EFN Secretary General stressed at the NVKVV Congress, with topic ‘Violence Against Nurses in the EU’, that violence and harassment against nurses is totally unacceptable and more National and European legal actions are urgently needed to stop violence against frontline nurses and allied healthcare professionals.
EFN members best practices can guide EU policy makers to develop a specific Directive on violence against frontline healthcare professionals.
EFN members reported that different kinds of violence need to be addressed at EU level, including verbal and physical attacks (e.g., hitting, kicking, biting) and unwelcome sexual attention and harassment. For example, Denmark, Portugal, and the United Kingdom pointed to up to 30% of nurses being sexually harassed in the workplace. The risk of violence for health professions overall can be as high as 80% (e.g., Croatia and Germany). Women appear to be especially vulnerable with twice the risk of being victims of violence (e.g., Estonia and Sweden).
In addition, three alarming trends were revealed from members’ reporting: under-reporting of violent incidents, perpetrators of violence, and effects on nurse retention.
First, there are serious concerns about under-reporting violent incidents due to fear of victimisation and overall employer discouragement; this holds especially true for female nurses (e.g., Bulgaria, Spain, Ireland, Croatia, Albania, and Portugal). Nurse respondents did not perceive reporting would make any difference.
Second, perpetrators of violence against nurses include patients, families, and other health professionals. Up to 41% of nurses report abuse from other professionals (e.g., Germany) with much of this abuse originating from physicians (e.g., Slovenia, Cyprus, and the Czech Republic). Participants perceived gender-based violence against nurses to be associated with their weak position in the hierarchy, subordination by other professions, and lack of social and political power.
Third, violence against nurses has a potentially negative effect on nurse retention. Representative associations reported that nurses reduce their working hours or opt for part-time work as a consequence of violence, with reported estimates of increasing up to 70% the likelihood of leaving the profession (e.g., Switzerland and Ireland).
These frontline data show that we urgently need to move towards EU legislation building on the EU Law combating violence against women. Although with this endorsed Directive the EU recognises that violence against women is an obstacle to achieving equality between women and men for which the EU has an obligation to fulfil, as stipulated in the EU Treaties, to stop violence against frontline healthcare professionals, the EU needs to go a step further, building on national legislation already in place.
Policies and legislation to counter violence against nurses are already in place at the local, regional, or national level (e.g., Denmark, Estonia, Finland, France, Germany). However, the countries with a lack of such policies are Ireland, Slovakia, and Switzerland or with no specific policies on violence against nurses are Iceland, Lithuania, and the United Kingdom. But we can report that in 2020, new legislation was passed in Sweden and Italy against violence in the healthcare sector. In Portugal, two resolutions have been approved by parliament to prevent violence against health professionals; in Croatia, legislation is in place to protect healthcare workers with implications for up to 5 years imprisonment for those committing violent acts against them.
But despite existing legislation, some EFN Members remain concerned and caution that the challenge does not lie in the lack of legislation but rather in the lack of enforcement. For example, in Switzerland, due to underfunding and personnel shortage, employers claim that they cannot afford to ensure their personnel’s working conditions remain in line with the legal requirements. It is also worth highlighting that in some countries (e.g., Spain and the Czech Republic), there are national observatories set up to monitor incidences of violence against health care professionals. Unfortunately, this is not the case across Europe, thus limiting precise estimates of violent incidents at the EU level. In Spain, legislation identifies nurses as public authority figures, with any violent incidents against them treated in the same way as violence against police officers
These were the examples shared with Belgium colleagues at the NVKVV congress in Oostende, where EFN continued highlighting that violence has an enormous negative impact on nurses’ psychological and physical well-being and on their job motivation, with nurses’, post COVID-19 pandemic, massively leaving the nursing profession. COVID-19 has aggravated the violence against nurses! We can only tackle the current healthcare workforce crisis, the shortage of nurses, by addressing the safety of nurses in all working environments. Violence increases in all healthcare settings as the complexity of care and the shortages of nurses at the bedside increases.
Nurses must be protected and supported through the development of policies, initiatives, and legislation at the national and European levels. Ultimately, if not prioritised politically, the increasing violence against healthcare professionals will drive nurses out of the nursing profession. So, we need to go beyond the Directive on Combatting Violence Against Women and Domestic Violence to Stop Violence Against Nurses: the EU needs to ensure a zero-tolerance approach to violence against nurses to eradicate all forms of abuse, and to strengthen at the EU level the responsibility of employers to provide safe working environments. The EFN will continue to lobby EU politicians to make sure that nurses are safe from workplace harassment and violence.