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Workplace violence (WPV) is any physical or psychological act of aggression that occurs at a worksite and/or against employees who are on duty (Occupational Safety and Health Administration [OSHA], 2015). Health care employees in the United States experience higher rates of WPV than professionals in other fields. For example, in 2018, health care employees experienced 73% of the nation's nonfatal WPV–related illnesses and injuries (U.S. Bureau of Labor Statistics, 2020). Among RNs and nursing students, approximately 21% experience physical WPV, and 50% experience verbal WPV annually (OSHA, 2015).
Although the actual number of WPV incidents against health care professionals is higher than what is documented, as many episodes of WPV are not officially reported (OSHA, 2015), it is clear that WPV has been rising in health care environments for years. Since the start of the coronavirus disease 2019 (COVID-19) pandemic, WPV has spiked acutely and is now considered a pressing issue that “undermines the very foundations of health systems” and “constitutes an international emergency” (World Medical Association, 2020, para. 3).
Health care departments where WPV is most common are referred to herein as high-incidence care areas. These departments include emergency departments, behavioral health units (e.g., psychiatric and neuroscience units), geriatric units (e.g., Alzheimer's disease/dementia units), cardiovascular departments, and neonatal intensive care units (Early, 2004; Ferri et al., 2016; OSHA, 2015). Inpatient units, especially inpatient psychiatric units, report even higher rates of WPV. Reasons for these increased rates include boredom, medication side effects, environmental stressors (e.g., lack of privacy), and more acute psychiatric symptoms due to challenges accessing mental health care (Antonysamy, 2013; Bellman et al., 2022; OSHA, 2016; Odes et al., 2020). Importantly, although patient factors are often heavily emphasized when analyzing causes of WPV, factors concerning employees (e.g., burnout) and institutions (e.g., number of inpatients) also contribute to these causes (Weltens et al., 2021). It is therefore necessary to consider all factors and stakeholders to explain the complex causes of WPV. From a humane and holistic viewpoint, this should encompass all players in “a culture of respect, dignity, and active mutual engagement in preventing workplace violence” (OSHA, 2016, p. 25).
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