Does workplace violence impact nurse retention?

In this fast-paced healthcare environment, finding new ways to attract nurses keeps recruiters busier than ever — especially if nurses leave as fast as you hire them.

Many factors play into the nursing shortage, such as considering how workplace violence affects nurse retention.

Recruiters also should consider the following questions:

  1. Does workplace violence affect nurse retention in your facility?
  2. If so, what needs to change?

Workplace violence wears many faces, from having objects thrown at you or smashed on your head to being stabbed, kicked, punched, choked, spat on or cussed out.

A 2019 study in the Journal of Clinical Nursing reports multi-factorial correlations between having meaningful work, workplace violence and its effect on nurse turnover.

The study highlights the importance of having positive relationships with staff and an upbeat work environment with ample learning opportunities – factors that influence nurse retention and turnover.

Workplace violence is real and carries far-reaching consequences from nurse retention to the nursing shortage, says Sandra Risoldi, MSN Ed., DNP, RN, CLNC, the CEO and president for Nurses Against Violence Unite, a nonprofit dedicated to raising awareness about nurses dealing with violence.

Risoldi said nurses can experience violence across the spectrum, from patients and their families to nursing peers and administrators who would rather turn away from the problem instead of leaning in to help nurses report problems.

In a statement from the American Nurses Association (ANA) that addresses the Joint Commission’s Sentinel Event Alert on Physical and Verbal Violence against Health Care Workers, ANA said “evidence indicates that barriers to reporting exist and hamper progress despite the presence of ‘zero tolerance’ policies.”

Preparing for patient populations

Another side of the issue looks at nurses new to the job who are ill prepared to handle certain patients, a reality that has some nurses walking off the job, Risoldi said.

Considering the expansive opioid epidemic, Risoldi used the example of patients experiencing opioid and alcohol withdrawal and become instantly violent without warning.

“Coming out of nursing school, (nurses) are not prepared to handle patients’ verbal and physical violence,” Risoldi said. “Nurses cannot even identify the withdrawal symptoms because they are not being taught.”

43.8 million American adults experience mental illness annually

The National Alliance on Mental Illness reports that 43.8 million American adults experience mental illness annually — and 10.2 million deal with the combination of addiction disorders and mental illness.

In other cases, Risoldi said it is common to see an underlying mental illness become magnified once the patient is injured or sick. For whatever reason, once these patients are admitted to the hospital, she said they become aggressive or violent.

“We have nurses who have been stalked and choked,” she said. “A plate was smashed on a nurse’s head. I watched the video.”

Risoldi said aggressive behavior can surface with pregnant patients who have stopped taking their antidepressant medication.

How violence affects the brain

Each day a nurse goes to work, either they look forward to it or they don’t. And if workplace violence becomes the new normal, it’s easy for nurses to dread the job they once loved. Eventually, some will quit.

“All nurses need to advocate for the passage of HR 5223, a federal bill, the Healthcare Workplace Violence Prevention Act, that proposes OSHA be responsible for providing a safe workplace to healthcare workers like they do with other jobs.” — Julia Winters Blanks, RN, BSN

Workplace violence and stress changes brain function, says St. Louis-based nurse practitioner Jessica Whelan, DNP, MSN, BSN, PMHNP-BC, who speaks at national conferences about epigenetics and consults with mental health facilities and Nurses Against Violence Unite.

“Over time, biochemical alterations that the stress is causing alters your DNA and how the DNA expresses itself,” Whelan said.

Compounded stress causes some people to act out in ways that are inconsistent with their usual personality, she said.

Stress has an uncanny way of forcing certain personality traits to the surface. With constant exposure to workplace violence, it might be surprising to see how it alters personality.

According to Whelan, during periods of constant stress, some people might become obsessive, paranoid or show narcissistic traits often associated with Cluster B personality disorders, even though they were previously undiagnosed.

The reason has to do with how stress turns on some genes.

“Chronic stress may cause activation or deactivation of certain genes causing a stress response,” she said, “Depending on each person’s unique genes and unique personality traits, when exposed to chronic stress, certain behavioral changes may be induced.”

People on the Cluster B spectrum often express dramatic behavior, make unpredictable decisions, become aggressive and have difficulty with relationships at work and home, according to the Mayo Clinic.

Finding ways to help nurses limit their exposure to stress is critical for their welfare and ability to perform their jobs well.

As a reminder, Whelan said, “Nurses experience the most amount of violence in the workplace, above police officers.”

Fixing workplace violence

As the president and CEO of Nurses Unite Against Violence, Sandy Risoldi, MSN Ed., DNP, RN, CLNC, shares the following tips for solving violence against nurses:

  • Increase awareness about workplace violence

  • Use your voice to report issues

  • Provide resources for nurses

  • Develop training to address workplace violence causes, such as patient mental illness, opioid or alcohol withdrawal