The president comments ...

The article "New nurses face endemic violence" in the June Kai Tiaki Nursing New Zealand (p12-14) caused me a great deal of concern. Not because I was shocked at the concept of nurses facing violence but because, aside from being the subject of a TVNZ news item, it has gone surprisingly uncommented on, despite its disturbing contents.

The article claims an astonishingly high level of disrespect, abuse and occasional violence within the health care system from patients and between nurses. The article reported research about new graduate nurses but one could assume that violence affects all nurses and that new graduate nurses experience it more acutely, not having yet normalised the phenomenon. Equally disturbing has been the reaction to my theory about the problem from senior public and nursing officials who seem more comfortable with the idea that badly behaved senior nurses and poorly prepared or supported new graduates nurses are the issue. Indeed even the discussion in the article suggests the solutions lie in a zero tolerance to violence, safer reporting systems and development of appropriate protocols to prevent and address violence.

The authors Brian McKenna, Suzette Poole, Naumai Smith and John Coverdale outline educational strategies to address the problem, eg risk assessment and clinical supervision. While these are of course sensible and important measures, it strikes me that what is missing in the debate is the identification of some major contributors to violence in the workplace.

The results from Linda Aiken's five-country survey point to increasing workloads and failure of organisational supports as major contributors to nurses' distress, dissatisfaction, and intention to leave. (1) Thus the cycle of abuse continues. Nurses are human and dissatisfaction inevitably affects patient care and collegial relations. I will call the phenomenon "chronic stress" and those who work in health know the symptoms.

The first thing people feet like letting go when experiencing chronic stress is their social skills. This creates an impossible situation for nurses, who are the archetypal servants and caring face of a dehumanised pubic health system. Add to the mix the patients' perspective. A feature of our health system is the waiting game: waiting lists, waiting rooms, and then waiting at the end of a bell for a nurse to return. Such waiting leads to frustration, particularly if coupled with anxiety, pain and altered consciousness. Frustration leads to complaints, boils over to abuse and sadly ends in occasional violence. The solutions? Well I hate to sound like a broken record but it seems to me that patients who have been kept waiting and chronically stressed nurses experience similar symptoms to the familiar problems of overcrowding and understaffing. Emergency departments and acute inpatient mental health units are hot spots for such phenomena. The onus is not just on education to deal with these issues. Professional and industrial leaders, politicians and health providers must all adopt a greater sense of urgency in addressing the root causes.

Reference

(1) Aitken, L.H., Clarke, S.P. et al. (2001) Nurses' reports on hospital care in five countries. Health Affairs; 33:3.