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Occup Med (Lond). 2008 Mar;58(2):107-14. doi: 10.1093/occmed/kqm142. Epub 2008 Jan 21.

Violence risks in nursing--results from the European 'NEXT' Study.

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Service Central de Médecine du Travail Hôpitaux Hôtel Dieu AP-HP de Paris, Paris, France.



Recent research suggests that violence in health care is increasing and that it strongly influences the recruitment and retention of nurses as well as sick leave and burnout levels.


To identify the prevalence of violence in nursing and to provide a basis for appropriate interventions.


Nurses from 10 European countries answered to a questionnaire and to a follow-up assessment. Stepwise adjusted multiple logistic regression was used to assess the association between frequency of violence, factors related to teamwork and other work-related factors and outcomes, such as burnout, intention to leave nursing and intention to change institution.


A total of 39,894 nurses responded to the baseline questionnaire (51% response rate). After adjustment for age, gender and other risk factors, quality of teamwork appeared to be a major factor with odds ratio (OR) 1.35 (1.24-1.48) for medium quality and 1.52 (1.33-1.74) for low quality. Uncertainty regarding patients' treatments was linked with violence, with a clear gradient (OR 1.59, 1.47-1.72 for medium uncertainty and 2.13, 1.88-2.41 for high uncertainty). Working only night shift was at high risk (OR 2.17, 1.76-2.67). High levels of time pressure and physical load were associated with violence OR 1.45 (1.24-1.69) and 1.84 (1.66-2.04), respectively. High and medium frequency of violence was associated with higher levels of burnout, intent to leave nursing and intent to change institution. A 1-year follow-up assessment indicated stability in the relationships between outcomes.


This study supports efforts aimed at improving teamwork-related factors as they are associated with a decrease in violence against nurses.

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