Silence is Violence: Voicing out to end Assaults on Nursing Personnel

Image credit: Nurse Daily

Healthcare workers are frequent victims of workplace assaults, as evidenced by the alarming spike of incidents in the past decade. The US National Institute for Occupational Safety and Health (NIOSH) defines workplace assaults as “violent acts, including physical assaults and threats of assaults, directed toward persons at work or on duty.” According to the US Bureau of Labor Statistics, workplace violence had “caused 10 to 11 percent of the serious injuries among healthcare workers”. This is in comparison to the 3% average coming from the private sector.

The said report furthered that patient interactions comprise 80% of these serious violent injuries against healthcare workers. In the Philippines, the recent incident on the assault done to a Cebu nurse has sparked discussions to improve the working conditions of healthcare providers. The Philippine Nurses Association, in its position statement, has denounced this recent incident, citing that “in this case, no reasonable person could be expected to endure it.”

Nurses’ Plight

Unfortunately for us nurses, we have learned to get used to these work hazards. The Cebu nurse assault incident reflects only a small fraction of the harsh reality that we experience every day. As one of the front-liners, nurses are overly exposed to these traumatic experiences: from physical, verbal and sexual abuses. Assailants can range from patients, their family members, and even their fellow healthcare workers.

The matter itself is already unsettling, but what is disturbing is the lack of established way of reporting these incidents, especially in the Philippines. There is little local information, if none, on these assaults on nursing personnel. The underreporting has been so rampant that Filipino nurses tend to ignore the problem, often dismissing these cases as “part of the job”. This psyche eventually developed into a pervasive notion, which in turn has crept into the attitudes of nurses.

I remember a time when I was assigned in the Operating Room Complex. I assisted a male surgeon who is notorious in “terrorizing” nurses. In the middle of the surgery, he hit my hand many times whenever he wanted to take the instrument that I was holding. A couple of tongue lashing followed thereafter. I reported the incident to my colleagues, only to hear their collective response of “masanay ka na sa ugali nya” (Get used to his attitude).

With these problems being swept under the rug, it now becomes ironic that those who render care are reciprocated with the opposite. Adding to this system-wide problem are nursing schools, which do not really prepare student nurses for the “brutality” of professional nursing and hospital setting. It is deeply frustrating is that at this age and time, there is still lack of palpable and concerted efforts to address this issue, especially at the national level.


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Nurses’ Fight

Remaining passive on these issues only solidifies the culture of violence in the healthcare setting. Speaking out to end this vicious cycle can create a large dent to the problem. On the macro level, strict government regulations must be passed to require all hospitals to have assault prevention programs and protocols.

In addition to these, hospitals must have strong surveillance/ security system, training policies for employees in recognizing and responding to violence. Sufficient resources for workers who are victims of violence must also be available in institutions. Nursing service divisions must establish a clear reporting system and metrics for nurse assaults (i.e., Assaults on Nursing Personnel per 1,000 nursing care hours indicator of the National Database of Nursing Quality Indicators).

On the unit level, nurses and nurse leaders can help create a safe work environment by doing the following:

1. Accept the fact that violence is NOT a part of the job.

Nurses must not suppress accounts of potential or actual assaults. Understand that every healthcare worker is entitled to have a safe working environment and the fight against violence should not be cumbersome. Talk to colleagues and superiors about these incidents, whether actual or potential. On the other end, managers and staff should actively listen to those who are voicing out and help the assailed nurse get through the traumatic experience.

2. Recognize cues.

According to NIOSH, violent behavior is preceded by warning signs. Nurses must be able to recognize these verbal and behavioral cues as red flags for an ensuing assault:

a. Verbal Cues (Speaking loudly or yelling, swearing, etc.)
b. Non-verbal or Behavioral Cues (e.g., Arms held tight across chest, clenched fists, pacing or agitation, sudden changes in behavior, etc.)

Once these cues are observed, be extra alert for a potential assault. Report this immediately to the security officers, your colleague, charge nurse or manager. Never match these threats and never return to this person without a companion.

3. Set limits

It takes an empowered nurse to tactfully call out an abusive behavior. Maintain a professional distance by setting limits, especially to verbally and sexually abusive persons. Be firm and give short answers. Maintain non-threatening eye contact and respect personal space by maintaining arm/leg distance away from the individual. It is best to refrain from touching the upset individual as this might be misinterpreted. Approach the patient from an angle or from the side.

4. Dress for Safety

It is best to remove anything from you that can be used as a weapon or grabbed by someone. For females, long hair should be tucked away so that it cannot be grabbed. Avoid jewelry or necklaces can be pulled. Wearing overly tight clothing can restrict movement while overly loose clothing can be caught/ grabbed. If possible, institutions must provide a panic device (i.e., blow whistle) to nurses as part of their uniform.

5. Documentation

Just like anything in the nursing world, documentation is key. It is important to take note about each episode of assaults, including the date, time, place, type of assault, names of assailants, names of witnesses and other useful information. If there are witnesses, ask them to take note as well. These documents can be used for analysis, process improvement and future legalities.

Our generation has to step up against assaults, and mere reporting should not be the end goal. While we recognize our unit-based efforts, large-scale measures must still ignite our combat against workplace violence. Nurses must have the courage to call out these perpetrators. On the other hand, nursing leaders must take a stand to urge authorities to protect healthcare workers. In every level of the nursing profession, silence on this issue is also violence. Together, let us help end this cycle. Will you fight or take flight?

About Jerland Casilan

Nurse Administrator, Researcher and Educator
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