Internal workplace violence from colleagues is more strongly associated with poor health outcomes in nurses than violence from patients and families.

Abstract

To examine the associations between different workplace violence sources and health outcome in nurses. Workplace violence is a major threat to nurses' physical and mental health. Other workers in the health sector, patients and visitors can cause workplace violence. To effectively prevent workplace violence-related health problems, the differential impact of internal and external violence needs to be explored. A cross-sectional survey of 1,690 fully employed female nurses. A self-administered questionnaire was used to record the nurses' experiences of workplace violence, including types (physical, psychological, verbal and sexual) and sources (internal and external) of violence. Data on psychosocial work conditions including work shift, psychological job demands, job control and workplace justice, were also collected. The nurses' health condition was measured using the 5-item Brief Symptom Rating Scale and Self-Rated Health Scale and multivariable logistic regression was used to examine the associations between workplace violence and health. The study was carried out in 2015-2016. Sixty percent of the internal workplace violence was psychological and verbal and adverse psychosocial work conditions were associated with workplace violence. After adjustment for demographic characteristics and psychosocial work conditions, internal workplace violence resulted in higher risks of poor self-rated health and mental health than did external workplace violence, particularly in nurses who had experienced psychological and verbal violence. Internal workplace violence in the form of psychological and verbal violence had a stronger effect on nurses' health than did external workplace violence. Organization-level measures should be implemented to prevent internal violence.