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Past violence, future violence: the effect of history of violence on nurses' risk of work-related physical assault.

Grice-M; Gromala-T; Gerberich-SG; Alexander-BH; Gurney-JG; McGovern-PM
AcademyHealth 2005 Annual Research Meeting (ARM), Boston, Massachusetts, June 26-28, 2005; :11
Research Objective: The majority of healthcare workers experience one or more violent events in the workplace during their career. A recent survey of registered nurses conducted by the American Nurses Association revealed that issues surrounding health and safety played a major role in nurses' decisions about leaving the profession. Prior research also reveals a significant cost burden associated with physical assault (PA) in healthcare settings, with average costs totaling $13,197 per case and $10 per employee. In addition, studies on revictimization show that persons with a prior history of violence are at increased risk of experiencing future PA. However, few studies address the relation between a history of workplace violence and subsequent risk of PA among those who work in healthcare settings. The primary research objective was to investigate the extent to which a reported history of work-related and non work-related PA and non-physical violence (NPV) was associated with the risk of current work-related PA among nurses. Study Design: A nested case-control study was conducted from a comprehensive survey of 6300 randomly selected Minnesota licensed registered (RNs) and practical (LPNs) nurses. Cases (n=310) were identified as respondents who reported being a victim of physical assault while at work in the twelve months prior to the survey date. Controls (n=946) were randomly selected from those who reported no physical assaults at work. Self-administered questionnaires were mailed to collect exposure information for one-month before the PA events for cases, and for a random month during the study period for controls. Multivariate logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI). Directed acyclic graphs, based on the hypothesized causal model, guided selection of variables for logistic regression. Horvitz-Thomspon reweighting was used to adjust for potential biases associated with unknown eligibility and non-response. Population Studied: The target population included all licensed registered (RN) and practical (LPN) nurses (79,128) who worked in Minnesota as of October 1, 1998. Principal Findings: Of the cases and controls, 90% and 35%, respectively, reported a history of work-related violence, which was strongly associated with the risk of current work-related PA (OR = 13.4; CI = 2.1, 85.2). Previous history of a work-related threat was also associated with increased risk of current work-related PA (OR = 4.6; CI = 1.01, 20.9). Risks were also elevated for histories of work-related sexual harassment (OR = 2.5; CI = 0.8, 27.3), verbal abuse (OR = 4.7; CI = 0.8, 27.3), non work-related PA (OR = 1.9; CI = 0.4, 8.7), non work-related threat (OR = 1.8; CI = 0.5, 6.5), sexual harassment (OR =1.6; CI = 0.4, 6.2) and verbal assault (OR = 1.9; CI = 0.6, 6.2). Conclusions: The results from this study revealed an association between histories of work-related and non work-related violence with an increased risk of current work-related PA among nurses. Implications for Policy, Delivery, or Practice: Given nurses' concerns and the significant cost burden associated with PA, a need exists to identify effective ways to reduce work-related violence. These findings serve as a basis for further research that can ultimately address relevant prevention and control measures.
Health-care-personnel; Health-services; Injuries; Injury-prevention; Medical-personnel; Nurses; Nursing; Health-care; Occupational-exposure; Risk-analysis; Risk-factors; Statistical-analysis; Work-analysis; Work-environment; Worker-motivation; Work-organization; Workplace-studies
Mira Grice, M.S., Doctoral Student, Environmental Health Sciences, University of Minnesota, 420 Delaware Street SE, MMC 807, Minneapolis, MN 55455
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AcademyHealth 2005 Annual Research Meeting (ARM), Boston, Massachusetts, June 26-28, 2005
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University of Minnesota Twin Cities