A surgeon in Tulsa shot by a disgruntled patient. A doctor in India beaten by a group of bereaved family members. A general practitioner in the United Kingdom threatened with stabbing. The reality is grim: healthcare workers across the globe experience violence while at work. A new study identifies this trend and finds that 25% of healthcare workers polled were willing to quit because of such violence.
“That was pretty appalling,” Dr Rahul Kashyap, MD, MBA, MBBS, recalls. Kashyap is one of the leaders of the Violence Study of Healthcare Workers and Systems (ViSHWaS), which polled an international sample of physicians, nurses, and hospital staff. This study has worrying implications, Kashyap says. In a time when hospital staff are reporting burnout in record numbers, further deterrents may be the last thing our healthcare system needs. But Kashyap hopes that bringing awareness to these trends may allow physicians, policymakers, and the public to mobilize and intervene before it’s too late.
Previous studies have revealed similar trends. The rate of workplace violence directed at US healthcare workers is five times that of workers in any other industry, according to the Bureau of Labor Statistics. The same study found that attacks had increased 63% from 2011 to 2018. Other polls that focus on the pandemic show that nearly half of US nurses believe that violence increased since the world shut down. Well before the pandemic, however, a study from the Indian Medical Association found that 75% of doctors experienced workplace violence.
With this history in mind, perhaps it’s not surprising that the idea for the study came from the authors’ personal experiences. They had seen coworkers go through attacks, or they had endured attacks themselves, Kashyap says. But they couldn’t find any global data to back up these experiences. So Kashyap and his colleagues formed a web of volunteers dedicated to creating a cross-sectional study.
They got in touch with researchers from countries across Asia, the Middle East, South America, North America, and Africa. The initial group agreed to reach out to their contacts, casting a wide net. Researchers used WhatsApp, LinkedIn, and text messages to distribute the survey. Healthcare workers in each country completed the brief questionnaire, recalling their pre-pandemic world and evaluating their current one.
Within 2 months, they had reached healthcare workers in over 100 countries. They concluded the study when they received about 5000 results, according to Kashyap, and then began the process of stratifying the data. For this report, they focused on critical care, emergency medicine, and anesthesiology, which resulted in 598 responses from 69 countries. Of these, India and United States had the highest number of participants.
In all, 73% of participants reported facing physical or verbal violence while in the hospital; 48% said they felt less motivated to work because of that violence; 39% of respondents believed that the amount of violence they experienced was the same as before the COVID-19 pandemic; and 36% of respondents believed that violence had increased. Even though they were trained on guidelines from the Occupational Safety and Health Administration (OSHA), 20% of participants felt unprepared to face violence.
Although the study didn’t analyze the reasons workers felt this way, Kashyap speculates that it could be related to the medical distrust that grew during the pandemic or the stress patients and healthcare professionals suffered during its peak.
Regardless, the researchers say their study is a starting point. Now that the trend has been highlighted, it may be acted on.
Moving forward, Kashyap believes that controlling for different variables could determine whether factors like gender or shift time put a worker at higher risk for violence. He hopes it’s possible to interrupt these patterns and reestablish trust in the hospital environment. “It’s aspirational, but you’re hoping that through studies like ViSHWaS, which means trust in Hindi…[we could restore] the trust and confidence among healthcare providers for the patients and family members.”
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