Workplace assaults in the healthcare sector

We fielded a survey to 6,743 US-based HCPs, and 1,037 UK HCPs across a broad range of specialties asking them a series of questions about their experiences of workplace assault, both physical and verbal.

In 2002, when the World Health Organization (WHO) published their ‘Framework Guidelines for Addressing Workplace Violence in the Health Sector’ in collaboration with the International Labour Organization (ILO), International Council of Nurses (ICN), and Public Services International (PSI), they believed that between 8% and 38% healthcare workers would suffer physical violence during their career. Our survey findings reflect this incidence, but highlights the frequency of abuse, as opposed to an isolated incident during a career, with a slightly higher risk of physical abuse in the UK.

The survey also found a much higher incidence of verbal aggression towards physicians in both countries:

Despite the publication of the WHO guidelines nearly 20 years ago, which highlighted the scale of the problem, 58% US respondents, and 68% UK respondents felt that workplace abuse has increased over the last five years:

A 2019 AJMC1 blog article by Wallace Stephens reports that 75% of all workplace assaults take place in a healthcare setting. Given the extraordinary stress that both patients and their families find themselves subjected to in hospitals and surgeries, it’s not altogether unsurprising that they ‘lash out’ at healthcare professionals (HCPs), both verbally and physically. This, of course, does not make such behaviour acceptable, but understanding the triggers may help prevent aggression against healthcare workers rather than the current position of responding to attacks.

In our survey the specialties reporting the highest incidence of violence were clinical areas that could expected to be ‘higher stakes’ and so invoke more stress and anxiety – emergency care was the highest, followed by general practice, psychiatry, critical care, and surgery.

Of particular interest is the reluctance to report incidents– the survey results show that nearly as many physical assaults go unreported as reported, and this is supported by the high tolerance that HCPs have for such attacks:

The higher incidence of cases of abuse in the UK is seen again here, UK respondents seeing more cases of both physical and verbal assault on a daily basis. Sadly, this seems to be attributed to an acceptance that being abused at work is ‘part of the job’, especially in highly stressful specialties where fear and illness often manifest themselves as agitation and aggression, and there is a certain amount of sympathy for their reactions.

This is particularly the case with psychiatric and behavioural illnesses, when potentially drugs are playing a part in impairing decision-making and contributing to aggressive behaviours. HCPs understand more than anyone how behaviour can be adversely affected by pharmacological substances, but this empathy should not extend to acceptance.

The long-term effects of abuse and violence should not be underestimated, negatively impacting both physical and psychological wellbeing. Motivation for their jobs inevitably suffers, and collectively risks healthcare provision and compromises quality of care.

Unfortunately, measures intended to address violence against healthcare workers appear to have been largely ineffective, and policies have focused on response rather than prevention. Work into evaluating the effectiveness of specific interventions has been largely inconclusive, and attention must be paid to new approaches to promoting a safe working environment for our frontline healthcare workers.

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