Murshed 1

Nurse Workplace Mistreatment: Research Paper

Shayma Murshed

Michigan Islamic Academy

Senior Project

Samar Abbasi

February 26, 2023

 Murshed 2

Table of Contents

Abstract……………………………………,……………………………………………..….……3

Introduction……………………….………...….…………………………………………..….…..4

An Islamic Perspective……………...…,……..…………………………………………..….…..4

Nurse Mistreatment…………………...………..…………………………………………..….…..5

Michigan Nurses …………………………………………….……....…………………...….…....5

Workplace Violence (WPV)...........................…………………………..………………………....6

A WPV policy...........................…………………………..……………….……………………....7

Occupational Safety and Health Administration (OHSA) guidelines...…..…………....................7

Cornwell Health guidelines...………..………………………..…………………...........................8

Comparing WPV guidelines.……………………………..…..…………………...........................9

Informing ……………………..………………………………………………………………......9

Conclusion…………………………………..………………...…………………………………10

References……………………………….……………….………………………………..……..11
 Murshed 3

Abstract:

One of the most important roles in healthcare is a nurse, contributing significantly to

patient care, safety, and overall well-being. A nurse's role is endless and ranges from helping a

patient out of bed to preventing the loss of a life. They care for long-term and short-term patients

regardless of their age, gender, or background; a baby fresh out of the womb or even a criminal

fresh out of jail. There are different types of nurses the most common types of nurses are

medical-surgical. Medical-surgical nurses perform basic tasks similar to other nurses such as

creating treatment plans, providing emotional support, evaluating patients, managing different

medical/surgical issues, and documenting everything.

The importance of nurses cannot be exaggerated, as they are often the primary caretakers

and patient advocates. Unfortunately, nurses may face various types of workplace violence while

doing their jobs. Workplace violence (WPV) is any act or threat of physical violence,

harassment, intimidation, or other disruptive behavior that occurs at the workplace; decreasing

job satisfaction, burnout, shame, lost productivity, emotional stress, etc. The result can have

significant physical, emotional, and psychological impacts on nurses. However, people do not

acknowledge the prevalent occurrence of nurse mistreatment and it is now regarded as a

displeasing part of the job and shut aside instead of any violent acts being reported. In order to

raise awareness and decrease the prevalence of nurse mistreatment, nurses should be adequately

educated on hospital policies and feel empowered by hospital management to report any

incidents.
 Murshed 4

Nurse Workplace Mistreatment

One of the most important roles in healthcare is a nurse, contributing significantly to

patient care, safety, and overall well-being. Their responsibilities extend beyond the management

of medication and monitoring vital signs; they provide emotional support and contribute

significantly to the overall well-being of those under their care. While frequently working long

hours and managing complex medical procedures, nurses are the base of patient experience and

safety. However, despite the important nature of their work, nurses often find themselves

encountering a lot of challenges that include nurse mistreatment leading to excessive stress.

Therefore, to prevent unneccesary stress or harassment, nurses should be adequately educated on

hospital policies.

In Islam, it is taught to treat people with respect regardless of their race, appearance,

gender, job, or social status. There are different verses and narrations of respect however one

notable one is a famous verse in the Quran in Surah (Chapter) an-Nisa (The Women) ayah

(verse) 135. Half of the verse talks about conveying justice and the other about being honest

eyewitnesses. There are different ways to interpret this verse such as using it to respect those

despite what their background may be. The verse states: “O you who believe! Stand out firmly

for justice, as witnesses to Allah, even though it be against yourselves, or your parents, or your

kin, be he rich or poor…” (The Quran Surah An-Nisa Ayah 135). According to Verse By Verse

Qur’an Study Circle (2012), in this verse, Allah (swt) commands His believing servants to stand

up for justice and fairness and not to deviate from it, right or left. They should not fear the blame

of anyone or allow anyone to prevent them from doing something for the sake of Allah. They are

also required to help, support, and aid each other for the sake of Allah. (“Tafseer Surah…”,
 Murshed 5

2017). The verse clearly states that no matter who we are facing we should be just to them

whether it be your parents or a stranger. It also mentioned that people should help, support, and

aid each other which is a common yet significant action nurses do. Also, from the viewpoint of

Islamic scholars, nursing is considered a holy job (Alimohammadi, N. et al., 2013). Therefore,

nursing is not taken something lightly from the Islamic viewpoint but rather highly respected

implying they should not be mistreated or abused when only performing their role.

Nurse mistreatment contains a range of negative conditions and behaviors that nurses

may endure in the workplace, often originating from aspects like constant overtime, an excessive

number of patients, persistent fatigue, and various forms of abuse. This mistreatment can come

out in physical, mental, and verbal ways, creating a challenging work environment for nurses.

Physically, nurses may face the pressure of excessive workload and extended working hours,

leading to fatigue and compromising their well-being. Mentally, the stress of managing excess

patients, navigating complicated healthcare systems, and tangled with emotionally charged

situations can take a toll on their mental health. Verbally, nurses may encounter abuse from

patients, families, colleagues, or superiors, ranging from harsh criticism and disrespectful

language to harassment. Managing nurse mistreatment is crucial for promoting a supportive

workplace culture that prioritizes the well-being of nurses and it is important to understand the

demanding nature of the nursing career such as a high-stress work environment.

In Michigan, a common source of nurse mistreatment is constant overtime leading to

burnout. When people are tired they make mistakes, it is not wise for a nurse to feel fatigued

working late and put a patient's life at risk since their brain is not functioning well compared to

their normal shift. Cassandra Craig, a nurse at the Kalamazoo Hospital said, "We're taking care

of patients and you want to be your most alert and using your problem-solving skills, for
 Murshed 6

anybody that's working an additional shift ... you're not going to be as alert, even if it's just one

time.” Hospitals are usually understaffed and rely on volunteers to help do small tasks but when

there are no volunteer nurses and not enough nurses, current nurses have to carry that burden of

working extra hours over their shoulders. Nurses admit to calling in sick or injured because they

are sick of working mandatory overtime. Other times nurses quit due to the amount of stress

overtime causes them and it also weakens their relationships with their families. John DeTizio,

labor relations director for the Michigan Association of Governmental Employees, said "These

are dangerous patients, and then (nurses) compare the pay and say, 'Why the heck should I stay

here?'" DeTizio admits that nurses are dealing with ‘dangerous patients’ however, he does not

mean all patients just a selective few which adds more stress to an overworked nurse

(Hinkley J. A., 2015).

A common threat to all workplace environments is workplace violence (WPV).

According to the American Nurses Association, WPV is any act or threat of physical violence,

harassment, intimidation, or other threatening, disruptive behavior from patients, patient's family

members, external individuals, and hospital personnel. It creates an unsafe and unhealthy work

environment impacting the well-being of individuals and the overall workplace productivity. In

healthcare environments, WPV is a significant concern, and nurses are particularly vulnerable to

experiencing such incidents. According to Cheung et al. (2017), out of the 25,630 incidences of

WPV that occurred in the United States 74% occurred in healthcare settings. This displays the

common occurrence of WPV in healthcare settings -- nurses specifically are at high risk due to

their close contact with patients. According to a Press Ganey Survey Report (2021), 2 nurses per

hour are assaulted in the acute care setting. The mistreatment of nurses in a hospital environment
 Murshed 7

is also a growing concern considering that 1 in 4 nurses are assaulted (“Workplace violence…”,

2018).

According to the Nurse Workplace Mistreatment survey sent out to nurses at Corwell

Health in Dearborn, Michigan, 88% of nurses have been involved in a situation where they felt

insulted by a patient. A nurse commented on the question saying they felt insulted both

physically and mentally. This shows that nurses are faced with both physical and mental

challenges in their workplace which adds a lot of stress affecting their performance and health.

However, WPV is not limited only to patients it can also be from colleagues. The survey shows

nurses have been yelled at, cursed, downgraded, shamed, and had items thrown at them by both

patients and colleagues. On a scale of 1 to 5 nurses were asked to rate how safe they felt at their

workplace and nearly 90% of nurses answered 3. Based on the other questions in the survey,

nurses feel undermined and stressed almost every day.

A way to reduce the amount of violence occurring in workplace environments has been

set with authorities according to different WPV policies. A WPV policy is a formal policy

developed by an organization to outline guidelines, procedures, and preventative actions to

manage aggressive behavior that may occur within the workplace. It is important to display these

policies in a healthcare environment for healthcare workers to understand the guidelines and

actions needed to take in certain situations. A key component of a good WPV policy in a

healthcare environment is to inform nurses how to protect themselves and report an incident.

This is an important aspect since out of the many nurses who experience WPV only 20-60% of

incidents are reported. Therefore, a nurse should be educated on how to report and also feel

empowered to report an incident rather than shy away from hospital management.
 Murshed 8

In an Occupational Safety and Health Administration (OHSA) article on “OSHA Worker

Rights and Protections”, explains how employees should know their rights and how to file a

complaint. The OHSA is an organization created by Congress that sets and enforces the

standards to ensure safe and healthful working conditions for workers. This article mentions that

Federal law guarantees a secure workplace, implying your employer must maintain a safe work

environment and you have the right to voice concerns about known health and safety risks

without facing retaliation. In the attachment, OHSA provides a clear view of how to file a

complaint regardless of where you work. If an individual were to file a complaint they should do

it as soon as possible through their workplace and if the issue is not resolved they should

immediately contact OHSA. There are a variety of accessible ways to contact OHSA including

online, in person, by call, or email.

The guideline for preventing WPV in OHSA is categorized into 5 main categories;

management commitment and employee participation, worksite analysis, hazard prevention and

control, safety and health training, and recordkeeping and program evaluation (“Guidelines for

Preventing…”, 2015). The overview of these guidelines is directed towards employers who

should follow them to create effective WPV prevention initiatives also involving employees to

ensure their viewpoints are recognized and their needs are added into the program. Since OHSA

sets the standards for other workplaces including healthcare environments, there should be a lot

of common similarities between OHSA guidelines and other healthcare environment guidelines.

When comparing other hospitals such as Corewell Health to the OHSA guideline certain

aspects need to be considered such as the main focus of identifying WPV. The Corewell Health

Reference Guide covers the essential parts of a guideline identifying, managing, and reporting

WPV. In general, the purpose of the policy is to identify a process with actionable steps to
 Murshed 9

prevent and address WPV and to protect the rights of patients, visitors, and staff to a safe

environment (“Reference guide”, 2023). The hospital recognizes any acts of physical violence,

intimidation, harassment, profanity, threats, stalking, shouting, bullying, and more as a sign of

WPV. The reference motivates nurses to report activity concerns they believe violate a law,

regulation, or policy or pose a safety concern. In cases where the concern is within the

department, the individual should first contact their immediate supervisor or local human

resources (HR) representative. However, if there is a safety issue where the individual might not

feel comfortable speaking directly to their supervisor or HR, they have an opportunity to report

their concerns anonymously online or by call. Overall, the Corewell Health guidelines take WPV

solemnly outlining a clear way to avoid certain situations and report a concern in their hospitals.

In the Nurse Workplace Mistreatment survey, 77% of nurses know where to report

concerns in their workplace at Corewell Health. Along with another 77% that have reported a

hostile patient incident. The data shows that Corewell Health makes sure nurses are educated and

aware of where and how to report patient incidents. However, a question asked on a scale of 1 to

5 how well nurses know their hospital policy on WPV, around 55% of nurses answered 2 and 3

and around 44% answered 4. According to these results, it can be concluded that nurses are

mainly aware of how to report patient incidents rather than any other incidents that fall under the

category of WPV such as colleague harassment or lost productivity.

In a healthcare environment, it is important to be clear on the message of how to identify

and report acts that are considered WPV. Nurses play a crucial role in patient care, and they must

be knowledgeable in both their rights and responsibilities within the workplace. When nurses

understand their rights it ensures that nurses are treated fairly and equitably. Additionally, being

aware of their responsibilities ensures that they can fulfill their duties effectively, providing
 Murshed 10

quality care to patients. Furthermore, nurses should be informed about the procedures for

reporting WPV incidents. This knowledge empowers them to report any instances of violence or

harassment. By having a clear understanding of their rights, responsibilities, and reporting

protocols, nurses play a part in the establishment of a supportive workplace enhancing the

quality of healthcare delivery.

However, healthcare agencies need to do a better job of making nurses feel empowered to

report WPV incidents. Considering that only 20-60% of WPV incidents are reported shows that

nurses are either scared or are not educated on what to do or where to go when experiencing

certain situations. An effective way to educate nurses is by performing a presentation or creating

flyers about WPV. These flyers can include a quick overview of a hospital’s guidelines on WPV

and summarize the main points; identifying, managing, and reporting WPV. It is also a great

option to provide flyers to patients or patients’ families informing the responsibilities of a nurse

and how they can handle certain situations themselves e.g. a relative's death in a hospital.

It is important for a nurse to feel safe and comfortable in their workplace instead of

constantly feeling vulnerable. The result of WPV can have significant physical, emotional, and

psychological impacts on nurses. However, people do not acknowledge the prevalent occurrence

of nurse mistreatment and it is now regarded as a displeasing part of the job and shut aside

instead of any violent acts being reported. The OHSA guidelines against WPV and information

on reporting incidents help set the standard for other healthcare organizations and it is a great

way for nurses to reflect on their current workplace -- is the environment safe? In order to raise

awareness and decrease the prevalence of nurse mistreatment, nurses should be adequately

educated on hospital policies and feel empowered by hospital management to report any

incidents.
 Murshed 11

References

Alimohammadi, N., Taleghani, F., Mohammadi, E., & Akbarian, R. (2013, July). Nursing in

Islamic thought: Reflection on application nursing metaparadigm concept: A

philosophical inquiry. Iranian journal of nursing and midwifery research.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3872860/#:~:text=From%20the%20view

point%20of%20Islamic,good%20evidence%20for%20this%20fact

American Nurses Association. (2018, December 13). Workplace violence/end nurse abuse.

https://www.nursingworld.org/practice-policy/work-environment/end-nurse-abuse/

Cheung, T., Lee, P. H., & Yip, P. S. F. (2017, August 4). Workplace violence toward

physicians and nurses: Prevalence and correlates in Macau. International journal of

environmental research and public health.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5580583/

Corewell Health. (2023, January). Reference guide.

https://volunteer.beaumont.org/custom/1545/documents/VolunteerReferenceGuide.pdf

Hinkley, J. A. (2015, October 8). Michigan Mental Health Nurses say OT Hurts Patient Care.

Detroit Free Press.

https://www.freep.com/story/news/local/michigan/2015/10/08/michigan-mental-health-nr

ses-say-ot-hurts-patient-care/73571680/

Murshed, Shayma. Survey of Nurse Workplace Mistreatment. 20 Jan. 2024

OHSA Publication 3148. (2015). Occupational Safety and Health Administration. Guidelines for

Preventing Workplace Violence for Healthcare and Social Service Workers.

https://www.osha.gov/sites/default/files/publications/osha3148.pdf
 Murshed 12

Surah An-Nisa - 135. Quran.com. (n.d.).

https://quran.com/4/135?translations=31%2C43%2C101%2C19%2C85%2C84%2C22

2C21%2C20%2C18%2C17%2C95

Tafseer Surah an-Nisa Ayah 135. Verse By Verse Qur’an Study Circle. (2017, March 25).

https://versebyversequranstudycircle.wordpress.com/2012/12/09/tafseer-surah-an-nisa-ay

ah-135/