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Factors related to on-the-job abuse of nurses by patients

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by Margot Shields and Kathryn Wilkins



Numerous studies indicate that health care providers, particularly nurses, face a high risk of on-the-job abuse from patients.  This article examines physical and emotional abuse from patients in nurses working in hospitals or long-term care facilities.

Data and methods

Data are from the 2005 National Survey of the Work and Health of Nurses. Cross-tabulations were used to examine abuse in relation to personal characteristics of the nurse, job characteristics, and workplace climate factors.  Multiple logistic regression modeling was used to examine abuse in relation to staffing and resource adequacy and relations among colleagues, controlling for personal and job characteristics.    


In 2005, 34% of Canadian nurses providing direct care in hospitals or long-term care facilities reported physical assault by a patient in the previous year; 47% reported emotional abuse.  Abuse was related to being male, having less experience, usually working non-day shifts, and perceiving staffing or resources as inadequate, nurse-physician relations as poor, and co-worker and supervisor support as low.  Associations between abuse and staffing or resource inadequacy and poor working relations persisted when controlling for personal and job characteristics.


Modifiable factors are important to nurses’ on-the-job safety.


resource allocation, violence, workload, workplace


Health care providers are subject to a particularly high risk of workplace violence, and nurses are most at risk. Evidence from numerous studies indicates that on-the-job abuse can result in a variety of negative outcomes among nurses, including anger, fear, depression, anxiety, sleep disruption, increased sick leave, symptoms of posttraumatic stress disorder, and job dissatisfaction. In addition, the likelihood of intending to leave their jobs or even the nursing profession altogether is greater among nurses who have experienced abuse on the job. [Full text]


Margot Shields (613-951-4177; and Kathryn Wilkins (613-951-1769; are with the Health Information and Research Division at Statistics Canada, Ottawa, Ontario, K1A 0T6.

What is already known on this subject?

  • Health care providers commonly experience violence or verbal abuse from patients in their care, and nurses are particularly at risk.
  • Nurses who experience on-the-job abuse are at risk of physical and psychological problems.
  • There is also some evidence of a link between on-the-job abuse of nurses and diminished quality of patient care.

What does this study add?

  • This is the first Canadian study based on nationally representative data to quantify the extent to which nurses working in hospitals or long-term care facilities report on-the-job abuse from patients, and to examine factors associated with abuse. 
  • Workplace climate factors—staffing and resource adequacy, relations between nurses and physicians, co-worker support and supervisor support—are negatively related to on-the-job abuse. 
  • Associations between workplace climate and abuse are independent of the effects of personal and job characteristics.