A Short Herstory of Violence

November 10, 2005 -- Today South Africa's Independent Online (IOL) site posted a fairly good Cape Argus story by Di Caelers headlined "Nearly half of our nurses suffer abuse." The piece indicates that research in South Africa, the U.K., and the U.S. suggests that among health workers, nurses experience a disproportionate amount of physical and psychological violence by patients and colleagues, especially physicians. The article might have explored why nurses face such abuse, and done more on its effects on patient care and the global nursing shortage. But the piece, which was based mainly on a recent South African study, does note that 80% of nurses surveyed "blamed abuse--largely by male doctors--in the private sector for nurses leaving the profession."

The IOL piece was based largely on an article by Sharon Slabbert, "client liaison executive officer" of the Hospital Association of South Africa. That article appeared in connection with the publication in the Association's Health Annals 2005 of a study conducted by Christine Zondagh of the Health and Other Service Personnel Trade Unions of South Africa, in conjunction with Dr. Susan Steinman, founder of the Work Trauma Foundation. The study, in addition to the physician abuse statistic, found that more than half of nurses reported suffering at least one incidence of "physical or psychological violence in a single year." Caelers' piece does not define "psychological violence," though it suggests that Slabbert's article says that the "violence ranged from harassment and bullying to aggression and assault, both physical and psychological." Almost half of the respondents "cited abuse by patients as a reason for nurses leaving the profession."

The piece said perpetrators were patients, their families and visitors, and colleagues, including physicians and other nurses. According to Slabbert, psychological violence was more common, and physical violence was more likely to be committed by patients or relatives. Slabbert reportedly wrote that violence against nurses was not widely acknowledged. Employers usually claimed it was rare, but the reverse was true. ED staff reportedly took "the brunt" of the abuse, but intensive care and "general wards" were also cited. Slabbert recommended a "zero tolerance" policy, noting that ignoring "less aggressive" violence, which often occurred, often led to more severe violence.

Slabbert's article reportedly pointed to studies in other nations documenting the disproportionate share of violence nurses face. She noted that the British National Health Service had experienced a recent increase in violence against nurses, relying on 2003 data from specific hospitals. Slabbert also apparently cited Massachusetts Nurses Association research reporting more than 4,000 assaults against (presumably Massachusetts) ED staff in 2002. And she quoted the U.S. Department of Justice as "saying nurses experienced violence and victimisation rates 72 percent higher than medical technicians, and twice that suffered by other health workers."

Slabbert reportedly stated that nurses regularly subjected to verbal abuse "experienced more stress, felt less job satisfaction and could take more days off work, so providing substandard care." This is an excellent point, though the piece might have pursued it further and explained just what that substandard care might entail. A nurse who is stressed out, afraid and often absent may be unable to function effectively in the whole range of nursing care, from providing vital psycho-social support to making judgments about patient conditions that can mean the difference between life and death, as Suzanne Gordon noted in her book Nursing Against the Odds. In addition, anything that drives nurses from the profession exacerbates the nursing shortage that threatens lives worldwide.

The piece might also have explored why nurses face such abuse. The South African findings about abuse by male physicians suggest that the troubled nurse-physician relationship, gender issues, and nursing's continuing struggle to attract men into its ranks may be factors. Indeed, Gordon discussed physician abuse of nurses, including the widespread impunity implied in this article, in her book. It is evident that too many physicians have little understanding of or respect for nurses. We believe reasons for the abuse of nurses by non-health workers include gender issues, a lack of general social respect for nurses, and the fact that--contrary to what most of the mass media suggests--nurses are the front-line health providers in hospitals and other care settings where people are likely to be volatile. It might amaze viewers of popular television shows in the U.S. to hear this, since such shows rarely show nurses playing any important role at the bedside or anywhere else, and often suggest that physicians provide all important bedside care. Of course, a class of disrespected females is far more likely to experience abuse, and far less likely to have it taken seriously.

We commend Ms. Caelers, the Cape Argus, and IOL for running this story. See the Cape Argus story "Nearly half of our nurses suffer abuse" on the November 10, 2005 edition of the IOL.

See a survey released in September 2005 by the Massachussetts Nurses Association research on workplace violence.