Experiences of Workplace Violence Among Nursing Staff in Selected Hospitals in India: A Qualitative Study

Abstract

Background

Workplace violence among nurses is prevalent, particularly due to their extended working hours and shift duties across hospital units. While extensive research has been conducted on this issue in developed countries, there is a lack of data from developing nations as India.

Aim

This study aims to explore the experiences of workplace violence among nursing staff in selected private hospitals in the National Capital Region, India.

Design

Qualitative research.

Method

Data were derived from original transcripts of interviews with 29 staff nurses working in various medical and surgical wards who had encountered workplace violence. Data collection occurred between July and December 2023. Hybrid thematic analysis was conducted using NVIVO qualitative research software.

Results

Twenty-nine nursing staff participated in the study, revealing five themes: Verbal aggression, safety concerns, Harassment experiences, training needs, conflict resolution, and advocacy. Interviews indicated that workplace violence, ranging from verbal abuse to physical assault, was frequent, primarily from patients’ caregivers or family members and, in some cases, from the patients themselves.

Conclusion

Interventions are needed at various levels, including nursing administration, policymakers, and community education, to foster a zero-tolerance approach toward workplace violence.

Keywords

Workplace violence qualitative research nursing experiences healthcare abuse

Introduction

Workplace violence, defined as incidents where staff are abused, threatened, or assaulted in circumstances related to their work, poses a serious threat to the safety, well-being, and health of workers worldwide.¹ While workplace violence affects various sectors and worker categories, the healthcare sector is particularly vulnerable, with violence in this sector constituting almost a quarter of all workplace violence incidents.² Nursing staff, in particular, face heightened risks of experiencing workplace violence due to their prolonged duty hours and shift work. The widespread prevalence of workplace violence in the healthcare sector can have negative consequences, severely impacting the quality of care provided and influencing healthcare workers’ (HCWs) decisions to remain in their positions. This issue is of particular concern in developing countries, where access to healthcare for all is paramount. If HCWs abandon their jobs or migrate to developed countries due to workplace violence, it could significantly affect the country’s healthcare system and exacerbate existing challenges related to staffing shortages and resource scarcity. Addressing workplace violence against nursing personnel is essential to ensure the safety and well-being of HCWs and maintain the integrity of healthcare services. This article aims to explore the experiences of nursing personnel who have experienced workplace violence in the last one year of their work in their hospitals.

Background

It has been well documented that while workplace violence affects practically all sectors and all categories of workers, the health sector is at major risk. Violence in this sector may constitute almost a quarter of all violence at work.² As per a US study, it has been steadily increasing due to changes in societal reforms resulting in healthcare needs, scarcity of resources, increasing work pressure, and stress. Consequently, HCWs often fall prey to their anger and emotional outbursts. Physical and verbal attacks on HCWs were a common sight during COVID-19. Comparatively, HCWs are four times more likely to be injured and may need time away from work as a result of workplace violence than any other private sector worker.³ In a cross-sectional survey conducted by AIIMS, New Delhi, among health care workers of North India, wherein 601 responses were analysed showed that majority (75%) of the participants experienced violence in some form, and these episodes of WPV lead to a significant impact on their physical and mental health. Around one-third of the participants felt uncomfortable reporting these incidents.⁴

The majority of HCWs face this violence from patients and family members, as they are overburdened by the disease and in a stressful and exhaustive state. These episodes of violence are of concern as they affect the physical and psychological health of HCWs, which in turn affects the quality of care, and the entire healthcare system can be compromised. It also results in higher rates of burnout, low self-esteem, and self-destructive aggression among healthcare professionals.⁵ The most common and significant violence experienced by nursing staff is patient-relative (visitor) violence, manifested in the form of verbal, physical, or damage to hospital property.⁶

While the phenomenon of workplace violence and its prevalence are well documented, studies pertaining to an in-depth exploration of the experiences of HCWs, particularly nursing staff who spend considerable time in patient care, are scarce in developing countries as India. The present study aims to explore the in-depth experiences of workplace violence among nurses in selected private hospitals.

Methods

Design and Setting

This qualitative study was conducted in conjunction with other cross-sectional study over eight months, from June 2023 to January 2024. A total of five (four private and one Government) hospitals were approached initially for the study based on their location (National Capital Region), size (>300 beds) and the diverse population (rural and urban) which they catered to. Two private multi-specialty hospitals (Noida and Gurgaon) were conveniently chosen for the study due to their willingness to grant permission and their diverse patient populations, offering broad geographical representation.

Participants

A total of 29 participants were purposively selected based on their firsthand experiences with workplace violence within the past year from the two conveniently selected multi-specialty hospitals and their willingness to share their experiences and consent to audio recording. The inclusion criteria included individuals working full-time for more than one year and who have personally experienced or witnessed any form of WPV in the past year of working in the same organization. The participants who were in severe distress that may be exacerbated by participation and those undergoing legal cases related to WPV that may prevent disclosure were excluded from the study.

Data Gathering

The research employed in-depth face-to-face interviews to explore the experiences of nursing personnel who had encountered workplace violence. The data collection process was facilitated by the primary researcher, who holds a position as a nursing faculty member in a teaching College. She had experience in conducting in-depth interviews. To minimize bias and ensure objectivity, the researcher was not employed by either of the two hospitals involved in the study. The interviews took place in a quiet room within the hospital premises, providing a comfortable and private setting. They were conducted in Hindi or English, depending on the participants’ preference. Each participant engaged in a single, comprehensive, in-depth interview session lasting approximately 40–50 minutes. Before commencing the interviews, participants provided written consent, affirming their willingness to share their experiences. An interview guide, structured to elicit detailed responses, was utilized to pose open-ended questions (Table 1), allowing participants to express themselves freely. The primary researcher employed active listening techniques to encourage participants to share their experiences, emotions, and insights related to workplace violence. To maintain accuracy and comprehensiveness, audio recordings of each interview were made with the participants’ explicit consent. Additionally, detailed field notes were taken during and after each interview to capture contextual nuances and non-verbal cues. Data collection continued until saturation was reached, indicating that no new information or themes were emerging from subsequent interviews. Following each interview session, transcriptions were promptly completed within 24 hours to preserve the fidelity of the data. To uphold confidentiality and protect participants’ privacy, original audio recordings were securely destroyed after transcription. This rigorous approach to data collection adhered to established ethical guidelines and best practices in qualitative research.

Table 1.

Interview Guide Questions.

What do you understand about workplace violence?
Explain your experience of workplace violence in detail.
How do you feel about it?
How has that experience affected you personally or at work?
How do you feel it can be prevented?

Data Analysis

The data analysis process utilised NVivo version 14 software to manage and analyse the qualitative data obtained from the in-depth interviews. A hybrid thematic data analysis approach was employed, incorporating iterative cycles of coding, theme generation, and subtheme identification. Initially, the primary researcher conducted the coding process, systematically organizing the raw data into meaningful categories and themes. Each segment of data was carefully examined, labeled, and categorized based on its relevance to the research objectives and emergent patterns. To ensure the credibility and rigor of the analysis, a second researcher, blinded to the initial coding, independently reviewed the coded data. Any discrepancies or differences in interpretation were resolved through discussion and consensus between the researchers. The themes and subthemes generated from the data were then refined and validated through a process of iterative review and comparison. Commonalities and variations within the data were identified, allowing for a nuanced understanding of the participants’ experiences and perspectives. Throughout the analysis process, adherence to the Consolidated Criteria for Reporting Qualitative Research Checklist was maintained to ensure transparency and methodological rigor in reporting the findings. This systematic approach to data analysis enabled a comprehensive exploration of the research questions and facilitated the generation of meaningful insights from the qualitative data.

Rigor

To evaluate the rigor of the research, key principles, including credibility, dependability, transferability, and confirmability, were rigorously applied.⁷ Credibility was ensured through multiple strategies, including peer debriefing sessions conducted after every four interviews. During these sessions, a second researcher independently reviewed and discussed the interpretations of the data to validate the findings and enhance their trustworthiness. Dependability, or the consistency and stability of the research findings over time, was achieved through detailed documentation of the study methodology and data collection procedures. This transparency allowed for the replication of the study by other researchers, enhancing the dependability of the findings. Transferability, or the extent to which the findings can be applied to other contexts or settings, was addressed by providing detailed descriptions of the study methodology, participant selection criteria, and data collection process. This facilitated the reader’s understanding of the research context and increased the potential applicability of the findings to similar settings. Confirmability, or the objectivity and neutrality of the research findings, was ensured through rigorous data management and analysis procedures. Field notes and transcripts were carefully checked to minimize the influence of personal biases or preconceptions on the interpretation of the data, enhancing the overall trustworthiness and validity of the research findings.

Ethical Considerations

The study adhered to stringent ethical standards to protect the rights and well-being of the participants. Before commencement, the study protocol was meticulously prepared and presented to the relevant hospitals for approval. Written permission letters dated 29/5/23 and 19/6/23 were obtained from the hospitals, affirming their support and cooperation in conducting the research within their premises. Informed consent was obtained from all participants before their inclusion in the study. They were provided with comprehensive information about the research objectives, procedures, potential risks, and benefits and were assured of their right to withdraw from the study at any stage without any repercussions. To safeguard the privacy and confidentiality of the participants, identifying information was excluded from all data collected, and participants were assigned numerical identifiers. This measure ensured that the identities of the participants remained anonymous throughout the study process. Overall, the study upheld the principles of respect, beneficence, and justice, ensuring that the rights and dignity of the participants were protected at all times.

Results

Participant Characteristics

A total of 29 participants were included in the study, ranging in age from 21 to 60 years. Participants were included based on their written consent to allow the primary researcher to explore their experiences. The mean age of the participants was 28.03 years, with a standard deviation of 8.25. The mean duration of working experience among participants was 5.39 years, with a standard deviation of 7.97. The majority of participants were females (62%), while the remaining (38%) were males. Regarding educational qualifications, the majority (68.9%) held a Graduation degree (BSc and Post Basic Nursing), while the remaining (31%) had a Diploma in Nursing. Table 2 summarizes the participant’s characteristics.

Table 2.

Participant Characteristics.

Sample No.	Age	Gender	Exp (Years)	Qualification
1	27	Male	6	BSc (N)
2	25	Male	2	BSc (N)
3	27	Male	1.3	GNM
4	27	Female	3	PBBSc (N)
5	22	Female	2	GNM
6	25	Female	3	PBBSc (N)
7	28	Female	2	PBBSc (N)
8	32	Female	4	GNM
9	28	Female	2	BSc (N)
10	23	Female	2	BSc (N)
11	32	Female	13	PBBSc (N)
12	23	Female	2	GNM
13	25	Female	1.5	BSc (N)
14	23	Female	3.5	BSc (N)
15	25	Male	4	BSc (N)
16	32	Male	6	BSc (N)
17	34	Male	15	GNM
18	25	Female	0.2	BSc (N)
19	23	Female	1	BSc (N)
20	26	Female	5	GNM
21	22	Male	1	BSc (N)
22	28	Male	1	GNM
23	50	Male	25	BSc (N)
24	21	Male	1	GNM
25	60	Female	37	GNM
26	26	Female	4	BSc (N)
27	23	Female	2	BSc (N)
28	25	Male	3	PBBSc (N)
29	26	Female	4	PBBSc (N)
Mean ± SD	28.03 ± 8.25		5.39 ± 7.97

Note: BSc (N), graduate prepared nurse; GNM, general nursing and midwifery nurse (diploma prepared nurse; PBBSc, post basic bachelors of science in nursing (equivalent to BSc (N).

Themes

There are five prominent themes (refer to Table 3) extracted from the data based on the narratives of the nurses who had experienced workplace violence—Verbal Aggression; Safety Concerns; Harassment Experiences; Training Needs; Conflict Resolution and Advocacy.

Table 3.

Data Extract Process.

S. No.	Themes	Sub Themes
1.	Verbal aggression	Impact of verbal conflict on staff and patientEmotional toll of verbal aggressionBuilding resilience against verbal aggressionVerbal intimidation exposure
2	Safety concerns	Physical violence in health care settingsEnhancing safety perceptions through communicationPreparedness and response to physical safety incidentsEvaluating and improving workplace safety policiesBuilding a positive safety cultureImpact of workplace abuse on staff well-being and performancePromoting safety policy adherence through training and communication
3	Harassment experiences	Sexual harassment experiencesSexual misconduct instancesHarassment prevention measuresSexual harassment reporting
4	Training needs	Communication training needGender bias awarenessHarassment awareness training
5	Conflict resolution and advocacy	Nurse advocacy rolesVerbal conflict resolution

Verbal Aggression

The majority of participants reported experiencing verbal aggression from patients or their caretakers. This form of workplace violence aligns with previous findings in the literature, where verbal abuse (83.9%) and verbal threats (27.6%) were identified as the most common forms of violence reported by nurses.⁸

Impact of Verbal Conflict on Staff and Patient: Two participants highlighted the impact of verbal conflict between staff and patients or their relatives. They expressed concern over the negative consequences of such conflicts, emphasizing that it creates a stressful work environment that hinders collaboration between staff and patients or their families. For example, one of the study participants expressed that

Verbal conflicts between staff and patients impact the overall work atmosphere. It creates a stressful environment, affecting the well-being of both nurses and patients. (No. 7)

The other participant felt that verbal aggression in the form of verbal conflict gives rise to an unhealthy, negative workplace culture.

Verbal conflicts not only hinder the workflow but also contribute to a negative workplace culture. Addressing the impact of such conflicts is crucial for maintaining a healthy work environment. (No. 19)

Emotional Toll of Verbal Aggression: Two participants shared their experiences of encountering verbal abuse during their work hours, including night shifts. They described these incidents as common occurrences that made them feel insecure and uncertain about the hospital environment in which they work. As stated below, they expect a safe workplace:

Verbal abuse occurrences from patients or their attendants are not uncommon. It’s a challenge for nurses to deal with such situations while providing quality care. (No. 2)

Verbal abuse incidents, especially during night shifts from the relatives and at times patients, pose a threat to the well-being of nursing staff. Addressing and preventing verbal abuse is essential for a safe workplace. (No. 9)

Building Resilience Against Verbal Aggression: Two participants described their exposure to verbal aggression directed towards them, highlighting its detrimental effects on their physical and mental well-being. They expressed experiencing stress and burnout as a result, which persisted beyond their duty hours. This prolonged impact affected them both during and after their shifts, contributing to their overall distress.

Exposure to verbal aggression is a common experience for nursing staff. It can lead to stress and burnout, highlighting the need for strategies to address and cope with such situations. (No. 17)

Verbal aggression exposure, such as confrontations with patients’ relatives, is a challenging aspect of nursing. Strategies for managing and preventing verbal aggression are crucial. (No. 24)

Verbal Intimidation Exposure: Some participants recounted experiences of verbal intimidation while facing verbal aggression from patients or their relatives. This verbal intimidation instilled feelings of threat and insecurity among the nursing staff. As a consequence, they reported feeling mentally disturbed and exhausted. Two participants highlighted that such intimidation hindered their ability to provide wholehearted nursing care, indicating the profound impact of verbal aggression on their professional responsibilities and well-being.

Nursing staff often face verbal intimidation, creating a hostile work environment. It’s vital to address and prevent such exposure to ensure the well-being of the healthcare team. (No. 5)

Verbal intimidation exposure from patients or their families can impact the mental health of nursing staff. Strategies for handling and mitigating intimidation are necessary. (No. 13)

Safety Concerns

The second major theme that emerged from the narratives of nursing staff was safety concerns stemming from incidents of workplace violence.

Physical Violence in Health Care Settings: Two participants highlighted the grave concern of physical violence as a significant threat to nursing staff safety. They recounted instances where verbal aggression escalated into physical violence, including acts such as slapping, hitting, or cornering by patients’ relatives. Witnessing such incidents left them feeling ashamed and embarrassed, to the extent that they felt compelled to take leave from work. These experiences not only subjected them to shame and disgrace in front of their colleagues and other patients but also left lasting psychological scars.

Workplace violence incidents, including physical altercations, pose a threat to nursing staff. Understanding the triggers and implementing preventive measures is crucial for creating a safe workplace. I have seen many incidents of physical violence with my coworkers … slapping, hitting, punching does happen. (No. 10)

I have personally experienced a slap from a relative over a conflict of medication which he was supposed to get for the patient. I felt so ashamed that I did not come for duty for a week. I was unable to face myself. Nurses encounter workplace violence incidents, impacting both their physical and mental well-being. Reporting and addressing such incidents are vital for ensuring a violence-free work environment. (No. 21)

Enhancing Safety Perceptions Through Communication: Two participants emphasized the importance of safety perceptions among nursing staff. Feeling safe in their workplace is crucial for nursing personnel as it contributes to their job security and satisfaction. When nurses feel safe, they can perform their duties more effectively and confidently, ultimately improving the quality of patient care.

Nursing staff’s safety perceptions play a significant role in their job satisfaction. Enhancing safety perceptions involves addressing concerns and implementing effective safety measures. (No. 8)

Improving safety perceptions among nurses requires a comprehensive approach, including communication, training, and a proactive safety culture. (No. 18)

Preparedness and Response to Physical Safety Incidents: Two participants highlighted the importance of taking physical safety incidents seriously by hospital management and addressing them promptly. Recognizing and addressing physical safety concerns promptly is essential to ensure the well-being and security of nursing staff within the workplace.

Physical safety incidents, such as confrontations with patients or their attendants, are a reality for nursing staff. Proper training and protocols are essential for preventing and managing such incidents. (No. 25)

Handling physical safety incidents demands quick and effective response strategies. Nursing staff’s preparedness is key to minimizing the impact of such incidents on both staff and patients. (No. 29)

Evaluating and Improving Workplace Safety Policies: Two participants emphasized the need to evaluate the effectiveness of safety policies in hospitals regularly. While guidelines, cameras, and security measures exist, their functionality needs to be assessed periodically. One participant noted that although cameras are installed, the majority are not functional, and security guards are weak, prioritizing their own safety over that of the staff in case of incidents. This underscores the importance of ensuring that safety policies are not only in place but also effectively implemented to protect HCWs. The following are their statements:

Evaluating the effectiveness of safety policies is crucial for enhancing workplace safety. Continuous improvement and feedback mechanisms contribute to the success of safety policies. (No. 7)

The effectiveness of safety policies directly influences the nursing staff’s confidence in their workplace. Regular assessments and adjustments are necessary for maintaining a safe environment. (No. 20)

Building a Positive Safety Culture: Two participants highlighted the importance of cultivating a safety culture in the workplace. They emphasized that working in an environment where safety is prioritized fosters motivation, support, and cooperation among nursing staff. In such an environment, they can fully commit to patient care without fear. They expressed the desire for a working environment characterized by open communication and freedom from fear, where all staff members feel empowered to voice their concerns and ideas. As they express:

Nursing staff’s perception of safety culture influences their overall job satisfaction. Encouraging a positive safety culture involves leadership support, communication, and staff engagement. (No. 12)

Building a robust safety culture requires collective efforts. Staff engagement, training, and open communication contribute to shaping a safety-conscious work environment. (No. 26)

Impact of Workplace Abuse on Staff Wellbeing and Performance: Two participants discussed the profound impact of workplace violence on nursing staff. They emphasized that such incidents can cause long-term and irreversible psychological trauma among staff members, significantly affecting their commitment to patient care and their profession as a whole.

I felt so weak and vulnerable on that day when that patient abused me in front of all other patients and other class IV employees. I was scared and shocked and didn’t know how to react. (No. 16)

I remained disturbed for almost many months after that incident of a family member shouting at me over a medicine payment issue. I was unable to concentrate on my work. Always felt preoccupied and apprehensive of any such incident occurring again. I feel like quitting. Our management must support staff in coping with the trauma. (No. 24)

Promoting Safety Policy Adherence Through Training and Communication: Two participants highlighted the importance of adherence to safety policies for preventing workplace violence. They emphasized that safety policies must be effectively disseminated to all staff members and strictly adhered to in both public and private hospitals.

Ensuring nursing staff’s adherence to safety policies is a key aspect of maintaining a secure workplace. Consistent training, reinforcement, and clear communication contribute to policy compliance. (No. 14)

Adherence to safety policies is foundational for preventing incidents and ensuring staff preparedness. Regular training and awareness programs play a crucial role in promoting policy adherence. (No. 27)

Harassment Experiences

Many study participants shared experiences of sexual misconduct and harassment incidents during episodes of workplace violence. They expressed a lack of support available when reporting these incidents and strongly advocated for specific measures to sensitize all levels of authorities regarding this issue.

Sexual Harassment Experiences: One participant highlighted instances of sexual misconduct involving her colleague and a coworker, expressing concerns about the lack of a proper reporting culture. The narrative underscored the experiences of staff nurses facing harassment and emphasized the need for more effective prevention measures to ensure a safe workplace environment. (No. 13)

Another study participant emphasized the significance of a harassment reporting culture and the necessity for awareness training. He discussed the challenges associated with addressing sexual harassment incidents and underscored the importance of implementing measures to prevent such occurrences through comprehensive awareness programs. (No. 18)

Sexual Misconduct Instances: In an account, the participant shared a specific incident of sexual misconduct within the workplace, providing insight into the real-time experiences of staff nurses. The narrative highlights the urgency of addressing such instances and emphasizes the importance of implementing preventative measures to create a safer work environment. (No. 8)

In another narrative, the participant discussed the prevalence of sexual misconduct, emphasizing the urgent need to address this issue. The nurse recounted specific incidents and stressed the importance of establishing effective reporting mechanisms to deal with sexual misconduct in the workplace. (No. 22)

Harassment Prevention Measures: A participant provided insight into the measures which should be taken to prevent harassment. The narrative outlined specific steps and strategies employed to mitigate the occurrence of harassment, highlighting the proactive approach needed to create a safer workplace. (No. 27)

Another participant underscored the significance of implementing robust prevention measures to combat harassment. The staff nurse emphasized the necessity for comprehensive policies and strategies aimed at preventing and addressing instances of harassment among nursing staff effectively. (No. 10)

Sexual Harassment Reporting: One participant shed light on the challenges and experiences associated with reporting incidents of sexual harassment. The nurse shared perspectives on the obstacles encountered by staff nurses when attempting to report such incidents, underscoring the necessity for a more streamlined and supportive reporting system. (No. 2)

Another participant explored the reporting dynamics of sexual harassment. The discussion revealed the complexities associated with reporting, emphasizing the importance of creating an environment that encourages and facilitates the reporting of such incidents. (No. 20)

Training Needs

In this theme, participants discussed the training needs of nursing staff related to the prevention of workplace violence. They emphasized the importance of providing comprehensive training to all HCWs to effectively prevent workplace violence.

Communication Training Need: One Participant highlighted the necessity for communication training among nursing staff. The participant discussed challenges in effective communication and emphasized the need for targeted training programs to enhance communication skills, facilitating better interactions among colleagues and reducing conflicts. (No. 4)

The other participant expressed the need for training to address communication challenges. The nurse shared experiences related to communication barriers and advocated for training initiatives to equip staff nurses with the necessary skills for improved workplace communication. (No. 14)

Gender Bias Awareness: One of the participants highlighted the issue of gender bias awareness among staff nurses, noting that female nurses experience more violence compared to their male counterparts. The participant attributed this discrepancy to cultural values and beliefs that perceive females as weaker and more vulnerable. As a result, female nurses often feel scared and avoid confronting violent situations, whereas male nurses tend to engage, sometimes exacerbating the conflict. The participant shared specific instances of gender bias in the workplace, underscoring the importance of raising awareness to address such biases and cultivate a more equitable work environment. (No. 9)

One of them discussed the need for heightened awareness regarding gender bias. The nurse highlighted situations where gender bias affected workplace dynamics and advocated for initiatives to increase awareness, promoting gender equity and fair treatment within the nursing profession. (No. 23)

Harassment Awareness Training: One of them stressed the need for harassment awareness training. The participant highlighted incidents where a lack of awareness led to inappropriate behavior. The excerpt emphasized the importance of training programs to raise awareness and prevent harassment, fostering a culture of respect and understanding among staff. (No. 1)

Another participant touched upon the significance of harassment awareness training. The participant shared experiences from the psychiatric ward, underscoring the necessity of training to deal with sensitive situations effectively. This highlighted the role of awareness programs in creating a supportive and informed work environment. (No. 26)

Conflict Resolution and Advocacy

Some participants discussed strategies for conflict resolution and the role of nursing staff in advocating for safer work environments.

Nurse Advocacy Role: One of the study participants emphasized the importance of nurse advocacy roles was discussed. The participant narrated an incident where advocating for a patient’s needs played a crucial role in ensuring appropriate care. This highlighted the advocacy responsibilities that nurses undertake to safeguard patients’ well-being in challenging situations. (No. 7)

The other touched upon nurse advocacy roles, showcasing instances where nurses acted as advocates for patients in bureaucratic processes. The excerpts emphasized the multifaceted role of nurses beyond direct patient care, contributing to the broader healthcare system. (No. 20)

Verbal Conflict Resolution: The participant highlighted the challenge of verbal conflicts among staff nurses. The participant discussed instances where conflicts arose due to delayed processes and stressed the need for effective resolution strategies. This excerpt showcased the significance of addressing verbal conflicts to maintain a healthy work environment. (No. 1)

The other participant said that verbal conflict resolution was discussed in the context of handling agitated patients and relatives. The participant shared experiences of dealing with escalated situations, emphasizing the importance of effective communication and conflict resolution skills in diffusing tensions. (No. 23)

Discussion

The findings of the study underscore the pervasive nature of workplace violence in India, spanning from verbal abuse to physical and sexual assaults. Through in-depth interviews, verbal aggression emerged as the most prevalent form of workplace violence experienced by nursing personnel, predominantly stemming from patients and their relatives.⁷ Furthermore, nurses voiced significant safety concerns and recounted instances of harassment, highlighting the urgent need for comprehensive training to effectively navigate such challenging situations.⁹ Moreover, participants emphasized the importance of hospital administration taking proactive measures to resolve conflicts among patients and their relatives, thereby mitigating potential triggers for workplace violence. Additionally, there was a consensus among participants regarding the necessity for advocacy initiatives aimed at raising awareness about the escalating incidents of workplace violence and implementing preventive measures.

Our findings align with a recent meta-analysis conducted by Zhang et al. which synthesized data from 38 studies involving 63,672 HCWs. The meta-analysis highlighted a concerning prevalence of workplace violence among HCWs, with notable rates of physical violence (9%), verbal violence (48%), and emotional violence (26%). Furthermore, the analysis revealed an escalation of workplace violence, particularly physical and verbal violence, during the mid to late stages of the COVID-19 pandemic.¹⁰ This underscores the heightened vulnerability of HCWs to violence amid a crisis situation.

In our study, verbal violence emerged as the most common form of workplace violence, consistent with findings reported by Cheraghi et al. where 74.1% of nurses experienced workplace violence, with 64% of incidents being verbal abuse. Similarly, Babaei et al. (2014) demonstrated that verbal violence accounted for the majority of violent incidents faced by nurses and hospital staff across various wards, with a prevalence rate of 66.2%. These studies corroborate our findings, emphasizing the pervasive nature of verbal aggression in healthcare settings and the urgent need for targeted interventions to address this issue effectively.¹¹

Our study uncovered a disparity in the frequency of workplace violence incidents, with female staff nurses experiencing a higher prevalence compared to their counterparts. This discrepancy can be attributed to cultural values and beliefs that perceive females as weaker and more vulnerable, predisposing them to a greater risk of violence. The participant narratives also highlighted instances of gender bias within the workplace, underscoring the need for heightened awareness to address such biases and foster a more equitable work environment. Females often exhibit a reluctance to confront violent situations, opting instead to avoid confrontation due to fear and apprehension. In contrast, males tend to actively engage in confronting perpetrators, potentially exacerbating the situation. These findings are consistent with another study, which observed gender-based differences in the types of violent incidents experienced and the corresponding reactions exhibited. Males are more likely to confront perpetrators directly, while females prioritize their safety by seeking escape routes and avoiding direct confrontation.¹² Such gender-based disparities underscore the complex dynamics of workplace violence and emphasize the importance of gender-sensitive interventions to mitigate its impact effectively. So, gender differences are evident in the frequency, type, and handling of incidents of workplace violence among male and female HCWs. Despite these variations, it is crucial to acknowledge that both genders are susceptible to experiencing workplace violence and are at risk of enduring physical and psychological harm as a result.

Workplace violence can have profound and detrimental outcomes, particularly for nurses, leading to a range of psychological and emotional challenges. Research studies have highlighted the significant impact of workplace violence on nurses, including stress, fear, depression, and low self-esteem.¹³ Nurses exposed to violent situations may experience frustration, difficulty in focusing attention, anxiety about potential injuries, and fear of confrontation. Moreover, workplace violence can contribute to a reduced sense of professional success, job dissatisfaction, and feelings of powerlessness in patient care.

Furthermore, studies have underscored the mental and physical health risks associated with workplace violence, posing threats to the professional and social integrity of HCWs.¹⁴ Our study corroborates these findings, demonstrating the serious repercussions of workplace violence on the well-being and professional fulfilment of nursing personnel. As such, it is imperative for healthcare organizations to prioritize the prevention of workplace violence and implement effective interventions to support the mental and physical health of HCWs.

It is noteworthy to mention that not all hospitals approached for this study agreed to participate. Many did not respond to permission requests or telephonic inquiries made by the primary researcher. This lack of response may stem from concerns regarding the absence of a comprehensive workplace violence policy or effective measures in place. Additionally, some nurses approached for participation declined to partake in the study, citing various reasons such as the sensitive nature of the research topic, fear of job loss, and discomfort discussing the issue.

We acknowledge that the non-participation of some hospitals and nurses may introduce certain limitations and potential biases, as their perspectives and experiences could have provided valuable insights to enrich our findings. Nonetheless, we have taken meticulous care to present the data collected from willing participants, ensuring that their experiences are faithfully represented within the scope of the study.

Limitations

The study has a major limitation, which is its focus on only two conveniently selected private hospitals that agreed to participate. This approach may introduce selection bias, as the responses obtained may disproportionately represent the perspectives and experiences of staff nurses employed at private hospitals.

Conclusion

This article underscores the significant implications of workplace violence for HCWs, government authorities, and hospital administrators. Workplace violence remains a pervasive and intolerable reality for nursing staff, as revealed by this qualitative study, which looked into the experiences of those who have encountered such incidents. From the analysis, five prominent themes emerged, with verbal aggression standing out as the most prevalent form of workplace violence, originating from both patients and family members. Concerns regarding safety in the workplace were paramount, with many participants experiencing episodes of harassment. The need for comprehensive training to equip HCWs in handling such situations was emphasized. Additionally, participants stressed the importance of conflict resolution measures and advocacy efforts aimed at protecting HCWs and addressing workplace violence. It is evident that interventions at various levels, including government policies and education initiatives, are imperative to prevent and effectively address the escalating issue of workplace violence.

Footnotes

Acknowledgements

We sincerely thank the Trained Nurses’ Association of India (TNAI) for their support. We also appreciate the anonymous reviewers for their insightful feedback and suggestions.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Ethical Approval

This rigorous approach to data collection adhered to established ethical guidelines.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: TNAI’s National Nurses Research Grant (TNNRG)-2022.

Informed Consent

Informed consent was obtained from all participants before their inclusion in the study.

ORCID iD

Sunita Srivastava

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