The aftermath of workplace violence among healthcare workers: A systematic literature review of the consequences
Introduction
Work plays a major role in our society where employment is considered to be the norm. It has been established that work has several benefits on health (Waddell & Burton, 2006). However, when the workplace becomes a “toxic environment”, job tenure becomes a complex problem, such as when a worker is the victim of workplace violence. Indeed, workplace violence constitutes a serious safety and health hazard and in the last decade, it has become a major issue.
Prevalence estimates of workplace violence vary considerably from one study to another, depending on the specific type of violence measured, the employment sector, the country in which the study was conducted, and the definition and measures that were used for workplace violence. According to the U.S. Bureau of Labor, Bureau of Justice Statistics (Harrell, 2011), a rate of 4 violent crimes per 1000 employed persons was perpetrated while the victims were working. A European study found that the prevalence of physical violence in the workplace is 5% (Parent-Thirion, Macias, Hurley, & Vermeylen, 2007). In Canada, workplace violence incidents represent 17% of all self-reported incidents of violent victimization (which represents over 356 000 acts per year). A recent systematic review of the literature found that verbal abuse was the most prevalent form of workplace violence (Guay, Goncalves, & Jarvis, 2014).
Several studies have demonstrated that some employment sectors are more at risk of exposure to workplace violence: healthcare (de Léséleuc, 2007, Foley and Rauser, 2012), psychiatric wards/hospitals (Chen et al., 2010, Nolan et al., 2001), elderly care facilities (Åström et al., 2002, Sharipova et al., 2008), transportation sector (André et al., 1997, Couto and Lawoko, 2011), teaching (Buck, 2006, Wilson et al., 2011), law enforcement (Dussault et al., 2010, Konda et al., 2012), and retail sales (Menéndez et al., 2013, Peek-Asa et al., 1999). In their systematic review of the literature on workplace violence, Piquero, Piquero, Craig, and Clipper (2013) stated that workers within the healthcare, education, public safety, retail and justice industries are more prone to experience workplace violence. However, throughout the world, healthcare is the sector where workplace violence is constantly a major problem. Indeed, a large proportion of workers have experienced at least one incident of physical violence within the previous year (75.8% Bulgaria, 67.2% Australia, 61% South Africa, 60% Portugal, 54% Thailand, 46.7% Brazil) (Di Martino, 2002). Elliott (1997) found that healthcare workers are 16 times more at risk of experiencing violence from patients or clients than other service workers. A review of the literature on the risk factors of workplace violence perpetrated by patients and visitors toward hospital staff revealed that the prevalence of verbal abuse ranges from 22 to 90%; threat of violence from 12 to 64% and physical assault from 2 to 32% (Pompeii et al., 2013). In their systematic review of literature on patient and visitor violence in general hospitals, Hahn et al. (2008) found that health professionals are at higher risk of experiencing various forms of workplace violence, particularly verbal abuse. As for workplace violence in clinical medical practice, a review of research established that 15–75% of workers were victims of verbal aggression and 2–29% of workers were victims of physical aggression (Hills & Joyce, 2013).
Workplace violence, like violence in general, can have multiple consequences not only on the physical but also on the psychological health of the victim (Hogh & Viitasara, 2005). Indeed, Steffgen (2008) pointed out that the consequences of workplace violence affect not only the worker himself, but also the organization and even the society as a whole. However, despite the evidence portrayed by the literature that suggests that workplace violence is a major issue in terms of health and safety, little is known about the consequences of exposure to workplace violence. Therefore, the aim of this article is to review the literature that examines the consequences of workplace violence specifically among employees in the healthcare sector. Findings from this review will be particularly useful for healthcare administrators interested in developing appropriate intervention strategies aiming at diminishing workplace violence in the healthcare sector.
To date, there is still no consensus on how to define workplace violence. The International Labour Organization defines workplace violence as “Any action, incident or behavior that departures from reasonable conduct in which a person is assaulted, threatened, harmed, injured in the course of, or as a direct result of, his or her work” (Organization, 2003). Workplace violence includes different forms of violence: physical assault, homicide, verbal abuse, bullying/mobbing, and sexual, racial, and psychological harassment (Chappell & Di Martino, 2006). There are four types of workplace violence: (1) violent acts by criminals who have no other connection with the workplace; (2) violence directed at employees by customers, clients, patients, students, or any others for whom an organization provides services; (3) violence against coworkers, supervisors, or managers by a present or former employee; (4) violence committed in the workplace by someone who does not work there but has a personal relationship with an employee. In the current review, only the literature addressing workers who were victims of type 2 violence will be analyzed.
Section snippets
Methods
A systematic review of the literature was conducted for research on workplace violence in the healthcare sector (Petticrew & Robert, 2006).
Results
Fig. 1 depicts the flow diagram of our search strategy, which yielded a total of 7078 references. After assessing the articles for relevance based on the inclusion/exclusion criteria, 68 articles were deemed eligible for this review. Descriptive statistics of the selected studies are shown in Table 2.
The methodological quality assessment of the included studies reveals that the median quality score obtained was 10, with a range from 4 to 12. There were 35 studies that had an excellent score, 24
Discussion
Since the deadly Edmond, Oklahoma post office tragedy in 1986 that raised public awareness of workplace violence, workplace violence has been of concern to numerous researchers and organizations, such as the International Labour Organization. However, research involving the investigation of the consequences of workplace violence is still in its infancy. The aim of this study was to review the literature on consequences of exposure to workplace violence. Consequences of workplace violence have
Conclusions
Although gaps still exist in our understanding of the consequences of workplace violence, this review clearly demonstrates that there is a growing body of evidence suggesting that the outcomes of workplace violence are not only profound but also multiple. This review shows that there are variations in the way employees react to workplace violence incidents, depending on the severity of the assault and the cumulative effect of multiple events. Implications in terms of work rehabilitation of
Acknowledgments
Nathalie Lanctôt is funded by a research grant from the Institute of Gender and Health (201202GWH-278184-172129) of the Canadian Institutes of Health Research. The authors wish to thank Jane Goncalves and Myra Gravel-Crevier for their invaluable contribution to the evaluation process of the studies selected in this review.
References (104)
- et al.
Violence towards health care staff and possible effects on the quality of patient care
Social Science & Medicine
(2001) - et al.
Work-related factors and violence among nursing staff in the European NEXT study: A longitudinal cohort study
International Journal Of Nursing Studies
(2008) - et al.
Emergency nurses' experience with violence: Does it affect nursing care of battered women?
JEN: Journal of Emergency Nursing
(2002) - et al.
Aggression and violence towards health care providers—A problem in Turkey?
Journal of Forensic and Legal Medicine
(2007) - et al.
Violence against emergency department workers
The Journal of Emergency Medicine
(2006) - et al.
Verbal violence in the workplace according to victims' sex — A systematic review of the literature
Aggression and Violent Behavior
(2014) - et al.
Patient and visitor violence in general hospitals: A systematic review of the literature
Aggression and Violent Behavior
(2008) - et al.
A review of research on the prevalence, antecedents, consequences and prevention of workplace aggression in clinical medical practice
Aggression and Violent Behavior
(2013) - et al.
Occupational injuries among U.S. correctional officers, 1999–2008
Journal of Safety Research
(2012) - et al.
Workplace violence: A survey of emergency physicians in the state of Michigan
Annals of Emergency Medicine
(2005)
The extent, nature, and precipitating factors of nurse assault among three groups of registered nurses in a regional medical center
Journal of Emergency Nursing
Disparities in work-related homicide rates in selected retail industries in the United States, 2003–2008
Journal of Safety Research
Violence at the workplace—A questionnaire survey of nurses
European Psychiatry
A comparative study of the experiences of violence of English and Swedish mental health nurses
International Journal Of Nursing Studies
Assessing research on workplace violence, 2000–2012
Aggression and Violent Behavior
Perpetrator, worker and workplace characteristics associated with patient and visitor perpetrated violence (Type II) on hospital workers: A review of the literature and existing occupational injury data
Journal of Safety Research
Physical violence at the workplace: Consequences on health and measures of prevention
European Review of Applied Psychology
A survey of violence against staff working in the emergency department in Ankara, Turkey
Asian Nursing Research
Les violences et agressions physiques au travail: Analyse de la littérature
European Review of Applied Psychology
Physical violence in the workplace among Jordanian hospital nurses
Journal of Transcultural Nursing
Workplace violence among Iraqi hospital nurses
Journal of Nursing Scholarship
Occupational violence at Lebanese emergency departments: Prevalence, characteristics and associated factors
Journal of Occupational Health
Controlled study of outcome after 6 months to early intervention of bus driver victims of aggression
L'Encéphale
Incidence of violence towards staff caring for the elderly
Scandinavian Journal of Caring Sciences
Violence experienced by nurses at six university hospitals in Turkey
Journal of Psychiatric and Mental Health Nursing
Violence against nurses in hospitals: Prevalence and effects
British Journal of Nursing
Violence toward physicians in emergency departments of Morocco: Prevalence, predictive factors, and psychological impact
Journal of Occupational Medicine and Toxicology
Cognitive factors in NHS staff responses to violence and aggression
Verbal and physical violence towards hospital- and community-based physicians in the Negev: An observational study
BMC Health Services Research
Verbal and physical abuse against nurses in Turkey
International Nursing Review
Violence at work
Workplace violence from psychiatric patients
Journal of Occupational Safety and Health
Burnout, workplace violence and social support among drivers and conductors in the road passenger transport sector in Maputo City, Mozambique
Journal of Occupational Health
La victimisation criminelle en milieu de travail
Psychosocial antecedents and consequences of workplace aggression for hospital nurses
Journal of Nursing Scholarship
Workplace violence in the health sector—Country case studies Brazil, Bulgaria, Lebanon, Portugal, South Africa, Thailand, plus an additional Australian study
Prévention de la violence entre membres d'une même organisation de travail: Évaluation d'une intervention participative
Aggression and violence towards health care providers, and effects thereof
Archives of Psychiatry and Psychotherapy
Basic emotions
Violence in health care. What nurse managers need to know
Nursing Management
Violence towards nursing staff in emergency departments in one Turkish city
International Nursing Review
Violence risks in nursing—Results from the European ‘NEXT’ Study
Occupational Medicine (Oxford, England)
Violence in the emergency department: A survey of health care workers
CMAJ: Canadian Medical Association Journal
Evaluating progress in reducing workplace violence: Trends in Washington State workers' compensation claims rates, 1997–2007
Work
Associations of workplace aggression with work-related well-being among nurses in the Philippines
American Journal of Public Health
Interpersonal conflict, social support, and burnout among home care workers in Japan
Journal of Occupational Health
Violence against nurses and its impact on stress and productivity
Nursing Economics
An epidemiological study of the magnitude and consequences of work related violence: The Minnesota Nurses' Study
Occupational and Environmental Medicine
Patient and visitor violence in the general hospital, occurrence, staff interventions and consequences: A cross-sectional survey
Journal of Advanced Nursing
Cited by (352)
Global prevalence and factors associated with workplace violence against nursing students: A systematic review, meta-analysis, and meta-regression
2024, Aggression and Violent BehaviorWorkplace violence and intention to quit in the English NHS
2024, Social Science and MedicineIntersecting structural barriers to reporting violence among men and non-binary sex workers under end-demand criminalization in Canada
2023, SSM - Qualitative Research in Health
- 1
Tel.: + 1 514 251 4000x3084; fax: + 1 514 251 4014.