Violence, Bullying, Incivility

• The National Institute for Occupational Safety and Health (NIOSH) defines workplace violence as “any physical assault, threatening behavior, or verbal abuse occurring in the work setting.” NIOSH defines four categories of workplace violence: criminal intent (Type I), client-on-worker (Type II), worker on worker (Type III), and personal relationship violence (Type IV) (NIOSH, 2013).

         Types of Violence

• • Type 1- Criminal intent: The perpetrator has no legitimate relationship to the business or its employees and is usually committing a crime in conjunction with the violence such as robbery, shoplifting, and trespassing.
  • Type 2- Client-on-worker: The most common type of violence in healthcare settings and includes relationships with patients, their family members, and visitors. An example is assaults on healthcare workers by patients with dementia/disorientation.
  • Type 3- Worker-on-worker: Commonly referred to as “lateral” or “horizontal” violence that frequently occurs as verbal and emotional abuse that is unfair, offensive, vindictive, and/or humiliating, and includes bullying. It is often directed at persons viewed as being “lower on the food chain” such as in a supervisor to an employee, doctor to nurse, or peer-to-peer violence.
  • Type 4- Personal relationship violence: The perpetrator has a relationship with the healthcare worker outside of work that spills over to the work environment.
• In 2010, 11,370 healthcare workers in the Healthcare and Social Assistance industry sector were victims of assaults with 19% occurring in nursing home/residential facilities.
• In a 2019 ANA survey of more than 20,000 nurses, 24% reported verbal/nonverbal aggression from persons in a higher authority level and 31% from peers; 34% experienced verbal or physical threats from patients and/or their family members.
• Most violence occurs in psychiatric units, emergency departments, waiting rooms, and geriatric settings.
• Nurses and aides who have the most direct contact with patients are at a higher risk of violence, but all healthcare providers are at some risk. Risk factors include the following:

• • Working directly with volatile people, especially those under the influence of drugs or alcohol and/or a history of violence.
  • Working understaffed especially during mealtimes and visiting hours; when working alone; and when transporting patients.
  • Long waits for service (busy, high traffic periods), overcrowded, uncomfortable waiting rooms.
  • Poor environmental design, poorly lit corridors, rooms, parking lots, and other areas.
  • Inadequate security, unrestricted movement of the public, potential perpetrator access to firearms.
  • Lack of staff training and policies for preventing and managing crises with potentially volatile patients.

Bullying involves repeated, unwanted harmful actions intended to humiliate, offend, harm, undermine, or degrade, and can cause lasting physical and psychological damage. Bullying often involves misuse of power and can become an accepted workplace norm. Actions may include, but are not limited to, hostile remarks, verbal attacks, threats, taunts, intimidation, and being unsupportive (American Nurses Association, 2015).

• Can take the form of rude and discourteous actions of gossiping and spreading rumors, and refusing to assist a coworker. Incivility left unaddressed can lead to bullying and violence.
• May also include name-calling, using a condescending tone, and expressing public criticism which can compromise coworker dignity and demonstrates a clear lack of respect.
• May occur face-to-face, on telephone, in web-based meetings, through email, or online.