Workplace aggression, including bullying in nursing and midwifery: A descriptive survey (the SWAB study)

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Abstract

Background

Workplace aggression remains an important source of distress among nurses and midwives and has negative effects on staff health, patient care and organisations’ reputation and fiscal health.

Objectives

To report on the nature and extent of workplace aggression, including bullying experienced by nurses and midwives in Victoria, Australia.

Design

A descriptive study design was chosen.

Settings and methods

The Nurses Board of Victoria posted 5000 surveys to the randomly selected registered nurses and midwives in Victoria, Australia, in 2010. The participants were asked about their experiences of violence (from clients) and bullying (from colleagues) within their most recent four working weeks. In addition, the study investigated staff actions following incidents, staff training and safety at work, and what staff believe contribute to incidents. Data analysis involved descriptive statistics, including frequencies and percentages. Chi square tests and P value were used to assess differences in categorical data.

Findings

1495 returned questionnaires were included in the study (30% response rate). Over half of the participants (52%) experienced some form of workplace aggression. Thirty-six percent experienced violence mostly from patients or their visitors/relatives and 32% experienced bullying mostly from colleagues or from their managers/supervisors. Significant differences were found between those who experienced aggression from patients and those who were bullied in respect to handling of incidents; factors thought to contribute to incidents; and organisations’ handling of incidents.

Conclusion

The study suggests that staff are less worried by patient initiated aggression compared to bullying from colleagues. For all types of aggression, respondents clearly wanted better/more realistic training, as well as enforcement of policies and support when incidents arise.

Section snippets

Background

The popular conception of nursing or midwifery work is of rewarding experiences and a fulfilling career. And for many this is true. However, a significant number of nurses and midwives have profoundly negative experiences because of workplace aggression (WA) – from patients or their visitors or bullying by colleagues. In a 1995/96 report, Australian registered nurses recorded the second highest number of violent-related workers’ compensation claims, higher than prison and police officers (

Causes of WA

There is a burgeoning literature on the causes of WA, which coalesces around three main types of explanations – ‘internal’ and ‘external’ factors and their ‘interaction’. For instance, ‘internal’ influences relate to properties affecting the patient, such as their personality or the effects of their illness; whereas ‘external’ influences focus on the environment, such as noisy environments or staff shortages. The ‘interactional’ approach acknowledges the interplay of ‘internal’ and ‘external’

Study design

A descriptive study design was chosen. In anticipation of this study, the Nurses Board of Victoria (NBV) included in their 2009 round of annual registration for nurses and midwives the option to indicate if they agreed to be sent invitations to participate in research, which had NBV approval. In 2010, the NBV distributed the questionnaire on behalf of the research team to a random selection (N = 5000) of those who had agreed to receive such invitations. Reply paid envelopes were used to return

Survey response rate

Five thousand questionnaires were posted, with 1513 returned. Two had returned to sender and 16 were blank or mostly incomplete, resulting in 1495 usable questionnaires, representing a response rate of 30%.

Characteristics of respondents

Representativeness of the study sample was assessed by comparing it with labour force data (which had a response rate of 33%) on registered nurses and midwives, and enrolled nurses (second-tier nurses in the Australian health care system) in Victoria (AIHW, 2010), using Index of Dissimilarity

Study limitations

Although the respondents were largely representative of the total population of nurses/midwives in Victoria, we cannot be certain that they hold similar views to those who did not participate in the study. Accordingly, caution should be exercised in generalising findings to the wider population of nurses and midwives in Victoria. Also, there are major problems in comparing studies on WA due to differences in respect to definition of concepts, data collecting methods and sampling, making direct

Conclusion

This is the first large-scale study to draw on the Victorian Department of Human Service's definition of WA in estimating its prevalence among Victorian nurses and midwives. The prevalence of patient-initiated aggression and bullying among staff are clearly documented, which is in line with national (and international) trends. The data presented here suggest that staff are less worried by patient-initiated aggression compared to bullying from colleagues. Clearly, respondents wanted better

Acknowledgements

The researchers are grateful to: Nigel Fidgeon, CEO, Nurses Board of Victoria, for his support of this project, including the in kind assistance he gave in respect to drawing a random sample of potential participants from the Victorian register, and for providing staff to assist with posting the survey; the ANF (Victoria branch) for financial help, and in kind assistance in the production of the questionnaire; Nicholas Gaynor, Nurse Practitioner, Mental Health, Austin Health; for the many

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