Excepts only – for full report go to:
The Washington State Psychiatric Hospital Work, Stress, and Health Project: Final Report to Washington DSHS Mental Health Division
and Western State Hospital
September 6, 2012
An Overview of Workplace Violence in Healthcare Settings
The health care sector continues to lead all other industry sectors in incidence of nonfatal workplace assaults with 48% of all nonfatal injuries from violent acts against workers occurring in this sector (BLS, 2001). According to the National Crime Victimization Survey, mental health workers experienced the highest rate of simple assaults in the health care sector, with 43.2 assaults per 1,000 workers (Duhart, 2001). Much of the research literature focuses on the nursing profession and psychiatric nurses report among the highest violent victimization rates among all types of nursing care providers (Islam, Edla, Mujuru, Doyle, & Ducatman, 2003). A multiregional study of 557 nursing staff members from various acute psychiatric settings showed that 76% of the respondents reported that they were assaulted at least once (Poster & Ryan, 1994). In a large population-based survey, the Minnesota Nurses Study, researchers examined rates of assault among nurses and found that only 15% of incidents of physical assault were ever reported. Non-physical incidents, such as threats, were even less likely to be reported in spite of their potential to escalate to a physical assault or their impact on the nurses’ psychological well-being. Over 40% did not report because they believed the risk of physical assault was “part of the job” (Gerberich, et al., 2004). Underreporting has also been found in other psychiatric care workplace violence studies (Bensley, Kaufman, Silverstein, Kalat & Shields, 1997; Myers, Kriebel, Karasek, Punnett, & Wegman, 2005).
Previous research on psychiatric hospital employees in Washington State has shown significant occupational risks for injury due to assault (Bensley, 1997). More recent research reported that 43% of surveyed staff at a university department of psychiatry were threatened and a quarter were physically assaulted (Privitera, 2005). Evidence suggests that workplace violence significantly influences the recruitment and retention of nurses, turnover intentions, absence due to sickness, and high levels of burnout (Chang, 2005; Estryn-Behar, 2008; Evans, 2006; Jackson, 2002; Sofield, 2003).
Burnout – exhaustion and cynicism
Burnout is an outcome of extended exposure to stressors, and is commonly used to describe a state of mental weariness. Our study with WSH examines two of the three dimensions of burnout—namely, exhaustion and cynicism (Maslach & Jackson, 1981). Exhaustion refers to emotional, cognitive, and physical fatigue brought on by a prolonged exposure to work stressors. Cynicism is an indifferent or distant attitude towards work in general and detachment toward others (Schaufeli, Leiter, Maslach, & Jackson, 1996).
Within the healthcare setting, the demanding nature of the work can lead to feelings of exhaustion, which in turn can drain staff members’ ability to effectively provide for and respond to patients’ needs. When staff members feel exhausted, often one way to manage ongoing work demands includes adopting an attitude of cynicism, thereby distancing oneself from patients. Burnout has been linked to a wide variety of employee and organizational outcomes, including lowered job performance and higher turnover intentions (Maslach, Schaufeli, & Leiter, 2001). Exhaustion and cynicism represent depleted resources for care providers, such that employees no longer have enough energy to engage in behaviors aiming at preventing assaults. Indeed, previous studies have supported that when employees report high levels of emotional exhaustion, they show poorer task performance, fewer helping behaviors, and diminished safety performance (e.g., Siu, Phillips, & Leung, 2004).
“Most hospital training looks good but is ignored at the ward level. WSH has a callous attitude about mental illness [and] mentally ill people. Some employees continue to believe that patients deserve/caused their illnesses.”
Source: Survey open-ended question
We asked participants to respond to whether they had been assaulted in the past 2 years and 55.3% of WSH care providers reported being assaulted by a patient. A high percentage (86%) of care providers reported experiencing disruptive behavior in the past year with 37.4% experiencing aggressive behavior from coworkers and supervisors on a weekly or daily basis. Finally, 47.3% of care providers reported witnessing disruptive behavior in the past year. [pg 38, last paragraph]
An independent review found there were hundreds of assaults by patients on staff members in the last year.
Registered nurse Paul Vilja works at Western State and said violence is an everyday occurrence.
“As a nursing supervisor, I process those injury reports as they occur and I actually investigate them,” he said.
Across the mountains at Eastern State Hospital in Spokane, registered nurse Sharon Silar says she and her coworkers are dealing with similar problems.
“It feels almost hopeless,” she said. “There’s nothing we can do.”
The new report says there have been 412 patient-on-staff assaults at Western State this year, compared to 322 last year.
The report claims assaults have dropped in the last three years at Eastern State, but Silar said those numbers are likely not accurate.
“I have to say it’s under reported,” she said. “Even the staff feels it’s not worth mentioning because no one hears us.”
The numbers have special meaning to Silar because she was assaulted in June by a patient she was caring for.
“I turned my back to walk with her and that’s when she assaulted me in the jaw, dislocated my jaw,” she said. “I just cried. It breaks my heart that she got to the point where that’s all she knew.”
Western State chief executive Ron Adler released a statement in response to the report.
“Staff and patient safety are of vital importance to the state’s psychiatric hospitals,” the statement reads. “Every assault is a sobering event that has negative consequences for the victim, coworkers, and the hospital administration.”
Nurses at both hospitals say they’re looking forward to working with administrators to help reduce violence.
“We are caring for people who want to take care of the patients. We want to take care of them the best way we can,” Silar said.