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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.
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).
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.”
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.”
Contact Tamra B. Orr at writinggoddess2@attbi.com.
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