Essentially, the term abuse is an issue facing the nursing profession today. Many unreported cases of encountered verbal and physical abuse have been found to be ample in acute and complex care settings. These cases are amongst professional individuals (nurse-nurse and nurse-physician abuse) and also among the patient abusing the nurses. Effectively, abuse is not only a Canadian issue. It has been reported internationally as well. Thus, many nurses today are lobbying for the decrease of abuse within health care settings in order to ameliorate the working conditions. Nursing abuse may lead to other issues which will be discussed in this study.
This paper will address the nurse-nurse, nurse-physician and nurse-patient abuse. In addition, this study will indicate the many choices that nurses are given in case of abuse and present the need for solution for the prevention of abuse in nursing. In 2006, the Registered Nurses Association of Ontario (RNAO) issued a document regarding violence in the workplace. The document estimated that 50 per cent of healthcare workers will be physically assaulted during their professional careers, and nurses are three times more likely to experience violence than any other professional group.
Given that nurses constitute 58. per cent 6 of Ontario’s health-care workers, the impact of workplace violence on nursing and the delivery of nursing care are significant (2006). These statistics are very frightening considering that they illustrate current events in Ontario. In addition, workplace violence is present in almost all health care settings, which increases the rates of violence in Ontario. Effectively, high-risk practice settings for abuse were thought to be almost exclusively psychiatric and emergency units, however, findings now also point to violence against nurses in medical surgical and community settings (Duncan, 2000).
The codes of ethics that regulate the roles of health care professionals not only establish rules regarding patient relations but also include rules regarding respect and dignity among health care professionals. Nonetheless, some of the nursing values instituted in the nursing code of ethics continue to be violated today. Indeed, the College Nurses of Ontario (2002) set a series of practice standards that would in fact promote respect and trust between health care workers, thus reducing abuse in nursing.
The statement confirms that reorganization and job uncertainty can have a negative impact on the way nurses work together and relate to each other. More than ever, nurses need to work collaboratively and promote an environment of collegiality. This means that nurses show consideration and respect for each other (CNO, 2002). However, studies show that the average nurse being is subjected to abuse from other employees and patients. When studying abuse in nursing, the hierarchy established in the health care system, is an important aspect to consider.
Fudge (2006) discusses the issues with the hierarchy established in health care. Certainly nurses are seen as functioning within a hierarchy where they are deemed to be second-class health care workers or the “Cinderellas” of health care, and that despite the changing role of women in society nurses continue to be oppressed. Indeed, professionalism is beyond education, however social status in the workplace seems to undertake a path of professional misconduct from health care professionals toward their peers.
The CNO (2002) Professional Standards: Ethics states that nurses have a duty to know and acknowledge each colleague’s role and unique contributions to the team effort. Nurses’ trust in the expertise of one another, share their expertise and knowledge with one another, and refer to each other when they do not have the necessary competence to provide a specific part of the nursing care themselves. Thus understanding the role and the scope of practice of individuals is critical for reducing abuse. Consequently, superiority, seniority and the scope of practice of the individual seems to result in some type of professional conflict.
Indeed, Fudge (2006) describes this as vertical violence, which means that the act of violence is between senior and junior colleagues. Horizontal violence is across peer groups and similar levels of staff. The most common aggressors or bullies are nurse-managers and supervisors (Leiper, 2005). Certainly, education is very influential in terms of the respect seen among health care professionals, because it has been an ongoing issue as to understanding the hierarchy in the health care profession. The bridge between education and collaboration is still suffering today and it is an issue to address.
Effectively, interpersonal conflict was found to be one of the major sources of stress for nurses. Fudge (2006) affirmed overt and covert types of horizontal and vertical violence. Overt violence is obvious for everyone to see whereas covert is the complete opposite while still encouraging cruelty to one’s peers (Fudge, 2006). However, partnerships within health care settings may be declining due to the fact that some nurses may feel overworked and stressed. Jacoba Leiper (2005) stated that nurses are under pressure to complete their workload during their shift.
Thus the nurse who’s having trouble completing her work on time, may skip breaks or stay late to avoid the ire of those on later shifts. But if she doesn’t take these steps and regularly fails to complete her tasks during her shifts, she may irritate her peers or take her anger out on her peers as well. Thus, the internal factors, such as elevated workload and unbearable work conditions, can be asserted as the leading cause of abuse in nursing. In addition, intraprofessional abuse in health care is of high prominence.
In a nursing survey established by Rowe & Sherlock (2005), identified that the most frequent source of abuse was nurses (27%), followed by patients/families (25%), doctors (22%), patients (17%), residents (4%), other (3%) and interns (2%). Of those who selected a nurse as the most frequent source, staff nurses were reported to be the most frequent nursing source (80%) followed by nurse managers (20%). These statistics are unfortunately American figures and not Canadian. However, it is interesting to see that abuse is a constant concern for the nurses in the United States as well.
The type of abuse that is observed mostly between health care professionals is verbal abuse. The latter, certainly a potential problematic consequence of interpersonal conflict, can be defined as verbal behaviour designed to humiliate, degrade, or otherwise demonstrate a lack of respect for the dignity and worth of another individual (Fudge, 2006). Verbal abuse is typically found in relationships of unequal power and is a factor in maintaining the disproportional amount of power of one individual in the relationship (Manderino & Berkey, 1997).
As mentioned earlier, nurses have always faced the gap between them and the physicians they work with. The current generation is not oblivious to the distribution of power. This bridge is even seen in the media such television shows and movies. According to Manderino & al, (1997), the unequal distribution of power has long been noted as a critical element in the traditional nurse-physician relationship. Nurses are socialized to relinquish power to physicians and to be passive or indirect in their communications.
Previous studies and recent polls have shown the devastating effects of patients abusing nurses. Indeed, a concept that student nurses are taught is that of client-centered care. This guideline recommends that nurses embrace that the clients are the experts regarding their own lives (Nelligan, Grinspun, Jonas-Simpson, McConnell, Peter, Pilkington, Balfour, Connolly, Lefebre, Reid-Haughian & Sherry, 2002). Client centered care exemplifies the promotion of quality of life of the patient to be cared for.
Nonetheless, this concept has its importance in the nursing world. However, one may wonder about abuse and ask how can nurses apply such a concept especially in the face of abuse? Concerns about unmanageable workloads and the inability to provide the desired level of care have been constant messages from nurses (Aiken & al, 2001). One can see that the lack of adherence on the part of the client is an important issue to consider especially in mental health care settings. That is where client client-centered care comes in.
Carlsson, Dahlberg & Drew (2000) stated that nurses are physically assaulted, threatened, and verbally abused more often than other professionals. However, some nurses are able to relate to clients in a way that produces positive resolution. The kind of resolution does not only reflect on the resolutions between patients and nurses, but between the nurses and their colleagues. Effectively, nurses are given certain choices as to diminish violence and abuse in the workplace. Reporting of workplace violence is one of the best ways to confront the issues related to nursing abuse.
However, due to the constant evidence of workplace violence in nursing, it is important to affirm that there are some nurses that do not report that they have been assaulted or abused. Indeed, workplace violence is not to be tolerated because it may lead to other unresolved issues such as nursing shortages and psychological stress. Duncan (2000) stated that nurses need to better understand the ethical and other issues nurses face when deciding whether or not to report especially when the patients are cognitively impaired.
The Occupational Safety and Health Administration (OSHA) clearly states that employees must be empowered to speak up without fear of reprisals (Leiper, 2005). Indeed, recent literature points out that there seems to be a general lack of adequate training, administrative support and political will as factors contributing to the situation of underreporting. To some degree, nurses view violence as an integral part of their work, and think that strategies to prevent it and lessen its impact when it does occur should be an automatic part of nursing preparation (Henderson, 2003).
Adequate training for resolving occupational conflicts is a good solution for nurses to learn how to deal with conflicts. However, there also seems to be unsupportive systems arising in nursing health settings. It may be evident that the lack of support may be the reason behind the nursing shortage, discouragement for the profession and early retirement. Assuredly, this research is essential for understanding the policies directed toward nurses who are violated against.
One can see that nurses are not protected against abuse, evidenced by the existence of underreporting cases. Nurse managers and supervisors do not seem to investigate the real issues underlying what nurses go through in all health care settings. Henderson (2003) noted that nurses lack the support they need from their supervisors. It has also been reported that nurses have been discouraged from supervisors, administration or the police from reporting violence (Henderson, 2003).
Unfortunately, the lack of support does not enact the nursing practice standards of the College Nurse of Ontario. Indeed, nurses should not be jeopardizing their lives in order to provide quality care and this is a struggle that nurses have to overcome today. Unfortunately, nurses have been proven to be one of the most targeted professionals for abuse. Violent acts exhibited by patients and families have been the most prevalent form of abuse due to the direct interaction that nurses have with the patients. This study has demonstrated the effects of abuse in nursing.
Indeed, many published papers regarding the issue of violence in the workplace, are now the voices to reduce such atrocities in health care settings. The purpose of these journals is to set in motion a series of awareness to health care professionals and by setting forth solutions for nurse abuse. Many research studies have found the answers to nurse abuse but why have they not been set in place? Workload management, better communication strategies between health care workers which leads to the reduction of stress in the workplace are all suitable solutions to reduce abuse.
Effectively, it is difficult to state that there are obstacles to overcome before achieving an absolute non-violent workplace environment. However, it is up to the nurses of today and prospect nurses to look to the future and search for effective safety measures that will prevent nursing abuse indefinitely. Importantly, some patients might be the ones to suffer if nurses do become successful in their battle to gain non-violent working conditions. Effectively, that is a whole other issue one might want to consider.