While protecting patient health is the main focus of nursing, who is protecting nurses as they perform their jobs?

One-third of nurses are abused in the workplace, according to a recent study by Colorado nurse Victoria Carroll, RN, clinical instructor and safety advocate. Nurses from around the world tell stories of violence in health care in the third quarter of Reflections, a nursing magazine.

In a multistate study, Carroll and the Colorado Nurses Association Violence Task Force found that nurses from more than 30 different practice areas had been victim of threats, sexual assaults, and acts of physical violence including kicks, slaps, pushes or harm from a weapon. Nurses were abused during their work shifts, usually by a patient, with weapons including guns, knives, flare guns and chairs.

"As nurses we are very nurturing in terms of our services and skills, and sometimes it's at the sake of personal safety," said Deborah V. DiBenedetto, RN, BSN, MBA, president of the American Association of Occupational Health Nurses. "We need to always find balance and be assertive in how we deliver services. We give, and we give, and we give, and we lay aside the need to recognize issues of self …."

In Austin, Texas, a study of violence in emergency departments revealed 63 percent of staff reported one to three incidents of violence while on the job. Ironically, the majority also responded that they didn't report the incidents to hospital management. An assessment by the Idaho Emergency Nurses Association found that male nurses are more likely than female nurses to be physically assaulted by patients in emergency rooms.

"The value of human life is inestimable and those who serve others, such as nurses, must be protected from attack and shielded from abuse," said Mary Manning, executive director of the MNA.

"These are patterns that we have been observing since the late 70's, only they are worse. This is a reflection of our times. We are less trusting and violence is at an all time high," according to Marilyn L. Lanza, DNSc, ARNP, CS, FAAN, an MNA member and a national expert and researcher on issues related to violence, specifically violence in the health care workplace.

Lanza believes management of health care facilities need to do much more to protect workers and to create an environment where workers are supported and protected.

"Most incidents are not reported to top management." Lanza said. "Only those unique facilities with supportive and knowledgeable management would have more realistic statistics. Generally, a decision is made to report only those assaults considered severe enough to warrant management action."

Lanza added, "Until top management changes its attitude about assault, the problem will continue. Management actions, overt and covert, must adequately support both patient and staff rights in assault situations to establish the climate for improvement.