The Rate of Workplace Violence in Oncology Remains High

Scott Christensen, PhD, MBA, APRN, ACNP-BC

Nurses and other health care professionals frequently experience instances of workplace violence, and the COVID-19 pandemic contributed to this problem, according to an article published in the Clinical Journal of Oncology Nursing.¹

Yet, oncology nurses can advocate for themselves and play an individual role in decreasing their risk of injury, according to Scott Christensen, PhD, MBA, APRN, ACNP-BC. They can also take preventative measures by knowing their patient’s history, and whether they have a history of disruptive behavior, whether there are any objects in the patient’s room that could be used as weapons, and whether the body language of patients and visitors seem as though escalation might ensue. If nurses feel that a situation is escalating, they are encouraged to trust their intuition and call for help.

“I encourage nurses to regularly consider their personal safety,” Christensen said. “When you walk into a patient room, how does the environment feel? Do the family members appear anxious?”

Christensen is a senior nursing director and nurse scientist at the University of Utah Health Hospitals and Clinics, where he worked for many years in various clinical and leadership roles. He is an adjunct assistant professor at the University of Utah College of Nursing. He has conducted nursing research and published articles on workplace violence, well-being, organizational development, and clinical operations.^2,3

In an interview with Oncology Nursing News, he explained what workplace violence is, how it impacts workers, how leaders can better protect their staff, and ways that nurses can mitigate their own risk.

On an individual level, nurses must listen to their intuition, he said.

“Follow your gut. If you walk into a patient room and it doesn't quite feel right, walk out, go get help,” he said.

What is Workplace Violence?

Workplace violence does not always represent physical violence, Christensen explained. In fact, most nurses will face other forms of violence.

“When people hear the term ‘workplace violence,’ they often think about physical altercations from patients, visitors, even coworkers, and things that result in a physical injury,” he explained. “However, workplace violence is broader than that; it is not just limited to physical behaviors.”

Christensen went on to share that throughout his nursing career, he cannot think of a time when he was physically harmed by patients, although he was aware of instances with his coworkers. Yet, there were multiple times when he faced verbal harm, verbal abuse, and intimidating behaviors—sometimes at the hands of patients and sometimes at the hands of his coworkers and leaders. For example, he shared that he had a supervisor who had created a hostile work environment for their reports.

Nurses who experience workplace violence experience serious psychological and often physical consequences. Some may experience minor harm including cuts and bruises, while acts of aggression can result in severe injury for others, such as the case of one nurse who was kicked in the jaw, and had her hair pulled and finger broken by her patient.

The psychological outcomes can be just as damaging to a nurse’s well-being and damage their ability to help other patients. Oncology nurses who experience workplace violence have reported low sleep quality, burnout, and depression. These factors can lead to absenteeism from work. In fact, the US Bureau of Labor Statistics has suggested that healthcare workers are among the most likely to miss work because of workplace-related injuries.

Violence Is Trending

During the pandemic, the rates of workplace violence increased. And, according to Christensen, there were multiple factors behind this uptake.

“There were a lot of factors in the pandemic that contributed to an increase in workplace violence,” Christensen said. “There were a lot of anxieties—especially at the start of the pandemic—a lot of fear, panic, misplaced anger, and strained mental health.”

He noted that there was often not enough personal protective equipment, not enough oxygen or ICU beds to adequately care for patients. Many nurses did not feel protected by their employers. All of these factors contributed to an environment where nurses and other health care workers felt more anxious. Pandemic-specific restrictions, such as masking and limiting visitors, increased the tension with certain patients and their loved ones and put more strain on the healthcare workers.

According to the US Bureau of Labor Statistics, 73% of violence-related nonfatal workplace injuries occur in health care. The rates of healthcare violence have been rising since 2011, but they increased dramatically between 2019 and 2020: during those years, investigators with the Bureau saw a 24% increase in reports. Further, a report from National Nurses United published in 2022 showed that there was a 119% increase in nurse-reported incidents between March 2021 and March 2022.

Christensen pointed out that there is only so much that the reports can show. As a nurse scientist and researcher, he is especially interested in uncovering the violence that goes unreported and finding ways to help bring those to light.

“Workplace violence is highly unreported,” he said. “So, if we're seeing high cases being reported through national organizations and in the media, just think about the workplace violence happening that is not reported.”

Physical violence is reported more than non-physical violence, he added. These reports likely do not show how often nurses are being belittled or threatened while at work.

“It's a very big problem,” he said.

Creating a Culture of Safety

The rising problems of violence in the workplace has caught the attention of national healthcare policymakers. In 2022, the Centers for Medicare and Medicaid Services released a memorandum requiring Medicare-certified institutions to provide training to protect their workforce and patients from workplace violence. The American Nurses Association has issued a call to stop tolerating violence against nurses.

However, changes at the institutional level are perhaps the most effective way to minimize the risk of violence, according to Christensen. Hospital administrators should establish a “zero-tolerance” policy for violence. This means creating a culture where nurses feel safe reporting instances of workplace violence, where resources for victims are available, and where practical skills for patient de-escalation are strengthened through regular training.

Some questions that administrators may ask themselves are whether their employees feel empowered to confront disruptive behavior, whether frontline employees were involved in the development of institutional policies or response, and if patients, staff, and visitors are held accountable for undesirable behavior.

In terms of prevention, leaders should ensure that engineering controls—including badge access cameras, and duress alarms‚—are in place, and that policies are regularly revisited and effectively communicated to staff and visitors alike.

There should also be a process for reporting acts of violence that is simple, efficient, and quick. After an incident has been reported, response teams should be at the ready to help de-escalate the situation, and there should be a follow-up procedure in place that helps address the incident and create solutions moving forward.

Reference

1. Christensen SS, Snyder C, Parkin ED, Austria MJ. Understanding Nursing Workplace Violence Trends for Safer Clinical Oncology Settings. Clin J Oncol Nurs. 2023;27(5):497-505. doi:10.1188/23.CJON.497-505
2. Christensen SS, Lassche M, Banks D, Smith G, Inzunza TM. Reducing patient aggression through a non-violent patient de-escalation program: A descriptive quality improvement process.Worldviews Evid Based Nurs. 2022;19(4):297-305. doi:10.1111/wvn.12540
3. Christensen SS, Wilson BL. Why nurses do not report patient aggression: a review and appraisal of the literature. J Nurs Manag.2022;60(60):1759-1767. doi: 10.1111/jonm.13618