Canada. 34% of Nurses Report On-the-job Abuse by Patients

In 2005, 34% of Canadian nurses providing direct care in hospitals or long-term care facilities reported having been physically assaulted by a patient in the previous year, and 47% reported emotional abuse.

About 218,000 nurses were delivering direct patient care in hospitals or long-term care facilities in 2005. The overwhelming majority (94%) were women.

Overall, three-quarters were registered nurses, 24% were licensed practical nurses, and the remaining 1% were registered psychiatric nurses.

On-the-job abuse of Canadian nurses by patients was related to nurses' personal and job characteristics and also to workplace climate factors.

Factors associated with abuse

Relatively high percentages of male nurses reported physical assault and emotional abuse. Close to half (46%) of male nurses reported that they had been physically assaulted by a patient in the previous year, compared with 33% of female nurses. Emotional abuse was reported by 55% of male nurses and 46% of female nurses.

Reasons that have been proposed in other research for the higher risk of abuse among male nurses include greater exposure to violent patients and a tendency for male nurses to feel protective of female staff and to assume the primary role in restraining aggressive patients.

Among nurses with less than five years' experience, 42% reported physical assault, compared with less than a third of those who had been in nursing for at least 20 years. As well, the percentages reporting emotional abuse tended to be lower among those with more years of experience.

Licensed practical nurses and registered psychiatric nurses were more likely than registered nurses to report abuse. Registered psychiatric nurses were particularly at risk, with 47% reporting physical assault and 72% reporting emotional abuse.

Nurses usually working evening, night or mixed shifts and those who usually worked a 12-hour shift were also more likely than those working exclusively days to report both types of abuse.

Reports of abuse varied substantially by clinical area of practice. The percentages reporting physical assault were especially high among nurses working in geriatrics/long-term care (50%), palliative care (47%), psychiatry/mental health (44%), critical care (44%), or the emergency room (42%).

Emotional abuse was more common among nurses working in psychiatry/mental health (70%), the emergency room (69%), critical care (54%), medicine/surgery (52%) or geriatrics/long-term care (49%).

The workplace climate

Independent of the effects of gender and job characteristics, four workplace climate factors were significantly associated with both physical assault and emotional abuse of nurses by patients: adequacy of staffing and resources; nurse-physician working relations; support from supervisors; and support from co-workers.

The odds that nurses would report physical assault or emotional abuse tended to be high among those who perceived staffing or resources to be the least sufficient, who perceived that relations with physicians were unfavourable, who had low supervisor support, or who had low support from colleagues.

Some of the workplace climate problems that were associated with abuse from patients were relatively common.

For example, more than half of nurses perceived that there were not enough nurses on staff to provide quality patient care (56%), or enough to get the work done (52%). Just under half (47%) believed that support services did not allow them time to spend with patients, and 43% said that there was not enough time and opportunity to discuss patient care. Close to half (46%) reported that they were exposed to hostility or conflict from co-workers.

A considerably lower percentage of nurses (28%) reported that their supervisor was not helpful in getting the job done.

A lack of teamwork between nurses and physicians was reported by 19% of nurses, and a lack of collaboration, by 11%, while 13% disagreed that physicians and nurses had good working relations.

Source: Statistics Canada, April 15, 2009

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