Workplace violence and intentions to quit: results from a survey of London nurses

Study Objective: Work-place violence, harassment and abuse is an increasing feature of nurses’ experience of work in many countries. There is some evidence that the experience of workplace violence affects levels of job satisfaction (Hesketh et al 2003) and career decisions (e.g. Mayer et al 1999, Fernandes et al 1999). This paper reports on verbal and physical abuse by patients, relatives and carers, as well as racial and sexual harassment in Acute Hospitals in London and investigates whether workplace violence affects nurses’ intentions to leave either their current job or the nursing profession, controlling for a number of other factors that are known to affect career decisions, such as workload, pay and own health. Method: A questionnaire designed by two of the authors (Reeves and West) to assess many different aspects of nurses work life was used in a postal survey of nurses grades A to I practising in twenty London acute trusts in 2002. A total of 6,160 clinical nurses were mailed the questionnaires and 2,880 returned completed questionnaires, resulting in an overall response rate of 47%, discounting undelivered questionnaires. Respondents worked in a wide variety of clinical settings but mainly in acute medical and surgical wards. In addition to descriptive statistics, results were analysed using logistic regression with robust standard errors: the appropriate test when the dependent variable is dichotomous and the individual respondents clustered within units (nurses working within hospitals are not statistically independent). Results: Our results show high levels of racial (%), sexual (%) and other, unspecified forms of harassment (%), as well as verbal and physical abuse (14% had been physically assaulted with 5% being assaulted more than once), over the previous 6 months. A very small number (1%) reported experiencing all three forms of harassment; 12% two forms and 29% one form. Only 45% of this sample intended to stay in nursing for at least 3 years; 40% were undecided and 15% intended to leave. Logistic regression estimates showed that reported levels of abuse and harassment had a significant impact on respondents’ career intentions, even in models that controlled for known factors affecting career decisions. About 70% of our respondents reported that they had had too little training in dealing with aggressive behaviour—or none at all—but there was no statistical relationship between lack of training and reported assaults. Conclusions: The international shortage of health care workers is due at least in part to low retention rates. It is crucial to investigate nurses’ experiences of work to identify the factors that shape their career decisions. Workplace violence is increasingly acknowledged as an international, service-wide, health care problem. This paper adds to the literature that shows that workplace violence has an impact on nurses’ career decisions. The implications for managers and policy makers are that strengthening systems of security and providing nurses with training in interpersonal relationships including dealing with aggressive patients could slow nurse turnover.

The reporting behaviours of student nurses who have experienced verbal abuse

Background: There is evidence that student nurses are vulnerable to experiencing verbal abuse from a variety of sources and under-reporting of verbal abuse is prevalent throughout the nursing profession. The objective of the study is to explore the reporting behaviours of student nurses who have experienced verbal abuse. Method: For this study a definition of verbal abuse was adopted from current Department of Health (England) guidelines. Questionnaires were distributed in 2005 to a convenience sample of 156 third year nursing students from one pre-registration nursing programme in England. A total of 114 questionnaires were returned, giving an overall response rate of 73.0%. Results: Fifty one students (44.7% of responses) reported verbal abuse; all of these completed the section exploring reporting behaviours. The incidents involved patients in thirty three cases (64.7%); eight cases (15.7%) involved visitors or relatives and ten cases (19.6%) involved other healthcare workers. Thirty two students (62.7%) stated that they did report the incident of verbal abuse they experienced and nineteen (37.3%) of respondents reported that they did not. Only four incidents developed from an oral report to being formally documented. There was a statistically significant association (P = 0.003) between the focus of verbal abuse (patient/visitor or colleague) and the respondents reporting practices with respondents experiencing verbal abuse from colleagues less likely to report incidents. Most frequent feelings following experiences of verbal abuse from colleagues were feelings of embarrassment and hurt/shock. Most frequent consequences of experiencing verbal abuse from patients or relatives were feeling embarrassed and feeling sorry for the abuser. When comparing non reporters with reporters, the most frequent feelings of non reporters were embarrassment and hurt and reporters, embarrassment and feeling sorry for the abuser. When considering levels of support after the incident the mean rating score of respondents who reported the incident was 5.40 (standard deviation 2.89) and of those that did not, 4.36 (standard deviation 2.87) which was not statistically significant (p = 0.220). Conclusions: 1. Not documenting experiences of verbal abuse formally in writing is a prevalent phenomenon within the sample studied and reporting practices are inconsistent. 2. Both Higher Education Institutions and health care providers should consider emphasising formal reporting and documenting of incidents of verbal abuse during student nurse training and access to formal supportive services should be promoted. 3. Effective incident reporting processes and analysis of these reports can lead to an increased awareness of how to avoid negative interactions in the workplace and how to deal with incidents effectively.

‘Martial races’ and ‘imperial subjects’: violence and governance in colonial India, 1857–1914

This essay explores the specificity of colonial violence in India. Although imperial and military historians are familiar with several instances of such violence—notably the rebellion in 1857 and the 1919 massacre at the Jallianwalla Bagh in Amritsar—there is a broader, and arguably more significant, history that has largely escaped attention. In contrast to metropolitan European states, where sovereignty derived, at least in principle, from a covenant between subjects and government, the sovereign power of the colonial state was always predicated on the violent subjugation of ‘the natives’. However, while violence was integral to colonialism, such violence was never a purely metropolitan agency: most of those recruited to serve in the colonial military were, themselves, Indian. Exploring the history of the imperial military in South Asia after 1857, the paper outlines the complex and rather ambiguous relationship between the colonial state and its ‘native armies’. RESUME Cet article se penche sur la spe´cificite´ de la violence coloniale. Malgre´ des exemples familiers—comme la grande re´volte de 1857 en Inde ou le massacre de Jallianwalla Bagh a` Amritsar en 1919—il y a une histoire plus large et plus importante qui a e´chappe´e a` l’attention des historiens. Contrairement aux e´tats europe´ens ou la souverainete´ de´rivait en principe du moins d’un contrat social entre les acteurs sociaux, le pouvoir souverain de l’e´tat colonial restait fonde´ sur la subjugation violente des indige`nes.

Law in the community: the University of Greenwich/Greenwich Association of Disabled People Centre for Independent Living (GAD) research project

The GAD Advocacy Service is funded by the London Borough of Greenwich Directorate of Neighbourhood Services; its remit to support disabled people experiencing Hate Crime, Domestic Violence and Harassment. Run by disabled personnel and giving advice to all disabled people it is unique in London. Since its inception in 2004, the Advocacy Service has been stretched to its limit - there is a need to extend the remit of the Advocacy Service to give specialist legal advice on other issues. In 2003, the CEDRM-UK project was set up in the University of Greenwich Law Department as part of the Disability Rights Promotion International Legal Education and Research Project; its objectives were firstly, to facilitate the collection of data on the effectiveness of legislation in promoting the rights of disabled persons; and secondly, to pilot new methods in teaching and training in Human Rights Law – students acquire an expertise in Human Rights Law through research into the practical application of legislation relating to civil and human rights in the daily life of the community. In July 2007, GAD and CEDRM-UK embarked on a joint project to report on the work of the Advocacy Service and to create a database to support its caseload. The 2008-9 Project team will report on their work and findings relating to facilitating equality in the workplace; the inclusion of cancer, HIV and multiple sclerosis within the legal definition of disability and the implications of the statutory duty to promote disability equality for the provision of extracurricular activities for schoolchildren. [From the Author]

Violence and aggression in the emergency department: factors impinging on nursing research

This paper examines issues involved in the debate regarding the role of research in nursing. The authors take the example of violence and aggression in the emergency field to discuss methodological, philosophical, professional, logistical, power differentials and leadership theory that influence and explain the process of conducting research surrounding violence and aggression experienced by nurses working in emergency departments. The paper examines the importance of research and discusses practical issues that impinge or frustrate clinical nursing staff who wish to conduct original research.