The purposes of this study were to examine the relation between (1) work-related violence prevention policies, (2) work-related violence prevention training, and the outcome of work-related assault against nurses. Importance to Occupational Safety and Health Work-related violence is a serious problem. While policies and training are often recommended as part of a comprehensive approach to address occupational violence, little empirical literature has existed to support this recommendation. From Phase 1 of the Minnesota Nurses' Study, a population-based survey of 6,300 Minnesota nurses (response 79%), the physical assault rate was 13.2 per 100 persons per year. In Phase 2, a case-control (1:3) study, 1,900 nurses (response 75%) were questioned about exposures relevant to violence, including work-related violence prevention policies and training. A comprehensive causal model, using a directed acyclic graph, served as a basis for survey design, analyses, and interpretation. Sensitivity analyses were also incorporated regarding unmeasured confounders and exposure misc1assification. Over 48% of cases and 43% of controls reported having ever received training about occupational violence. Time spent in training within the past year was primarily less than five hours and, while topics varied, most nurses indicated being trained about: reporting violence; managing assaultive or violent patients; risk factors for violence; how to operate safety alarms/devices; and about their work-related violence prevention policies. At the univariate Work-Related Assault: Impact of Training and Policy Final Performance Report level, training about managing assaultive or violent patients, and training about reporting work related physical assault appeared to increase the risk of work-related physical assault. Results of multivariate logistic regression analyses varied by training topic: three types of training appeared to decrease the risk of violence, four types appeared to increase the risk of violence, but none were found to be statistically distinct from 1. Regarding policies, respondents reported institutional written policies that, among others, addressed: prohibited types of violent behaviors (cases: 66%, controls: 73%); and zero tolerance for violence (cases: 37%, controls: 53%). Results of multiple regression analyses, controlling for the type of facility, administration attitude toward violence, department/unit, and types of patients, indicated that the odds of physical assault decreased for having a zero tolerance policy (OR=0.5, 95% CI: 0.3, 0.8) and having policies regarding types of prohibited violent behaviors (OR=0.5, 95% CI: 0.3, 0.9). Sensitivity analyses were conducted for exposure misclassification and the presence of an unmeasured confounder, providing further confidence that some work related violence policies may be protective. This study is an important first step in evaluating the influence of policies and training on work-related violence in a population of workers. Zero tolerance policies, and policies about types of prohibited violent behaviors may be protective in this population of Minnesota nurses, while the effects of violence prevention training appear to vary by topic. This research serves as a basis for future research.
Regional Injury Prevention Research Center and Center for Violence Prevention and Control, Division of Environmental and Occupational Health, University of Minnesota, School of Public Health, MMC 807, 420 Delaware St., SE, Minneapolis, MN 55455