The way we do things around here. A qualitative study of the workplace aggression experiences of Victorian nurses, midwives and care personnel

Background
Workplace aggression in the health and care sectors is a major work health and safety and public health concern, worldwide. In Australia, rates of exposure to workplace aggression are consistent with those experienced by nurses internationally, and have not decreased over the past 35 years.

Objectives
To explore the experiences and perspectives of nurses, midwives and care personnel relating to experiences of verbal or written and physical aggression from external sources (patients, patients’ relatives or carers and others external to the workplace) and internal sources (co-workers).

Design
A pragmatic, descriptive, qualitative study, integrating themes emerging from online survey comments and follow-up, in depth interviews.

Settings
Health and aged care services in the Australian State of Victoria.

Participants
Nurses, midwives and care personnel who were members of the Australian Nursing and Midwifery Federation – Victorian Branch in May and June 2017.

Method
Thematic analysis was undertaken on the combined comments provided in up to seven free-form text fields of an online survey questionnaire and the content of follow-up interviews of selected survey participants.

Results
From the online survey data, comments from 623 participants were able to be included in analyses. Of the 293 respondents initially indicating a willingness to be contacted by researchers, a sample of 29 participated in in-depth interviews. Eight thematic categories emerged from the data, relating to patient aggression, contextual categories (three sub-categories – care of older people, mental health care and emergency department settings), co-worker aggression (two sub-categories – aggression from managers/supervisors, aggression from colleagues/peers), reporting behaviours, trade union involvement, security personnel and police involvement, legal action and the impacts of workplace aggression.

Conclusions
Over the past 35 years, little progress has been made in mitigating the likelihood and consequences of this serious work health and safety, and public health issue. There appears to be have been a sustained failure to implement co-ordinated, multi-sectorial, system-wide and targeted interventions to reduce what seem to be growing levels of harmful exposure to incivility and aggression in care settings in Victoria. There is an urgent need to strengthen and enforce existing legislation, introduce new laws and develop more effective systems and practices to adequately protect the health and safety of nurses, midwives and other care personnel in their daily work. Stronger evidence for system and service level interventions to prevent and minimise workplace aggression in care settings is also required.