Workplace Violence Jeopardizes Nurse Recruitment

How does workplace violence impact nurse retention?

In this fast-paced healthcare environment, finding new ways to attract nurses keeps recruiters busier than ever — especially if nurses leave as fast as you hire them.

Many factors play into the nursing shortage, such as considering how workplace violence affects nurse retention. Recruiters need to consider the extent to which workplace violence is a concern for nurse candidates and what needs to change.

Workplace violence wears many faces, from minor verbal or physical abuse to more extreme instances of being stabbed, kicked, punched, choked, or spat on.

A 2020 study in the Journal of Healthcare Organization, Provision, and Financing reported multi-factorial correlations between having meaningful work, job-related stress, workplace violence, and effects on nurse turnover.

The study highlights the importance of addressing job-related stress and building positive relationships with staff and an upbeat work environment with ample learning opportunities — factors that influence nurse retention and turnover.

Workplace violence is real and carries far-reaching consequences from nurse retention to the nursing shortage, said Sandra Risoldi, DNP, APRN, MSN-Ed, PMHNP-BC, and Founder and President of Nurses Against Violence Unite, a nonprofit dedicated to raising awareness about nurses dealing with violence.

Risoldi said nurses can experience violence across the spectrum, coming from patients and their families to nursing peers and administrators who would rather turn away from the problem instead of leaning in to help nurses address pressing issues.

A 2019 issue brief from the American Nurses Association (ANA) addresses the challenges that exist in reporting occurrences of workplace violence. The ANA said, “Ambiguity on what constitutes workplace violence has proven to be a major impediment to reporting such incidents; a uniform zero-tolerance policy diminishes those barriers and ensures that employees report all incidents.”

Preparing for patient populations

Another side of the issue looks at new nurses who are ill prepared to handle certain patients, a reality that has some nurses walking off the job, Risoldi said.

Considering the extensive opioid epidemic, Risoldi used the example of patients experiencing opioid and alcohol withdrawal who then become violent without warning.

“Coming out of nursing school, [nurses] are not prepared to handle patients’ verbal and physical violence,” Risoldi said. “Nurses cannot even identify the withdrawal symptoms because they are not being taught.”

52.9 million individuals experienced mental health conditions in 2020

In 2020, the Substance Abuse and Mental Health Services Administration (SAMHSA) reported that 52.9 million American adults experienced mental health conditions — and 17 million experienced a combination of substance use disorders and mental health conditions.

In other cases, Risoldi said it is common to see an underlying mental health condition become magnified once the patient is injured or sick. For a variety of reasons, once these patients are admitted to the hospital, she said they can become aggressive or violent.

“We have nurses who have been stalked and choked,” she said. “A plate was smashed on a nurse’s head.”

Risoldi said aggressive behavior can also surface with pregnant patients who have stopped taking their antidepressant medication.

How violence affects the brain

If workplace violence becomes a new normal, it’s easy for nurses to dread the job they once loved. Eventually, some will quit.

The Nurses’ March, held May 12 in Washington D.C., was an event where nurses advocated for change in many areas which included a focus on staff safety and workplace violence. Amanda Littleton, BSN, RN, CPN, a nurse in the Atlanta area who attended the march, shared that she had been assaulted by patients by being punched in the face. She added that although nurses have compassion, at times, it feels as though they must sacrifice their own safety for their compassion.

Workplace violence and stress change the way the brain functions, said St. Louis-based nurse practitioner Jessica Giddens, DNP, MSN, BSN, PMHNP-BC, who speaks at national conferences about epigenetics and consults with mental health facilities and Nurses Against Violence Unite.

“Over time, biochemical alterations that the stress is causing alters your DNA and how the DNA expresses itself,” Giddens said.

Compounded stress causes some people to act out in ways that are inconsistent with their usual personality, she said.

Stress has an uncanny way of forcing certain personality traits to the surface. With constant exposure to workplace violence, it might be surprising to see how it alters personality.

According to Giddens, during periods of constant stress, some people might become obsessive, paranoid or show narcissistic traits often associated with Cluster B personality disorders, even though they were previously undiagnosed.

People on the Cluster B spectrum often express dramatic behavior, make unpredictable decisions, become aggressive, and have difficulty with relationships at work and home, according to the Mayo Clinic.

The reason has to do with how stress turns on some genes.

“Chronic stress may cause activation or deactivation of certain genes causing a stress response,” she said. “Depending on each person’s unique genes and unique personality traits, when exposed to chronic stress, certain behavioral changes may be induced.”

Finding ways to help nurses limit their exposure to stress is critical for their welfare and ability to perform their jobs well.

As a reminder, Giddens said, “Nurses experience the most amount of violence in the workplace, above police officers.”

Fixing workplace violence

As a leader of an organization that advocates for safer workplace conditions for nurses, Risoldi, shared the following tips for solving violence against nurses:

  • Increase awareness about workplace violence.
  • Use your voice to report issues.
  • Provide supportive resources for nurses.
  • Develop training to address workplace violence causes, such as patient mental health conditions, or opioid or alcohol withdrawal.

Editor’s Note: This post was originally published in June 2020 and has been updated with new content.