Where's Nurse Ratched when you need her?

Violence is just a part of a nurse's job, right? A new study says no, and warns that hospitals can't afford to be complacent

By Wendy Banks

In 2000, a mother, angry at a long wait in the emergency room, tried to strangle Jennifer Shortell with the ID badge she wore around her neck. Last year a cardiac patient, enraged at being confined to his bed, tore out his IV; when Ms Shortell went to put gauze over the wound, he grabbed her hand and broke her wrist. Verbal abuse is a daily occurrence. "Happens all the time � it happened today," she says wearily from Toronto East General Hospital where she works. She's only been a nurse for four years.

Is she unlucky, or is she doing something wrong? Neither, according to a recent study by Dr Angela D Henderson, an associate professor in the School of Nursing at the University of British Columbia. Dr Henderson set out to make a qualitative

study exploring nurses' work with abused women, but stumbled across an epidemic of workplace violence so deep and pervasive that she decided to devote a paper exclusively to that. The research is published in the current issue of Nursing Leadership.

In interviewing 49 nurses from four clinical settings (maternity, community health, emergency and community mental health) in Canada and the UK, Dr Henderson discovered that violence is a constant in their line of work. "Nurses experience significant threat at the hands of patients and their relatives; verbal abuse is an almost daily occurrence; and support from other healthcare professionals or from administration in addressing the issue, while improving somewhat, is inadequate," she writes in the study. "This has implications not only for nurses' health and safety but also, in the broader sense, for the profession's ability to attract and retain nurses within the healthcare system."

Hospital administrators will often blame nurses for the violence inflicted on them. When Ms Shortell's wrist was broken, the administration sent around a memo to nurses instructing them to take more precautions around irate patients. Ms Shortell took it to heart. "I guess I should have been more careful," she says.

Ms Shortell, like many nurses, has found ways to cope with the frustrations of her job: "As long as the patient in the bed is stable, I can walk away satisfied that I've done my job." She focuses on the well-being of the patient and ignores abusive behaviour from family members. It helps that she finds her work challenging and meaningful. "It makes you think about your life, and how lucky you are. You go home feeling fulfilled."

Dr Henderson's study confirms that Ms Shortell's coping strategies are typical; "emotionally, [nurses] coped in one of only two ways. They described themselves either ignoring [abuse] � 'If I thought about it too much, I'd go nuts and I couldn't do it' � or consciously tuning into their fear and monitoring their own responses to the threat."

A little legislative support would go a long way towards making the job more livable. "If you were to assault a cop, you would be charged and arrested... but you can kick a nurse, punch a nurse, swear at a nurse," Ms Shortell says.

She laid charges against the woman who tried to strangle her four years ago; the case finally went to trial last year. "She got a slap on the wrist." Dr Henderson points out that the kind of frustration this engenders damages not only nurses' ability to care for patients, but also future prospects for recruiting new nurses.

"Administrators in healthcare settings must make clear to both their staff and the public... that violence will not be condoned," she stresses. "Failure to recognize this imperative represents not only a moral failure, but a pragmatic and strategic one with profound implications for future healthcare delivery."