Exploring nurses' emotional reactions to and reporting of patient-on-nurse workplace violence: A mixed-methods study

Abstract

Background: Workplace violence, including violent, intimidating, and disruptive acts, commonly occurs in healthcare settings. Type 2 workplace violence in nursing refers to patient/visitor behaviors directed toward clinicians, contributing to physical and psychological harm. Nurse victims often do not report these events to employers or law enforcement, making it challenging to address workplace violence.

Objectives: Our research examined nurse reactions to Type 2 workplace violence by identifying what behaviors they perceived as aggressive and reportable. Specific aims included: 1) developing and testing video vignettes to portray realistic patient aggression scenarios; 2) identifying nurse understandings of aggressive events that prompt affective reactions, and; 3) examining clinical characteristics related to the nurse victim's likelihood to report.

Design: Through a sequential mixed-methods design, we qualitatively developed novel video vignettes portraying Type 2 workplace violence to experimentally examine how nurses interpreted them within a quantitative repeated measures survey.

Methods: Two expert nurse research panels (n = 10) created five vignettes, from which nurses (n = 282) completed a survey with 1382 unique responses. Analyses included descriptive statistics and repeated measures ANOVA/regression models.

Results: Video vignettes realistically portrayed workplace violence events, eliciting negative emotional responses among nurses that increased in magnitude with statistical significance as the level of displayed aggression escalated. Statistically significant factors influencing nurse reporting of workplace violence included; 1) the level of aggression displayed by the patient; 2) the level of harm received by the nurse; 3) whether the nurse felt the patient's actions were intentional, and; 4) the nurse's perceived frequency of exposure to workplace violence.

Conclusions: Results suggested that nurse victims of Type 2 workplace violence experience depression, anger, fear, and anxiety, which may contribute to long-term mental health consequences. Findings also identified factors related to nurse reporting behaviors, which may help mitigate workplace violence in healthcare settings by informing research and promoting workplace practices that encourage reporting and safety.

Registration: Not registered.

Tweetable abstract: Nurse reactions to workplace violence: Video vignettes reveal escalating aggression's impact on reporting. #EndNurseAbuse #WorkplaceViolence.

Keywords: Aggression; Behavior and behavior mechanisms; Emotions; Nurses; Nurse–patient relations; Reporting; Safety management; Videotape recording; Workplace violence.