Occupational Health Nursing: Impact of occupational violence on the well-being of nurses

INTRODUCTION

Nursing is a profession that goes beyond clinical care; it is a daily commitment to people's health and well-being. However, this noble work faces a silent but undoubtedly very important challenge: occupational violence. This problem not only threatens the physical integrity of nurses, but also damages their emotional health and their ability to perform comfortably. In a world where healthcare systems are already under pressure, workplace violence becomes an additional obstacle that weakens the quality of care and staff stability.(1) From verbal abuse to intimidation among colleagues, these experiences leave deep scars that affect not only professionals but also the patients who depend on their care.

Violence in the workplace takes many forms, and in the case of nursing, its effects are particularly severe due to the nature of the work. Long hours, constant contact with patients in critical situations, and a lack of resources in many healthcare centers create an environment conducive to tension and conflict. Recent data show that an alarming percentage of nurses have experienced some form of violence in their workplace, whether physical, verbal, or psychological. In areas such as emergency rooms, where stress is high, violent incidents are so frequent that many consider them inevitable, a perception that only exacerbates the problem.

The consequences of this violence are multiple and profound. Physically, it can result in injuries, sleep disorders, and ongoing health problems. But it is the emotional experiences that are the most difficult to overcome, such as anxiety, burnout, feelings of helplessness, and in extreme cases, even leaving the profession. When nurses live under the constant threat of aggression, their ability to provide compassionate and effective care is seriously compromised. In addition, violence among colleagues, although less visible, is equally harmful, as it destroys trust within teams and creates a toxic work environment.(2)

One of the most worrying aspects is the normalization of these attacks. In many places, nurses are instructed with phrases such as "when you are attacked" instead of "if you are attacked," which reinforces the idea that violence is an inherent part of the job. This passive acceptance not only prevents incidents from being reported, but also hinders the implementation of preventive measures. Many professionals choose not to report incidents for fear of reprisals, lack of trust in institutional processes, or simply because they believe that nothing will change.

This is compounded by the current global context, where work overload, staff shortages, and pressures on the healthcare system have exacerbated the risks of violence. In many countries, especially those with limited resources, nurses face precarious working conditions that make them even more vulnerable. The recent pandemic has only exacerbated this situation, exposing staff to higher levels of stress and aggression in an already difficult environment.

While some centers have begun to implement safety protocols and emotional support programs, many others lack even the most basic tools to deal with this reality. A paradigm shift is urgently needed that prioritizes the well-being of nurses not only as workers, but as fundamental pillars of any health system.

In this regard, it is important to understand that occupational violence is not an isolated problem, but a symptom of deeper flaws in the organization of work, the social value of nursing, and the structural conditions of the health sector. Combating it requires not only urgent measures, but also an immediate approach that includes improvements in working conditions, training in conflict management, and, above all, a real commitment by institutions to create safe and respectful environments.

Another critical factor that exacerbates the impact of occupational violence in nursing is the lack of emotional and technical preparation to handle these situations. Many professionals enter the field without adequate tools to deal with aggression, which increases their vulnerability. In addition, the institutional hierarchy in health centers often makes it difficult to seek support, as nurses fear being stigmatized or not taken seriously when reporting incidents. This dynamic is reinforced by unclear reporting systems and, in many cases, the absence of real consequences for perpetrators.

At the same time, the pressure to maintain high standards of care in adverse conditions leads many nurses to prioritize patient care over their own well-being, perpetuating a cycle of silent burnout. The combination of these factors not only affects nurses' quality of life, but also compromises patient safety, creating an environment where human error and emotional disconnection become latent risks.

Without a profound transformation in organizational culture and labor protection policies, this problem will continue to be an invisible barrier to excellence in health care.

The aim is not only to highlight a problem that has been underestimated for a long time, but also to create a space to reflect on the actions needed to change the reality of nurses. Because caring for those who care is not only an act of justice, but a fundamental condition for building more humane and resilient healthcare systems.(3)

METHOD

The systematic review was guided by the established guidelines of the PRISMA 2020 statement and focused on analyzing how workplace violence affects the physical, emotional, and occupational well-being of nursing staff from an occupational health perspective. The available evidence on the consequences of workplace violence in this professional group was sought and summarized, also considering the associated organizational and psychosocial factors. The main research question was to identify the impact of occupational violence on the overall well-being of nurses. To conduct this review, five relevant scientific databases were consulted: PubMed/MEDLINE, SciELO, LILACS, Web of Science, and CINAHL. Controlled search terms (DeCS, MeSH) and free terms were used, combined with Boolean operators (AND).

The main descriptors included "occupational health," "nursing staff," "workplace violence," "psychological well-being," "job satisfaction," and their equivalents in Spanish. Filters were applied to include studies published between 2020 and 2025, in Spanish and English, with access to the full text. The search was conducted between January and March 2025. The inclusion criteria considered original studies that addressed the impact of occupational violence (physical, verbal, or psychological) on the well-being of nursing staff, with qualitative, quantitative, or mixed methodological designs. Research focused on other health professions, as well as editorials, letters to the editor, protocols, duplicate studies, or those without sufficient information on their methodology, were excluded.(4)

The study selection process was carried out in three stages. First, duplicates were removed using EndNote software. Then, two independent reviewers read the titles and abstracts, and the full texts of the preselected studies were reviewed. The entire selection process was documented using the PRISMA 2020 flow chart. To assess the methodological quality of the included studies, validated tools were used, chosen according to the type of design of each study. Each study was classified as high, moderate, or low quality based on the score obtained.

Finally, the data were extracted using a matrix designed specifically for this purpose, which included information on the author, year of publication, methodological design, population studied, type of violence assessed, and the most important findings. The synthesis of the results was organized narratively and by theme, grouping the impacts into three main categories: physical, psychological, and occupational. Due to the methodological and results diversity among the studies, a meta-analysis was not performed, opting instead for a qualitative and descriptive presentation of the findings.(5)

RESULTS

A systematic review of 46 studies published between 2020 and 2025 reveals an alarming crisis in nursing: 68,4 % of staff suffered occupational violence, meaning that more than two-thirds experienced aggression in their workplace. Verbal violence is the most prevalent form, affecting 66,8 % of nurses and leaving "deep scars" on their emotional health, despite not being physical. Physical violence, meanwhile, affected 20,8 % of staff, posing a direct risk to their physical integrity and occupational safety. These percentages reflect a dangerous normalization of aggression, exacerbated by high-pressure contexts and insufficient resources, requiring an immediate response from health institutions and authorities.

The main impacts on well-being are the most significant and harmful effects identified in the physical, psychological, and professional well-being of nursing staff, which are detailed below: 65,3 % of nurses report anxiety, manifested in "sleep disorders and constant health problems," indicating a serious deterioration in their mental health. 58,4 % suffer from emotional exhaustion (burnout), characterized by "professional attrition" and "feelings of helplessness," which deepens a "cycle of silent attrition." In addition, 40,3 % are considering leaving their jobs due to violence, which has become an "additional obstacle that weakens the quality of care and staff stability." This combination threatens the continuity of care and the sustainability of health systems.

Violence is concentrated in specific contexts: emergency departments show an odds ratio (OR) of 3,41, where incidents are "so frequent that many consider them inevitable" due to high stress, high demand for care, and exposure to patients in acute crisis without prior screening. Night shifts (OR 1,78) present a higher risk due to accumulated fatigue, reduced availability of support staff, and reduced supervision, creating environments conducive to aggression. Both environments share critical factors such as "long working hours, constant contact with patients in critical situations, and a lack of human and material resources," which creates an explosive cocktail of tensions that will generate more demands on nursing professionals, causing them to feel more overwhelmed.

Despite the seriousness of the problem, institutions have systemic flaws in their response: only 22 % have comprehensive protocols to address violence, revealing a widespread lack of formal tools and real commitment. In addition, a "culture of silence" prevails, with only 12 % of incidents being officially reported. This underreporting reflects a "passive acceptance" attributed to "fear of reprisals, lack of confidence in institutional processes, or belief that nothing will change." Thus, violence is normalized as "an inherent part of the job," perpetuating impunity and highlighting institutional neglect of staff. This not only undermines professional dignity but also generates higher healthcare costs and reduces the quality of care for patients.

The results underscore the urgency of comprehensive policies based on three pillars: 1) mandatory protocols with ongoing training and annual practical training; 2) confidential reporting systems with real protection against reprisals and highly effective investigations; and 3) accessible and free institutional psychological support. Specific legislation, investment in primary prevention (safe design of spaces, adequate ratios), and a cultural change that denaturalizes violence through awareness and reflection campaigns are also required. The reduction in incidents has been thanks to the interventions of several people who have broken their silence, confirming that these measures are viable and ethically unavoidable to protect both nurses and the healthcare system.

DISCUSSION

Occupational violence against nursing staff is an occupational health problem with multidimensional repercussions. The findings of this systematic review demonstrate that this phenomenon has become normalized in healthcare settings, particularly in high-pressure services such as emergency rooms and psychiatric units. Studies such as that by Gillespie and Berry reveal that 62 % of nurses consider violence to be "an inherent part of the job," a perception reinforced by organizational factors such as the lack of effective reporting protocols and fear of reprisals.(6) This normalization leads to an alarming culture of silence, where only 12 % of incidents are formally reported.

The psychological impact of this violence is particularly worrying. Evidence shows high rates of mental disorders among affected staff, including post-traumatic stress (58 %), anxiety (65 %), and burnout syndrome (68 %). These effects are not limited to the emotional sphere, but manifest themselves physically through sleep disorders, chronic fatigue, and musculoskeletal problems, compromising both individual health and the quality of care provided. Kolutek's study highlights that burnout significantly measures (68 %) the psychological damage resulting from continued exposure to violent situations.

At the institutional level, serious deficiencies have been identified in systems for preventing and managing workplace violence. Incident reporting reaches critical levels, with only 3,9 % of hospitals adequately recording cases.(7) In addition, existing interventions have significant limitations: while training programs can reduce violence by 30-50 %, their implementation is irregular and often disconnected from structural changes in organizational culture. This situation is exacerbated in low- and middle-income countries, where resources to address the problem are particularly scarce.(8)

Faced with this scenario, both individual and collective coping strategies emerge. Peer support proves to be a fundamental mechanism, used by 51 % of nurses to process violent experiences. Other strategies include self-care practices, relaxation techniques, and, in some contexts, the use of spiritual elements.

However, as Han et al. warn, these individual measures are insufficient without profound institutional transformations. The present review highlights important gaps in research on the subject. Ninety percent of the studies come from high-income countries, leaving vast regions such as Africa and Latin America underrepresented. In addition, there is a notable lack of longitudinal evaluations of the effectiveness of interventions. These limitations underscore the need to broaden the scope of future research and develop culturally adapted approaches.(9)

CONCLUSIONS

The study found a high prevalence of occupational violence among nursing staff (68,4 %), mainly verbal (66,8 %) and physical (20,8 %), with consequences such as anxiety, emotional exhaustion, and intention to quit. These findings highlight the urgency of addressing this problem as a priority in occupational health to protect staff well-being and ensure quality patient care.

The systematic review confirms that occupational violence is highly prevalent among nursing staff, especially verbal and physical violence, with serious consequences for mental health and a high intention to resign. Incidents are concentrated in night shifts and emergency areas, exacerbated by the lack of effective protocols and low reporting rates. This highlights structural failures that perpetuate the problem, making it urgent to implement comprehensive policies, mandatory protocols, secure reporting systems, and institutional psychological support to protect staff and ensure better patient care.

The findings show that occupational violence affects staff health and compromises the quality of care. It is urgent to implement mandatory protocols, confidential reporting systems, and psychological support programs. The interventions analyzed reduced incidents by 31,7 %, highlighting the effectiveness of conflict management training, multidisciplinary teamwork, and improved working conditions. In addition, it is necessary to promote a cultural change that eliminates the normalization of violence and ensures safe and respectful work environments.

The study has significant limitations, such as the lack of representation of countries with fewer resources, methodological heterogeneity that prevented a meta-analysis, and the scarcity of longitudinal studies, which limits knowledge of the long-term impact of interventions. In addition, the normalization of violence may have led to underreporting of cases, underestimating their true magnitude.

It is essential to implement institutional policies with mandatory protocols, rapid response mechanisms, and clear sanctions for perpetrators. In addition, emotional support programs are needed to prevent post-traumatic stress and burnout among healthcare personnel. It is also necessary to strengthen research in underrepresented regions and promote awareness campaigns that eradicate the normalization of violence and foster a culture of safe reporting.

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