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The ANA noted in their #EndNurseAbuse: Take The Pledge stance that nurses are more likely to encounter violence when compared to police officers and correctional officers.

According to the 2018 Critical Care Nurse Work Environment Study by the AACN, 73% of the 8,080 respondents said they had received verbal abuse from patients, 64% said it came from patients' families, and 20% said it came from other sources.

Violent behavior leads to an unhealthy work environment and causes distress to the workers. The most common type of distress that workers experience is depression and anxiety. Incivility is a taboo topic in healthcare, but speaking more about it will help bring more awareness.

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What is the nurse doing or not doing related to the issue?
- Since nurses are not consistently reporting the incivility, it is not correctly documented, and the Unit Coordinators or Nurse Managers will not know about the incidents. This causes a problem because if each act of incivility is not reported, this problem cannot be adequately resolved.
- Nurses may also be reluctant to report incivility because the reporting process is unclear. For example, they may not know who to escalate the situation to, what forms they need to fill out, and what the process looks like moving forward for themselves or their patients.

Explain how this is improving or exacerbating the problem.
- Due to nurses not reporting these acts of incivility, reoffenders are returning to the hospitals and becoming perpetrators to whoever is next in charge of their care.
- These actions cause the problem to become exacerbated, which can lead to more incivil encounters across the units.
- If incivility was reported and escalated each time, fewer incidents would occur. So it is imperative to report any acts of violent behavior.

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How would the nurse be able to help?
- Nurses collectively as a team can seek solutions by investigating and analyzing occurrences of abuse in the same manner as medication errors.
- Nurses can contribute to fostering a healthy working environment by using skilled communication, developing strategies and skills, and sharing their best practices to help reduce the risks of incivility.
- Nurses can also implement zero-tolerance policies and procedures for all abusive behaviors, no matter what circumstance (AACN Position Statement: Zero Tolerance for Bullying, Incivility, and Verbal Abuse - AACN, 2019).
- Nurses can actively participate in education and training programs that teach them proper responses to incidents of violence or aggression (Compliance 360, n.d.).

How will the nurse's involvement help resolve or improve the issue?
- If nurses adhere to the above duties, this can significantly reduce the amount of WPV because previous offenders will be deemed abusive in their charts and potentially unable to visit that same hospital or unit.
- This will not resolve the issue but will improve the issue and hopefully decrease the likelihood of a perpetrator offending again because proper consequences were put in place.

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What are the barriers for nursing involvement?
- The type of perpetrator, the initial incident response, the incident reporting process, and organizational action are all barriers to follow-up (Thomas et al., 2021).
- There is a high frequency of violent events that have led to staff members failing to report all incidents, which prevented any follow-up on violent incidents (Thomas et al., 2021).
- There was a lack of feedback from police officers from previous reports, which caused staff members to become discouraged with future reporting (Thomas et al., 2021).

If the participation is limited, explain why:
- Participation has been limited due to the type of perpetrators, described as complex patients with challenging mental health and behavioral issues, including reoffenders (Thomas et al., 2021).
- A research study found that while reporting, their experience with the police limited their reporting abilities. It was said that police officers had prevented some individuals from reporting a violent act. The police officers reasoned that no action would be taken against the perpetrator if the individual did report the incident (Thomas et al., 2021).

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Sentara Health Care Workplace Violence Prevention Plan

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Sentara Health Care Workplace Violence Prevention Plan

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What is the problem?
- Incivility and bullying in the Healthcare profession. The ANA (2017) states violence, bullying, and incivility in the workplace are severe problems in nursing, with bullying and incivility being pervasive in all environments. Such aggressive behaviors, whether verbal or physical, are never acceptable, whether they come from patients or coworkers. These incidents negatively impact the nurse's well-being and capacity to provide patient care (Violence, Incivility, & Bullying | American Nurses Association, 2017).

Who is Affected?
- Incivility and bullying can affect any healthcare professional team member. For example, the ANA (n.d.) found that 1 in 4 nurses have been a victim to assault at work (American Nurses Association, n.d.).

How?
- Sexual harassment, verbal and nonverbal abuse, and passive aggression are all examples of uncivil behavior (Shoorideh et al., 2021). Moreover, these factors can act as stressors and result in physical ailments like depression (Shoorideh et al., 2021).

Where?
- Research revealed that while the majority of primary studies on nurses in different wards had been conducted in general hospitals, the prevalence of incivility and violence was higher there (Shoorideh et al., 2021).

When?
- Although it has always existed, incivility seems to be a growing and worsening issue for organizations (Harris, n.d.).

Why?
- The risks of working in the public are inherent, and the stress that staff, patients, and families experience in healthcare settings adds to that risk (Gates et al., 2011).

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Two Curricular Concepts:
1. Prevention

The hospital should promote a culture of intolerance for violence and align its violence prevention guidelines with that stance (Gates et al., 2011).

Implement Environmental Controls

Adequate lighting, security devices, bullet-resistant barriers in the emergency department, and curved mirrors in hallways (Sullivan, 2017, p. 343).

Implement Safe Work Practices

Escort services, adequate staffing, judicious use of restraints or seclusion, and staff alerts about patients with histories of violent behavior, dementia, or intoxication (Sullivan, 2017, p. 344).

2. Recognizance

Violence can range in intensity and result in various damages, including death, permanent or temporary disability, psychological trauma, and physical injuries (Howard & Gilboy, 2009).

Violence at work can lower employee morale, increase employee stress, foster management distrust, and worsen a hostile environment (Gates et al., 2011).

Preparation for Leadership Role
These two curricular concepts that I learned while attending SCOHS have prepared me to take a leadership role once I transition to professional practice by:
- Providing me with the necessary tools and resources to find the policies related to workplace violence, implement those policies, and report any incidents of workplace violence.
- SCOHS also has its own zero-tolerance rule when it comes to bullying and incivility. Seeing how the staff has used their professionalism and therapeutic communication to work through conflicting situations has given me insight into how I would be able to handle the situations if placed in one.

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3 Recommendations to promote the nurse's participation to improve the issue

1. A more streamlined process would improve the reporting of workplace violence in the ED; a document similar in nature to the patient history would be ideal; a reporting process that can be written freely, without the need to select excessive drop boxes, and could be completed in real-time alongside the patient notes (Thomas et al., 2021).

2. In order to promote more frequent reporting of incidents, nurses would like to see action taken in response to their reports and be informed of the results (Thomas et al., 2021).

3. All team members, including leadership, need to be accountable for modeling and enforcing the code of conduct. Without this enforcement, the code is useless. Leadership needs to be not only committed to the process but also to modeling civility and reinforcing its importance (Harris, n.d.).

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3 Peer-Reviewed Articles That Explain What The Literature Reveals About The Issue

AACN

Abusive behavior creates unfavorable working conditions that hinder the collaboration and communication necessary to uphold patient and clinician safety.

Receivers may experience psychological trauma as a result of this behavior, such as depression and anxiety.

(AACN Position Statement: Zero Tolerance for Bullying, Incivility, and Verbal Abuse - AACN, 2019).

Cross-Sectional Survey

The majority of hospital nurses reported encountering incivility.

Under difficult circumstances, it raises the turnover rate for nurses.

The prevalence of rude behavior at work ranges from 67.5% to 90.4%.

Kanitha, D. K., & Naik, P. R. (2021). Experience of workplace incivility and its impact on stress and turnover intention among the nurses working at a hospital: Cross-sectional survey approach. Iranian Journal of Nursing and Midwifery Research. https://doi.org/10.4103/ijnmr.ijnmr_124_20

Systematic Review and Meta-Analysis

Nursing managers should identify risk factors in the workplace due to the high prevalence of unruly behavior, particularly verbal behavior.

According to studies on workplace incivility, it is frequently brought on by emotionally upsetting interactions brought on by inappropriate displays of rage and grief, tension, a heavy workload, a lack of communication, occupational insecurity, organizational change, poor task management, differences in social power, and reciprocal relation to duties.

The findings indicated that 74% of the nurses had experienced verbal and 28% had experienced physical violence.

Shoorideh, F. A., Moosavi, S., & Balouchi, A. (2021). Incivility toward nurses: a systematic review and meta-analysis. Journal of Medical Ethics and History of Medicine. https://doi.org/10.18502/jmehm.v14i15.7670