Understanding Reporting of Type II Workplace Violence Among Home Health Care Nurses

Abstract

Background: Home health care nurses (HHNs) work alone in patients’ homes. They experience high rates of Type II (client/patient-on-worker) workplace violence (WPV); however, little is known about the extent and factors of their reporting. Methods: A convenience sample of employees aged 18 years and older and working as an HHN or management staff were recruited from a U.S. nonprofit home health care agency. To describe the extent of reporting of WPV events, an HHN survey was conducted. To identify the barriers and facilitators to reporting, two HHN focus groups were conducted, and management key informant interviews were employed. Findings: We recruited 18 HHNs and five management staff into the study. Almost all HHNs reported to management the most serious forms of violence they experienced, and that HHNs reported WPV when they perceived that reporting was beneficial (alerting other nurses and management) and supported by management staff. However, they were unwilling to report when it was perceived as disadvantageous (reliving the trauma), discouraged (by a norm that experiencing violence is a part of the job), unachievable (unstandardized reporting process), and ambiguous (uncertain of what is reportable). Management staff perceived a lack of standardized reporting processes as a barrier when responding to HHNs’ reporting. Conclusion/Application to Practice: High reporting was related to strong support from management. Policies and procedures should clearly define WPV, the threshold for reporting, how to report, and how management will respond to the reports.

Nurses’ Experience With Type II Workplace Violence and Underreporting During the COVID-19 Pandemic

“…One out of 10 (9.5%) RNs in this study expressed more difficulty in reporting the violent incident to management during the pandemic than before. Studies in various health care settings have shown that barriers of Type II WPV reporting include lack of time to report; belief that violence is part of the job; unstandardized reporting process; ambiguity on the reportability of violence, including an unclear definition of violence; and lack of management support (Byon et al, 2020; Pompeii et al, 2016; Sato et al, 2013). It is likely that some of these factors for underreporting may have been elevated during the pandemic and become more challenging.…”

“…The harmful but pervasive belief that violence is part of nursing may have solidified during the pandemic, and the nurses might have felt that they had to provide compassionate health care to the sick, even to those whose behaviors were violent. And the nurses might have found it difficult to report violent behaviors, rationalizing such behaviors were possibly related to the frustration the pandemic had put on their patients, and they were obliged to tolerate and not report them (Byon et al, 2020). The pandemic also restrained the support and resources that management could utilize, thus adding challenges for nurses to report violent incidents.…”

“…Nurses experience one of the highest Type II WPV in the U.S. health care settings (U.S. Bureau of Labor Statistics, 2020b) as involved in direct patient care (Pompeii et al, 2015). Workplace violence in the health care setting is compounded by the problem of underreporting incidents to hospital administration, thereby underestimating the magnitude of the problem and reducing efforts to control the hazard (Arnetz et al, 2015;Byon et al, 2020;Pompeii et al, 2016).…”

Why nurses do not report patient aggression: A review and appraisal of the literature

“…Another factor limiting the nurse's ability to report was confusion about whether an event should be considered aggressive. Nursing victims had different understandings about aggression terminology and which events qualified for reporting, contributing to their underreporting (Byon et al, 2020;Ferns & Chojnacka, 2005;Findorff, 2003;Mahoney, 1991;Martell, 2014;Natan et al, 2011;Rodriguez-Acosta, 2007;Song et al, 2021).…”

Determinants of violence towards care workers working in the home setting: A systematic review

“…[13][14][15] Reasons home care workers may not report violence include growing tolerance to violence, concerns of being blamed for the violence, losing working hours or their jobs, holding a temporary work visa, and unfamiliarity with legal system. 14,[16][17][18][19] Overall, it was not uncommon that home care workers were subject to different forms of violence perpetrated by clients.…”