Workplace aggressions on hospital workers: A current and prevalent problem with a high demand for training

1Introduction

Workplace aggression on hospital workers is a very frequent problem with important consequences and is being addressed by different international organizations [1, 2]. The negative consequences of workplace aggressions on hospital workers are very diverse, such as physical injuries, psychological disorders, fear to health caring, deterioration in the quality of care provided and the decision by health care workers to leave the health care profession altogether [1, 2].

Aggressions on hospital workers are a very common problem [3–9]. In Canada, 33% of workplace aggressions involve healthcare workers [3]. In the United Kingdom, healthcare professionals, after protection professionals (e.g., police officers) are most at risk of workplace violence [4]. A study in China of 1,656 physicians found that 90% of physicians had been victims of workplace aggressions in the year prior to the survey [5]. A study of 588 nurses in China found that 72% of nurses had been verbally aggressed in the workplace in the year prior to the survey [6]. In a study conducted in Italy with 518 nurses, 90% of nurses were found to have been victims of workplace aggressions in the year prior to the survey [7].

A systematic review on the aggressions on healthcare workers in Spain found that 58% –76% of medical/nursing personnel have been aggressed at some time during their working lives, with an increase in the magnitude of the phenomenon in recent years, that in most cases the aggressors are men, and that the aggressed professionals are mostly women [8]. The Spanish General Nursing Council reported in a survey that 33% of nursing staff had been the victim of a physical aggression, and 69% of verbal aggression in the year prior to the survey [9].

Workplace aggressions on hospital workers need to be studied, as they are rarely reported to management [10–13]. In a study conducted in Saudi Arabia with 213 surveys of medical and nursing staff, it was observed that 75% of physical and 50% of psychological aggressions had not been reported [10]. A study in Iran with 5,874 surveys of medical and nursing staff found that 57% of racial aggressions and 53% of psychological aggressions due to sexual harassment went unreported [11].

The Spanish Collegiate Medical Organization reported that annually between 0.14% –0.26% of collegiate doctors in Spain report an aggression [12]; however, the percentage of aggressed personnel is much higher (58% –76% of physicians/nurses) [8]. The Spanish Health National System reported that annually between 1.3% –1.7% of personnel report an aggression [13]; similarly, the percentage of aggressed personnel is much higher (58% –76% of physicians/nurses) [8]. The number of aggressions on hospital workers recorded in our hospital ranged between 25 and 50 annually according to the data of Occupational Risk Prevention Service (ORPS). ORPS is the hospital service with the set of human and material resources necessary to carry out preventive activities for injuries during work activities in the hospital.

Some studies have explored the possible association between the risk of hospital workers aggression and sex, professional category, and hospital unit. Some studies showed higher hospital aggressions in women [14–17], nursing care category [18–21], Emergency Units [22–25], Critical Care Units [26, 27] or Psychiatry Units [28–30]. Different surveys show that hospital aggressions are underreported because hospital workers accept violence as part of their normal workday and do not consider incidents without physical injury as an aggression [31–34]. Hospital aggression training programs aimed at hospital workers are necessary to improve knowledge of hospital aggression management [35–43]. Different causes and risk factors have been associated with these aggressions [44, 45].

Previous research on hospital workers aggressions lacks information about individual workers and management’s attitudes, particularly in unique settings such as university hospitals. Previous studies on aggressions on university hospital workers reported the percentage of workers who experience any workplace aggression. However, the number of workplace aggressions per university hospital worker was not reported.

The novel objectives of our study were to analyze the number of workplace aggressions per hospital worker as well as hospital management’s knowledge and interest in receiving training about such aggressions. We believe that it is necessary to study this aspect to better describe and quantify the problem in university hospitals. Having a clearer and quantified understanding on aggressions experienced by university hospital workers would allow preventive measures to be taken.

2Methods

3Results

4Discussion

In 1118 anonymous surveys, we found that our hospital workers have suffered throughout their working life some form of verbal aggression in the hospital in 68.5% of cases and some form of physical aggression in 35.2% of cases. The high percentage of physical of verbal aggressions found in study is in consonance with data from other published studies [5–9]. Another interesting finding was that hospital aggressions were very frequent, not only due to the number of positive responses, but also for the high number of physical or verbal aggressions that were reported in the surveys as a message (“many”, “daily”, “uncountable” or “infinite”).

The number of hospital aggressions recorded in the Occupational Risk Prevention Service of our hospital ranged between 25 and 50 annually. Therefore, hospital aggressions are a scarcely recorded problem in our hospital considering the rate of hospital workers who reported having suffered an aggression. This finding conforms to the findings of other studies that concluded that these aggressions are underreported [10–13].

We found that women, the nursing care category, and the Emergency, Critical and Psychiatry Units were risk factors for physical or verbal aggression. These findings are consistent with the findings of other studies that showed higher hospital aggressions in women [14–17], the nursing care category [18–21], Emergency Units [22–25], Critical Care Units [26, 27] or Psychiatry Units [28–30]. Another interesting finding was that 32% and 12% of responders thought that their verbal and physical aggressions had increased in the last 2 years, respectively. Therefore, we believe it is recommendable to study this issue in more depth, especially in health centers with Emergency, Critical Care or Psychiatry Units, such as university hospitals, non-university hospitals, psychiatric hospitals, primary care health center with emergencies.

Hospital aggressions are underreported. Several surveys have found that hospital workers accept violence as part of their normal workday and do not consider incidents without physical injuries as aggressions [31–34]. Another interesting finding was that the opinion of survey responders on their low knowledge on the legal, psychological, and physical management of hospital aggressions, and their great interest in receiving training in these aspects. Therefore, we believe it is necessary to implement training programs on hospital aggressions to hospital workers [35–37]. Positive results of these programs have been published, reporting an improved knowledge on the management of hospital aggressions [38–42] and even a reduction in the rate of hospital aggressions [43].

According to the results of our study, the main professional targets of hospital aggressions are women, nurses and professionals in the Emergency, Critical Care or Psychiatry Units. Therefore, special attention should be paid to university hospitals since in these health centers have students, residents, and staff, and that they are the hospital units with the highest risk of aggressions on hospital workers. To reduce aggressions in hospitals, several measures could be taken: 1) reduce aggressions by male patients on female professionals, 2) protect female professionals from these aggressions, 3) prepare pre-professionals (i.e., students and residents) about this reality before they enter the field, and 4) raise awareness of the problem among hospital managers and pre-health educational centers.

5Conclusions

Workplace aggressions on hospital workers is a prevalent problem today. This problem mainly affects women, the nursing category and the Emergency, Critical Care and Psychiatry Units. Hospital workers expressed little knowledge and great interest in receiving training on the legal, psychological, and physical management of hospital aggressions. Therefore, different approaches are needed to reduce aggressions on hospital workers, specifically in female nurses and health centers with Emergency, Critical Care or Psychiatric Units.