Should I Stay or Should I Go: Navigating Nursing Care When the Patient is Violent

BackgroundViolence in nursing workplaces is alarmingly common. While much research has been done concerning the prevalence, antecedents, and consequences of workplace violence (WPV) in health care settings, the ethical dilemmas that it produces have not been well studied.PurposeThis study examines how nurses navigate conflicting priorities between the duty to provide care and the need to protect their own safety in situations where a person who is behaving aggressively requires intervention.MethodsApproaching the issue of WPV through a nursing ethics lens, we took a grounded theory approach to the analysis of data from interviews with 36 Canadian nurses to explore their experiences with competing ethical values governing the duty to provide care and the safety of patients, other people, and themselves.ResultsThe factors that nurses consider when navigating these decisions were categorised into two overarching themes, each with three subthemes: 1) factors that increase the likelihood or magnitude of the risks of violence, evident in a) patient factors, b) environmental factors, and c) personal characteristics of the nurse, and 2) factors that mitigate them, including a) situational awareness, b) the availability of supports, and c) the skills or tools at the nurse's disposal.ConclusionsInsights were gleaned into nurses' processes for assessing the strength and limits of their professional obligations in the context of violence and offer a framework for weighing the implications of staying in a high-risk situation to fulfil a duty to provide care, or leaving when it is necessary to maintain personal safety.