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. 2004 Jun;61(6):495–503. doi: 10.1136/oem.2003.007294

An epidemiological study of the magnitude and consequences of work related violence: the Minnesota Nurses' Study

S Gerberich 1, T Church 1, P McGovern 1, H Hansen 1, N Nachreiner 1, M Geisser 1, A Ryan 1, S Mongin 1, G Watt 1
PMCID: PMC1763639  PMID: 15150388

Abstract

Aims: To identify the magnitude of and potential risk factors for violence within a major occupational population.

Methods: Comprehensive surveys were sent to 6300 Minnesota licensed registered (RNs) and practical (LPNs) nurses to collect data on physical and non-physical violence for the prior 12 months. Re-weighting enabled adjustment for potential biases associated with non-response, accounting for unknown eligibility.

Results: From the 78% responding, combined with non-response rate information, respective adjusted rates per 100 persons per year (95% CI) for physical and non-physical violence were 13.2 (12.2 to 14.3) and 38.8 (37.4 to 40.4); assault rates were increased, respectively, for LPNs versus RNs (16.4 and 12.0) and males versus females (19.4 and 12.9). Perpetrators of physical and non-physical events were patients/clients (97% and 67%, respectively). Consequences appeared greater for non-physical than physical violence. Multivariate modelling identified increased rates for both physical and non-physical violence for working: in a nursing home/long term care facility; in intensive care, psychiatric/behavioural or emergency departments; and with geriatric patients.

Conclusions: Results show that non-fatal physical assault and non-physical forms of violence, and relevant consequences, are frequent among both RNs and LPNs; such violence is mostly perpetrated by patients or clients; and certain environmental factors appear to affect the risk of violence. This serves as the basis for further analytical studies that can enable the development of appropriate prevention and control efforts.

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Selected References

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  1. Aiken L. H., Clarke S. P., Sloane D. M., Sochalski J. A., Busse R., Clarke H., Giovannetti P., Hunt J., Rafferty A. M., Shamian J. Nurses' reports on hospital care in five countries. Health Aff (Millwood) 2001 May-Jun;20(3):43–53. doi: 10.1377/hlthaff.20.3.43. [DOI] [PubMed] [Google Scholar]
  2. Aquilina C. Violence by psychiatric in-patients. Med Sci Law. 1991 Oct;31(4):306–312. doi: 10.1177/002580249103100406. [DOI] [PubMed] [Google Scholar]
  3. Arnetz J. E., Arnetz B. B., Söderman E. Violence toward health care workers. Prevalence and incidence at a large, regional hospital in Sweden. AAOHN J. 1998 Mar;46(3):107–114. [PubMed] [Google Scholar]
  4. Barlow C. B., Rizzo A. G. Violence against surgical residents. West J Med. 1997 Aug;167(2):74–78. [PMC free article] [PubMed] [Google Scholar]
  5. Baxter E., Hafner R. J., Holme G. Assaults by patients: the experience and attitudes of psychiatric hospital nurses. Aust N Z J Psychiatry. 1992 Dec;26(4):567–573. doi: 10.3109/00048679209072090. [DOI] [PubMed] [Google Scholar]
  6. Bensley L., Nelson N., Kaufman J., Silverstein B., Kalat J., Shields J. W. Injuries due to assaults on psychiatric hospital employees in Washington State. Am J Ind Med. 1997 Jan;31(1):92–99. doi: 10.1002/(sici)1097-0274(199701)31:1<92::aid-ajim14>3.0.co;2-2. [DOI] [PubMed] [Google Scholar]
  7. Brewin C. R., Andrews B., Rose S., Kirk M. Acute stress disorder and posttraumatic stress disorder in victims of violent crime. Am J Psychiatry. 1999 Mar;156(3):360–366. doi: 10.1176/ajp.156.3.360. [DOI] [PubMed] [Google Scholar]
  8. Caldwell M. F. Incidence of PTSD among staff victims of patient violence. Hosp Community Psychiatry. 1992 Aug;43(8):838–839. doi: 10.1176/ps.43.8.838. [DOI] [PubMed] [Google Scholar]
  9. Carmel H., Hunter M. Staff injuries from inpatient violence. Hosp Community Psychiatry. 1989 Jan;40(1):41–46. doi: 10.1176/ps.40.1.41. [DOI] [PubMed] [Google Scholar]
  10. Castillo D. N., Jenkins E. L. Industries and occupations at high risk for work-related homicide. J Occup Med. 1994 Feb;36(2):125–132. doi: 10.1097/00043764-199402000-00006. [DOI] [PubMed] [Google Scholar]
  11. Cooper A. J., Mendonca J. D. A prospective study of patient assaults on nursing staff in a psychogeriatric unit. Can J Psychiatry. 1989 Jun;34(5):399–404. doi: 10.1177/070674378903400507. [DOI] [PubMed] [Google Scholar]
  12. Drummond D. J., Sparr L. F., Gordon G. H. Hospital violence reduction among high-risk patients. JAMA. 1989 May 5;261(17):2531–2534. [PubMed] [Google Scholar]
  13. Eisele G. R., Watkins J. P., Matthews K. O. Workplace violence at government sites. Am J Ind Med. 1998 May;33(5):485–492. doi: 10.1002/(sici)1097-0274(199805)33:5<485::aid-ajim8>3.0.co;2-r. [DOI] [PubMed] [Google Scholar]
  14. Findorff-Dennis M. J., McGovern P. M., Bull M., Hung J. Work related assaults. The impact on victims. AAOHN J. 1999 Oct;47(10):456–465. [PubMed] [Google Scholar]
  15. Gabel Christine L., Gerberich Susan G. Risk factors for injury among veterinarians. Epidemiology. 2002 Jan;13(1):80–86. doi: 10.1097/00001648-200201000-00013. [DOI] [PubMed] [Google Scholar]
  16. Grainger C., Whiteford H. Assault on staff in psychiatric hospitals: a safety issue. Aust N Z J Psychiatry. 1993 Jun;27(2):324–328. doi: 10.3109/00048679309075785. [DOI] [PubMed] [Google Scholar]
  17. Greenland S., Pearl J., Robins J. M. Causal diagrams for epidemiologic research. Epidemiology. 1999 Jan;10(1):37–48. [PubMed] [Google Scholar]
  18. Hanson R. H., Balk J. A. A replication study of staff injuries in a state hospital. Hosp Community Psychiatry. 1992 Aug;43(8):836–837. doi: 10.1176/ps.43.8.836. [DOI] [PubMed] [Google Scholar]
  19. Helmuth R. Nursing staff educational preparation and patient inflicted injuries in a 160 bed psychiatric hospital. Alaska Med. 1994 Oct-Dec;36(4):189-92, 203. [PubMed] [Google Scholar]
  20. Hernán Miguel A., Hernández-Díaz Sonia, Werler Martha M., Mitchell Allen A. Causal knowledge as a prerequisite for confounding evaluation: an application to birth defects epidemiology. Am J Epidemiol. 2002 Jan 15;155(2):176–184. doi: 10.1093/aje/155.2.176. [DOI] [PubMed] [Google Scholar]
  21. Jones M. K. Patient violence. Report of 200 incidents. J Psychosoc Nurs Ment Health Serv. 1985 Jun;23(6):12–17. doi: 10.3928/0279-3695-19850601-04. [DOI] [PubMed] [Google Scholar]
  22. LaMar W. J., Gerberich S. G., Lohman W. H., Zaidman B. Work-related physical assault. J Occup Environ Med. 1998 Apr;40(4):317–324. doi: 10.1097/00043764-199804000-00005. [DOI] [PubMed] [Google Scholar]
  23. Lanza M. L. The reactions of nursing staff to physical assault by a patient. Hosp Community Psychiatry. 1983 Jan;34(1):44–47. doi: 10.1176/ps.34.1.44. [DOI] [PubMed] [Google Scholar]
  24. Lee S. S., Gerberich S. G., Waller L. A., Anderson A., McGovern P. Work-related assault injuries among nurses. Epidemiology. 1999 Nov;10(6):685–691. [PubMed] [Google Scholar]
  25. Levin P. F., Hewitt J. B., Misner S. T. Insights of nurses about assault in hospital-based emergency departments. Image J Nurs Sch. 1998;30(3):249–254. doi: 10.1111/j.1547-5069.1998.tb01300.x. [DOI] [PubMed] [Google Scholar]
  26. Liss G. M., McCaskell L. Injuries due to violence: workers' compensation claims among nurses in Ontario. AAOHN J. 1994 Aug;42(8):384–390. [PubMed] [Google Scholar]
  27. Liss G. M., McCaskell L. Violence in the workplace. CMAJ. 1994 Nov 1;151(9):1243–1246. [PMC free article] [PubMed] [Google Scholar]
  28. Mahoney B. S. The extent, nature, and response to victimization of emergency nurses in Pennsylvania. J Emerg Nurs. 1991 Oct;17(5):282–294. [PubMed] [Google Scholar]
  29. Maldonado George, Greenland Sander. Estimating causal effects. Int J Epidemiol. 2002 Apr;31(2):422–429. [PubMed] [Google Scholar]
  30. Miller T. R., Cohen M. A., Rossman S. B. Victim costs of violent crime and resulting injuries. Health Aff (Millwood) 1993 Winter;12(4):186–197. doi: 10.1377/hlthaff.12.4.186. [DOI] [PubMed] [Google Scholar]
  31. Moracco K. E., Runyan C. W., Loomis D. P., Wolf S. H., Napp D., Butts J. D. Killed on the clock: a population-based study of workplace homicide, 1977-1991. Am J Ind Med. 2000 Jun;37(6):629–636. doi: 10.1002/(sici)1097-0274(200006)37:6<629::aid-ajim7>3.0.co;2-7. [DOI] [PubMed] [Google Scholar]
  32. Murray M. G., Snyder J. C. When staff are assaulted. A nursing consultation support service. J Psychosoc Nurs Ment Health Serv. 1991 Jul;29(7):24–29. doi: 10.3928/0279-3695-19910701-06. [DOI] [PubMed] [Google Scholar]
  33. Nelson N. A., Kaufman J. D. Fatal and nonfatal injuries related to violence in Washington workplaces, 1992. Am J Ind Med. 1996 Oct;30(4):438–446. doi: 10.1002/(SICI)1097-0274(199610)30:4<438::AID-AJIM9>3.0.CO;2-R. [DOI] [PubMed] [Google Scholar]
  34. Peek-Asa C., Erickson R., Kraus J. F. Traumatic occupational fatalities in the retail industry, United States 1992-1996. Am J Ind Med. 1999 Feb;35(2):186–191. doi: 10.1002/(sici)1097-0274(199902)35:2<186::aid-ajim10>3.0.co;2-4. [DOI] [PubMed] [Google Scholar]
  35. Peek-Asa C., Howard J., Vargas L., Kraus J. F. Incidence of non-fatal workplace assault injuries determined from employer's reports in California. J Occup Environ Med. 1997 Jan;39(1):44–50. doi: 10.1097/00043764-199701000-00009. [DOI] [PubMed] [Google Scholar]
  36. Peek-Asa C., Schaffer K. B., Kraus J. F., Howard J. Surveillance of non-fatal workplace assault injuries, using police and employers' reports. J Occup Environ Med. 1998 Aug;40(8):707–713. doi: 10.1097/00043764-199808000-00008. [DOI] [PubMed] [Google Scholar]
  37. Riopelle D. D., Bourque L. B., Robbins M., Shoaf K. I., Kraus J. Prevalence of assault and perception of risk of assault in urban public service employment settings. Int J Occup Environ Health. 2000 Jan-Mar;6(1):9–17. doi: 10.1179/oeh.2000.6.1.9. [DOI] [PubMed] [Google Scholar]
  38. Ryan J. A., Poster E. C. The assaulted nurse: short-term and long-term responses. Arch Psychiatr Nurs. 1989 Dec;3(6):323–331. [PubMed] [Google Scholar]
  39. Schaffer Kathryn Brown, Casteel Carri, Kraus Jess F. A case-site/control-site study of workplace violent injury. J Occup Environ Med. 2002 Nov;44(11):1018–1026. doi: 10.1097/00043764-200211000-00007. [DOI] [PubMed] [Google Scholar]
  40. Simonowitz J. A. Health care workers and workplace violence. Occup Med. 1996 Apr-Jun;11(2):277–291. [PubMed] [Google Scholar]
  41. Simonowitz J. A. Violence in health care: a strategic approach. Nurse Pract Forum. 1995 Jun;6(2):120–129. [PubMed] [Google Scholar]
  42. Sullivan C., Yuan C. Workplace assaults on minority health and mental health care workers in Los Angeles. Am J Public Health. 1995 Jul;85(7):1011–1014. doi: 10.2105/ajph.85.7.1011. [DOI] [PMC free article] [PubMed] [Google Scholar]
  43. Toscano G. Workplace violence: an analysis of bureau of labor statistics data. Occup Med. 1996 Apr-Jun;11(2):227–235. [PubMed] [Google Scholar]
  44. Williams M. F. Violence and sexual harassment: impact on registered nurses in the workplace. AAOHN J. 1996 Feb;44(2):73–77. [PubMed] [Google Scholar]
  45. Yassi A. Assault and abuse of health care workers in a large teaching hospital. CMAJ. 1994 Nov 1;151(9):1273–1279. [PMC free article] [PubMed] [Google Scholar]

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