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Appraisal, Coping, Social Support, Perceived Patient Safety and Intent to Leave in Emergency Department RNs Who Have Experienced Workplace Violence

Abstract

Workplace violence (WPV) has been cited as one of the most worrisome occupational hazards for nurses (Gacki-Smith, Juarez, Boyett, Homeyer, Robinson & Maclean, 2009). Registered nurses (RNs) experience the majority of the incidences of WPV with a 5% increase in incidence since 2006 (Wassell, 2009 and the highest levels of WPV occur in psychiatric and emergency department settings (Chapman, Styles, Perry & Combs, 2010). This study employed a cross-sectional design using surveys administered online to Emergency Department RNs (ED RNs) via Facebook and staff emails in multiple Southern California hospitals and universities. This study examined the relationships between appraisal, coping styles, perceptions of organizational safety

and patient safety and intent to leave in ED RNs who have experienced WPV. The following tools were used: a modified version of Lazarus and Folkman's Ways of Coping questionnaire, the Jaloweic Coping Scale, the Survey of Perceived Organizational Support and the Safety Attitudes Questionnaire. Intent to Leave was measured using a two part question. A total of 190 surveys were initiated resulting in 159 complete. ANOVA statistics demonstrated a significant relationship between the appraisal question "You had to hold yourself back from doing what you wanted to do" and confrontive and fatalistic coping styles F (4, 161)= 2.50, p=.045 and F (4, 161) = 2.73, p=.031 respectively. The effects of fatalistic, evasive, emotive and optimistic coping were significant with organizational support, F (2, 162) = 3.40, p=.036, F (2,162)=3.837, p=.024, F (2, 162)=4.098, p=.018 and F (2, 162)=4.832, p=.009, respectively. Pearson correlation coefficients showed a positive correlation between PWPV and VWPV r(113)=.201, p <.05. Negative correlations existed between social support and PWPV and VWPV r(139)=-.210, p <.05 and r(129)= -.197, p <.05 respectively. The analysis of the relationship between organizational support and perceived patient safety demonstrated a significant correlation (rs[158] = 0.59, p <.0001). The Spearman's rho revealed a significant relationship between VWPV and perceived patient safety (rs[126] = -0.29, p < .001). Only 13.7% of ED RNs reported an intention to leave their current job in the next year, 19.8% said maybe and 53.8% said no. However, of the "yes" and "maybe" responses 49.2% reported that their intentions to leave were related to WPV. This study demonstrates relationships between higher levels of WPV (both verbal and physical), certain coping styles, organizational support and perceived patient safety. As levels of WPV increase, utilization of negative coping styles increases and perceptions of organizational support and patient safety decrease.

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