Rules of engagement: The role of mistreatment from patients in the nurse, physician and advanced practice provider experience

Meese, Katherine A.; Colón-López, Alejandra; Montgomery, Aoyjai P; Boitet, Laurence M.; Rogers, David A.; Patrician, Patricia A.

doi:10.35680/2372-0247.1719

Cited by 5 publications

(10 citation statements)

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“…Organizations may not have as much control over patient behaviors, but they can set expectations of behavior for employees. In concert with our prior research (Meese et al, 2022), clinicians who experience stress from patient mistreatment also have lower perceived organizational support, which predicts several important outcomes including turnover and engagement.…”

Section: Discussionsupporting

confidence: 72%

“…The availability of necessary supplies and equipment was the top organizational predictor of stress from violence and mistreatment. Besides the long wait times, staffing shortages, and policy changes associated with WPV and mistreatment in the literature (Li et al, 2019;Meese et al, 2022;Zhao et al, 2018), our study highlights the importance of ensuring that clinicians have the tools they need to deliver high-quality care to patients and that they feel safe to do so. Those who reported increased stress from violence or mistreatment from patients or visitors were also more likely to feel that their pay was inadequate.…”

Section: Organization-level Factors Associated With Increased Stress ...mentioning

confidence: 86%

“…However, another survey of nurses found that the two largest causes of verbal and physical assault were frustration with hospital guidelines and staffing (Chapin & Koller, 2022). The location also plays an important role in reports of mistreatment and WPV: Nurses who work in emergency rooms (ERs) are significantly more likely to experience mistreatment from patients relative to other work locations (Meese et al, 2022). As a result, mistreatment of nurses has led to major nursing shortages in more than 57 countries (Vagharseyyedin, 2016).…”

Section: Introductionmentioning

confidence: 99%

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Exploring National Trends and Organizational Predictors of Violence and Mistreatment From Patients and Visitors

Meese,

Boitet,

Schmidt

et al. 2023

Journal of Healthcare Management

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SUMMARY Goal: Rising incidents of violence and mistreatment of healthcare workers by patients and visitors have been reported. U.S. healthcare workers are five times more likely to experience nonfatal workplace violence (WPV) than workers in any other profession. However, less is known about the national trends in the incidence of violence and mistreatment in healthcare. The specific organizational and individual-level factors that relate to stress arising from these occurrences specifically by patients and family members are also not fully understood. The goals of this study were to examine national trends of violence toward healthcare workers, understand which populations are most vulnerable to stress from violence and mistreatment, and explore organizational factors that are related to these occurrences. Methods: Data were collected from three sources: (1) The Bureau of Labor Statistics Intentional Injury by Another Person data for the period 2011–2020, (2) data from a large national workers' compensation claim services provider for the period 2018–2022, and (3) results from a survey distributed at a large medical center in June and July 2022. Data were represented graphically and analyzed using multivariate regression and dominance analysis to identify specific predictors of WPV and mistreatment among healthcare workers. Principal Findings: Of the total surveyed sample, 23.7% of participants reported mistreatment from patients or visitors as a major stressor and 14.6% reported WPV from patients or visitors as a major stressor. Stress from mistreatment and WPV was most frequently reported by nurses, employees aged 18 to 24 years other than nurses, those who identified as White, and those who identified as female or a gender minority. The emergency room (ER) showed the highest percentages of stress from mistreatment (61.8%) and violence (55.9%) from patients or visitors. The top predictors of stress from WPV and mistreatment by patients or visitors among healthcare workers ranked high to low were working in the ER, working as a nurse, a lack of necessary supplies or equipment, patient or visitor attitudes or beliefs about COVID-19, and working in a hospital-based unit. Practical Applications: In addition to protecting employees as a moral imperative, preventing WPV is critical for organizational performance. Employee productivity is estimated to decrease up to 50% in the 6 to 18 weeks following an incident of violence, while turnover can increase 30% to 40%. An effective WPV prevention plan and a proactive approach to supporting the physical and mental health conditions that may result from WPV can mitigate the potential costs and exposures from these incidents. Organizations must also set clear expectations of behavior with patients and visitors by refusing to tolerate violence and mistreatment of caregivers. The impact of WPV can remain present and active for up to 8 years following an incident. Policy-level interventions are also needed. Currently, there are no federal protections for healthcare workers related to violence, though some states have made it a felony to abuse healthcare workers.

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Section: Discussionsupporting

confidence: 72%

Section: Organization-level Factors Associated With Increased Stress ...mentioning

confidence: 86%

Section: Introductionmentioning

confidence: 99%

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Exploring National Trends and Organizational Predictors of Violence and Mistreatment From Patients and Visitors

Meese,

Boitet,

Schmidt

et al. 2023

Journal of Healthcare Management

Self Cite

View full text Add to dashboard Cite

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“…Discrimination at work was significantly associated with PTSS in both clinical and nonclinical populations, and feeling mistreated by other employees at work was also among the top predictors of PTSS in clinical workers. While much of this discrimination at work may arise from perceived or actual discrepancies in the treatment of employees, allocation of resources, and benefits, there may also be instances of discrimination arising from HCW and patient interactions, including microaggressions, overt aggressions, and violence (Meese et al, 2022). While the origins are different, discrimination and mistreatment have the potential to cause enduring harm, as evidenced by the findings in this survey.…”

Section: Discussionmentioning

confidence: 99%

“…Participants identified work-related and nonwork-related stressors using a list that had been developed in collaboration with more than 25 clinical and nonclinical leaders (Meese et al, 2022). This list included discrimination at work, heavy workload, financial strain, social isolation, patient death, and violent behavior from patients.…”

Section: Independent Variablesmentioning

confidence: 99%

Burnout, Moral Distress, and Compassion Fatigue as Correlates of Posttraumatic Stress Symptoms in Clinical and Nonclinical Healthcare Workers

Boitet,

Meese,

Hays

et al. 2023

Journal of Healthcare Management

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Goal: Research has highlighted psychological distress resulting from the COVID-19 pandemic on healthcare workers (HCWs), including the development of posttraumatic stress symptoms (PTSS). However, the degree to which these conditions have endured beyond the pandemic and the extent to which they affect the entire healthcare team, including both clinical and nonclinical workers, remain unknown. This study aims to identify correlates of PTSS in the entire healthcare workforce with the goal of providing evidence to support the development of trauma-informed leadership strategies. Methods: Data were collected from June to July 2022 using a cross-sectional anonymous survey in a large academic medical center setting. A total of 6,466 clinical and nonclinical employees completed the survey (27.3% response rate). Cases with at least one missing variable were omitted, for a total sample size of 4,806, the evaluation of which enabled us to understand individual, organizational, and work-related and nonwork-related stressors associated with PTSS. Data were analyzed using ordinal logistic regression and dominance analyses to identify predictors of PTSS specific to clinical and nonclinical workers. Principal Findings: While previous studies have shown that HCWs in different job roles experience unique stressors, our data indicate that the top correlates of PTSS among both clinical and nonclinical HCWs are the same: burnout, moral distress, and compassion fatigue. These three factors alone explained 45% and 44.4% of the variance in PTSS in clinical and nonclinical workers, respectively. PTSS was also associated with a lower sense of recognition and feeling mistreated by other employees at work in the clinical workforce. Concerningly, women and sexual minorities in the clinical sample exhibited a higher incidence of PTSS. In nonclinical workers, social isolation or loneliness and lower trust and confidence in senior leadership were associated with PTSS. Nonwork-related factors, such as exhaustion from caregiving responsibilities and financial strain, were also significantly associated with PTSS. Even after controlling for discrimination at and outside of work in both samples, we found that non-White populations were more likely to experience PTSS, highlighting a deeply concerning issue in the healthcare workforce. Practical Applications: The primary objective of this article is to help healthcare leaders understand the correlates of PTSS across the entire healthcare team as organizations recover from the COVID-19 pandemic. Understanding which factors are associated with PTSS will help healthcare leaders develop best practices that aim to reduce HCW distress and strategies to circumvent trauma derived from future crises. Our data indicate that leaders must address the correlates of PTSS in the workforce, focusing attention on both those who work on the frontlines and those who work behind the scenes. We urge leaders to adopt a trauma-informed leadership approach to ensure that the entire healthcare workforce is recognized, supported, and cared for as each HCW plays a unique role in the care of patients.

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Considerations of communication challenges facing sonographers in Australia beyond 2024: An ageing population, ageism and maintaining the focus on patient‐centred care

White,

Humphreys,

Oomens

2024

Sonography

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In the coming decades, the number of people in the Australian population over the age of 65 is predicted to increase to 23% by the year 2066. The process of physiological ageing is associated with an increase in the presentation of disease pathologies, an increased potential for physical and cognitive deficits and a decrease in health literacy. The ageing of the Australian population presents challenges for the sonography profession including an increasing age gap between the sonographer and their patient as well as increasing complexities in performing ultrasounds on older patients. The natural changes that accompany ageing can create barriers to effective communication between sonographers and their patients. Ageist beliefs can lead to conscious and unconscious bias and unfounded judgements by sonographers decreasing the quality of patient care. To combat the decline in the quality of healthcare that is reported for older patients, sonographers can endeavour to put into place deliberate practical tools and strategies to avoid ageism and improve communication with older patients. Conversely, institutional awareness, education and policies that address age related judgements and bias from older patients towards younger sonographers can foster respectful dialogue, promote understanding and stimulate positive communication across different age groups.

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Rules of engagement: The role of mistreatment from patients in the nurse, physician and advanced practice provider experience

Cited by 5 publications

References 0 publications

Exploring National Trends and Organizational Predictors of Violence and Mistreatment From Patients and Visitors

Exploring National Trends and Organizational Predictors of Violence and Mistreatment From Patients and Visitors

Burnout, Moral Distress, and Compassion Fatigue as Correlates of Posttraumatic Stress Symptoms in Clinical and Nonclinical Healthcare Workers

Considerations of communication challenges facing sonographers in Australia beyond 2024: An ageing population, ageism and maintaining the focus on patient‐centred care

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