Danger
Zone
Often caught in the cross fire of aggressive patients and
abusive physicians, nurses fall victim to harassment, abuse and attacks
By Tamra B. Orr
November 4, 2002
The image of nurses is almost always one of comfort, help and gentleness. People turn to nurses when they are sick or in pain. It is particularly ironic that nurses, whose job it is to soothe and reassure, are the ones most often in danger. Whether it is violence, hostility, sexual harassment or discrimination, nurses are near the top of the victims list. Statistics show that health care workers, especially nurses, are physically assaulted more often in the workplace than any other group, including prison guards and police.
Study after study reports some disturbing findings:
According to a NURSEWEEK/American Organization of Nurse Executives survey,
28 percent of nurses have experienced episodes of violence in the workplace
in the past year.
Between 1992 and 1996, about 69,500 nurses were victims of nonfatal incidents.
An online survey last year by the American Nurses Association reported
that 17 percent of nurses stated that they have been physically assaulted
in the past year and more than half said that they have been threatened
or have experienced verbal abuse.
A 1998 survey initiated by the Colorado Nurses Association Task Force
on Workplace Violence queried almost 600 nurses from seven states and
found that more than one-third reported being victims of workplace violence,
primarily through assault from patients. Those in the emergency room and
in psychiatric and long-term care settings are at highest risk. Half of
all long-term care staff and almost all nurses, psychiatrists and therapists
reported at least one assault during their careers.
Personal stories
While the statistics are sobering, it is the individual stories that bring a chill. “I have been assaulted several times in my career,” said Maureen Doyle, Ph.D., RN, a nurse since 1965 who teaches at New York’s Pace University. “I was pinned to a bed by a psychiatric patient,” she said. “He jumped on top of me and began grabbing roughly at my breasts. I screamed for help and, fortunately, I wasn’t too far away from the nurses station.” Doyle has taught a number of classes on crisis prevention and intervention to nurses, including information on self-defense and how to restrain a patient.
Nicole Marie Spring, an RN in Ohio, shares a similar story. “I was a home care nurse for a 70-year-old female patient who was experienced in doing much of her own self-care. She was capable of checking off what medications she had taken and when and so on.
“However, one day,” Spring said, “she decided that she shouldn’t have to do that since that was what Medicare was paying me to do. I tried to discuss it with her but when I went to leave, the woman grabbed my jacket and arm and began flinging me around. I had no warning; there was no tangible escalation. Afterwards, I was more than shaken emotionally.”
Her experience led her into researching assaults on nurses and she now has her own private e-mail discussion group where these issues are raised (more information at www.nurseadvocate.org).
Attacks from within
Some of the worst attacks nurses undergo come from within. The nasty words, vicious threats and even physical assaults occasionally arise not from angry or confused patients, but from the physicians with whom nurses work.
In the NURSEWEEK/AONE survey, up to 19 percent of nurses reported personally experiencing sexual harassment or a hostile work environment related to other staff in the past year. The groups most at risk were male nurses (32 percent) and nurses between the ages of 45 and 54 (22 percent).
According to this same survey, statistics are similar when the incident is directly related to encounters with physicians. Of male nurses, 32 percent reported an incident, compared with 19 percent for their female colleagues. Of nurses aged 18 to 34, 23 percent reported sexual harassment or a hostile work environment.
David Woodruff, a nurse with extensive experience in critical and emergency room care in inner-city hospitals, said, “Nurses are treated with hostility from physicians who don’t value the work they do or to demonstrate the power of their positions. I once saw a nurse order an EKG on an ER patient because he was having chest pains. She took the results to the doctor and he grabbed it, crumpled it up and tossed it in the trash. It was terribly demeaning to the nurse, but he hadn’t ordered it.
“Of course,” Woodruff said, “once he saw the patient, he walked out and ordered an EKG. It was nothing but a power play.”
Alan Rosenstein, MD, medical director and vice president of VHA West Coast, recently wrote a report, “Nurse-Physician Relationships: Impact on Nurse Satisfaction and Retention.” More than 1,200 nurses sent in responses to questions about their daily interactions with physicians. “I saw two issues of concern: the nurse shortage and disruptive physician behavior (defined as any kind of communication that has a negative impact on the relationship) and I wondered if they were connected,” Rosenstein said.
He believes that the shortage is due less to recruitment issues and more about retention of experienced nurses and how they are treated.
“We need to raise physicians’ awareness and sensitivity to nurses’ feelings,” he said. “Nurses simply want respect and value and to be part of the medical team. We need educational programs that help with conflict management and a policy that does not allow or condone inappropriate behavior.”
Woodruff has other suggestions. “Nurses and physicians need a more personal connection; there needs to be a blending of the staff, not separation. Nurses need to be made part of the physicians’ community.”
Doyle agrees. “My broadest recommendation is to give nurses the respect they deserve for the responsibilities they are carrying.”
The discrimination factor
Discrimination is also an issue in the nurses’ work environment and can be just as dangerous to a nurse as a violent patient or a colleague with a temper.
The NURSEWEEK/AONE survey shows that 19 percent of nurses report having been personally discriminated against based on gender, age or race in the past year. The nurses most at risk for this appeared to be non-Caucasians (27 percent) and males (29 percent). Discrimination reported in this study was most prevalent in the Texas-Oklahoma-Louisiana-Arkansas area, with 20 percent of the nurses experiencing discrimination in the past year while working as a nurse.
Kathleen, a nurse with a Ph.D. in medicosociology who requested anonymity because, as she put it, “I’m still working and want to keep my job,” reported uncaring colleagues and a case of age discrimination.
Doyle added, “Just this past semester, three of my students were hired and they are making more money than I am already. Why? Today’s shortage is created because administration is throwing us older nurses away.”