chapter 12 | Promoting a Healthy Workplace 177The overall private sector injury incidence rate is 2;
the overall incidence rate for health service workers
9.3. Broken down further, the incidence rate for
social service workers is 15, and the rate for nurses
and personal care workers is 25 (bls.gov/news/
release/cfoi.nr0).
The aggressor can be a disgruntled employee or
employer, an unhappy significant other, or a person
committing a random act of violence. Nurses have
been identified as a group at risk for violence from
patients, family members, and other staff members.
Violence may also have negative organizational
outcomes. Box 12-2 identifies some of the causes.
Examples of violence include:
■Threats.Expressions of intent to cause harm,
including verbal threats, threatening body lan-
guage, and written threats
■Physical assaults.Slapping, beating, rape, homi-
cide, and the use of weapons such as firearms,
bombs, and knives
■Muggings.Assaults conducted by surprise with
intent to rob (cdc.gov/niosh/pdfs/2002-101.pdf )
The circumstances surrounding health-care work
contributes to workers’ susceptibility to homicide
and assault (Edwards, 1999; nursingworld.org/
dlwa/osh/wp5; cdc.gov/niosh/pdfs/2002-101.pdf;
http://www.osha.gov/))
■Prevalence of handguns and other weapons
among patients, families, and friends
■Increased use of hospitals for criminal holds and
violent individuals
■Increased number of acute and chronic mentally
ill patients being released without follow-up care
■Health-care personnel having routine contact
with the public in unrestricted areas
■Health-care personnel working alone or in small
numbers
■Health-care personnel working late or until very
early morning hours
■Health-care personnel working in high-crime
areas
■Health-care personnel working in buildings
with poor security
■Health-care personnel treating weapon-carrying
patients and families
■Health-care personnel working with inexperi-
enced staff
■Health-care personnel working in units needing
seclusion or restraint activities
■Health-care personnel transporting patients
■Patients waiting long times for service
■Overcrowded, uncomfortable waiting areas
■Health-care personnel lacking training and poli-
cies for managing crises
Nurses must know their workplace. For example
(www/nursingworld.org/dlwa.osh/wp5?):
■How does violence from the surrounding
community affect your workplace?
■Do services like trauma or acute psychiatric care
increase the likelihood of violence?
■Does the facility’s physical layout invite
violence—for example, do doors open to the
street? are waiting rooms cramped?
■How frequently do assaultive incidents, threats,
and verbal abuse occur? where? who is involved?
are incidents reported?
■Are current emergency response systems
effective?
■Are post-assaultive treatment and support
available to staff?
■Are staffing patterns sufficient? is the staff
experienced?
Earlier in the chapter, the Florida nurse who was
attacked and killed by a patient in April 2001 was
mentioned. Although assaults that result in severe
injury or death usually receive media coverage,
most assaults on nurses by patients or coworkers are
not reported by the nurse.
Ms. Jones works on the evening shift in the emergency
department (ED) at a large urban hospital. The
ED frequently receives patients who are victims of
gunshot wounds, stabbings, and other gang-related
incidents. Many of the patients entering the ED are
high on alcohol or drugs. Ms. Jones has just inter-
viewed a 21-year-old male patient who is awaiting
treatment as a result of a f ight after an evening of
heavy drinking. Because his injuries have been deter-
mined not to be life-threatening, he had to wait to seebox 12-2
Negative Organizational Outcomes
Due to Workplace Violence- Low worker morale
- Increased job stress
- Increased worker turnover
- Reduced trust of management
- Reduced trust of coworkers
- Hostile working environment