ANA Healthy Nurse, Healthy Nation® Blog: Speaking Up - Not Staying Silent About Workplace Violence
Published
Two experts tackle a critical topic
Nurses are often drawn to nursing because they want to help and care for others. But the caring and supportive work environment they envision may not always be reality. Workplace violence in the form of patient/visitor aggression and nurse-to-nurse incivility is a common and urgent issue.
Consider these facts:
“Nurses aren’t prepared when faced with hostility and incivility in the workplace,” says #healthynurse JoEllen “Ellen” Schimmels, PhD, DNP, PMHNP-BC, ANP-BC, CNE, FAAN, program director for the psychiatric mental health nurse practitioner program at Emory University. “It can come from patients, visitors, colleagues, or leadership.”
Many nurses don’t speak about the extent of the hostility they experience. There’s a fear of repercussions, confusion about reporting procedures, or too little time to handle it during their shift. But when they don’t speak up, it’s impossible to determine the scope of the problem or devise strategies to reduce the incidence and impact.
“This topic is difficult to discuss because nurses have ethical responsibilities to report unsafe situations, so highlighting nurses silence can be critical of the nursing profession,” says #healthynurse Emily Hauenstein, PhD, LCP, MSN, RN, FAAN, who is a research professor and professor emerita at the University of Virginia School of Nursing. “But if we want to improve the work environment for nurses, talking about silencing of nurses is critical.”
Why Nurses Don’t Always Speak Up
Nurse silencing and workplace violence are closely related. When acts of violence, aggression, or bullying are a normal part of the work environment, Dr. Hauenstein says it can be challenging for nurses to fulfill their professional obligation to speak up. This is true even if their silence may affect their own safety or the safety of a patient.
Most incidents of nurse silencing fall within the context of one of these circumstances:
Acquiescence (willingness to accept or allow what others demand)
Nurses who feel disengaged or burned out may be resigned to aggressive conditions, believing nothing they say or do will make a difference. They may also fail to take action if they feel undervalued as a nurse or they don’t think the situation is worth it.
Self-protection
Remaining silent serves as social preservation for many nurses. They use it to keep themselves and others socially safe.
“There’s a fear that if you speak up, you may be ostracized or create an enemy,” Dr. Schimmels says. “Those fears are valid, especially if someone else speaks up and is outcast by their colleagues.”
Prosocial
Nurses may feel comfortable speaking up about conditions on the unit or talking about an assault they experienced. But an unclear reporting protocol or lack of follow-through by leadership may deter them.
“Not having a clear path for reporting an incident can be a significant barrier for nurses who are otherwise willing to speak up,” Dr. Hauenstein says.
Interventions to Address Nurse Silencing
Dr. Hauenstein and Dr. Schimmels agree that health care leaders and institutions who take action to understand why nurses are not speaking up have the best chance of changing the situation. However, intervention is necessary across 3 general levels of the nursing profession:
Nursing schools
The environment of incivility and the expectation of silence begins in nursing school.
“Nursing students are more likely to speak up early on in their program,” Dr. Hauenstein says. “As their programs continue, they are less likely to speak up, and their fear of it increases. By the time they get to their first unit, they may be conditioned to keep it to themselves.”
Even for nurses who are empowered to speak up, reporting incidents of aggression, nursing error, or bullying can be complicated. Nursing school does not routinely prepare them in the conflict management and resolution skills necessary to defuse situations that are often emotionally fraught.
“Reporting aggressive incidents requires an understanding of the complexity of these situations and how to illustrate the problem in a way that addresses the concerns and feelings of all involved,” Dr. Hauenstein says. “These are not skills they necessarily learn.”
Institutions and health care settings
Health care institutions can take several actions to decrease the rate of nurse silencing, including:
“Stress first aid (SFA) is a preventive, peer-driven model worth exploring,” Dr. Schimmels says. “The goal is a psychologically safe environment where nurses are empowered to speak without retribution.”
Regional and national organizations
High-level organizations are working to create safe work environments that promote regulation, collaboration, and well-being. Strategies have been outlined by:
Nursing unions have also made a difference by advocating for laws that require institutions to outline procedures for managing and reducing workplace violence. Most states now have such laws in place. Unions can also require institutions to provide support for nurses who experience workplace violence.
“Some unions have gone so far as to guarantee safety as part of their contract with health care workers, including nurses,” Dr. Schimmels says. “This hasn’t been done in the past.”
How to Find Your Voice as a Nurse
Nurse silencing is often the result of gendered structural violence and an environment of incivility, Dr. Schimmels says. These things — combined with insufficient or absent protocols for preventing, managing, and reporting workplace violence — exacerbate the problem. Nurses may even believe that they don’t deserve anything better or that violence is part of the job.
If you find yourself silenced, Dr. Hauenstein and Dr. Schimmels suggest these actions to strengthen your ability to use your voice:
“The more we talk about nurse silencing and what is happening, the less difficult it will become,” Dr. Hauenstein says, “and the more likely we’ll be able to do something about it.”
Have you ever spoken up about violence, aggression, or bullying at work? Share with us in our discussion below.
Not a member of Healthy Nurse, Healthy Nation (HNHN) yet? Join today!
Sign up for our monthly challenges!
Consider these facts:
- On average, hospital staff members experience at least 1 verbally or physically aggressive event every 40 hours they work.
- Nearly 50% of nurses report an increase in workplace violence on their unit, and more than 80% have experienced workplace violence in the past year.
- Workplace bullying affects at least 25% of the nursing population.
“Nurses aren’t prepared when faced with hostility and incivility in the workplace,” says #healthynurse JoEllen “Ellen” Schimmels, PhD, DNP, PMHNP-BC, ANP-BC, CNE, FAAN, program director for the psychiatric mental health nurse practitioner program at Emory University. “It can come from patients, visitors, colleagues, or leadership.”
Many nurses don’t speak about the extent of the hostility they experience. There’s a fear of repercussions, confusion about reporting procedures, or too little time to handle it during their shift. But when they don’t speak up, it’s impossible to determine the scope of the problem or devise strategies to reduce the incidence and impact.
“This topic is difficult to discuss because nurses have ethical responsibilities to report unsafe situations, so highlighting nurses silence can be critical of the nursing profession,” says #healthynurse Emily Hauenstein, PhD, LCP, MSN, RN, FAAN, who is a research professor and professor emerita at the University of Virginia School of Nursing. “But if we want to improve the work environment for nurses, talking about silencing of nurses is critical.”
Why Nurses Don’t Always Speak Up
Nurse silencing and workplace violence are closely related. When acts of violence, aggression, or bullying are a normal part of the work environment, Dr. Hauenstein says it can be challenging for nurses to fulfill their professional obligation to speak up. This is true even if their silence may affect their own safety or the safety of a patient.
Most incidents of nurse silencing fall within the context of one of these circumstances:
Acquiescence (willingness to accept or allow what others demand)
Nurses who feel disengaged or burned out may be resigned to aggressive conditions, believing nothing they say or do will make a difference. They may also fail to take action if they feel undervalued as a nurse or they don’t think the situation is worth it.
Self-protection
Remaining silent serves as social preservation for many nurses. They use it to keep themselves and others socially safe.
“There’s a fear that if you speak up, you may be ostracized or create an enemy,” Dr. Schimmels says. “Those fears are valid, especially if someone else speaks up and is outcast by their colleagues.”
Prosocial
Nurses may feel comfortable speaking up about conditions on the unit or talking about an assault they experienced. But an unclear reporting protocol or lack of follow-through by leadership may deter them.
“Not having a clear path for reporting an incident can be a significant barrier for nurses who are otherwise willing to speak up,” Dr. Hauenstein says.
Interventions to Address Nurse Silencing
Dr. Hauenstein and Dr. Schimmels agree that health care leaders and institutions who take action to understand why nurses are not speaking up have the best chance of changing the situation. However, intervention is necessary across 3 general levels of the nursing profession:
Nursing schools
The environment of incivility and the expectation of silence begins in nursing school.
“Nursing students are more likely to speak up early on in their program,” Dr. Hauenstein says. “As their programs continue, they are less likely to speak up, and their fear of it increases. By the time they get to their first unit, they may be conditioned to keep it to themselves.”
Even for nurses who are empowered to speak up, reporting incidents of aggression, nursing error, or bullying can be complicated. Nursing school does not routinely prepare them in the conflict management and resolution skills necessary to defuse situations that are often emotionally fraught.
“Reporting aggressive incidents requires an understanding of the complexity of these situations and how to illustrate the problem in a way that addresses the concerns and feelings of all involved,” Dr. Hauenstein says. “These are not skills they necessarily learn.”
Institutions and health care settings
Health care institutions can take several actions to decrease the rate of nurse silencing, including:
- Creating a space for open dialogue and decompression
- Defining and announcing a protocol for reporting incidents
- Encouraging peer support
- Outlining clear consequences for bullying and incivility
“Stress first aid (SFA) is a preventive, peer-driven model worth exploring,” Dr. Schimmels says. “The goal is a psychologically safe environment where nurses are empowered to speak without retribution.”
Regional and national organizations
High-level organizations are working to create safe work environments that promote regulation, collaboration, and well-being. Strategies have been outlined by:
- ANA Nursing Staff Task Force Recommendations (2023)
- National Academy of Medicine Workforce Well-Being (2022)
- Partners for Nurse Staffing Think Tank (2022)
- Surgeon General Report (2022)
Nursing unions have also made a difference by advocating for laws that require institutions to outline procedures for managing and reducing workplace violence. Most states now have such laws in place. Unions can also require institutions to provide support for nurses who experience workplace violence.
“Some unions have gone so far as to guarantee safety as part of their contract with health care workers, including nurses,” Dr. Schimmels says. “This hasn’t been done in the past.”
How to Find Your Voice as a Nurse
Nurse silencing is often the result of gendered structural violence and an environment of incivility, Dr. Schimmels says. These things — combined with insufficient or absent protocols for preventing, managing, and reporting workplace violence — exacerbate the problem. Nurses may even believe that they don’t deserve anything better or that violence is part of the job.
If you find yourself silenced, Dr. Hauenstein and Dr. Schimmels suggest these actions to strengthen your ability to use your voice:
- Engage in self-care: Stress management, self-compassion, and stress reduction activities like yoga, meditation, or tai chi can help restore a sense of control.
- Increase your self-awareness: Reflect and identify what’s preventing you from speaking out. Show yourself grace by recognizing that cultural and organizational factors make it difficult to speak up. And know your options for reporting aggression or incivility, should you need to act.
- Connect with a supportive person or group: Having a safe space for conversations and emotional processing can be empowering. If you can’t connect to anyone at your workplace, look to national or regional organizations. They may offer a supportive community of health care workers.
“The more we talk about nurse silencing and what is happening, the less difficult it will become,” Dr. Hauenstein says, “and the more likely we’ll be able to do something about it.”
Have you ever spoken up about violence, aggression, or bullying at work? Share with us in our discussion below.
Not a member of Healthy Nurse, Healthy Nation (HNHN) yet? Join today!
Sign up for our monthly challenges!
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02/04/2025 8:43am CST
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