Factors contributing to workplace violence against nurses perpetrated by patients or visitors (type II violence) in the United States: A scoping review
- 1Washington University School of Medicine, St Louis, MO, 63110, United States
- 2Goldfarb School of Nursing, Barnes-Jewish College, BJC HealthCare, St Louis, MO, 63110, United States
- 3Department of Dentistry, Kaohsiung Medical University Chung-Ho Memorial Hospital, No.100, Tzyou 1st Road, Sanmin District, Kaohsiung City, 80756, Taiwan
Abstract
Background: Type II workplace violence against nurses by patients and visitors is a persistent occupational hazard with individual and organizational consequences. Although the prevalence and impact of workplace violence are well documented, less is known about the specific factors contributing to violence against nurses in hospital-based acute care settings in the U.S.
Objective: This scoping review aimed to identify and synthesize evidence on factors contributing to incidents of workplace violence directed at nurses in hospital-based acute care settings in the U.S.
Information sources: A medical librarian searched Embase, MEDLINE, Scopus, CINAHL, PsycINFO, and Cochrane databases for U.S.-based studies published between 2016 and 2025.
Methods: A scoping review was conducted following Joanna Briggs Institute methodology and reported in accordance with PRISMA-ScR guidelines. Two reviewers independently screened titles, abstracts, and full texts. Data were inductively synthesized using descriptive and narrative review approaches, and methodological quality was appraised using Joanna Briggs Institute Critical Appraisal Tools.
Results: Of 1547 unique records screened, 22 studies met inclusion criteria. Factors contributing to workplace violence clustered across patient-level, interactional/task-related, and organizational domains, as well as temporal trends. Patient-related factors included altered mental status, developmental impairment, trauma histories, substance use, prior violent behaviour, and gaps in communication regarding behavioural triggers. Workplace violence incidents were commonly precipitated during routine care activities, including medication administration, waiting for care, and delivery of food or beverages. Organizational contributors included understaffing, limited access to security, and insufficient training. Included articles which spanned the COVID-19 pandemic indicated an increased proportion of violent incidents relative to patient volume.
Conclusions: Type II workplace violence against nurses is associated with patient vulnerabilities, routine care processes, and organizational conditions. Future research is needed to identify and test multilevel prevention strategies embedded within everyday clinical practice and healthcare systems to reduce Type II workplace violence against nurses.
Registration: not registered
Social media abstract: Violence against nurses is associated with patient vulnerability, routine care processes, and organizational conditions.
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BibTeX
@article{tessmer2026factors,
title = {{Factors contributing to workplace violence against nurses perpetrated by patients or visitors (type II violence) in the United States: A scoping review}},
author = {Lindsay Tessmer and Yu-Chun Chang and Lauren Yaeger},
journal = {International Journal of Nursing Studies Advances},
year = {2026},
month = oct,
doi = {10.1016/j.ijnsa.2026.100718},
url = {https://doi.org/10.1016/j.ijnsa.2026.100718},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Factors contributing to workplace violence against nurses perpetrated by patients or visitors (type II violence) in the United States: A scoping review
AU - Lindsay Tessmer
AU - Yu-Chun Chang
AU - Lauren Yaeger
PY - 2026
DA - 2026/10/21
JO - International Journal of Nursing Studies Advances
DO - 10.1016/j.ijnsa.2026.100718
UR - https://doi.org/10.1016/j.ijnsa.2026.100718
AB - Background: Type II workplace violence against nurses by patients and visitors is a persistent occupational hazard with individual and organizational consequences. Although the prevalence and impact of workplace violence are well documented, less is known about the specific factors contributing to violence against nurses in hospital-based acute care settings in the U.S. Objective: This scoping review aimed to identify and synthesize evidence on factors contributing to incidents of workplace violence directed at nurses in hospital-based acute care settings in the U.S. Information sources: A medical librarian searched Embase, MEDLINE, Scopus, CINAHL, PsycINFO, and Cochrane databases for U.S.-based studies published between 2016 and 2025. Methods: A scoping review was conducted following Joanna Briggs Institute methodology and reported in accordance with PRISMA-ScR guidelines. Two reviewers independently screened titles, abstracts, and full texts. Data were inductively synthesized using descriptive and narrative review approaches, and methodological quality was appraised using Joanna Briggs Institute Critical Appraisal Tools. Results: Of 1547 unique records screened, 22 studies met inclusion criteria. Factors contributing to workplace violence clustered across patient-level, interactional/task-related, and organizational domains, as well as temporal trends. Patient-related factors included altered mental status, developmental impairment, trauma histories, substance use, prior violent behaviour, and gaps in communication regarding behavioural triggers. Workplace violence incidents were commonly precipitated during routine care activities, including medication administration, waiting for care, and delivery of food or beverages. Organizational contributors included understaffing, limited access to security, and insufficient training. Included articles which spanned the COVID-19 pandemic indicated an increased proportion of violent incidents relative to patient volume. Conclusions: Type II workplace violence against nurses is associated with patient vulnerabilities, routine care processes, and organizational conditions. Future research is needed to identify and test multilevel prevention strategies embedded within everyday clinical practice and healthcare systems to reduce Type II workplace violence against nurses. Registration: not registered Social media abstract: Violence against nurses is associated with patient vulnerability, routine care processes, and organizational conditions.
SN - 2666-142X
ER -