Management in Health Care Practice: Workplace Violence and Dealing with Difficult People

This literature review discusses the impact of workplace violence and dealing with difficult people on nursing practices in healthcare facilities. It explores strategies to address these issues and emphasizes the importance of effective leadership and management in creating a safe and supportive working environment for nurses.

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INSTITUTIONAL AFFILIATION(S) |
Management in
Health Care Practice
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Literature review
Introduction
The continuous change and complexity seen within healthcare environment
challenges to evaluate and develop capabilities to cope with the identified issues strategically.
A strong leader stands out in providing a conducive environment for the development of
nursing professionals along with nurse’s teams. Ideally, in a healthcare facility, leadership
and management functions must be combined correspondingly, considering that leadership
role is recognised by leader’s ability to carry out every management responsibility as well as
leadership role. In literature, leadership is defined as ethical, dynamic and relational process
within people who desire enabling positive change in groups (Fernandes, Araújo & Pereira,
2018). Acknowledging multiple leadership and management concepts along with its
implications for nursing practices is the basic aim behind preparing this literature review.
Along with it, this paper will identify two critical issues like workplace violence and dealing
with difficult people that impacts nursing practices adversely while working in a healthcare
workplace. After reviewing current literature pertaining aforementioned issues and how they
are impacting nursing practices, this paper will analyse potential strategies that can address
the identified issues. For the same, this paper will utilise online credible sources that are
relevant for this study, majorly peer-reviewed articles that can aid in comprehending the
issues from multiple perspectives.
Workplace violence impacts on nursing practices
Workplace violence can be defined as incidents in which employees are threatened,
abused, assaulted or bullied under various circumstances that are related to their job role. This

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may include commuting for the work along with implicit or explicit challenges that effects
safety and well-being of the employees (Boafo, 2018). In present literature, it is been
identified that workplace violence is one of the major issues for the nurses worldwide as the
available evidences reveals that workplace violence rates against nurses have increased
considerably in past few years. Both non-physical and physical forms of violence results in
detrimental impacts on physical as well as psychological well-being of hospital nurses that
consequently reduces the quality of work provided by them. Alongside, many qualified
nurses tend to leave their job and even sometimes nursing profession due to such workplace
dilemmas that can potentially range from post-traumatic disorders to physical injuries
(Engeda, 2016).
Workplace violence against hospital nurses is a widespread and commonly discussed
phenomenon where World Health Organisation (WTO) discriminated workplace violence as ,
“physical assault, homicide, verbal abuse, bullying/mobbing, sexual and racial harassment,
and psychological stress” in which most commonly encountered violence includes verbal
abuse, racial harassment and mobbing (Leung, 2006). In fact, it can be seen that although
violence is prevalent to every workplace environment, nurses remains in the frontline within
healthcare systems as they are most closely contacted with patients as well as their families
and therefore are highly risked for getting abused. International studies reveals that
workplace violence against nurses varies from 10% to 50% that can even reach to 87%
sometimes and thus workplace violence calls for a recall period (Leung, 2006).
Mitchell, Ahmed & Szabo (2014) finds that when workplace tensions are high, it is
likely that nurses tend to under-perform that may result in poor care for patients along with
hampering organisational reputation and productivity. The author pinpoint that violence can
cause negative impacts and errors due to distraction caused among nurses that may further
impact nurses health in the long run. Therefore, the authors recommended that nursing

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leaders can play vital role in bringing a change to negative workplace environment by making
a unit examination of issues that are supported by disruptive behaviour. While nurses see any
issue within workplace, they must adopt an appropriate and immediate action that ensures
stoppage of abusiveness within predators and effective steps are taken to prevent repetitive
negative behaviours.
The Occupational Safety and Health Administration (OSHA) cites that workplace
violence “ranges from threats and verbal abuse to physical assaults and even homicide. It can
affect and involve employees, client’s customers and visitors” (Gustin, 2013, p. 14). The
author recognised that workplace violence to be one of the most critical issues in occupation
hazards that ranks among top four reasons for suicide in workplace in past 15 years. Around
3000 people died due to homicide in between 2006 and 2010 alone according to Bureau of
Labor Statistics (Gustin, 2013). Furthermore, a research undertaken by Teymourzadeh, et al.
(2014) reveals that out of 300 nurses who responded to their questionnaire, over 70% of them
felt disturbed due to workplace violence. The participant nurses reported that exposure to
verbal abuse, bullying and mobbing, including physical violence were faced by each one of
them at least once during previous years. Relatives of the hospital patients were responsible
most of the times especially for abusing the nurses who looked after outpatient clinics and
emergency department. Moreover, the nurses unlikely reported the violence to healthcare
managers and around 40% of them were not sure about existing safety policies that can
potentially reduce workplace violence.
Based upon recent publications related to workplace violence, Bordignon & Monteiro
(2016) reflects workplace violence consequences that directly affected healthcare institutions
through decreased organisational commitment which were associated to bullying and internal
emotional instability. The reflection made by the author concerned midwives and nurses
working in Australian hospitals and finds that besides impacting job performance, the

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healthcare organisations recognised decreased work quality, more psychological demands
and ineffective control over tasks. Due to such consequences, the chances of adverse events
increased and thus workplace violence contributed in development of critical diseases and
impairs to those who suffered as well as ones who were around them. Leaders and
management have to bear every cost, both direct and indirect ones along with low
performance levels which further damages institutional image along with reduction of clients.
Dealing with difficult people impacting nursing practices
The exchange of concerns, feelings or information is a vital part in therapeutic
relationships within healthcare institutions. Many clinical situations and diagnoses produce
anxiety among patients that requires them to discuss regarding their concerns. However, in
healthcare organisations, communicational issues can be seen especially while dealing with
difficult people that impacts nursing practices adversely. Hardavella, et al (2017) identifies
most common and practical scenarios that can create difficult situations for nurses while
dealing with patient care. This includes situations like patients living with long list of medical
symptoms, drug dose decrease, noncompliance’s, no diagnosis irrespective of thorough work-
ups and delivering bad news. Under such circumstances, even if nurses are enabled with best
communication skills, faces challenges that further impacts their work routines.
Gerzon (2018) argues that a leader has to face many workplace conflicts, but to deal
every conflict it is necessary to rethink whether the conflict is “hot or cold”. The author
defines that ‘hot conflicts’ are those incidents where more than one parties become
emotionally influenced thereby resulting in shouting or speaking in louder voices along with
showing physical aggressiveness that pretends to be potentially explosive. ‘Cold conflict’ on
the other hand are those circumstances where more than one parties seems to supress their

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emotions or pretends to be unemotional while performing their duty. Such outcomes may
result in muttering under breath, being physically controlled or withdrawn along with
remaining silent or following a passively aggressive tone. The author pinpoints that neither of
the conflicts are constructive and thus needs to be dealt with communicational skills that can
tackle the conflicts to “cool it down”.
Bramley & Matiti (2014) reflected a diversified perception that underlines
compassion and commitments from clinical nurses. The study made by the authors
acknowledges that although compassion towards work may prove time-consuming process, it
also highlights significance behind transiting such emotions that can establish compassionate
connection between patients and nurses. Although the psychological demand from nurses is
often cited as a barrier in forming compassionate relationship in workplace, the reasons
behind such challenges must not be overlooked under which the smallest exchange of
expression may turn into conflict situation. Although most of the nurses show virtue and
ethics while performing expected duty, patients still expect more compassionate response
from the nurse’s and desire that they remain morally supportive during intense situations also.
Nevertheless, this paper lacked few supportive information and mentioning that to identify
enhanced compassion from nurses, it is significant to identify compassion from patient
perspectives also that can create a balanced situation among workplace. In fact, most of the
recent work and media reports calls for an immediate need for descriptive accounts that
delivers patient perspectives alongside nurses’ viewpoints to articulate empirical research and
calls required from both the sides.
Arguably, Freedman (1993) states that no matter how much people try to get along
with others, everyone tries to run them out. Difficult people, according to the author are
among countless varieties that may provoke others in diversified ways. Difficulty may stem
in a person while trying to meet personal demands and while they face different attitude,

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gesture or opinion in any unavoidable situation. Remarkably, the author identified two
broader thinking styles present in nursing workplace that can potentially address workplace
conflicts, vertical and horizontal thinkers. Vertical thinkers look for and manipulates
differences along with methodically distinguishing them separately. They identify pinpoint
issues, eliminates unnecessary conversations and finally breaks the task into smaller and
discrete steps. Horizontal thinkers also look for and manipulates along with methodically
finding commonalities, but try and make unpredictable associations between related events,
items or ideas. They keep focussing upon common thread points and organise them according
to different thoughts to signify the underlying purpose.
Strategies to address workplace issue
Developing patient safety culture within health facilities is the top most
recommendation made by international health communities after being reported by
considerable issues such as workplace violence and dealing with difficult people impacting
nurses’ practices. The first strategy that requires to be implemented is accessing existing
safety culture to comprehend whether present reporting mechanisms are in accord that
encourages nurses to report whenever they feel any violence taking place in the hospital.
Engeda (2016) identified that in literature, basic understanding concerning patient safety and
positive outcomes are based upon effective communication and mutual trust that allows
proper synchronization of information, strong commitment from healthcare leaders and
existence of stronger mechanisms that allows nurses report whenever any issue is faced by
them.
The above literature review finds that physically violent patients establishes a non-
conductive workplace environment that results in reduced compassion among nurses, thereby

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creating chaos and distractions. To eliminate such disruptions, nurses requires advocating
safety culture and standards by encouraging healthcare organisations to implement violence-
prevention policies and frameworks that provides them with support whenever any adverse
incident occurs. Some significant resources that contains critical violence prevention
measures are Emergency Nurses Association, American Nurses Association and OSHA (Ali,
2018).
Leadership to manage clinical nurses is the third significant strategy that needs to be
developed and initiated by enabling good leaders to produce effective environment. By
identifying, supporting and developing future of nurses, good leaders acknowledges the shift
in standard of leadership theory along with contexts that is required by future nurses to grow
without facing workplace dilemmas. Along with showing capabilities to identify and
nurturing nurses’ leadership, it is necessary to avoid fostering those people who do not poses
either of the capabilities or displays negative traits that results in detrimental outcomes for the
nurses. Therefore, Scully (2015) reveals that contemporary theories of leadership demands
combined aspects in which both situational and personal traits theories must be recognised
that can establish effective leadership and management practices.
Conclusion
Workplace violence along with disrespect shown towards nurses, especially while
difficult people misbehaves during intense situations impacts nurses personally as well as
professionally. The persistent impacts further lead to humiliation, fear, anger and lowered job
satisfaction along with decreasing organisational performance level and workplace
productivity. The above literature review identifies significance behind effective leadership
and management for nurses that can create encouraging, safe and effective working

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environment for them. The paper discussed negative impacts that is created over nurses’
professional practices that further leads to increased turnover in healthcare facilities.
Therefore, it is crucial to identify and develop nurses’ leaders by providing them with
strategic reporting mechanisms which suits with modern dynamic environment along with
instilling effective communication skills within nurses so that they report any negative
incident immediately for support. This paper recognises need for appropriate support
standards, development and identification of nurses’ capabilities to implement effective
leadership and management within healthcare organisations that aims at providing excellent
patient service along with nurturing future of nurses.

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References
Ali, M. (2018). Communication skills 6: difficult and challenging conversations. Nursing
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Boafo, I. M. (2018). The effects of workplace respect and violence on nurses’ job satisfaction
in Ghana: a cross-sectional survey. Human Resources for Health, 16(06), 1-10.
Bordignon , M., & Monteiro, M. I. (2016). Violence in nursing work: a look at the
consequences. Brazilian Journal of Nursing, 69(05).
Bramley , L., & Matiti, M. (2014). How does it really feel to be in my shoes? Patients'
experiences of compassion within nursing care and their perceptions of developing
compassionate nurses. Journal of Clinical Nursing, 23(19-20), 2790–2799.
Engeda, E. H. (2016). Incident Reporting Behaviours and Associated Factors among Nurses
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Gerzon, M. (2018). To Resolve a Conflict, First Decide: Is It Hot or Cold? In Dealing with
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Gustin, J. F. (2013). Workplace Violence and the Facility Manager. (P. E. Central, Ed.) The
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