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Dealing With Victimization:
When the Nurse is the Subject of Violence
By Tina Brooks
 SOME LIFE EXPERIENCES, both positive and
negative, have so much impact that they change the course of one’s life; just
ask Yvonne McKoy, RN, PhD, CS, DABFN, associate professor in the department of
nursing at Xavier University in Cincinnati, Ohio.
“I was a victim as a student nurse,” McKoy says. “I was
also victimized when I was working with a client. In fact, I received a
concussion. Instead of me saying ‘No’ to the field, it made me want to
be in the field even more.”
McKoy’s background includes psychiatric nursing with 19
years of forensic nursing experience. She was always interested in the area of
human behavior and what motivates individuals. McKoy believes that other forces,
and not just mental illness, drive people to hurt others.
“I was in shock initially when I realized that I was
actually hurt that badly,” McKoy says. “I didn’t go through phases of
detachment. I accepted what happened. I regrouped and said, ‘I have to
make some changes.’”
She adds, “Did it make me change how I went about my job? Yes, it did. I became more astute about my surroundings, not
as trusting in my relationships with clients. When you’ve been hit (before),
it puts you more on guard.”
Becoming a forensic nurse because of personal or professional
victimization may not be as uncommon as one thinks. McKoy mentions that she has
a student who wishes to enter the field because of past negative experiences
with teenagers. The student has already become nationally certified.
Julie Jervis, RN, MD, MBA, senior faculty and program director
at Kaplan College, says she knows another forensic nurse who had been a former
victim as well. “People who have been victimized, whether it is prior to them
becoming a forensic nursing professional or not, I think might be motivated to
help. It could be as a result of having a bad experience with the system and
wanting to make it better, or having a good experience with the system and
wanting to be another person who helps.”
McKoy says that forensic nursing is an excellent area to go
into for individuals who have been victimized. “It makes me want to be a
better educator, researcher and practitioner because it really gives me more of
a driving force not only to help myself, but help others,” she says.
One study has explored how eight nurses experienced and
evaluated the relation between their childhood adaptation to dysfunctional
families and their nursing careers.1 The study’s findings did not support the
view that children of alcoholics sought careers in nursing to meet codependent
needs, but rather some of them became competent nurses by finding positive
application for the coping skills they learned in their families.
“Having been a victim, it places individuals in a perfect
position to be empathetic toward other victims,” Jervis says. “If the victim
says, ‘Has this happened to you?” It is OK to say ‘Yes,’ but it shouldn’t
become a war story. ‘Oh yeah, when this happened to me, this happened,’ or
‘Well, it went this way for me.”
Jervis suggests this response instead: “‘That was in the
past and we are here to concentrate on you and make you better.’”
Each individual enters nursing with varying degrees of
motivation, values, beliefs and unresolved family-of-origin issues.2
However, circumstances that generate anxiety or strong emotion
can interfere with objective, logical decision making.3 “A sexual assault is a
critical incident,” Jervis says. “Some people have problems with
critical-incident stress and relive the incident when faced with something
similar that reminds them of it. If the nurse is falling apart, that’s not a
good thing. If it’s a tragic story and the nurse sheds a few tears and is
empathetic ... there’s a fine line of what’s OK and not OK. The caring definitely has to be there, but complete detachment
is just going to make the victim feel worse.”
The literature suggests that negative reactions, biases, and
stereotyping should be recognized and explored.4 Often, self-awareness begins
unconsciously with the internal organization of life experiences.5 McKoy’s
students use case studies, journaling and discussions.
“How do they guide other people to explore these things if
they have not explored these feelings themselves,” McKoy says. “The best
arena in which to do this is a safe environment where other people can give them
different perspectives on how to look at things. Students often say ‘I never
thought about that. Sometimes it’s good for people who aren’t in forensics
but who want to do this, to be in a safe place to talk about it, such as in a
classroom setting. Don’t let the first experience be the crime scene.”
SAYING NO to Violence Against Nurses
By Tina Brooks
WORKPLACE VIOLENCE takes many forms
such as aggression, harassment, bullying, intimidation and assault. Violent acts
are perpetrated against nurses by patients, relatives, other nurses and other professional groups.7
Nurses experience workplace crime at a rate of 72 percent
higher than medical technicians and at more than twice the rate of other medical
fieldworkers, according to the Bureau of Justice statistics.
Yvonne McKoy, RN, PhD, CS, DABFN, associate professor in the
Department of Nursing at Xavier University in Cincinnati, Ohio, would not be
surprised by these numbing statistics. She has done extensive research in this
area herself.
McKoy says, “I found that nurses thought this came with the
territory. We thought and said for a long time that we were not willing to sue
patients or to sue clients because this is a part of what we did. We accepted
this.”
Part of McKoy’s research explored if nurses knew patients
were in their right mind and why were nurses accepting of this behavior. “They
thought that their colleagues would not understand and their employers would
think that they were not doing their jobs. It must have been something about
them that caused the behavior,” she says.
McKoy, who was also victimized on the job several years ago,
felt that the community where she worked did not understand her plight. “They
saw it as part of what I did,” she says. “When I was victimized, I was in the area of mental health.”
Some of the injuries that McKoy received could have been life
threatening, including a concussion, could have been life threatening.
Through her research, McKoy discovered that other nurses
received physical injuries as well. Some individuals were able to go back to
work in a couple of days, but in some instances the experience had lasting
effects. Nurses changed areas where they worked or changed jobs. Others
experienced nightmares, which lasted for some time. Some individuals had
psychological problems while others had physiological problems such as nausea or
vomiting. Other research suggests that consequences of violence also include the
deterioration in the quality of patient care, low morale, high stress levels,
and increased errors.
Violence against these nurses had implications for their
families as well. “My family was most concerned about me being hurt,” McKoy
says. “They immediately wanted me to look at other employment, but I couldn’t
do that. My feelings were that I was called to do what I did.”
When McKoy asks former victims if they would now prosecute the
perpetrator, some of the individuals at this point say ‘Yes.’ They feel the
person knew the difference between right and wrong. “So we stand on the edge
of certain areas of the law where nurses are now saying ‘If you know what you’re
doing to me I may not take it,’” she says.
Mental illness is one thing, but even in this area nurses are
beginning to question patients’ cognitive abilities. Do patients know what
they are doing? Do patients know what they are doing when they hit a nurse? “Nurses
are definitely fighting back differently now,” McKoy says. “It doesn’t
mean that we’re not compassionate.”
As McKoy travels throughout the country presenting at
different professional conferences, she is encouraging the profession to
investigate this subject. The link between workplace violence, recruitment and
retention and diminished job performance of nurses cannot be ignored.8 The
Bureau of Health Professions’ 2000 Survey revealed that too few young people
are choosing careers in nursing, and the average age of registered nurses has
increased substantially. In 1980, 52.9 percent of RNs were younger than age 40;
in 2000, 31.7 percent were younger than 40. In 1980, 26 percent of RNs were
under the age of 30, but by 2000, less than 10 percent were under age 30.
“Nurses are not willing to be victimized as much as they
used to be and still stay on the job,” McKoy says. “That is a critical issue
to look at.”
References:
1. Biering P. Codependency. A disease or the root of nursing
excellence. Journal of Holistic Nursing. 1998;16(3):320-337.
2. Jerome AM, Ferraro-McDuffie AR. Nurse self-awareness in
therapeutic relationships. Pediatric Nurse. 1992;18(2):153-156.
3. Echroth-Bucher M. Philosophical basis and practice of
self-awareness in psychiatric nursing. Journal of Psychosocial Nursing of Mental
Health Service. 2001;39(2):32-39.
4. Ibid.
5. Ibid.
6. O’Keefe ME. Nursing Practice and the law. Philadelphia:
F. A. Davis Co. 2001. p.403.
7. Jackson D, Clare J, Mannix J. Who would want to be a nurse?
Violence in the workplace - A factor in recruitment and retention. Journal of
Nursing Management. 2002;10:13-20.
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