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
AcademyHealth 2005 Annual Research Meeting (ARM), Boston, Massachusetts, June 26-28, 2005
University of Minnesota Twin Cities