Workplace aggression, both physical and non-physical, is a serious problem in health care settings.1–3
In 2007, the US Bureau of Labor Statistics reported 25360 incidents of physical assaults in health care settings, or 158.4 per 100000 employees3
—a rate higher than in any other US industry. A study of nurses in Minnesota estimated an incidence of 13 physical assaults in the workplace per 100 employees.4
With regard to nonphysical aggression (e.g., bullying, harassment, intimidation), several studies have reported that about one third to one half of health care employees experienced such aggression within the past year.4–8
Workplace aggression research struggles with the definition of the concept, as discussed in several recent reviews.9–11
Following Aquino and Thau’s approach, we define workplace aggression as harmful acts that “inflict psychological, emotional, and even physical pain” as perceived by the targeted individuals.10
In this paper, we contrast physical aggression (harmful acts that involve physical contact, such as assault) with nonphysical aggression (harmful acts that include verbal abuse and psychological harassment, such as “passive-aggressive” acts). Physical and non-physical aggression are often studied in relation to different classes of outcomes. Physical aggression is typically examined in terms of the injury or mortality directly resulting from the assault, lost wages, and costs to the employer.1,2,12
In contrast, nonphysical aggression is commonly studied as a correlate of mental health problems such as depression and anxiety.5,13
Although evidence clearly supports the negative effects of both types of workplace aggression, several aspects have not been fully researched.
First, the general health effects of physical aggression are not well documented. Because most acts of physical aggression in health care settings do not result in injuries that require treatment,4
focusing solely on injuries may fail to address other potential health consequences. For example, the Minnesota Nurses’ Study reported that targets of physical assault commonly felt frustration, anger, fear, anxiety, and depression.4
Thus, acts of physical aggression may have health consequences other than the injury stemming from the physical aggression itself.
Second, nonphysical aggression may have consequences beyond its effects on mental health. Niedhammer et al.14
documented that being the target of workplace bullying, a form of nonphysical aggression that involves persistent intimidation and isolation,9
was associated with poor self-rated health and sickness absence among workers in France. Kivimäki et al.15,16
found that targets of workplace bullying in Finland were more likely than nontargets to have medically certified sickness absences and higher odds of developing cardiovascular disease.
Third, the contribution of workplace aggression to occupational injury and illness has not been fully explored. The presence of workplace aggression may reflect an overall hazardous work environment, which can result in poor work-related health. In a 3-year prospective study of Dutch employees in various industries, Swaen et al.17
found conflicts with colleagues to be significant risk factors for work-related injury. Being the target of workplace bullying was associated with experiencing at least 1 work-related injury during the past 12 months among French workers.14
Although these studies suggest that poor work-related health may be a consequence of workplace aggression, this line of research is still scarce.
Finally, with just 1 exception,4
previous studies have examined physical and nonphysical aggression separately; therefore, the relative effect of both types of aggression is not known. For example, the current literature does not indicate whether physical assault has a stronger effect on health than does verbal abuse. Moreover, it is plausible that workers who experience both types of aggression are at a greater health risk than are those who experience either type alone because of the combined greater exposure or “dose” of aggression. Simultaneously examining physical and nonphysical aggression is particularly relevant in health care settings because health care workers are at high risk for both types of aggression.
In summary, the literature suggests that workplace aggression may contribute to various health problems. However, the effect of workplace aggression on general health and work-related injury and illness is not well understood. Issues involving workplace aggression are important not only for the workers themselves but also for patients and employers. For example, if workplace aggression leads to work absences, health care facilities may experience staff shortages, which can adversely affect quality of care.
In this study, we investigated how physical and nonphysical aggression in the workplace were related to health outcomes among nurses in the Philippines. Specifically, we examined (1) whether the experience of workplace aggression was associated with poor self-rated health, as well as with work-related injury or illness, and (2) whether being exposed to physical assault and verbal aggression simultaneously was associated with a higher risk of work-related injury or illness, compared with being exposed to either type of aggression alone.