Workplace violence is a prevalent phenomenon in healthcare and nurses are particularly at risk from workplace violence due to the nature of their work or inadequacies within their work environments. Although workplace violence is known to have serious negative implications for nurses, patients and the larger healthcare system, the mechanism through which it functions is less clear.
The purpose of this study is to examine whether work environment conditions moderate the mediating effect that burnout has on the relationship between workplace violence and three health outcomes.
A secondary analysis of cross-sectional correlational survey data was conducted.
The study took place in British Columbia, Canada.
537 medical-surgical nurses were included in the study.
Survey data were analyzed using moderated mediation regressions with the PROCESS macro on SPSS.
Burnout mediated the relationship between workplace violence and health outcomes including musculoskeletal injuries, anxiety disorders and sleep disturbances. Work environment conditions moderated the direct relationship between workplace violence and burnout; and the indirect relationship between workplace violence and the three health outcomes. In healthier work environments, workplace violence was more strongly related to increased reports of burnout, musculoskeletal injuries, anxiety disorders and sleep disturbances compared to less healthy work environments.
Nurses in healthier work environments may not expect workplace violence, and they may be at more burnout risk than nurses in less healthy environments who have normalized unsafe work conditions. Violence may be the new ‘reality shock’ for nurses.

Copyright © 2020. Published by Elsevier Ltd.

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