NURS5155 Professional Issues and Nursing Practice in Australia

Introduction

It has been reported that in Australia the rate of verbal abuse is constantly increasing and almost 95% to 100% of the nurses involved in the emergency care reported to experience violence. The data suggests that the nurses in a major population-based study was found to experience an enhanced physical assault at 13.2 per 100 nurses, per year and the rate of non-physical violence is also high such as sexual harassment, threats and verbal abuse (Li et al., 2020). The healthcare workers who mostly faces the violence are nurses and other staffs who are directly involved in the patient care. The violence faced by the nurses are verbal abuse, bullying, insulting, verbal threats and the physical violence are grappling, throwing things and sexual harassment. The workplace violence is found to affect the nurses by developing psychological burnout, stress, lack of quality care, reduced the level of efficiency and it also lowers the productivity of the nurses involved in patient care (Vento et al., 2020). The negative impact of violence among nurses involves lack of proper willingness to work, lack of job satisfaction and increased absenteeism. It is evident that there exist lack of proper policies or intervention for reducing the enhanced violence and bullying among nurses (Tian et al., 2020). A proper implementation of policy will help in upholding the workplace safety of the nurse. The below paper will discuss about violence against nurses and its impact upon the health and healthcare organisation along with that the study will also discuss about the implementation of zero tolerance policy within healthcare setting.

Discussion  

Violence against nurses and evidence

Havaei (2021) performed a study for determining the type of violence which occurs in the workplace and its impact upon the mental health of the nurses. The study determined that violence is prevalent particularly in the nursing profession.  It has been found that the nurses are directly or indirectly involved in violence which resulted in a negative impact upon the mental health of the nurses. The study result determined that the direct exposure to the violence faced by the nurses is found to increase the level of post-traumatic stress, depression, anxiety and burnout in comparison to those losses which are not directly involved or did not face any exposure to the violence.  The study also clearly determined that there is an urgent need for better mental health support by implementing a proper preventive policy which will decrease the violence activity in the health care setting and thereby increase the security and safety of the nurses (Fallahi et al., 2016). The study also determined that the nurses who are directly involved in the violence mostly faces emotional abuse such as insult or gestures, verbal or written threats, physical punishment structures pushed or biting and lastly sexual abuse. It is also determined that development of trauma after exposure to violence is common among the nurses which reduced the quality of care and increased burnout which reduced the staff retention and dysfunction between the co-workers.  This lack of proper workplace safety increases the adverse effect of the patient such as error in treatment and increase incident of fall. Hence, the study clearly determined that workplace violence faced by the nurses not only impacts the quality of care but also results in mental distress among the nurses and it requires a proper preventive intervention (McLindon et al., 2018).

Pich & Roche (2020) stated that violence in healthcare is recognised as one of the significant issues all over the world and the nurses are at a greater risk of facing the violence. The results of the study determined that the nurses who are involved in providing care in the public health sector has been reported to face more physical violent behaviour than other nurses working in private sectors.  The violent behaviour which was reported highest in the clinical settings are specially in the mental health ward, emergency departments and drug and alcohol settings. The study presented an Australian data on violence in the Healthcare organisation particularly in hospital and it has been found that the rate of physical assault has been increased from the year 2015 to 2018.  The study determined that a source in hospital has been increased by 48 % in Queensland and that of 44% in the New South Wales.  It is also evident that almost 60% increase in nurses’ assault has been reported in Victoria.  The patient has been determined to be the most common perpetrators of the violence and it is also observed in the paediatric where the parents of the caregivers are often involved in violent activity with the nurses which threatens the clinical environment (Spelten et al., 2020). The impact of violence upon healthcare staff has been reported to be a long-lasting effect which comprises of insomnia, development of trauma due to enhanced flashback, physical suffering or harm, and development of anxiety and depression. The study also determined that the regions where the violence is mostly found to be reported are in major cities where minimal restriction upon accessibility to the widest range of services and there is an opportunity for social interaction, the inner and outer region where moderate restriction has been applied and lastly in the remote region where is very high restriction of accessibility has been found. Thus, it can be stated that the workplace violence impacts the quality of care provided to the patient and a proper policy needs to be implemented specially for the emergency department as nurses providing care in this department faces maximum verbal abuse which results in the development of psychological distress and reduces the rate of turnover.

Duma et al., (2016) performed a study for determining the violence against nurses. The study determined that almost 86% of the participant nurse agreed that they experienced workplace violence and the prevalence of violence was highest in the psychiatric hospitals. The type of violence which was identified in this case was sexual harassment, physical assaults, threatening behaviours, verbal abuse. The study also determined that perpetrators of violence such as patients rated about 71%, work colleague which was 43% and patient’s relative is 47%. The nurses were found to complain the incident of violence to the managers and reacted by crying, ignoring the incident, telling to the co-mate and retaliating. The nurses also reported that the incident of violence impacted upon the psychological wellbeing of the nurses and thus, a proper implementation of policy is essential in order to reduce the incidence (Al-Shamalan et al., 2017).

Impact of violence among nurse’s health and healthcare setting

Berlanda (2019) performed study for determining the risk of violence against the Healthcare staff especially in the emergency department and its effect upon the job satisfaction and attachment style. It is already evident that violence is workplace is one of the most serious issue which affect the healthcare sectors.  It is often found that the incident is under reported for ignore which impacts the quality of care provided to the patient. The study clearly determined that the nurses who are exposed to the violence are found to have lower job satisfaction and recorded to be suffering from emotional distress which increased the psychological burnout and thereby reduced the quality of care provided to the patient by increasing the treatment error. It can be determined that the impact of violence not only affect the nurses but also affects the healthcare organisation by disrupting the workplace environment for developing fear among other nurses while providing care and this increases the chance of treatment error. Hassankhani et al., (2018) performed study for determining the consequences of violence against nurses working in the emergency department. The study highlighted that nurses who are involved in workplace violence are found to complain about physical and mental health issues, lives a negative social and professional life after facing the workplace violence, the workplace violence consecutively impacts the entire healthcare organisation and the study also highlighted that the serious consequences of workplace violence impact the patient care.  Hence, it is highly important to implement a proper policy within the Healthcare organisation which will help in upholding the safety of the nurses and thereby improve the quality of care provided to the patient. It can be stated that the workplace violence not only impacts the nurses mental and physical health but it also hampers the professional environment of the hospital.  The nurses are often disrespected which results in anger, excessive fear of violence, lower level of job satisfaction, decreases the turnover intention and actual turnover, lower the performance of the nurses which impacts the patient care by increasing error in treatment and lastly development of hypertension and insomnia. Thus, a proper intervention needs to be implemented for addressing this issue and thereby increasing the workplace safety for the nurses and increasing the turnover rate which will also reduce the issue of nursing shortage (Boafo, 2018).

Implementation of Zero Tolerance Policy in the hospital

The Zero Tolerance policy is found to be established in the healthcare organisation in order to punish someone who are at the authority of the situation. This policy is effective in eradicating the unusual or unrealistic behaviour faced by the nurses in the hospital by punishing the individual who violated the rules. This policy is also termed as an aggressive policy which needed to be applied in the healthcare organisation for managing the undesirable behaviour from both the patient, relatives and even it is helpful in reducing violence and bullying within the healthcare organisation which is often faced by the junior nurses (Park & Yu, 2019). However, it has been found that there is less evidence of implementation of zero tolerance policy within the healthcare organisation which needs a proper concentration and attention as it is evident that violence faced by the nurses reduces the staff retention and delivers adverse effects upon the safety and health of the healthcare workers (ohsrep.org.au, 2021). The ANA, already declared a new position statement upon the violence faced by the healthcare workers which defines this policy is effective in reducing and addressing the continuum of the harmful workplace action which might range from incivility, physical violence and bullying. Hence, implementation of Zero tolerance policy withing the healthcare organisation in Australia will be effective in reducing the workplace violence.

Rationale for implementing the zero-tolerance policy

Provost et al., (2021) aimed at understanding the impact of violence and violence prevention education among the healthcare workers. The researcher also aimed at determining the impact of violence prevention education upon the physical and psychological wellbeing of the healthcare workers. The researcher defined that occupational violence refers to abuse, intimidation, assault and the implementation of the zero-tolerance policy is successful in empowering and supporting the nurses. The nurses are found to be more confident in managing the issues and handling this type of situation in a better way in future. Thus, implementation of zero tolerance policy will be helpful in reducing the workplace violence and it will also improve the staff retention by respecting the staffs involved in the care process.  The implementation guideline states that after the implementation of this policy the healthcare organisation shares a sustained commitment by the nurses which promotes respect and dignity of the nurses (Hemati-Esmaeii et al., 2018). This policy reduces the issue of lack of reporting the harmful incidence which was previously ignored by the nurses. The employees will be encouraged to report the violence incidence. The policy will provide the nurses with proper knowledge in handling the situation and involving them in educational programs which will develops the sense of situational awareness and to anticipate the potential for violence. This policy also helps in implementing violence prevention program with safe guidelines. Cheung et al., (2017) performed a study for determining the workplace violence toward physicians and nurses. The stated that the organisation aimed at planning and implementing of zero tolerance policy with the collaboration with police which will help in developing a belief within the healthcare workers that no one will be left without proper judgement. The Australian government should also aim at spreading the policy to the rural area’s which will help in supporting the nurses practicing in the Aboriginal community.

Evaluation

The nurse leaders and the healthcare manager must assure that a proper knowledge and education is provided to the staffs along with the patient admitted in the hospital. The clinical supervisor will be responsible for providing training and education about the situation management programs with the help of case studies which will help in managing adverse situation. The nurses will be much more confident in providing care without any fear of violence which will improve the quality of care (Faghihi et al., 2021). The patient will be able to communicate with the nurses with respect which will develop a healthy therapeutic relationship between the nurse and the patient and hence, the nursing turnover rate will be increased in the healthcare setting.

Conclusion

The above paper discussed about violence against nurses and implementation of zero tolerance policy within the healthcare setting. The healthcare workers who mostly faces the violence are nurses and other staffs who are directly involved in the patient care. The violence faced by the nurses are verbal abuse, bullying, insulting, verbal threats and the physical violence are grappling, throwing things and sexual harassment. It is also determined that development of trauma after exposure to violence is common among the nurses which reduced the quality of care and increased burnout which reduced the staff retention and dysfunction between the co-workers. The zero-tolerance policy will provide the nurses with proper knowledge in handling the situation and involving them in educational programs which will develops the sense of situational awareness and to anticipate the potential for violence. Lastly, the paper discussed about the evaluation of the policy which can be followed in the healthcare organisation.

References

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