Workplace aggression, including bullying in nursing and midwifery: A descriptive survey (the SWAB study)
Section snippets
Background
The popular conception of nursing or midwifery work is of rewarding experiences and a fulfilling career. And for many this is true. However, a significant number of nurses and midwives have profoundly negative experiences because of workplace aggression (WA) – from patients or their visitors or bullying by colleagues. In a 1995/96 report, Australian registered nurses recorded the second highest number of violent-related workers’ compensation claims, higher than prison and police officers (
Causes of WA
There is a burgeoning literature on the causes of WA, which coalesces around three main types of explanations – ‘internal’ and ‘external’ factors and their ‘interaction’. For instance, ‘internal’ influences relate to properties affecting the patient, such as their personality or the effects of their illness; whereas ‘external’ influences focus on the environment, such as noisy environments or staff shortages. The ‘interactional’ approach acknowledges the interplay of ‘internal’ and ‘external’
Study design
A descriptive study design was chosen. In anticipation of this study, the Nurses Board of Victoria (NBV) included in their 2009 round of annual registration for nurses and midwives the option to indicate if they agreed to be sent invitations to participate in research, which had NBV approval. In 2010, the NBV distributed the questionnaire on behalf of the research team to a random selection (N = 5000) of those who had agreed to receive such invitations. Reply paid envelopes were used to return
Survey response rate
Five thousand questionnaires were posted, with 1513 returned. Two had returned to sender and 16 were blank or mostly incomplete, resulting in 1495 usable questionnaires, representing a response rate of 30%.
Characteristics of respondents
Representativeness of the study sample was assessed by comparing it with labour force data (which had a response rate of 33%) on registered nurses and midwives, and enrolled nurses (second-tier nurses in the Australian health care system) in Victoria (AIHW, 2010), using Index of Dissimilarity
Study limitations
Although the respondents were largely representative of the total population of nurses/midwives in Victoria, we cannot be certain that they hold similar views to those who did not participate in the study. Accordingly, caution should be exercised in generalising findings to the wider population of nurses and midwives in Victoria. Also, there are major problems in comparing studies on WA due to differences in respect to definition of concepts, data collecting methods and sampling, making direct
Conclusion
This is the first large-scale study to draw on the Victorian Department of Human Service's definition of WA in estimating its prevalence among Victorian nurses and midwives. The prevalence of patient-initiated aggression and bullying among staff are clearly documented, which is in line with national (and international) trends. The data presented here suggest that staff are less worried by patient-initiated aggression compared to bullying from colleagues. Clearly, respondents wanted better
Acknowledgements
The researchers are grateful to: Nigel Fidgeon, CEO, Nurses Board of Victoria, for his support of this project, including the in kind assistance he gave in respect to drawing a random sample of potential participants from the Victorian register, and for providing staff to assist with posting the survey; the ANF (Victoria branch) for financial help, and in kind assistance in the production of the questionnaire; Nicholas Gaynor, Nurse Practitioner, Mental Health, Austin Health; for the many
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