Workplace violence against Bangladeshi registered nurses: A survey following a year of the COVID‐19 pandemic

Abstract

Aims

To investigate the prevalence of workplace violence and its associated factors among Bangladeshi registered nurses.

Background

Workplace violence is prevalent among nurses, particularly in developing countries. However, the issue has never been examined in Bangladeshi nurses.

Methods

Between February 26 and July 10, 2021, this cross‐sectional survey involving 1264 registered nurses was conducted. Workplace violence was determined by the Workplace Violence Scale (WVS). A multivariable logistic regression model was fitted to find the factors associated with workplace violence. This study complies with the EQUATOR (STROBE) checklist.

Results

Of the 1264 nurses, 885 (70%) nurses reported being exposed to workplace violence in the previous year. Three hundred twenty‐four (324; 25.6%) nurses reported physical violence, whereas 902 (71.4%) nurses reported nonphysical violence. According to the multivariable logistic regression model, male nurses, nurses in the Sylhet division, emergency department nurses, nurses working extended hours, and non trained nurses to tackle workplace violence were prone to physical violence. Furthermore, public hospital nurses and non trained nurses to tackle workplace violence were more likely to be exposed to nonphysical violence. Nurses who had not been exposed to workplace violence were satisfied with their current job, but those who had been exposed to workplace violence were dissatisfied and intended to leave their current job.

Conclusions and implications for nursing and health policy

High prevalence of workplace violence underscores nurses’ current working conditions, which are particularly poor in public hospitals and emergency departments. Moreover, the COVID‐19 pandemic put unprecedented pressure on the whole healthcare system and caused various difficulties for healthcare workers. To develop a zero‐violence practice environment, health authorities should implement policy‐level interventions. Healthcare staff should be guided to deal more successfully with patients and coworkers to create a positive working environment.

INTRODUCTION

Workplace violence (WPV) is defined as violent acts such as physical or verbal assaults and threats of assault by someone at the workplace (CDC NIOSH, 2002). This is a serious issue in healthcare settings. Healthcare facilities and staff play a vital role in public health as they are the center of the functioning of health service delivery systems. The National Institute for Occupational Safety and Health (NIOSH) reported that hospitals are the public place where maximum violence occurs against employees. Nevertheless, nurses were reported to be the most vulnerable group to frequent exposure to WPV (Warshawski et al., 2021). Nurses contribute to alleviating patients’ sufferings along with their colleagues and communicate with patients’ relatives. While providing these services, conflicting events from colleagues, patients, and their relatives may trigger WPV (Bordignon & Monteiro, 2019; Eneroth et al., 2017). Nurses are the most important frontline workforce in healthcare settings, and the quality of patient care solely depends on the quality of the nursing workforce and the standard of their working environment (Cheung & Yip, 2017; Rayan & Ahmad, 2017; Zainal et al., 2018). WPV is a serious concern in healthcare settings, which requires prevention and control to secure occupational health of the workforce to ensure the highest possible standards of care for patients.

Visitors, patients, their family members, and coworkers can be perpetrators of WPV against healthcare personnel, particularly nurses. A systematic review found that WPV against nurses was mostly perpetrated by patients and their families (Edward et al., 2016). The study also revealed that most nurses were subjected to verbal or physical violence at least once throughout their careers (Edward et al., 2016). Similarly, another review reported the aspects of the higher level of WPV against nurses (Mitchell et al., 2014). Several studies reported the prevalence of WPV in hospital settings ranging from 8.4% to 87.3% (Lafta et al., 2021; Özkan Şat et al., 2021). A study in Hong Kong on 850 nurses found that among the perpetrators of WPV, the most prevalent were patients (36.6%) and their relatives (17.5%), followed by colleagues (7.7%) and supervisors (6.3%) (Cheung & Yip, 2017). A study in Bangladesh found that 91% of WPV against medical personnel committed by patients and their relatives occurred in public healthcare settings, whereas 39% occurred in tertiary‐level hospitals (Hasan et al., 2018). Another study in Bangladesh reported that nurses cited poor quality of work life as a reason for their experiences of WPV (Akter et al., 2018).

WPV among healthcare workers has been identified as a major global phenomenon. During the COVID‐19 crisis, there was a huge shortage of personal protection equipment, and COVID‐19 impacted nurses’ communication, isolated them from relatives, and created uncertainty (Axe et al., 2022). The overwhelming spread of COVID‐19 caused an outbreak of violence against people working in healthcare settings. Since the COVID‐19 outbreak, there were multiple reports of acts of violence, harassment, and stigmatization directed at healthcare workers (Devi, 2020). These incidents resulted in higher stress levels among healthcare workers, exacerbating the psychological effects resulting from moral injuries (Brewis et al., 2020). Furthermore, many healthcare workers experienced adverse mental health outcomes during COVID‐19. A recent study in Bangladesh while examining mental health consequences of the COVID‐19 pandemic on nurses found that the prevalence of mild to extremely severe depression was 50.5%, anxiety was 51.8%, and stress was 41.7% (Chowdhury et al., 2021).

Previous research reported WPV as a predictor that significantly affects nurses’ working environment (Cheung & Yip, 2017; Zainal et al., 2018). Studies found that WPV reduced nurses’ job satisfaction and performance, as well as adversely affected patient care (AbuAlRub et al., 2007; Cai et al., 2010; Kling et al., 2009). In addition, WPV can cause severe physical and psychological problems. It can lead to poor quality of life, higher job stress, burnout, and sleep disturbance (Gan et al., 2018).

Although numerous studies investigated WPV against nurses in developed countries (Alameddine et al., 2015; Ramacciati et al., 2019; Tonso et al., 2016), a few studies were found in the Asian regions (Choi & Lee, 2017; Hasan et al., 2018; Tian et al., 2020). Bangladesh is a lower‐middle‐income country, and the health service system is still progressing. In Bangladesh, to the authors’ knowledge, there was limited evidence of WPV against nurses. Therefore, this study aimed to determine the prevalence of WPV against Bangladeshi nurses and to address the associated factors.

METHODS

Study design and population

This cross‐sectional study was carried out between February 26, 2021, and July 10, 2021, among Bangladeshi registered nurses. Inclusion criteria of the participants included: (a) registered nurses, (b) engaged in working in clinical settings during the COVID‐19 pandemic, (c) had at least a year of working experience, and (d) agreed to participate in the study.

Sample size

The required sample size was 1024 at 80% power, 95% CI of 0.05 to 1.96, with the assumption that 50% of nurses were exposed to WPV, and the margin of error at 3%. However, the authors targeted more participants to be included. Therefore, after data collection, a total of 1264 completed samples were included in the final analysis.

Questionnaire development and data collection procedure

Data were collected by following both the online and offline methods. A semistructured questionnaire was used for data collection. The questionnaire was composed of three parts. The first part described the study objectives and the responding procedure, and the respondent's consent was asked. The second part contained demographic and occupational characteristics of respondents. The last part contained WPV‐related questions. The questionnaire was translated into Bangla with the help of an expert. Due to the COVID‐19 pandemic, face‐to‐face interviews were limited, and people were reluctant to physical interviews. Therefore, a convenience sampling method was followed, where a self‐reported questionnaire was created using Google Forms, and the link to the online questionnaire was shared on several social media platforms (Facebook, WhatsApp, etc.), and Bangladeshi nurses were asked to fill it out. Using the online data collection method, 802 responses (721 completed responses) were obtained. To collect the required responses from nurses, the authors distributed an additional 700 printed questionnaires to eight hospitals located in two administrative divisions of Bangladesh. Of the 655 returned questionnaires, 543 were complete, making the number of complete responses to 1264. This study complied with the EQUATOR (STROBE) checklist (Table S2).

Independent and dependent variables

The dependent variable of this study was WPV faced by nurses working in clinical settings from patients, patients’ relatives, or their colleagues. Independent variables included socio‐demographic characteristics (sex, age, marital status, educational level, and administrative division of workplace) and occupational variables (type of job, level of hospital, professional title, work department, weekly working hours, years of experience, and training to tackle WPV). In addition, three dichotomous‐response (yes/no) questions related to participants’ “present job satisfaction,” “thinking of leaving present job,” and “acceptance of another job with the same compensation” were asked.

Workplace violence measure

The Workplace Violence Scale (WVS) consisting of five items was utilized in this research (Hesketh et al., 2003; Wang et al., 2006). Previous studies used the WVS for nurses and other healthcare workers (Tian et al., 2020; Wu et al., 2012). A study conducted during the COVID‐19 pandemic used WVS (Kabir et al., 2022). The scale demonstrated good reliability and validity among healthcare workers in China, with a Cronbach's alpha coefficient and an intraclass correlation coefficient of the test–retest reliability that both exceeded 0.70 in all dimensions (Wang et al., 2006). Scale items were composed of five types of violence: physical assault, emotional abuse, threat, verbal sexual harassment, and sexual assault. The questionnaire included specific definitions of each type of violence. The responses of each item (ranging from 0 to 3) reflected the frequencies of WPV exposure in the last 12 months. In WVS, frequencies of WPV exposure were labeled as 0 = 0 time, 1 = 1 time, 2 = 2 or 3 times, and 3 = more than 3 times. The total score was calculated by summing all items that ranged from 0 to 15. The four levels of WPV were derived from the total score of the scale (0 = none, 1 to 5 = low, 6 to 10 = intermediate, and 11 to 15 = high). The confirmatory factor analysis of McDonald's omega (ω) was performed to measure the internal consistency of the tool (Hayes & Coutts, 2020). The overall reliability coefficient was calculated at ω = 0.61, which indicated an acceptable internal consistency of WVS among the studied population. We classified five types of violence into two categories: physical violence and nonphysical violence. Physical violence included physical assault and sexual assault, and nonphysical violence included emotional abuse, threat, and verbal sexual harassment.

Data analysis

For descriptive analyses, frequency and percentages to report the distributions of the studied variables were presented. The five types of WPV were categorized as two dependent variables, physical violence and nonphysical violence, and coded as a dichotomous response (yes/no). The crude association between independent and dependent variables was investigated by performing a chi‐square test. The factors associated with outcome variables at a priori specified p value of 0.1 in the chi‐square test were included in the subsequent multivariable logistic regression model to find the adjusted association between independent and dependent variables. The association between three job‐related questions and the level of WPV was evaluated using the chi‐square test. At a 95% confidence interval, p  < 0.05 was deemed statistically significant. Statistical software STATA‐16 was used to perform data analyses (Stata Corp LP, College Station, TX, USA).

Ethical considerations

The Helsinki Declaration 2013 guideline was followed in this study (World Medical Association, 2013). The ethical review committee of Begum Rabeya Khatun Chowdhury Nursing College, Bangladesh, granted ethical approval to this study (approval ID: BRKCNC‐IRB‐2021/5). Data collection permission was obtained from the study sites using this ethical approval. The first page of the questionnaire contained the study's aims and objectives. As the questionnaire was self‐reported, respondents' implied consents were defined by their participation in the study. The authors maintained anonymity of the collected data and ensured freedom to withdraw from the research at any time. All the participants in this study were Bangladeshi citizens, and none of them were under 18 years old.

RESULTS

Demographic and occupational characteristics of participants

A total of 1264 nurses were included in this study. Of these, 70.0% (n = 885) were female, and the mean age of the respondents was 28.4(± 5.5) years. More than half of them (53.4%, n = 675) were married, and 40.7% (n = 514) of nurses completed a bachelor's degree. Approximately half of them (48.9%) resided in the Dhaka division. The majority of the respondents (59.8%, n = 756) were government employees. Nurses from tertiary‐level hospitals were 72.0% (n = 910). Nurses with a working experience of six or more years accounted for 33.6% of the total. Lastly, only 18.2% of the nurses had undergone training to tackle WPV. The details of the demographic and occupational characteristics of participants are presented in Supplementary Table S1.

Prevalence of exposure to WPV among nurses

The prevalence of exposure to WPV among nurses over 12 months of the pandemic is presented in Figure 1. The overall prevalence of physical assault was found at 22.2% (n = 281). The prevalence of emotional abuse was 65.5% (n = 828), threats was 39.2% (n = 495), verbal sexual harassment was 14.8% (n = 187), and sexual abuse was 5.9% (n = 75).

FIGURE 1.

Prevalence of exposure to WPV among nurses (n = 1264)

Distribution of different levels of WPV among nurses

Different degrees of WPV are presented in Table S2. More than two thirds of the nurses were found exposed to any levels of WPV (70.0%). Among the respondents, 57.8% (n = 730) nurses were exposed to a low level of WPV, 15.0% (n = 190) were exposed to an intermediate level of WPV, and 1.3% (n = 16) were exposed to a high level of WPV. After categorizing the five types of WPV into physical violence and nonphysical violence, 324 (25.6%) of the 1264 nurses reported having exposure to physical violence, and 902(71.4%) nurses were found to be exposed to nonphysical violence.

Distribution of physical and nonphysical types of WPV by demographic and occupational characteristics

In Table 1, the distribution of physical and nonphysical WPV by demographic and occupational characteristics is presented. Male nurses had a significantly higher prevalence of physical violence (34.3% vs. 21.9%, p < 0.001). The senior most age group (≥30 years) had the highest prevalence of both physical (30.8%, p = 0.005) and nonphysical violence (76.5%, p = 0.005). Master's or above degree holders were reported to have the highest prevalence of nonphysical violence (75.2%, p = 0.014). Prevalence of physical violence was found highest among nurses in the Sylhet division (30.9%, p = 0.035). In occupational characteristics, the prevalence of physical violence (28.6% vs. 21.3%, p = 0.004) and nonphysical violence (76.1% vs. 64.4%, p < 0.001) was found significantly higher among government jobholders compared with private job holders. Emergency department nurses were more exposed to physical violence (43.8%, p = 0.007). Among the most experienced group of nurses (≥ 6 years), physical violence (30.4%, p < 0.001) and nonphysical violence (76.2%, p = 0.021) were found highest. Finally, the nurses who did not receive any training to tackle WPV had a significantly higher prevalence of both physical violence (27.1% vs. 19.1%, p = 0.013) and nonphysical violence (75.1% vs. 54.8%, p < 0.001).

TABLE 1.

The distribution of physical and nonphysical types of WPV by demographic and occupational characteristics

	Physical violence a				Nonphysical violence b
Demographic variables	n (yes)	Percent	χ2	p value	n (yes)	Percent	χ2	p value
Sex
Male	130	34.3	21.335	<0.001	269	71.0	0.039	0.843
Female	194	21.9			633	71.5
Age group (year)
<25	60	19.8	10.434	0.005	197	65.0	10.536	0.005
25–29	154	25.5			432	71.5
≥30	110	30.8			273	76.5
Marital status
Unmarried	141	23.9	1.660	0.198	398	67.6	7.746	0.005
Married	183	27.1			504	74.7
Educational level
Diploma degree	135	26.0	0.471	0.790	348	66.9	8.606	0.014
Bachelor degree	127	24.7			381	74.1
Master's degree or above	62	27.0			173	75.2
Administrative division of workplace
Dhaka	149	24.1	8.633	0.035	446	72.2	4.417	0.220
Chattogram	27	20.5			94	71.2
Sylhet	116	30.9			255	68.0
Others c	32	23.0			107	77.0

Occupational variables
Type of job
Government	216	28.6	8.521	0.004	575	76.1	20.31	<0.001
Private	108	21.3			327	64.4
Level of hospital
Primary	27	18.4	5.741	0.057	102	69.4	0.842	0.656
Secondary	49	23.7			144	69.6
Tertiary	248	27.3			656	72.1
Professional title
Nurse in‐charge	7	21.2	0.347	0.556	23	69.7	0.046	0.830
Staff nurse	317	25.8			879	71.4
Work department
Critical ward	82	25.6	15.804	0.007	230	71.9	5.028	0.412
Emergency	35	43.8			60	75.0
General ward	45	22.8			130	66.0
Gynecological ward	24	24.7			75	77.3
Medicine ward	75	23.0			233	71.5
Surgery ward	63	25.8			174	71.3
Weekly working hours
≤ 36	154	25.8	4.775	0.092	431	72.2	1.425	0.490
37–48	123	23.7			363	69.8
>48	47	32.6			107	74.3
Years of experience
<3	81	18.6	17.604	<0.001	296	68.1	7.760	0.021
3–5	114	28.2			282	69.8
≥6	129	30.4			324	76.2
Had training to tackle WPV
Yes	44	19.1	6.236	0.013	126	54.8	37.810	<0.001
No	280	27.1			776	75.1

p values appearing in bold are statistically significant.

^a Physical violence: Physical assault and sexual abuse.

^b Nonphysical violence: Emotional abuse, threats, and verbal sexual harassment.

^c Others = Rajshahi, Khulna, Barishal, Rangpur, and Mymensingh.

Factors associated with physical and nonphysical types of WPV identified from the multivariable logistic regression model

Table 2 shows the results from two multivariable logistic regression models taking physical and nonphysical WPV as outcomes.

TABLE 2.

Multivariable logistic regression models to find the association of physical and nonphysical types of WPV with demographic and occupational factors

Risk factors	Physical violence a		Nonphysical violence b
	OR (95% CI)	p value	OR (95% CI)	p value
Sex
Female	Reference
Male	1.938 (1.449–2.59)	<0.001
Age group (year)
<25	Reference		Reference
25–29	0.935 (0.617–1.417)	0.751	0.991 (0.685–1.435)	0.963
≥30	1.026 (0.588–1.792)	0.928	0.901 (0.52–1.562)	0.711
Marital status
Unmarried			Reference
Married			1.159 (0.866–1.551)	0.321
Educational level
Diploma degree			Reference
Bachelor degree			1.322 (0.996–1.753)	0.053
Master's degree or above			1.261 (0.863–1.842)	0.231
Administrative division of workplace
Dhaka	Reference
Chattogram	0.881 (0.521–1.488)	0.636
Sylhet	1.406 (1.031–1.916)	0.031
Others †	0.921 (0.565–1.502)	0.743
Type of job
Private	Reference		Reference
Government	1.287 (0.873–1.898)	0.202	1.453 (1.039–2.032)	0.029
Level of hospital
Primary	Reference
Secondary	1.239 (0.709–2.165)	0.451
Tertiary	1.408 (0.834–2.377)	0.200
Work department
Critical ward	Reference
Emergency	1.956 (1.132–3.381)	0.016
General ward	0.99 (0.635–1.542)	0.963
Gynecological ward	1.164 (0.672–2.017)	0.587
Medicine ward	0.935 (0.642–1.361)	0.726
Surgery ward	0.897 (0.6–1.343)	0.598
Weekly working hours
≤ 36	Reference
37–48	0.966 (0 .718–1.299)	0.817
>48	2.058 (1.324–3.199)	0.001
Years of experience
<3	Reference		Reference
3–5	1.462 (0.99–2.161)	0.056	0.856 (0.606–1.21)	0.379
≥6	1.599 (0.988–2.587)	0.056	0.989 (0.63–1.554)	0.962
Had training to tackle WPV
Yes	Reference		Reference
No	1.524 (1.041–2.233)	0.030	2.218 (1.634–3.009)	<0.001

Note: The factors associated with each type of WPV at a priori specified p value of 0.1 in the chi‐square test were included in multivariable logistic regression analyses.

p values appearing in bold are statistically significant.

^a Physical violence: Physical assault and sexual abuse.

^b Nonphysical violence: Emotional abuse, threats, and verbal sexual harassment.

^c Others = Rajshahi, Khulna, Barishal, Rangpur, and Mymensingh.

Physical type of WPV: Male nurses had almost two times higher odds of physical violence than female nurses (OR = 1.938, 95% CI = 1.449–2.59, p < 0.001). Compared with nurses in the Dhaka division, nurses in the Sylhet division had a 40.6% more likelihood of exposure to physical violence (OR = 1.406, 95% CI = 1.031–1.916, p = 0.031). Emergency department nurses were 95.6% more prone to physical violence than nurses in the critical ward (OR = 1.956, 95% CI = 1.132–3.381, p = 0.016). The nurses working more than 48 hours per week were two times more likely to be faced with physical violence compared with the nurses working less than or equal to 36 hours per week (OR = 2.058, 95% CI = 1.324–3.199, p = 0.001). Nontrained nurses to tackle WPV were at 52.4% more likelihood of exposure to physical violence (OR = 1.524, 95% CI = 1.041–2.233, p = 0.030).

Nonphysical type of WPV: Government employees were 45.3% more likely to face nonphysical types of WPV (OR = 1.453, 95% CI = 1.039–2.032, p = 0.029). Nurses who did not receive any training to tackle WPV had more than two times higher odds of exposure to nonphysical types of WPV (OR = 2.218, 95% CI = 1.634–3.009, p < 0.001).

Association between WPV and three job‐related questions

Finally, we determined the association between different degrees of WPV and three job‐related questions. The nurses who did not expose to WPV were highly satisfied with their present job (p < 0.001). 62.5% of nurses exposed to high WPV ever considered leaving their current job (p < 0.001). Similarly, 56.3% of nurses exposed to high WPV responded that they would accept another job at the same compensation level if offered (p < 0.001). Table S3 presents the results in detail.

DISCUSSION

This study investigated WPV against nurses in Bangladesh and addressed the associated demographic and occupational factors. The findings demonstrate that the prevalence of WPV among Bangladeshi nurses was quite high. Sex, administrative division of workplace, type of job, work department, weekly working hours, and training to tackle WPV were significantly associated with physical and nonphysical types of WPV.

This study found that 22.2% of nurses were exposed to physical assault, 65.5% were exposed to emotional abuse, 39.2% were exposed to threats, 14.8% were exposed to verbal sexual harassment, and 5.9% were exposed to sexual abuse at the workplace. A recent cross‐sectional study conducted in China among 3706 healthcare workers also found a high rate of emotional abuse (48.6%), followed by threats (27.0%), verbal sexual harassment (16.2%), physical assault (15.9%), and sexual abuse (8.1%) (Tian et al., 2020). Overall, in our study, more than two thirds of the nurses were exposed to nonphysical violence (71.4%), and one fourth of the nurses were exposed to physical violence (25.6%). A study conducted among general practitioners in China found that 18.9% and 61.4% of respondents encountered physical and nonphysical violence, respectively (Gan et al., 2018). Similarly, a study in Nepal also showed that about two thirds of the nurses reported being experienced physical assaults and emotional violence (Pandey et al., 2018). In all, our study found that more than two thirds of the nurses (70.0%) were exposed to any degree (low to high) of WPV. Similarly, among Italian emergency department nurses, the prevalence of WPV was found at 76% (Ramacciati et al., 2019), and among Australian nurses and midwives, WPV was reported at 67% (Shea et al., 2017). A recent meta‐analysis of 44 observational studies also reported a high prevalence of workplace violence in China at 62.2% (Lu et al., 2020). However, the overall prevalence of WPV found in our study was much higher than in the recent cross‐sectional studies conducted among healthcare workers in China (56.4%) (Tian et al., 2020) and Hong Kong (44.6%) (Cheung & Yip, 2017). Moreover, the COVID‐19 pandemic put unprecedented pressure on the whole healthcare system and caused various difficulties for healthcare workers. Healthcare workers experience a great deal of stress and anxiety, which adversely affects their mental health, as a result of long working hours, insufficient access to personal protective equipment, fear of virus transmission, and stress about moral and ethical decisions in prioritizing care (Braquehais et al., 2020; Chowdhury et al., 2021). During the COVID‐19 pandemic, in addition to the fear of infection, significant cases of violence, intimidation, or stigmatization were targeted at healthcare workers, patients, and medical infrastructure. These occurrences were probably merely the “tip of the iceberg,” with many more going unreported (Devi, 2020). According to a systematic review and meta‐analysis of 17 studies, the prevalence of WPV during the COVID‐19 pandemic was 47%. The authors also estimated the prevalence of physical and psychological WPV at 17% and 44%, respectively (Ramzi et al., 2022).

In this study, male nurses were two times more likely to be subjected to physical violence. This finding was supported by previous studies that found males were at high risk of being exposed to physical abuse (Gan et al., 2018; Tian et al., 2020). The possible reason could be that they are more likely to work in the emergency department and in an erratic environment. Nurses in the Sylhet division, a north‐eastern region of Bangladesh, were more vulnerable to physical violence. As per the literature review, no studies on WPV against Bangladeshi nurses were conducted regarding the geographical distribution of physical and nonphysical violence. The prior study determined nonphysical WPV against medical personnel in Dhaka at 64.2% (Hasan et al., 2018).

Our study revealed that nurses in public hospitals experienced a higher rate of both physical and nonphysical violence. Our study finding is consistent with the earlier study in Bangladesh and China (Cheung et al., 2017; Shahjalal et al., 2021), where healthcare professionals in public hospitals experienced a high prevalence of WPV. Besides, the nurse–patient ratio in public hospitals is higher than in private hospitals in Bangladesh, which might be a reason for the high prevalence of WPV in public settings (The Financial Express, 2021). In our study, emergency department nurses experienced a higher rate of physical violence and nonphysical violence. A study conducted among nurses in China also reported that nurses in the emergency department experienced a higher rate of physical violence and nonphysical violence (Jiao et al., 2015). This may be due to the fact that nurses of the emergency department initially deal with high‐risk patients who are agitated, and extended wait times in the emergency department trigger potential violent behaviors (Park et al., 2015).

The nurses who work more than 48 hours per week were two times more likely to be exposed to physical violence, a result consistent with a previous study (Tian et al., 2020). Longer working hours lead to more interactions with patients, work stress, and load, and these may raise the chances of encountering physical violence. In addition, the nurses who did not receive any training to address WPV had a 1.5 times greater likelihood of being exposed to physical violence and a two times greater likelihood of being exposed to nonphysical violence. The trained nurses are supposed to be well‐communicated with patients and their relatives, and they know how to deal with them during an erratic event. Another study also reported similar findings (Wells & Bowers, 2002).

This study revealed that WPV‐exposed nurses were significantly dissatisfied with the present job, considered leaving the present job, and would accept another job at the same compensation. Similarly, studies found that WPV impacted nurses’ job satisfaction, mental health, and quality of life and may exhilarate a higher level of burnout and leaving intention (Choi & Lee, 2017; Duan et al., 2019; Eneroth et al., 2017).

Strengths and limitations

To the best of our knowledge, this is the first study to investigate the status of Bangladeshi nurses' WPV and the factors that influence it. Nurses from all administrative divisions of the country were given the opportunity to participate in the study. There are several drawbacks to this study as well. Selection bias could not be avoided because a nonrandom sample technique was used. Due to the self‐reported questionnaire, there is a potential for information bias. Finally, causality could not be established due to the nature of a cross‐sectional study.

Implications for nursing and health policy

The findings of our study have summed up Bangladeshi nurses' workplace violence exposure status. Identifying the significant components of WPV may aid the healthcare system's resilience and suggest the need for a multidimensional approach (Jang et al., 2022). Continuous assessment of the risk of WPV in healthcare settings and providing nurses with training and support are indeed the ways to prevent WPV (Hilton et al., 2022). Healthcare staff should be instructed on how to deal more successfully with patients and coworkers in order to create a positive working environment. There should be a reporting system and management support for nurses regarding WPV. If any nurse faces WPV, there should be a body of administration they can report to (Tyler et al., 2022). It is outlined in convention No. 190 and recommendation No. 206 of the International Labour Organization (ILO) that “Governments should adopt legislation requiring employers to secure adequate protection against workplace violence and harassment” (International Labour Organization, 2019). However, there are no national guidelines in Bangladesh to ensure that it is the legal responsibility of employers to offer a safe, decent, and healthy working environment for their employees, as well as an atmosphere in which the employees' legitimate rights are protected. So, there should be specific government legislation that prioritizes the interests of health workers and, in particular, their safety. A positive culture should be created to combat WPV. A harmonious nurse–patient relationship, respect, tolerance, gender sensitivity, equality, collaboration, and care should be practiced, and no form of WPV should be tolerated (Shahjalal et al., 2021). Staff and patient ratios should be improved by recruiting new staff that will minimize time pressure on health workers. In order to reduce waiting times, implement interventions that will help optimize service delivery, and design comfortable and convenient waiting areas. It is crucial to limit public access or visitors to hospitals (Shahjalal et al., 2021).

CONCLUSIONS

This study investigated the prevalence of the occurrence of WPV in Bangladeshi nurses and the factors that contributed to it. The high prevalence of WPV underscores nurses’ current working conditions, which were particularly poor in public hospitals and emergency departments. This study could help policymakers to understand the burden of WPV in the country and identify the factors that may help to prevent WPV in healthcare settings. To develop a zero‐violence practice environment, health authorities should conduct interventions to reduce the occurrence of WPV. To develop sustainable work settings, a more in‐depth and rigorous study on nurses' WPV exposure is needed.

AUTHOR CONTRIBUTIONS

Study design: SRC, HK; data collection: SRC, HK, MRC, MRC; data analysis: SRC, HK; study supervision: AH; manuscript writing: SRC, HK, DCD; critical revisions for important intellectual content: SRC, AH.

CONFLICTS OF INTEREST

The authors have declared no conflict of interest.

FUNDING

This research received no specific grant from any funding agency in the public, commercial, or not‐for‐profit sectors.

Supporting information

Supporting Information

Chowdhury, S.R. , Kabir, H. , Das, D.C. , Chowdhury, M.R. , Chowdhury, M.R. & Hossain, A. (2022) Workplace violence against Bangladeshi registered nurses: A survey following a year of the COVID‐19 pandemic. International Nursing Review, 00, 1–10. 10.1111/inr.12802