title: Incidence and risk factors of workplace violence on psychiatric staff.
abstract: BACKGROUND
  A study by Hesketh et al. found that 20% of psychiatric nurses were physically assaulted, 43% were threatened with physical assault, and 55% were verbally assaulted at least once during the equivalent of a single work week. From 2005 through 2009, the U.S. Department of Justice reported that mental health occupations had the second highest average annual rate of workplace violence, 21 violent crimes per 1,000 employed persons aged 16 or older.
  
  
  OBJECTIVE
  An evaluation of risk factors associated with patient aggression towards nursing staff at eight locked psychiatric units.
  
  
  METHODS
  Two-hundred eighty-four nurses in eight acute locked psychiatric units of the Veterans Health Administration throughout the United States between September 2007 and September 2010.
  
  
  METHODS
  Rates were calculated by dividing the number of incidents by the total number of hours worked by all nurses, then multiplying by 40 (units of incidents per nurse per 40-hour work week). Risk factors associated with these rates were analyzed using generalized estimating equations with a Poisson model.
  
  
  RESULTS
  Combining the data across all hospitals and weeks, the overall rate was 0.60 for verbal aggression incidents and 0.19 for physical aggression, per nurse per week. For physical incidents, the evening shift (3 pm - 11 pm) demonstrated a significantly higher rate of aggression than the day shift (7 am - 3 pm). Weeks that had a case-mix with a higher percentage of patients with personality disorders were significantly associated with a higher risk of verbal and physical aggression.
  
  
  CONCLUSIONS
  Healthcare workers in psychiatric settings are at high risk for aggression from patients.
authors.affiliation: Division of Safety Research, National Institute for Occupational Safety and Health, Morgantown, WV, USA.
authors.forename: Marilyn
authors.initials: M
authors.lastname: Ridenour
authors.affiliation: Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA.
authors.forename: Marilyn
authors.initials: M
authors.lastname: Lanza
authors.affiliation: Division of Safety Research, National Institute for Occupational Safety and Health, Morgantown, WV, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Hendricks
authors.affiliation: Division of Safety Research, National Institute for Occupational Safety and Health, Morgantown, WV, USA.
authors.forename: Dan
authors.initials: D
authors.lastname: Hartley
authors.affiliation: University of Massachusetts, Boston, MA, USA.
authors.forename: Jill
authors.initials: J
authors.lastname: Rierdan
authors.affiliation: Veterans Health Administration, Washington, District of Columbia, CO, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Zeiss
authors.affiliation: Division of Safety Research, National Institute for Occupational Safety and Health, Morgantown, WV, USA.
authors.forename: Harlan
authors.initials: H
authors.lastname: Amandus
mesh_terms: D000328:Adult; D003953:Diagnosis-Related Groups; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D001523:Mental Disorders / Q000523:psychology; D008875:Middle Aged; D010564:Personnel, Hospital / Q000706:statistics & numerical data*; D011567:Psychiatric Department, Hospital / Q000706:statistics & numerical data*; D011570:Psychiatry / Q000706:statistics & numerical data*; D012307:Risk Factors; D013997:Time Factors; D064450:Workplace Violence / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Aggression; nursing; training