensic patients caused the least severe incidents. The findings have important clinical implications, such as corroborating the need for an intensive treatment program for aggressive and disruptive civil psychiatric patients, as well as emphasizing the importance of gender-responsive treatment.

Exposure to workplace trauma for forensic mental health nurses: A scoping review

BACKGROUND

Forensic mental health is a challenging workplace, with nurses subject to various trauma exposures in their professional role.

OBJECTIVES

To identify the key concepts related to the nature, extent and impact of workplace trauma for forensic mental health nurses.

DESIGN

A scoping review, informed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) tool.

METHODS

Sources of evidence were identified and assessed for inclusion using an explicit search strategy. Relevant information was extracted and synthesised to present a descriptive summary of existing evidence.

RESULTS

Of the 16 articles on workplace trauma for forensic mental health nurses included in the review, nine reported data related to extent (incidence and severity) and 14 described the impact. The incidence (per bed/per year) of each workplace trauma type ranged from 0.95 - 7.15 for physical violence, 0.39-5.12 for verbal abuse, 0.03-0.12 for sexual violence, and 1.47-7.9 for self-harming behaviour. The proportion of incidents at the lowest severity rating ranged from 15.1% to 84.7%, and the range for the highest severity rating was 0% to 38.7%. In the single study that examined the incidence of vicarious trauma, 14.9% reported low levels and 27.7% reported high levels. Psychological distress was the most commonly reported impact of workplace trauma, identified in eight studies. Seven studies reported limited data for physical injury from workplace trauma. The impacts of exposure to workplace trauma reported in the remaining studies included needing to access psychological support, experiencing physiological symptoms, feeling less safe at work, and requiring time off work. With the exception of two studies providing limited data related to absenteeism, the impact for organisations was not explored in existing literature.

CONCLUSIONS

While studies indicated that forensic mental health nurses are frequently exposed to various forms of workplace trauma, reports of severe assaults on staff were rare. Although limited, these findings suggest that cumulative exposure to workplace trauma over time, or exposure to more severe forms of physical violence, increase forensic mental health nurse vulnerability to experiencing detrimental impacts on their personal and professional wellbeing.

Whose fault is it? Attribution of causes of patient violence among exposed and unexposed community-based family physicians

Extensive research has dealt with violence directed at healthcare workers in hospital settings; however, few studies have examined community-based settings. Furthermore, there is also scant literature regarding the perceptions of healthcare providers who were exposed to violence, compared to those who were not. This study aims to narrow these gaps in the literature by examining community-based family physicians' (CBFPs) perceptions in a large national Health Maintenance Organisation (HMO) regarding patient-initiated violence. Using a voluntary online survey, directed at all CBFPs working at the HMO, 412 CBFPs were surveyed on the following issues: exposure to violence initiated by patients or their family members; perceptions of violent occurrences and possible safety measures. The differences between CBFPs who had been exposed to violence and those who had not were compared. The majority of CBFPs reported experiencing verbal attacks (64%), and a small percentage experienced property-related violence (11.7%) or physical violence (3.4%). Comparing CBFPs who were exposed to violence with those who were not, regarding their perceptions of the 'causes of violence', revealed three differentiating factors: 'waiting time', 'failure to meet the patient's expectations' and 'the nature of the physician-patient encounter'. Regarding the desired preventive actions, the four differentiating factors were as follows: 'reduction in the number of patients per physician', 'improved queue management processes', 'longer meetings' and 'violence prevention training'. Conducting separate analyses, according to violence type (verbal abuse, vandalism or physical violence), indicated finer differentiations. In terms of Attribution Theory, one might argue that CBFPs who were directly exposed to patients' aggression attributed internal locus to the attacker, and tended to blame the attacker's personal characteristics and cultural values. Conversely, family CBFPs who were not attacked attributed external locus to situational factors such as waiting time, not receiving service, and the nature of the interaction between the attacker and the CBFP.

Effects of a Workplace Violence Intervention on Hospital Employee Perceptions of Organizational Safety

OBJECTIVE

To examine hospital employee perceptions of organizational safety one-year following a workplace violence intervention and to evaluate perceptions based on violence exposure status.

METHODS

In 2014, 343 employees across 41 hospital units (N = 21 control units, N = 20 intervention units) completed a questionnaire capturing organizational safety perceptions and violence exposure.

RESULTS

Intervention unit employees reported more positive perceptions of organizational safety compared to control unit employees. However, intervention group employees who experienced patient-to-worker violence (Type II) had significantly more positive perceptions than those who experienced worker-to-worker violence (Type III).

CONCLUSIONS

Organizational safety perceptions improved following a violence-prevention intervention, especially among employees who reported Type II violence. Certain employees report worsened safety perceptions. Hospitals and units that implement violence prevention interventions should strive to address all types of violent behavior.

Associations among patient care workers' schedule control, sleep, job satisfaction and turnover intentions

Healthcare is the fastest growing occupational sector in America, yet patient care workers experience low job satisfaction, high turnover, and susceptibility to poor sleep compared to workers in other jobs and industries. Increasing schedule control may be one way to help mitigate these issues. Drawing from conservation of resources theory, we evaluate associations among schedule control (i.e. a contextual resource), employee sleep duration and quality (i.e. personal resources), job satisfaction, and turnover intentions. Patient care workers who reported having more schedule control at baseline reported greater sleep duration and sleep quality 6 months later, as well as higher job satisfaction and lower turnover intentions 12 months later. Workers who experienced greater sleep sufficiency (i.e. feeling well-rested) reported higher job satisfaction 6 months later, and workers who experienced fewer insomnia symptoms (i.e. trouble falling and staying asleep) reported lower turnover intentions 6 months later. The association between schedule control and job satisfaction was partially mediated by greater sleep sufficiency, though this effect was small. Providing patient care workers with greater control over their work schedules and opportunities for improved sleep may improve their job attitudes. Results were not replicated when different analytical approaches were performed, so findings should be interpreted provisionally.

Addressing Aggression in the Residential Setting for Juveniles with Mild Intellectual Disability through Training in Non-Violent Resistance

Background

Levels of aggression are high in residential settings for juveniles with Mild Intellectual Disability (MID). As a result, treatment is less effective, aggression causes injury, traumatic experiences and longer inhabitation for juveniles. Additionally, inpatient aggression has been linked to burnout and stress among group workers, which has negative consequences such as less job satisfaction or poorer work performance

Objective

Therefore, it is crucial to diminish aggressive incidents in these settings and to find a way for staff how to respond to aggression properly.

Methods

As there is no intervention method which tackles all of the referred problems efficiently, a new method Non-violent Resistance for MID was introduced into three residential settings for juveniles with MID, in a quasi-experimental stepped wedge design. Reports of aggressive incidents were assessed seven times before, during and after the training in NVR-MID on group level. Multilevel analyses were carried out in order to assess the development of the aggressive incidents over time.

Results

Aggressive incidents decreased significantly in time during and after training in NVR-MID, this decrease is seen in all three institutions. Thus, regardless of resident’s age, gender or IQ, NVR-MID seemed successful in diminishing aggressive incidents. Furthermore, a significant interaction effect was found between institution and time, indicating that regardless if incidents of aggression were relatively high at baseline, decrease in incidents was similar to institutions where incidents were relatively low on baseline.

Conclusions

Implementing NVR-MID into residential settings for juveniles with MID and comorbid behavioral problems might help to decrease aggressive incidents.

Verbal abuse and psychological disorders among nursing student interns in KSA

Objective

This study aimed to investigate the forms and frequency of verbal abuse (VA) among nursing student interns and determine the prevalence of psychological disorders (i.e. depression, stress, and anxiety) within this group.

Materials and methods

A cross-sectional study was conducted in an urban teaching hospital in KSA. Nursing student interns responded to the Verbal Abuse Questionnaire and Depression Anxiety Stress Scales.

Results

A total of 54 interns completed the questionnaires; 55% of them had been exposed to one type of VA at least once a year, and 5% of them had experienced VA several times a week. ‘Ignoring’ was the most frequently experienced form of VA (50.8%), and feeling overwhelmed was the most commonly experienced emotional reaction (51.1%) to VA. ‘Stop talking to the abusive person’ was the most frequently reported behavioural reaction to VA (57.9%). Most of them (59.3%) did not report a sign of depression, but 18.5% of them had severe to extremely severe depression. Most interns (70.4%) did not report a sign of anxiety, but approximately 11.1% of them had severe to extremely severe anxiety. A majority (70.4%) of the interns did not report a sign of stress, and only 5.6% of them reported experiencing severe stress.

Conclusion

VA is a major problem that is encountered in clinical settings, especially by future nurses. The present findings underscore the need to further examine the levels and forms of VA that are experienced by them and their reactions to such stress-inducing behaviours.

Bibliometric analysis of Journal of Nursing Management from 1993 to 2018

AIM

This study presents a general bibliometric overview of the developmental status of Journal of Nursing Management from its first issue (1993) to 2018.

BACKGROUND

Bibliometric method is proved to be effective in analysing the publication characteristics and influence of a given journal, and it gained considerable interest from the scientific community in recent years. However, to the best of our knowledge, bibliometric approach was not previously used to analyse the publications of Journal of Nursing Management.

METHODS

A total of 1,913 publications of Journal of Nursing Management were retrieved from Scopus database. Bibliometric analysis was used to explore the dynamic trends of publications and to identify most influential authors, institutions, countries and research teams in this journal. This paper also uses the VOS viewer software to graphically map the hot topics of Journal of Nursing Management.

RESULTS

After a rapid growth from 2006 to 2008, the number of publications of Journal of Nursing Management tends to stabilize with exception of several years in the latest 11 years. The top prolific institutions are mainly from the UK, Canada, Finland and Sweden, and Journal of Nursing Management has attracted increasing attention from researchers around the world. Nursing, nurses, management, leadership and job satisfaction are the most frequently used keywords in Journal of Nursing Management.

CONCLUSION

Nursing management, nursing leadership/leaders, nursing human resource management, nursing quality and safety management, nursing communication, and conflict management have always been popular topics in Journal of Nursing Management.

IMPLICATIONS FOR NURSING MANAGEMENT

This study informs scholars and managers within nursing management field about structured knowledge of the research status and development of Journal of Nursing Management.

Promoting anti-corruption, transparency and accountability in the recruitment and promotion of health workers to safeguard health outcomes

Background: Human Resources for Health are a core building block of a health system, playing a crucial role in improving health outcomes. While the existing literature has examined various forms of corruption that affect the health sector, few articles have examined the role and impact of corruption in the recruitment and promotion of health-workers.Objectives: This study reviews the role of corrupt practices such as nepotism, bribery and sextortion in health-worker recruitment and promotion and their implications for health systems.Methods: The study is based on an interdisciplinary non-systematic review of peer-reviewed journal articles in the public health/medicine and political science literature, complemented with the 'grey' literature such as technical reports and working papers.Results: Political and personal ties, rather than merit are often factors in the recruitment and promotion of health-workers in many countries. This results in the employment or promotion of poorly qualified or unsuitable workers, with negative implications for health outcomes.Conclusion: Corrupt practices in health-worker recruitment and promotion 'set the tone' for other forms of corruption such as absenteeism, embezzlement, theft and bid-rigging to flourish, as those recruited corruptly can collude for nefarious purposes. On the other hand, merit-based recruitment is important for curbing corruption. Corrupt recruitment practices have deleterious effects on health-worker motivation and retention, quality and competency, citizens' trust in health services and health outcomes. Whereas international law and policy such as the United Nations Convention Against Corruption and the WHO Handbook on Monitoring and Evaluation of Human Resources for Health state that recruitment of public officers and health workers respectively should be done in a transparent and accountable manner, more research is needed to inform policies on merit-based recruitment.

Factors and Characteristics of Workplace Violence Against Nurses: A Study in Iran

Violence against nurses is a serious problem that can affect negatively the quality of nursing care. The extent of violence against nurses in Iran and the factors leading to this violence have not been known. Thus, the aim of this study was to investigate all forms of violence against nurses in Shahrekord hospitals in 2014. In this 2014 study, 100 nurses working in Shahrekord's Hajar, Kashani, and Social Security branch hospitals were studied. Data were collected through standardized questionnaires on workplace violence, as well as demographic data, in health units on five types of violence, including physical and verbal violence, intimidation and bullying, ethnic violence, and violation of chastity. The analysis was done by SPSS (Version 19) software. All nurses indicated that during some period of their work, they had been subjected to at least one type of violence; the highest prevalence of mental violence was belonged to the subtype of intimidation and bullying (91%). The primary agents of violence against nurses were patients and their relatives. Factors such as gender, age, work experience, and nursing shifts played important roles in the distribution of violence. In ethnic violence, the only factor affecting nurses was race (p < .05). The highest rate of violence against nurses was due to mental or psychological violence. To minimize violence in hospitals, authorities should consider appropriate preventive strategies, good management, proper protective measures, and public education.

Are perspective-taking outcomes always positive? Challenges and mitigation strategies

BACKGROUND

Engaging in perspective-taking often has positive outcomes for both healthcare providers and patients. Perspective-taking by healthcare providers has been linked to increased patient satisfaction and compliance, patients' positive perceptions of healthcare providers' interpersonal skills, and a reduction in judgmental attitudes toward individuals who engage in health-risk behaviors. The positive outcomes that are associated with perspective-taking are often highlighted in the literature. However, less discussed are the negative outcomes.

AIM

This paper discusses the positive and negative outcomes associated with perspective-taking and presents potential methods for mitigating negative outcomes.

CONCLUSION

When designing and implementing perspective-taking interventions, educators and researchers should consider potential negative intervention outcomes and strategies to attenuate these outcomes.

An Economic Model of Optimal Penalty for Health Care Workplace Violence

This article provides an economic model on the optimal penalty of health care workplace violence based on health care workplace classification and cost structure, aiming to deter potential offenders. By developing an EIP (externality, identifiability, and preventability) analytical method, we distinguish the characteristics of different workplaces and find that the health care workplace is the combination of externality, low identifiability, and low preventability. Besides the private cost to victims for ordinary workplace violence, the cost structure of health care workplace violence includes social costs like externality-related public safety cost, defensive medicine cost, and specific factors cost. When the optimal penalty corresponding to different levels of health care workplace violence increases, the threshold level of punishable violence decreases after incorporating the social costs into analysis. Our model shows that public safety costs are positively correlated with the importance of health care workplace in the service network, and a higher public safety cost should be matched with a greater optimal penalty.

Prevalence of verbal and physical workplace violence against nurses in psychiatric hospitals in China

OBJECTIVE

Workplace violence (WPV) is common in mental health services in China, but its multi-center prevalence measured using standardized rating scales has rarely been reported. This study aimed to explore the prevalence of verbal and physical violence against nurses working in psychiatric hospitals and examine its independent socio-demographic correlates in China.

METHODS

This was a cross-sectional study conducted in 11 major psychiatric hospitals in China using a 9-item self-reported workplace violence scale.

RESULTS

A total of 1906 psychiatric nurses were recruited to participate in this study. The one-year prevalence of verbal and/or physical workplace violence (WPV) was 84.2% (95% CI: 82.4-85.8). The prevalence rates of verbal abuse, threats and physical violence were 79.3% (95% CI: 77.4-81.1), 70.9% (95% CI: 68.8-73.0) and 57.9% (95% CI: 55.7-60.2), respectively. Multiple logistic regression analysis revealed that working in department of psychiatry (OR = 3.42, P < 0.001), having moderate (OR = 2.05, P = 0.009), severe (OR = 2.04, P = 0.015) or extremely severe (OR = 3.21, P < 0.001) anxiety level of WPV and working in hospitals with a WPV reporting system (OR = 1.88, P < 0.001) were significantly associated with WPV.

CONCLUSION

WPV against nurses is a serious occupational and public health concern in Chinese psychiatric hospitals. Appropriate preventive measures should be undertaken to reduce the risk of WPV in healthcare settings.

Aggression against middle and high school teachers: Duration of victimization and its negative impacts

Prior research indicates that student aggression against teachers is widespread, and it has negative impacts on victimized teachers' emotional and physical well-being and job performance. However, little is known about the relationship between the recency and duration of victimization and teachers' thoughts about quitting the teaching profession and related job dissatisfaction and disconnectedness to school. Analyses of data from a longitudinal study of 1,236 US teachers fills these gaps. The study found that many teachers experienced theft/vandalism and sexual harassment victimization that was limited to just 1 year. In contrast, sizeable proportions of teachers experienced verbal abuse and nonphysical contact aggression that occurred over 2 years. Multiple regression analyses showed that teachers who reported recent or multiyear victimization had lower levels of connectedness to school, less job satisfaction, and more thoughts about ending their teaching careers. These results may indicate that unless victimization recurs, negative effects of victimization are contemporaneous and are less likely to persist. Additional research is needed to examine victimization over longer than 2 years, investigate the effects of the frequency of different types of aggression against teachers, and identify school policies and interventions that weaken the connection of victimization to negative outcomes.

Disrupting gender norms in health systems: making the case for change

Restrictive gender norms and gender inequalities are replicated and reinforced in health systems, contributing to gender inequalities in health. In this Series paper, we explore how to address all three through recognition and then with disruptive solutions. We used intersectional feminist theory to guide our systematic reviews, qualitative case studies based on lived experiences, and quantitative analyses based on cross-sectional and evaluation research. We found that health systems reinforce patients' traditional gender roles and neglect gender inequalities in health, health system models and clinic-based programmes are rarely gender responsive, and women have less authority as health workers than men and are often devalued and abused. With regard to potential for disruption, we found that gender equality policies are associated with greater representation of female physicians, which in turn is associated with better health outcomes, but that gender parity is insufficient to achieve gender equality. We found that institutional support and respect of nurses improves quality of care, and that women's empowerment collectives can increase health-care access and provider responsiveness. We see promise from social movements in supporting women's reproductive rights and policies. Our findings suggest we must view gender as a fundamental factor that predetermines and shapes health systems and outcomes. Without addressing the role of restrictive gender norms and gender inequalities within and outside health systems, we will not reach our collective ambitions of universal health coverage and the Sustainable Development Goals. We propose action to systematically identify and address restrictive gender norms and gender inequalities in health systems.

Nurses Between the Hammer and the Anvil: Analyzing the Role of the Workplace Prevention Climate in Reducing Internal and External Violence

The aim of this study was to test a model including relationships among internal and external violence, workplace violence-prevention climate, exhaustion, and intention to leave (ITL) in a sample of nurses. Data were collected by a self-report questionnaire involving nurses (n = 313) from two multispecialist hospitals in Italy. The survey was cross-sectional and nonrandomized. Path analyses showed the presence of the mediating role of internal violence between workplace prevention climate and exhaustion, as well as the mediating function of both types of violence between workplace prevention climate and ITL. Moreover, an indirect effect through exhaustion between internal violence and ITL was highlighted. These findings suggested that organizations that invest in preventive measures may reduce incidents of violence and, in turn, prevent negative consequences on worker well-being.

The relationship between physical work hazards and employee withdrawal: The moderating role of safety compliance

We examined the relationship between physical work hazards and employee withdrawal among a sample of health care employees wherein safety compliance was hypothesized to moderate the relationship between physical work hazards and withdrawal. Health care workers (N = 162) completed an online questionnaire assessing physical work hazards, withdrawal, and indicators of workplace safety. Safety compliance moderated the relationship between patient aggression and withdrawal. Interaction plots revealed that for all significant moderations, the relationship between physical work hazards and withdrawal was weaker for those who reported high levels of compliance. Results shed initial light on the benefits of fostering safety compliance in health care contexts, which can contain exposure to physical work hazards.

Development and validation of an instrument to measure stress among older adult nursing students: The Student Nurse Stressor-15 (SNS-15) Scale

AIMS AND OBJECTIVES

To report the development, testing and validation of an instrument to assess the stressors experienced by student nurses during their older adult clinical placements.

BACKGROUND

The world's population of older adults is accelerating rapidly, with associated increased healthcare demands and a growing need for skilled nursing staff. However, this sector fails to attract adequate numbers of nursing graduates which is leading to a significant gap between nursing supply and demand. Older adult care is considered to be less attractive than other specialties and accompanied by more sources of stress.

DESIGN

A quantitative design was used.

METHODS

Data were collected from a cohort of Irish student nurses (n = 242) completing older adult clinical placements as part of their undergraduate degree. Exploratory and confirmatory factor analysis examined the instrument's underlying latent structure. Discriminant validity was investigated using a confirmatory factor analysis model with covariates. STROBE guidelines for cross-sectional studies informed reporting of this paper's research.

RESULTS

Factor analyses identified two factors relating to "Knowledge and Workload" and "Resources," which were assessed by nine and six items, respectively. Discriminant validity analyses found a significant relationship between age and the workload and knowledge factor, and between year of programme and the resources factor. The new instrument was labelled the Student Nurse Stressor-15 (SNS-15) Scale.

CONCLUSIONS

The SNS-15 contained some overlap with stressors from extant general student nurse stress instruments and a number of unique stressors encountered in older adult care. Future research directions are discussed.

RELEVANCE TO CLINICAL PRACTICE

The SNS-15 may assist stakeholders in nurse education and practice with the development of undergraduate degree programmes and clinical placements, and ultimately, in improving patient care and student retention.

Horizontal violence among nurses: Experiences, responses, and job performance

Horizontal violence (HV), or nonphysical intergroup conflict expressed in overt and covert behaviors of hostility, is pervasive in nursing and has been discussed in the literature for more than two decades. It is costly and has potentially devastating effects including high nurse turnover rates, increased illness, decreased productivity, and decreased quality of patient care. Recognizing how these behaviors are established and sustained is necessary if nurses are to overcome these types of behaviors. This mixed methods study used an online survey to examine 76 hospital nurses' experiences and responses to episodes of HV as well as its effects on job performance. Seven of these nurses answered more in-depth questions during a follow-up interview. Nurses in this study recognize HV as a phenomenon that occurred early in their careers as novice nurses. The literature suggests that these behaviors are evident during nursing education. The academic environment is an ideal place to teach the skills necessary to respond appropriately to HV with peer support being essential. Nurses also reported that manager and staff support and workplace education were the most helpful in reducing HV. Increased workload and stress and HV being accepted practice on the unit were factors identified as most important in promoting HV. Further, nurses cited reasons why they continue in their jobs after episodes of HV. Intervention studies are needed to test effective ways of reducing this very difficult behavior among nurses in the workplace.

Future Emergency Nursing Workforce: What the Evidence Is Telling Us

INTRODUCTION

In Australia, on any given day, there are more than 300 advertised emergency nursing positions, and this situation can be replicated in nearly every country internationally. The nursing shortage globally is known. The importance of not only why nurses specialize in the field of emergency nursing but also why they remain in the field requires an understanding of the evidence and research into nursing recruitment and retention. Leadership within the emergency department has a strong correlation to staff retention. It is hoped that, by gaining a greater understanding of the elements that influence staff retention, we will be able to lay down a strong foundation for the future of emergency nursing.

METHODS

This literature review used a bibliographic search as well as the author's own experience.

RESULTS

This article presents the key factors that have impact on emergency nursing retention: workplace environment, demands on emergency nurses, resilience, and education and training.

DISCUSSION

Emergency nursing recruitment and retention is a multifaceted issue that requires urgent attention to develop tools and strategies to support organizations to build a sustainable workforce. This literature review has highlighted the need for further studies to understand why emergency nurses lack the knowledge or capability for a long-term career in emergency nursing.

Autoethnography and cognitive adaptation: two powerful buffers against the negative consequences of workplace bullying and academic mobbing

Work is undoubtedly fundamental to human life, social development and the economic development of individuals, organizations and nations. However, the experience of working is not always pleasant as there are many instances where relationships between workers could deteriorate, leading to practices and behaviours that could be characterized as workplace bullying and/or mobbing. The current study is an exploratory study which used autoethnography to investigate experiences of academic bullying and mobbing, and relates the practices to power structures in academic institutions. Specifically, the author shares personal experiences and explores the physical and emotional pain of being bullied and mobbed. The author also outlines how both autoethnography and meaning in life strategies were used to cope with the physical and emotional distresses associated with the negative experiences. By outlining the success of the meaning in life strategies, the author hopes to inspire other "victims" to move from victims to being survivors of bullying and mobbing.

Verbal and Non-Verbal Aggression in a Swiss University Emergency Room: A Descriptive Study

Workplace violence (WPV) by patients and visitors is a hazard in many emergency departments (ED), with serious consequences for both staff and patients. Patients with a migratory background seem to be prone to being involved in WPV. We therefore reviewed all reports of ED staff who experienced WPV over a 4-year period (2013–2016). We analyzed data on the reasons for the incident, the time of day, the manner of violence, the consequences, and the migratory background of the aggressor. In total, 83 cases of WPV were reported over a four-year period. The average age of the violent person was 33.1 years; in 35 cases (42.0%), aggressors were younger than 30 years old, 53 (63.8%) were male, 49 (59%) were of Swiss nationality, and 35–40% had a migratory background. The odds ratio of people originating from a low- to middle-income country versus those originating from a high-income country was 1.8. Furthermore, 45.8% of the patients arrived by ambulance (n = 38) and 19 patients (22.9%) were self-presenting. Most cases (92.8%) involved verbal aggression, but in more than half of the cases, physical assault (56.6%) was also reported. In addition, 43 (51.8%) of the events occurred during the night. Results also showed that 42 (50.6%) of patients who were involved in WPV were under the influence of alcohol and 29 (34.9%) suffered from psychiatric disorders. Security personnel and police were involved in 53 (63.9%) and 47 (56.6%) cases, respectively. Twenty patients (24.1%) were sedated and 16 (19.3%) were restrained. In 18 cases (21.7%), the psychiatrist ordered compulsory hospitalization in a psychiatric institution. Taken together, WPV is a relatively common event in our ED and persons with a migratory background are involved more often relative to their frequency of ED visits.

Factors influencing workplace violence risk among correctional health workers: insights from an Australian survey

Little is known about the environmental and organisational determinants of workplace violence in correctional health settings. This paper describes the views of health professionals working in these settings on the factors influencing workplace violence risk. All employees of a large correctional health service in New South Wales, Australia, were invited to complete an online survey. The survey included an open-ended question seeking the views of participants about the factors influencing workplace violence in correctional health settings. Responses to this question were analysed using qualitative thematic analysis. Participants identified several factors that they felt reduced the risk of violence in their workplace, including: appropriate workplace health and safety policies and procedures; professionalism among health staff; the presence of prison guards and the quality of security provided; and physical barriers within clinics. Conversely, participants perceived workplace violence risk to be increased by: low health staff-to-patient and correctional officer-to-patient ratios; high workloads; insufficient or underperforming security staff; and poor management of violence, especially horizontal violence. The views of these participants should inform efforts to prevent workplace violence among correctional health professionals.

A Qualitative Study of Difficult Nurse-Patient Encounters in Home Health Care

The purpose of this study was to explore nurse-patient encounters from the perspective of the home health care registered nurse. A qualitative descriptive design was used to collect data from a purposive sample of 20 nurses from Connecticut, Massachusetts, and Rhode Island currently or previously employed as a home health care nurse. Four themes and 1 interconnecting theme emerged from the data: objective language; navigating the unknown; mitigating risk; looking for reciprocality in the encounter; and the interconnecting theme of acknowledging not all nurse-patient encounters go well. Three types of encounters-constructive, nonconstructive, and destructive-were defined.

Aggression and violence in healthcare and its impact on nursing students: A narrative review of the literature

Aggression and violence is a significant social problem in many countries and an increasing problem in healthcare settings in which nurses are particularly vulnerable. The literature suggests that aggression and violence has a significant negative impact upon nurses and potentially upon nursing students and can result in these staff members experiencing stress as a direct result of these adverse events. The literature suggests that there is confusion over what constitutes aggression and violence in the workplace and therefore a true lack of understanding of the scale of the problem relating to nursing students. This review proposes that nursing students are indeed at significant risk of aggression and violence in the clinical setting which has the potential to significantly impact their role as a novice carer. Furthermore, aggression and violence can manifest negative stress responses in individuals, therefore, the potential for nursing students to cope with stressful situations shall be presented.

Well-Being and Safety Among Inpatient Psychiatric Staff: The Impact of Conflict, Assault, and Stress Reactivity

Psychiatric staff are faced with multiple forms of hostility, aggression, and assault at work, collectively referred to as workplace violence, which typically is activated by patients but can also come from coworkers and supervisors. Whether workplace violence adversely affects staff well-being may be related not only to its presence, but also to an individual's stress reactivity. At a large public psychiatric hospital, an online survey was completed by 323 clinical care staff, of whom 69.5 % had experienced physical assault in the previous 12 months. Staff well-being (depression, anger, and physical health) and staff safety concerns were adversely affected by conflicts with other staff members and by individual reactivity to social conflict and to assault. To improve staff well-being, in addition to safety protocols, interventions should target staff relationships, personal health maintenance practices, and individual coping skills for dealing with adverse workplace experiences.

"I was yelled at, intimidated and treated unfairly": Nursing students' experiences of being bullied in clinical and academic settings

AIMS AND OBJECTIVES

To present findings from a study that explored nursing students' experiences of bullying in clinical and academic settings, the strategies used to negotiate bullying and recommendations for empowering future students.

BACKGROUND

Nursing students are identified as a group who are at particular risk of bullying. Numerous studies have examined students' experiences of bullying in clinical contexts by qualified nurses; however, there has been far less attention to the bullying that occurs in academic settings where the perpetrators are university staff and other students.

DESIGN

The qualitative findings presented in this paper form one component of a mixed-methods, multisite study that examined the nature and extent of bullying in one cohort of nursing students.

METHODS

A convenience sample of 29 first-, second- and third-year undergraduate nursing students from one semimetropolitan Australian university was recruited for semistructured interviews in 2014. Interview data were analysed using NVivo.

FINDINGS

Participants described multiple examples of bullying occurring in both clinical and academic settings. Perpetrators included clinicians, facilitators, academics and fellow students. Bullying ranged from incivility to physical attacks. The impact of the bullying was profound; it caused many of the participants to feel anxious and distressed, it undermined their confidence and perception of competence, and it often led them to question their career choice. Strategies described by participants to cope with or manage the bullying included avoidance, trying to "just survive" and seeking support from trusted academic staff, family and friends. No episodes of bullying were formally reported.

CONCLUSION

Bullying remains a pervasive phenomenon occurring in both clinical and academic settings. Students are, in many respects, a vulnerable and disempowered population who often fear the consequences of making a formal complaint. Thus, reporting structures and support strategies need to be re-examined, and resilience training is imperative.

RELEVANCE TO CLINICAL PRACTICE

Bullying remains a continuing concern in undergraduate nursing degrees. Efforts must be made in clinical and academic settings to heed the advice of undergraduates using broader strategies to address the issues.

A qualitative meta-synthesis of emergency department staff experiences of violence and aggression

INTRODUCTION

Patient and visitor violence or aggression against healthcare workers in the Emergency Department (ED) is a significant issue worldwide. This review synthesises existing qualitative studies exploring the first-hand experiences of staff working in the ED to provide insight into preventing this issue.

METHOD

A meta-ethnographic approach was used to review papers.

RESULTS

Four concepts were identified: 'The inevitability of violence and aggression'; 'Staff judgments about why they face violence and aggression'; 'Managing in isolation'; and 'Wounded heroes'.

DISCUSSION

Staff resigned themselves to the inevitability of violence and aggression, doing this due to a perceived lack of support from the organisation. Staff made judgements about the reasons for violent incidents which impacted on how they coped and subsequently tolerated the aggressor. Staff often felt isolated when managing violence and aggression. Key recommendations included: Staff training in understanding violence and aggression and clinical supervision.

CONCLUSION

Violence and aggression in the ED can often be an overwhelming yet inevitable experience for staff. A strong organisational commitment to reducing violence and aggression is imperative.

Mental Health Nurse's Exposure to Workplace Violence Leads to Job Stress, Which Leads to Reduced Professional Quality of Life

Professional quality of life (ProQOL) reflects how individuals feel about their work as helpers. Psychiatric ward nurses cope with significant psychological and physical challenges, including exposure to verbal and physical violence. This study was based on two aspects of ProQOL, the positive compassion satisfaction, and the negative compassion fatigue, with the aim of investigating the relation of ProQOL to job stress and violence exposure at a large mental health center. Data were collected from 114 mental health nurses (49/63 M/F) who completed a self-administered questionnaire examining violence exposure, ProQOL, and job stress. The results showed that during the last year, almost all nurses (88.6%) experienced verbal violence, and more than half (56.1%) experienced physical violence. Only 2.6% experienced no violence. ProQOL was not associated with violence exposure but was reduced by work stress and by previous exposure to violence; nurses who perceived their work as more stressful had lower satisfaction from their work. In conclusion, although most mental health nurses are exposed to physical and verbal violence, their ProQOL is more related to job stress than to workplace violence (WPV). Hospital managements should conduct work stress reduction intervention programs and promote strategizes to reduce WPV. Further exploration of (a) factors affecting ProQOL and (b) the effect of violence coping workshops on ProQOL is warranted.