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Calls to address widespread violence against nurses

Introduction by Croakey: The COVID-19 pandemic has exacerbated growing rates of abuse and violence experienced by nurses in and out of their workplaces, the recent Australian College of Nursing (ACN) National Nursing Forum heard.

The ACN launched its Nurses and Violence Taskforce position paper at the three-day conference, where issues of bullying and violence were the focus of a number of sessions.

Croakey’s Jennifer Doggett reports on the discussions below, in her final article from the Forum for the Croakey Conference News Service, which also features Twitter coverage of a range of masterclass sessions featuring nursing and midwifery leaders.

Bookmark all the #NNF2021 coverage here.


Jennifer Doggett writes:

Australia was already facing a nursing shortage prior to the COVID-19 pandemic, which has prompted the exodus of 20,000 nurses from the profession this year.

One reason for this, according to the Australian College of Nursing (ACN), is the growing rates of  abuse and violence experienced by nurses in their workplaces, again exacerbated by the pandemic, including reports of a surge in abuse from the families of COVID-19 patients.

Victorian community health organisation cohealth reported in September that it had been forced to close its Melbourne CBD vaccination hub and homelessness services after several incidents where health workers in the city were physically and verbally abused while on their way to work, targeted because they were wearing their cohealth identification.

Aged Care Minister Richard Colbeck also weighed in on the issue at the ACN’s recent National Nursing Forum, expressing his disappointment that nurses working in aged care felt unsafe wearing uniforms home last year in the first coronavirus wave, and said they continue to be threatened by violence when travelling to and from work in uniform.

And the issue is not confined to Australia, with The Lancet reporting last year on emerging patterns of violence against health facilities, ambulances and staff in Europe, the Middle East, the US, Latin America, Asia, the Pacific and Africa – nearly 20 years after a groundbreaking report from the World Health Organization identified violence as a major threat to health.

Younger workers and women at risk

In response to growing findings and concerns from nurses, ACN established a Nurses and Violence Taskforce, co-chaired by its CEO Associate Professor Kylie Ward and Professor Georgina Willetts, who currently leads an Academic Nursing team at Swinburne University.

The Taskforce has developed a position paper on ‘occupational violence against nurses’, which was released at #NNF2021 and calls for a whole of system approach.

The paper reports a recent campaign by Worksafe Victoria which found that up to 95 percent of healthcare workers have experienced verbal or physical assault.

That’s in the context, it said, of overall concerns of occupational violence, which is a major issue in Australia, with younger workers and women at particular risk. Among concerns identified over the years by Safe Work Australia are:

  • 15 percent of mental disorder claims are caused by exposure to workplace violence (Safe Work Australia 2015).
  • There is a 55 percent higher chance among young workers (under 24 years) of being awarded a mental disorder claim due to exposure to workplace violence compared to workers 55 years or older (Safe Work Australia 2015).
  • More than twice the rate of claims due to workplace violence are recorded among females compared to males — 11.3 versus 4.7 claims per 100 million hours worked (Safe Work Australia 2021).
  • The Victorian Government found WorkCover claims related to occupational violence between 2009-2014 totalled $3,971,281.

Saying the unacceptable experience of occupational violence against nurses is widespread, the ACN position paper commits it to “work tirelessly to support the introduction of legislation and initiatives that will ensure our workplaces are safe for the nursing profession”.

It also identifies the need to understand the specific nature of occupational violence in nursing as a critical first step and explains that occupational violence is not limited to hospitals and must be inclusive of all healthcare working environments where nurses engage, for example rural, remote, community, mental health, and aged care.

The paper also addresses the diverse ways in which nurses experience violence in their work, saying research suggests patients and families are frequently perpetrators of occupational violence.

However, the paper says occupational violence also includes unsafe working cultures where acts of ‘horizontal violence’ and psychologically unsafe working cultures result in devastating impacts.

Data is key

It is clear that reducing violence against nurses is vital to ensure Australia can attract and retain nurses in our health workforce to meet the growing healthcare needs of our ageing population.

Federal and state/territory governments, as well as health service managers, have an important role in developing a system-wide approach to this issue, which needs to focus on nurses’ unique experiences as both victims of violence and as health professionals responding to the impact of violence.

The ACN position paper notes that while there have been some state-based initiatives to address violence towards nurses, including research, training programs and policies, there has never been a nationally consistent, whole of system approach to this issue.

The paper states that this should start with the collection of specific data on occupational violence experienced by nurses. Currently this data is integrated with other work health and safety data, which means it is impossible accurately capture the scope of the occupational violence nurses face in their workplaces.

A key recommendation from the ACN paper is for state and federal governments to develop a national approach to data collection and analysis on occupational violence in healthcare. ACN has also called on governments to publish the results of this in the Australian workers compensation report.

Other recommendations include the development and implementation of a national campaign to highlight key issues around occupational violence and address inappropriate behaviour both within the community and across workplace environments.

This includes advocating for the introduction of mandated psychologically safe processes across all work environments where nurses work and developing a National Work Health and Safety Code of Practice on Psychological Health at Work and a Work Health and Safety Code of Practice for Managing the Risk of Occupational Violence.

Need for a systematic approach  

A recently published report from NSW argued that a systematic approach to addressing occupational violence is needed across healthcare from government level, down to the frontline worker.

It says this requires a shift in public attitudes and behaviours towards healthcare workers and that cultural change is also required to prioritise psychological safety, improve work environments and reduce occupational violence.

This reflects the findings of an independent national review of the model Work Health and Safety laws by Marie Boland, which identified the importance of organisational cultures which promote psychological health, saying:

“Psychosocial safety climates are a type of organisational climate that prioritise employees’ psychological health. Psychosocial safety climates are a predictor of work conditions, worker health and engagement.”

Other aspects of organisational violence

Other issues relevant to nursing and violence were presented by nursing leaders at #NNF2021, including the  the role of nurses in supporting people who may be experiencing domestic or family violence.

Dr Jacqui Pich, Course Director of the Bachelor Of Nursing at the School of Nursing and Midwifery at University of Technology Sydney, argued for violence prevention to be built into undergraduate nursing programs as well as for broader organisational and public interventions.

In 2014, Pich led the national VENT Study, Violence in Emergency Nursing and Triage, on Australian Emergency Department nurses’ experiences with patient-related violence, in which triaging was identified as a significantly high risk nursing activity, with nurses almost three times more likely to experience violence when performing this role.

In another session, Dr Peter Hartin, Senior Lecturer, Nursing and Midwifery at James Cook University, discussed the evolution of bullying in nursing over the past four decades. His research found that bullying in nursing is a pervasive problem but the evolution of bullying is poorly understood.

He described how bullying in nursing has changed from mostly overt and physical manifestations in the 1980s to verbal bullying in the 1990s, partly fuelled by power imbalances at that time between university and non-university educated nurses.

He said that workforce shortages and pressures in the 2000s contributed to bullying, which has become entrenched as part of nursing culture in the 2010s.

Since then, he said, bullying has evolved to look more like micro managing and unrealistic workplace demands, with nurses often told to “suck it up…as that’s what nursing is…”

Hartin argued that the myriad ways in which bullying in nursing is defined in Australia has important implications for research, practice, education, and policy.

See also this Twitter thread on discussions by Adjunct Professor Kylie Ward, Professor Georgina Willetts and Dr Leesa Hooker, a nurse/midwife academic and Senior Research Fellow at the La Trobe Rural Health School, President of the Nursing Network on Violence against Women International (NNVAWI).


Masterclasses in nursing & midwifery

The National Nursing Forum featured a range of masterclasses and other panel events that sought insights and advice from nursing and midwifery and other health experts. They included former Labor Federal Health Minister Nicola Roxon, ACN chair Professor Christine Duffield, ACN CEO Kylie Ward, former Victoria Chief Nurse and Midwife Officer Fiona Brew, Associate Professor Denise Heinjus and Tasmanian Chief Nurse and Midwife Francine Douce.

See the tweets below for some of the discussions and speakers.




#NNF2021 Twitter analytics


See Croakey’s archive of stories about nurses and nursing.

See also our coverage of the 2019 NNF.

 

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