Workplace violence against female nurses in hospitals: prevalence, patterns, reporting barriers, and risk factors

Abstract

Objectives: To determine the prevalence, patterns, reporting barriers, and factors associated with workplace violence (WPV) against Palestinian female nurses in government hospitals. Background: WPV targeting nurses is a growing concern with significant negative impacts on healthcare services. Female nurses are more vulnerable to gender-based violence and human rights violations. Study design and methods: We conducted a multicentre cross-sectional study at four major government hospitals in the West Bank, Palestine. We used a structured, validated, self-administered questionnaire adapted from the World Health Organization to collect data. The study included female nurses from the selected hospitals with at least one year of experience. Results: 421 (76.5%) female nurses participating in the study reported experiencing violence in the previous year. The most frequently reported form of violence was verbal violence (50.8%), followed by bullying (9.9%) and physical violence (8.8%). Less frequently reported were racial (4.3%) and sexual (2.6%) instances of violence. Patients' relatives and companions were the principal perpetrators (66.4%), followed by patients themselves (21.4%) and colleagues (9.7%). Logistic regression analysis revealed that nurses aged ≤ 35 had a substantially higher odds ratio (OR) of 1.66 (95% CI [1.081, 2.559], p = 0.021) for WPV compared to older nurses, while, having < 3 staff members in the department during shifts was associated with 1.63 times higher odds of exposure to violence (OR = 1.626, 95% CI [1.094, 2.417], p = 0.016). On average, only 3.4% of female nurses reported the incidence of violence following exposure. When considering the most common reasons for not reporting, 64.6% of the female nurses believed that reporting was unimportant, followed by 13.5% who said there were no reporting advantages, and 9% were unaware of whom to report to. Conclusions: WPV against Palestinian female nurses is highly prevalent, and verbal harassment is the most frequently reported form. Most perpetrators were patients’ relatives. Despite the availability of reporting systems, the reporting rates among female nurses remain low. Risk factors for violence include younger age and working with fewer staff members during shifts. Implications for research, policy, and practice: The findings of this study can inform revisions to existing anti-violence policies. Additional interventions are needed to reduce WPV and limit its negative consequences for female nurses and the quality of patient care. Further research is required to explore the underlying factors contributing to female nurses’ perceptions that WPV is unimportant. What is already known about the topic? Workplace violence is a major problem that affects nurses worldwide, leading to emotional stress and job dissatisfaction. Female nurses are particularly vulnerable to verbal, physical, and psychological abuse, especially in hospital settings. There is a widespread underreporting of WPV occurrences for a variety of reasons, such as feelings of futility and fear of repercussions. What this paper adds The study provides the first multi-centre data on the prevalence, patterns, and risk factors of WPV, specifically targeting female nurses across Palestinian government hospitals, a context marked by distinct cultural, occupational, and geopolitical challenges. Although a high prevalence of WPV exists (76.5%), formal reporting rates are critically low (3.4%), indicating that there is a significant gap in accountability for violence in Palestinian healthcare. Younger age (≤35 years) and low shift staffing (≤3 staff) are both significant and modifiable risk factors for WPV and provide tangible and actionable targets for policy.