Nurses Exposure to Workplace Violence in a Large Teaching Hospital in Iran

Document Type : Original Article


1 Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran

2 Department of Health Management and Economics, School of Public Health and Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran

3 Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran


Workplace violence is one of the factors which can strongly reduce job satisfaction and the quality of working life of nurses. The aim of this study was to measure nurses’ exposure to workplace violence in one of the major teaching hospitals in Tehran in 2010.
We surveyed the nurses in a cross-sectional design in 2010. The questionnaire was adapted from a standardized questionnaire designed collaboratively by the International Labor Office (ILO), the International Health Organization (IHO), the International Council of Nurses (ICN), and the Public Services International (PSI). Finally, in order to analyze the relationships among different variables in the study, T-test and Chi-Square test were used.
Three hundred and one nurses responded to the questionnaire (a response rate of 73%). Over 70% of the nurses felt worried about workplace violence. The participants reported exposure to verbal abuse (64% CI: 59-70%), bullying-mobbing (29% CI: 24-34%) and physical violence (12% CI: 9-16%) at least once during the previous year. Relatives of hospital patients were responsible for most of the violence. Nurses working in the emergency department and outpatient clinics were more likely to report having experienced violence. Nurses were unlikely to report violence to hospital managers, and 40% of nurses were unaware of any existing policies within the hospital for reducing violence.
We observed a considerable level of nurse exposure to workplace violence. The high rate of reported workplace violence demonstrates that the existing safeguards that aim to protect the staff from abusive patients and relatives are inadequate.


Main Subjects


    1. Celik SS, Celik Y, Agırbas İ, Ugurluoglu O. Verbal and physical abuse against nurses in Turkey. Int Nurs Rev 2007; 54: 359-66. doi: 10.1111/j.1466-7657.2007.00548.x  
    2. Kwok R, Law Y, Li K, Ng Y, Cheung M, Fung V, et al. Prevalence of workplace violence against nurses in Hong Kong. Hong Kong Med J 2006; 12: 6-9.
    3. Oztunc G. Examination of incidents of workplace verbal abuse against nurses. J Nurs Care Qual 2006; 21: 360.  doi: 10.1097/00001786-200610000-00014
    4. Esmaeilpour M, Salsali M, Ahmadi F. Workplace violence against Iranian nurses working in emergency departments. Int Nurs Rev 2011; 58: 130-7.  doi: 10.1111/j.1466-7657.2010.00834.x
    5. Shiao JS, Tseng Y, Hsieh YT, Hsieh YT, Hsieh YT, Guo YL. Assaults against nurses of general and psychiatric hospitals in Taiwan. Int Arch Occup Environ Health 2010; 83: 823-32. doi: 10.1007/s00420-009-0501-y
    6. Shoghi M, Sanjari M, Shirazi F, Heidari S, Salemi S, Mirzabeigi G. Workplace Violence and Abuse Against Nurses in Hospitals in Iran. Asian Nurs Res (Korean Soc Nurs Sci) 2008; 2: 184-93. doi: 10.1016/s1976-1317(08)60042-0
    7. Farrell GA, Bobrowski C, Bobrowski P. Scoping workplace aggression in nursing: findings from an Australian study. J Adv Nurs 2006; 55: 778-87.  doi: 10.1111/j.1365-2648.2006.03956.x
    8. Nolan P, Soares J, Dallender J, Thomsen S, Arnetz B. A comparative study of the experiences of violence of English and Swedish mental health nurses. Int J Nurs Stud 2001; 38: 419-26. doi: 10.1016/s0020-7489(00)00089-4
    9. Khademi M, Mohammadi E, Vanaki Z. Nurses’ experiences of violation of their dignity. Nurs Ethics 2012; 19: 328-40.  doi: 10.1177/0969733011433926
    10. Khademloo M, Moonesi FS, Gholizade H. Health care violence and abuse towards nurses in hospitals in north of Iran. Glob J Health Sci 2013; 5: 211. doi: 10.5539/gjhs.v5n4p211  
    11. Di Martino V. Workplace violence in the health sector, Country Case Studies. Geneva: WHO; 2002. 
    12. Whelan T. The escalating trend of violence toward nurses. J Emerg Nurs 2008; 34: 130.  doi: 10.1016/j.jen.2007.05.018
    13. Cooper CL. Workplace violence in the health sector: State of the art. International Labour Office; 2002. Available from:
    14. Di Martino V. Workplace violence in the health sector: relationship between work stress and workplace violence in the health sector. ILO/ICN/WHO/PSI Joint program on workplace violence in the health sector.Geneva: WHO; 2003. 
    15. Lin YH, Liu HE. The impact of workplace violence on nurses in South Taiwan. Int J Nurs Stud 2005; 42: 773-8.  doi: 10.1016/j.ijnurstu.2004.11.010
    16. Harris B, Leather P. Levels and consequences of exposure to service user violence: Evidence from a sample of UK social care staff. Br J Soc Work 2012; 42: 851-69. doi: 10.1093/bjsw/bcr128
    17. Leather P, Beale D, Lawrence C, Dickson R. Effects of exposure to occupational violence and the mediating impact of fear. Work & Stress 1997; 11: 329-40. doi: 10.1080/02678379708252996
    18. Gates DM, Gillespie GL, Succop P. Violence against nurses and its impact on stress and productivity. Nurs Econ 2011; 29: 59-66. 
    19. Magnavita N. The Exploding Spark: Workplace violence in an infectious disease hospital—A longitudinal study. BioMed research international 2013; 2013: 316-58.  doi: 10.1155/2013/316358
    20. Magnavita N. Workplace Violence and Occupational Stress in Healthcare Workers: A Chicken‐and‐Egg Situation—Results of a 6‐Year Follow‐up Study. J Nurs Scholarsh 2014; 46: 366-76. doi: 10.1111/jnu.12088
    21. Chen WC, Huang CJ, Hwang JS, Chen CC. The relationship of health-related quality of life to workplace physical violence against nurses by psychiatric patients. Qual Life Res 2010; 19: 1155-61. doi: 10.1007/s11136-010-9679-4
    22. Miranda H, Punnett L, Punnett L, Punnett L. Violence at the workplace increases the risk of musculoskeletal pain among nursing home workers. Occup Environ Med 2011; 68: 52-7. doi: 10.1136/oem.2009.051474
    23. Magnavita N, Heponiemi T. Workplace violence against nursing students and nurses: an Italian experience. J Nurs Scholarsh 2011; 43: 203-10.  doi: 10.1111/j.1547-5069.2011.01392.x
    24. Magnavita N, Heponiemi T. Violence towards health care workers in a Public Health Care Facility in Italy: a repeated cross-sectional study. BMC Health Serv Res 2012; 12: 108.  doi: 10.1111/j.1547-5069.2011.01392.x
    25. International Labour Office, ICoN, World Health Organization, and Public Services International (ILO/ICN/WHO/PSI). Framework guidelines for addressing workplace violence in the health sector. Geneva: International Labour Office; 2002. 
    26. Zamanzadeh V, Soleymannezadeh N. Nature of violence toward nurses working in hospitals. Medical Journal of Tabriz University of Medical Sciences 2007; 29: 61-6. 
    27. Ghasemi M, Rezaei M. Exposure of Nurses with Physical Violence in Academic Hospitals of‎ Baqiyatallah Medical University. MilMed Journal 2007; 9: 113-21. 
    28. Aghajanloo A, Nirumand-Zandi K, Safavi-Bayat Z, Alavi-Majd H. Clinical violence in nursing students. Iranian Journal of Nursing And Midwifery Research 2011; 16: 284. 
    29. Eslamian J, Fard SHH, Tavakol K, Yazdani M. The effect of anger management by nursing staff on violence rate against them in the emergency unit. Iranian Journal of Nursing And Midwifery Research 2010; 15: 337. 
    30. Khoshknab MF, Tamizi Z, Ghazanfari N, Mehrabani G. Prevalence of workplace violence in psychiatric wards, Tehran, Iran. Pak J Biol Sci 2012; 15: 680-4.  doi: 10.3923/pjbs.2012.680.684
    31. Chen WC, Hwu HG, Kung SM, Chiu HJ, Wang JD. Prevalence and determinants of workplace violence of health care workers in a psychiatric hospital in Taiwan. J Occup Health 2008; 50: 288-93. 
    32. Arnetz JE, Arnetz BB. Violence towards health care staff and possible effects on the quality of patient care. Soc Sci Med 2001; 52: 417-27.  doi: 10.1016/s0277-9536(00)00146-5
    33. Rose M. A survey of violence toward nursing staff in one large Irish accident and emergency department. J Emerg Nurs 1997; 23: 214-9. doi: 10.1016/s0099-1767(97)90010-6