Nursing Assignment: Workplace Violence and Leadership Attributes

This nursing assignment discusses workplace violence in the healthcare industry, particularly in the emergency department, and proposes that the efficacy of educational and training programs coupled with the implementation of a zero tolerance policy on workplace violence is dependent on key leadership attributes and skills.

Running head: NURSING ASSIGNMENT 1
Nursing Assignment
Student’s Name
Institution

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Nursing Assignment
Workplace violence is one of the main issues facing the healthcare industry with nurses
being the most affected of all the healthcare professionals. Workplace violence comprises of any
physical or psychological actions that are damaging and which occur within a professional’s line
of duty. The prevalence of workplace violence and their impacts on physical and emotional
wellbeing for nurses especially in the emergency departments is worrying concern for many
nursing leaders. Furthermore, other adverse effects such as job dissatisfaction and high nurse
turnover are also associated with the issue (Morphet et al, 2014). This paper proposes that the
efficacy of educational and training programs coupled with the implementation of a zero
tolerance policy on workplace violence is dependent on key leadership attributes and skills
including; vision, staff empowerment, driving change, level of influence and authority, and good
listening and communication skills. Alternatively, nursing leaders should use strength-based
nursing principles by strategically contributing to the development of policy.
Overview of the Issue and Its Context
Some of the most common types of workplace violence include but are not limited to;
direct physical assaults, written and verbal threats, physical and verbal harassments, and
homicide. Nurses are subjected to physical aggression from their patients in various areas
of practice. They are in turn affected both physically when they incur injuries and
psychologically when they are verbally abused (Martinez, 2016). Workplace violence within
the health care industry can be classified into four basic types with type 2 and type 3 being the
most prevalent case of violence in the nursing profession. Type 1 involves criminal intent where
the perpetrator of violence is driven by criminal intent and has no relationship to the organization

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or the employees of the organization. The second type of workplace violence is orchestrated by a
customer, client or patient. In this case, the patient becomes violent while receiving health care
services. Type 3 involves worker-on-worker where employees or nurses attack themselves. The
final type of violence occurs among individuals who have interpersonal relationships such as
patients and their families (Johnson, 2015).
In the healthcare industry workplace violence occurs in almost every sector wit ED,
maternal and child health units, acute care settings, and psychiatry departments all experiencing
different levels of workplace violence. In all these areas, sensitive and emotionally charged
issues were the root causes inclining patients to be violent against nurses (Papa & Venella,
2013). Studies have also indicated that triage nurses especially in ED have likewise exhibited
workplace violence against each other.
Analysis of the Issue and Why Change is required
Aside from being the largest sector in the healthcare workforce, nurses are particularly
vulnerable to workplace violence because they provide the first line of care to the patients. This
also implies that they spend more time with the patients and interact with all types of patients
checking into health care facility. The emergency department is the most adversely affected
department and this can be attributed to a variety of factors. Their first point of contact status
primarily puts these nurses at the highest risk. Other factors including crowding, drugs and
alcohol consumption among patients, high patient volume and prolonged waiting times are some
of the primary reasons putting ED nurses at the highest risk of workplace violence (Papa &
Venella, 2013).

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Recent reports indicate that more than 50% of the emergency room nurses experience
some form of workplace violence either in the form of physical or verbal abuse. Although most
of the commonly experienced abuse was in the form of verbal abuse such as yelling, swearing
and threats, nearly half of the nurses who reported physical abuse revealed that they were pulled
and grabbed by their offenders (Papa & Venella, 2013). The prevalence of violence in the
workplace creates a high stress environment which results in nurses’ burnouts and reduced
quality of care. By being concerned about their safety, nurses become dissatisfied with their
work environment a factor which may incline them to leave their jobs (Niu et al, 2019). In the
event that these nurses leave their jobs, high staff turnover will be observed thereby creating
another adverse effect in the form of staff shortages (Morphet et al, 2014). It is therefore, critical
that this issue be immediately addressed.
Critical Discussion of the Barriers to Change
One of the main barriers to change relates to the limited number of reports made by
nurses. Nurses are particularly deterred from reporting workplace violence because they are
fearful of retaliation and lack of support from their employers. Most worryingly, most of the
nurses currently do not understand which acts constitute violence and thus warrant reporting
(Niu et al, 2019). Hence, the failure to report such incidences by emergency department nurses
results in cases of under-reporting. Study by Blando et al (2015) found other multiple factors
that act as barriers to change process. They include; varying perceptions of violence, lack
of action even after an incident is reported and lack of accountability from management
(Blando et al, 2015).

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Study by Giordano (2017) also indicates that another barriers in implementing
change process is administrative resistance a factor which will result in poor employee
perception and support for the EBP (Giordano, 2017). Failure to report events of violence
eventually prevents the direct release of resources that are required to mitigate the issue. In cases
where zero-tolerance policy is stipulated, nursing leaderships have failed to develop intervention
measures that will enable the organizations to act on the reported incidences (Morphet et al,
2014). Eventually, nurses are inclined to think that workplace violence is the norm, or otherwise,
part of their jobs.
Leadership Attributes and Skills to Facilitate and Evaluate the Change Process
Studies have recommended that ensuring that healthcare providers have the appropriate
levels of education and training to recognize, diffuse and deescalate incidences of violence
within the workplace is crucial in addressing the issue (Papa & Venella, 2013). Nonetheless,
leadership support and reliance on effective leadership skills are the chief factors towards
mitigating workplace violence.
Vision
A strength-based nursing leadership relies on nursing leaders who have a strong vision of
where their organization is heading. Such leaders utilize strong communication and call to action
to impart the vision and assist the nurses to understand how such strategies contribute towards
achieving the vision (Gottlieb, Gottlieb & Shamian, 2012). In this light, therefore, nursing
leadership is tasked with driving cultural change as the key vision at the organizational level.
Drivers of Change

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Leaders are expected to be drivers of change given that organizational change has
become an inevitable aspect in the success of any institution. In healthcare for instance, the
myriad number of issues that plague this sector coupled with diverse and changing needs of
patients requires that health care organizations adapt to these challenges. Workplace violence is
one of the main challenges that faces the nursing profession and for this reason, there is need to
eradicate the issue by adopting a zero-tolerance policy. The implementation of such a policy
implies that the organization will have to undergo structural changes that will primarily
affect the administration or leaders within the health care organization (Blando et al,
2015). These changes are supposed to be spearheaded by nursing leaders to ensure that the policy
is a success towards eliminating incidences of workplace violence and supporting a healthy or
positive working environment.
Level of Influence and Authority
Leaders are expected to exert a great level of influence among their followers while at the
same time doing well to signify their authority in a bid to command respect. It is worthy to note
that positively influencing followers is essential to committing to the vision of the organization.
Influential leaders are preceded by their employees’ trust and in such cases; the staff will
acknowledge the authority of their leader if such leaders can influence the staff positively
(Martinez, 2016). Thus, leaders as the initiators of the change process should capitalize on their
level of influence on the nursing staff to be able to exert authority and oversee the entire
implementation process.
Listening and Communication

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Great and effective leaders also exhibit exemplary listening and communication skills
which could be pivotal in education and training programs that mitigate workplace violence. This
notion is confounded on the fact that every follower or team members want to be understood
intellectually in regards to how they perceive the working environment and, emotionally in
relation to how the feel. Alternatively, leaders ought to be empathetic and pay attention to the
diverse needs of their followers. Incubating such skills could prove to be essential in
implementing an education and training program that is tailored towards improving safety
at the workplace (Martinez, 2016). On this note, leaders with good listening and
communication skills can be able to align the course content used in the program with the culture
and needs of the nurses within their organizations. Such skills would similarly prove to be
valuable in multidisciplinary forums which are recommended and preferable in educating nurses
on how to recognize and deescalate violent behaviors within their areas of practice (Blando et al,
2015). Hence, it becomes affirmative that the success of training programs used in mitigating
workplace violence relies on the ability of nursing leaders to fully communicate and integrate the
outcomes of the training with the needs and experiences of the nurses.
Delegation and Empowerment of Staff
Delegating duties and empowering nursing staff by helping them develop traits that will
facilitate carrying out of professional duties are essential skills that should be inculcated by
nursing leaders. Such skills can be cultivated through mentoring and coaching. For instance,
nursing leaders should provide the required support both intellectually and emotionally that will
enable their subordinates to handle issues in their absence. Leaders provide clear and succinct
instructions of what should be done with clear supervision also taking place to ensure that the
tasks are completed as instructed. This teaching process will enable the nursing staff to manage

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the duties in the event that the leaders are absent and the tasks are delegated (Giordano, 2017). In
other words, the best form of empowerment employed by effective nursing leaders is by showing
staff how to perform a task and then supporting them in completing it. Consequently, this
practice-based approach will empower and motivate staff to undertake duties in the absence of
their leaders or supervisors.
In regards to developing and educational program, staff empowerment and delegation
could as well be used towards the success of the change process. Regardless of how unique a
program is, every nursing staff should be able to know their roles and responsibilities inclusive
of what is expected of them. Such knowledge will be pivotal in enabling nurses to make
informed decisions when encountering workplace violence (Giordano, 2017). To ensure that
this is the case, the leadership in place needs to coach the nurses on what to do and further
support them through individualized and unique training sessions for nurses.
Strategic Contribution to Health Care Policy
Nursing leaders have an important role to play in providing professional help to the
nursing staff and this includes making significant contributions to healthcare policies. One way
in which such assistance can be accorded is by ensuring all nursing units have the necessary
resources to create positive practice environments and deliver high quality of care. This
coincides with the nursing leadership principle of building work environments that promotes the
health of nurses and facilitates their development as well. It can alternatively be noted that an
unhealthy working environment often contributes to high rates of nurse burnouts, job
dissatisfaction, and poor physical and mental wellbeing. Moreover, such environments
compromise the safety of patients and bring to question the quality of care that is provided

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thereby resulting in high rates of mortality and morbidity (Koh et al, 2016). It is the
responsibility of nurses to therefore, ensure that they contribute to healthcare policy by providing
the necessary tools to create a positive work environment that can mitigate the above mentioned
adverse effects.
Similarly, eliminating workplace violence requires leaders who can be able to allocate the
required resources and tools in the form of adequate channels to reporting incidences.
Contribution to healthcare policy will therefore, entail nursing leaders’ action to take time and be
involved in developing and implementing workplace zero-tolerance policy. Also, such a policy
should further encompass educational program for nurses that will enable the nursing staff to
deal with aggressive and violent behaviors (Stene et al, 2015). It can alternatively be noted that
nursing leadership have the topmost control of all the resources needed to exert cultural
transformation within their organizations (Doby, 2017). It thus, implies that leaders have the
responsibility to implement effective policies and practices that can inculcate a culture of non-
tolerance towards workplace violence.
Allocation of resources also implies being able to empower nursing staff to control their
own working environments and encourage positive professional relationships. In such cases,
such a leadership skill goes beyond attending to structures and instead ensures that nurses are
treated as assets to be developed and not managed. As such, the leaders would be fostering
relationships and create experiences where nurses can strive on their own (Gottlieb, Gottlieb &
Shamian, 2012). Alternatively, this is to say that nursing leaders create a healing environment
where nurses feel safe and secure both emotionally and physically. In this light, one way of
mitigating workplace violence in the emergency department is through leader’s commitment to
ensuring a safer workplace.

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Conclusion
Education and training program in conjunction with implementation of a zero-tolerance
policy have often been effective in reducing workplace violence. However, in the healthcare
industry, the success of such strategies is dependent on leadership support characterized by
effective leadership skills and attributes. Such techniques can be realized in the form of clearly
communicated vision, reputable influence and authority, good communication and listening
skills, and leaders who take the initiative to be the drivers of change. It can likewise be observed
that given that leaders are given the mandate to control resources, their nursing leadership
strengths can be revealed by being at the forefront towards contributing to policy change and
implementation.
References
Blando, J., Ridenour, M., Hartley, D., & Casteel, C. (2015). Barriers to Effective
Implementation of Programs for the Prevention of Workplace Violence in Hospitals.
Online Journal of Issues in Nursing, 20(5), 5. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4719768/

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Doby, V. (2017). Leadership’s Role in Eliminating Workplace Violence and Changing
Perceptions in the Emergency Department. Journal of Emergency Nursing, 41(1), 7-8.
Retrieved from https://www.jenonline.org/article/S0099-1767(14)00384-5/fulltext
Giordano, D. L. (2017). Combating Workplace: An Evidence-Based Initiative. Retrieved
from https://scholar.valpo.edu/cgi/viewcontent.cgi?article=1108&context=ebpr
Johnson, S. L. (2015). Workplace Bullying Prevention: A Critical Discourse Analysis. Journal of
Advanced Nursing, 71(10), 2384-2392. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4896752/
Koh, W. M. (2016). Management of Workplace Bullying in Hospital: A Review of the Use of
Cognitive Rehearsal as an Alternative Management Strategy. International Journal of
Nursing Sciences, 3(2), 213-22. Retrieved from
https://www.sciencedirect.com/science/article/pii/S2352013215300247
Martinez, S. A. (2016). Managing Workplace Violence with Evidence-Based Interventions:
A Literature Review. Journal of Psychosocial Nursing and Mental Health Services,
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Morphet, J., Griffiths, D., Plummer, V., Innes, K., Fairhall, R., Beatie, J. (2014). At the
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Association, 38(2), 194-201. Retrieved from https://www.publish.csiro.au/ah/AH13189

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Niu, S. F., Kuo, S. F., Tsai, H. T., Kao, C. C., Traynor, V., & Chuo, K. R. (2019). Prevalence of
Workplace Violence Episodes Experienced by Nurses in Acute Psychiatric Settings.
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