Workers who are assaulted can experience profound and long-lasting psychological trauma. If violence persists, they may seek to leave the profession, or areas of the profession where there is an especially acute need for care, such as ER work. The "financial loss resulting from insurance claims, lost productivity, legal expenses, property damage, and possible staff replacement costs" due to violence is also considerable (Workplace violence, 2009, ANA). Ironically, understaffing is a critical aspect of the reason that there is workplace violence: tired workers are apt to be less vigilant, and there are also fewer 'hands no deck' to restrain violent patients. A further facilitator of workplace violence is that more and more nurses are providing services within clients' homes. In such situations, the nurse is almost always unsupervised and unprotected. Less oversight can lead to greater risk of violence. 38% of 364 public health field-workers in one study said they experienced violent events during their employment, a total of 611 events (McPhaul & Lipscomb 2004). "Transporting patients, long waits for service, inadequate security, poor environmental design and unrestricted movement of the public are associated with increased risk of assault in hospitals and may be significant factors in social services workplaces as well. Finally, lack of staff training and the absence of violence prevention programming are associated with elevated risk of assault in hospitals" (McPhaul & Lipscomb 2004).

As crime grows more common, staff members are apt to see it as less remarkable. Amongst nurses themselves, there can create a sense that an increased level of physical risk is acceptable, along the lines of 'broken windows' theory which suggests that "ignoring or tolerating" even "low-level crime creates an environment conducive to more serious crime…when verbal abuse, threats of assault and low level daily violence are tolerated in health care environments more serious forms of violence will follow" (McPhaul & Lipscomb 2004). There is growing resignation within the profession that violence "is part of the job" (McPhaul & Lipscomb 2004). Few environments provide widespread training in how to guard against violence, how to deal with it, and how to spot it before it spirals out of control. Additional protocols which can prove useful to include are the tracking of large and small abuses, to see if preventative measures are adequate.

"Worksite analysis includes regular walk-through surveys of all patient care areas and the collection and review of all reports of worker assault. A successful job hazard analysis must include strategies and policies for encouraging the reporting of all incidents of workplace violence, including verbal threats that do not result in physical injury," as well as a comprehensive alarm system (McPhaul & Lipscomb 2004). If managers do not take the initiative to protect nurses, nurses must take the initiative themselves and demand adequate training and other precautions, particularly if they work in an innately high-risk environment, such as an emergency room. They must also note and report all violent assaults, and encourage their fellow nurses to do so. While risk has historically be a part of the nursing profession -- after all, modern professional nursing was born when Florence Nightingale went to the front lines of a battlefield during wartime -- nurses should not have to endure unnecessary risks. Risk mitigation strategies must be implemented, and training in the diffusion of conflict will benefit both patients and staff members. The more comfortable and confident nurses feel in treating patients, the better the care patients will receive, and fewer nurses will leave a profession already suffering from high rates of attrition.
References

Carroll, Victoria. (1998, September/October). Workplace violence affects one-third of nurses.

TAN issue. ANA. Retrieved June 14, 2010 at http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/TAN/1998/SepOct1998NewsViolence.aspx

McPhaul, K., Lipscomb, J., (September 30, 2004). "Workplace violence in healthcare:

Recognized but not regulated." Online Journal of Issues in Nursing, 9 (3): 6.

Available on June 14, 2010 at www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume92004/No3Sept04/ViolenceinHealthCare.aspx

Workplace violence. (20009). ANA. Retrieved June 14, 2010 at http://www.nursingworld.org/MainMenuCategories/ANAPoliticalPower/State/StateLegislativeAgenda/WorkplaceViolence.aspx

Workplace violence: OSHA standards. (2010). Safety and health topics. OSHA.

Retrieved June 14, 2010 at http://www.osha.gov/SLTC/workplaceviolence/standards.html