Nurse Abuse and Workplace Harassment

Workplace Harassment in Healthcare Settings
Nurses experience a wide range of abuses in the workplace including physical and psychological harassments and physical violence. Patients, patients’ families or friends, and coworkers can all precipitate harassment and abuse directed at nurses, with worldwide prevalence rates at over 36% for physical violence and 66.9% for nonphysical violence (Spector, Zhou & Che, 2014). Bullying, abuse of power, gender discrimination, sexual harassment, or racial harassment by coworkers and supervisors are also relatively common, creating toxic environments in healthcare organizations (Lee, Bernstein, Lee, et al., 2014). In fact, the majority of violent or abusive acts remain unreported due to the lack of institutional support or formal methods of reporting experiences of violence or harassment by either patients or coworkers (Kvas & Seljak, 2014).
Females and demographic minority nurses are at a much higher risk for being targeted for harassment and abuse (Okechukwu, Souza, Davis, et al., 2013). Incidence rates and types of abuse also vary depending on geographic location and cultural context, with physical violence most common in psychiatric facilities, geriatric facilities, and emergency units in Anglo countries, and nonphysical violence being more common in other healthcare settings and in the Middle East (Spector, Zhou & Che, 2014). Also, patients are the cause for physical violence more often in Anglo and European countries than in the Middle East, which has more incidents of patient and patient family-related violent incidents towards nurses (Spector, Zhou & Che, 2014). Identifying at risk populations and environmental risk factors would therefore help administrators and policymakers prevent abuses and create a culture of safety within healthcare organizations.
The lack of motivation to report a potentially large number of abusive incidents in the workplace could suggest a lack of institutional support for nurses who experience violence or harassment from patients, patients’ families, or coworkers. When the abuses are caused by supervisors, physicians, or administrators, nurses may even be less likely to report the incidents due to fear of losing their job, fear of repercussions like loss of reputation, or a “belief that reporting it would not change anything,” (Kvas & Seljak, 2014, p. 344). Moreover, a perceived lack of institutional support for patients and their families might increase the risk for violent outbursts and aggressive behaviors. Leadership and organizational culture have a major role to play in preventing workplace abuse at all levels. Healthcare administrators need to provide patients and their families with clear communications and empathetic support to prevent problems from arising, while also empowering nurses to report any instance of abuse or harassment. Likewise, administrators and nurse leaders can put in place systems to prevent violence and abuse, such as practicing team-based care, using CCTV, and making sure nurses have a means of anonymously or discreetly reporting unwanted or harmful behaviors. Preventing and mitigating workplace violence would improve employee morale and also ensure higher standards of care.
It is in the best interests of healthcare organizations to support nursing staff and inculcate a zero tolerance for harassment policy, given the ethical and legal ramifications of harassment. Experience of abuse and harassment on the job can lead to adverse physical and mental health outcomes for nurses, with ramifications that extend into family and community life (Okechukwu, Souza, Davis, et al., 2013). Furthermore, workplace abuses lead to loss of productivity, low morale, and high turnover rates (Lee, Bernstein, Lee, et al., 2014). Ultimately, workplace harassment in the healthcare setting can negatively impact patient care due the toll it takes on nurses.
The Importance of Peer Review
Peer review is a gold standard in nursing research, viewed as central to the scientific method and critical for offering “trustworthy” material (Nicholas, Watkinson, Jamali, et al, 2015). The process of peer review is relatively straightforward: in order to publish the results of a scientific study, researchers must submit their work to academic journals or professional organizations staffed by experts in the same or a relevant field. Theoretically, a panel of one’s peers in the same professional milieu will be able to scrutinize the original research for flaws, errors, biases, and assumptions that threaten the validity, reliability, or ethical standards of the research. Peers may point out weaknesses in the design, methodology, or conclusions offering suggestions for strengthening future research. The peer review process helps to keep the standards high for academic rigor and professionalism, while preventing the proliferation of misinformation.
Unfortunately, the process of peer review is itself potentially flawed and haphazard. The problems with peer review have grown since the advent of open access and online publications, many of which claim to be peer reviewed by which fail to pass the muster as evidenced in numerous studies showing how journals often accept papers with “fatal flaws,” (Bohannon, 2013, p. 60). As Sood (2015) points out, peer reviews “egregiously...aren’t able to catch simple, common, important errors,” and many of the reviews are clouded by subjectivity and bias (p. 1). The lack of standards in the peer review process hampers the integrity of the nursing profession, and reduces the perceived or actual credibility of published studies. Complicating matters further is the fact that peer reviewing can entail a panoply of services from copy editing to deeming a study “worthy” of inclusion in a journal or the body of evidence in a field of inquiry (Sood, 2015, p. 2). To streamline and improve the peer review process, also helping academic journals operate more cost-effectively, it would be wise to segregate copy editing duties from more executive level decisions like determining worthiness or assessing the value of an article based on its potential contribution to the field of knowledge. Artificial intelligence systems can also be used to catch errors in statistical data analysis.
Determining whether information has been peer reviewed or not has become more difficult with the abundance of false academic journals only claiming to be peer reviewed (Nicholas, Watkinson, Jamali, et al., 2015). Even the most reliable, name-brand scientific journals have flawed peer review processes and a pressure to accept certain authors for publication without sufficient scrutiny (Bohannon, 2013). The only way to truly determine if an article has been properly peer reviewed is to perform due diligence: such as researching the editors and staff of the journal and following up on the list of peer reviewers mentioned in the publication. Also, it helps to differentiate between phoney academic journals and credible sources. Just because a journal has a professional-sounding name does not mean that it has established credentials or is staffed and edited by experts in the field. Unfortunately, even credible journals are sometimes forced to use non-expert “peer reviewers” to cut costs or maintain a competitive advantage (Bohannon, 2013).
In addition to peer review, two other criteria for determining quality of information include a thorough analysis of the research methods used in the study, and also careful assessment of logical fallacies in both the introduction and discussion/conclusion sections. Learning how to identify logical fallacies helps readers to recognize flaws in reasoning, and understanding more about appropriate research methods and their strengths and weaknesses also helps nurses to understand potential issues with reliability and validity. Finally, readers can sometimes base their decisions on the author’s personal credentials—although even the most established researchers are human and therefore prone to error, flaw, or even fraud. Sometimes the best defense against unreliable information is to evaluate the entire body of evidence to find patterns in results rather than cite one or two studies as definitive proof of a phenomenon or theory.



References
Bohannon, J. (2013). Who’s afraid of peer review? Science 342(6154): 60-65.
Kvas, A. & Seljak, J. (2014). Unreported workplace violence in nursing. International Nursing Review 61(3): 344-351.
Lee, Y.J., Bernstein, K., Lee, M., et al. (2014). Bullying in the nursing workplace. Nursing Economics 32(5): 255-267.
Nicholas, D., Watkinson, A., Jamali, H.R., et al. (2015). Peer review: still king in the digital age. Learned Publishing 28(1): 15-21.
Okechukwu, C.A., Souza, K., Davis, K.D., et al. (2013). Discrimination, harassment, abuse, and bullying in the workplace: Contribution of workplace injustice to occupational health disparities. American Journal of Industrial Medicine 57(5): 573-586.
Sood, G. (2015). Reviewing the peer review. http://www.gsood.com/research/papers/peer_review.pdf
Spector, P.E., Zhou, Z.E. & Che, X.X. (2014). Nurse exposure to physical and nonphysical violence, bullying, and sexual harassment: A quantitative review. International Journal of Nursing Studies 51(1): 72-84.