Workplace Harassment in Healthcare: Nurses and Peer Review

Workplace Harassment in Healthcare Settings

Nurses experience a wide range of abuses in the workplace, including physical and psychological harassment and physical violence. Patients, patients' families or friends, and coworkers can all precipitate harassment and abuse directed at nurses, with worldwide prevalence rates exceeding 36% for physical violence and 66.9% for nonphysical violence (Spector, Zhou & Che, 2014). Bullying, abuse of power, gender discrimination, sexual harassment, and racial harassment by coworkers and supervisors are also relatively common, creating toxic environments in healthcare organizations (Lee, Bernstein, Lee, et al., 2014). In fact, the majority of violent or abusive acts remain unreported due to the lack of institutional support or formal methods of reporting experiences of violence or harassment by either patients or coworkers (Kvas & Seljak, 2014).

Female and demographic minority nurses are at a much higher risk of being targeted for harassment and abuse (Okechukwu, Souza, Davis, et al., 2013). Incidence rates and types of abuse also vary depending on geographic location and cultural context, with physical violence most common in psychiatric facilities, geriatric facilities, and emergency units in Anglo countries, and nonphysical violence being more common in other healthcare settings and in the Middle East (Spector, Zhou & Che, 2014). Additionally, patients are the cause of physical violence more often in Anglo and European countries than in the Middle East, which sees more incidents of patient- and patient-family-related violent incidents toward nurses (Spector, Zhou & Che, 2014). Identifying at-risk populations and environmental risk factors would therefore help administrators and policymakers prevent abuses and create a culture of safety within healthcare organizations.

Reporting Culture and Institutional Responsibility

The lack of motivation to report a potentially large number of abusive incidents in the workplace suggests a lack of institutional support for nurses who experience violence or harassment from patients, patients' families, or coworkers. When the abuses are caused by supervisors, physicians, or administrators, nurses may be even less likely to report incidents due to fear of losing their job, fear of repercussions such as loss of reputation, or a "belief that reporting it would not change anything" (Kvas & Seljak, 2014, p. 344). Moreover, a perceived lack of institutional support for patients and their families may increase the risk for violent outbursts and aggressive behaviors.

Leadership and organizational culture have a major role to play in preventing workplace abuse at all levels. Healthcare administrators need to provide patients and their families with clear communication and empathetic support to prevent problems from arising, while also empowering nurses to report any instance of abuse or harassment. Likewise, administrators and nurse leaders can put in place systems to prevent violence and abuse, such as practicing team-based care, using CCTV, and ensuring nurses have a means of anonymously or discreetly reporting unwanted or harmful behaviors.

The Importance and Limitations of Peer Review

Peer review is a gold standard in nursing research, viewed as central to the scientific method and critical for offering "trustworthy" material (Nicholas, Watkinson, Jamali, et al., 2015). The process of peer review is relatively straightforward: in order to publish the results of a scientific study, researchers must submit their work to academic journals or professional organizations staffed by experts in the same or a relevant field. Theoretically, a panel of one's peers in the same professional milieu will be able to scrutinize the original research for flaws, errors, biases, and assumptions that threaten the validity, reliability, or ethical standards of the research. Peers may point out weaknesses in the design, methodology, or conclusions, offering suggestions for strengthening future research. The peer review process helps to maintain high standards for academic rigor and professionalism while preventing the proliferation of misinformation.

Unfortunately, the process of peer review is itself potentially flawed and haphazard. The problems with peer review have grown since the advent of open-access and online publications, many of which claim to be peer reviewed but fail to pass muster, as evidenced in numerous studies showing how journals often accept papers with "fatal flaws" (Bohannon, 2013, p. 60). As Sood (2015) points out, peer reviews "egregiously…aren't able to catch simple, common, important errors," and many reviews are clouded by subjectivity and bias (p. 1). The lack of standards in the peer review process hampers the integrity of the nursing profession and reduces the perceived or actual credibility of published studies.

Complicating matters further is the fact that peer reviewing can entail a range of services from copy editing to deeming a study "worthy" of inclusion in a journal or the body of evidence in a field of inquiry (Sood, 2015, p. 2). To streamline and improve the peer review process—while also helping academic journals operate more cost-effectively—it would be wise to separate copy-editing duties from more executive-level decisions, such as determining worthiness or assessing the value of an article based on its potential contribution to the field. Artificial intelligence systems can also be used to catch errors in statistical data analysis.

Determining whether information has been peer reviewed has become more difficult with the abundance of false academic journals that only claim to be peer reviewed (Nicholas, Watkinson, Jamali, et al., 2015). Even the most reputable, established scientific journals have flawed peer review processes and face pressure to accept certain authors for publication without sufficient scrutiny (Bohannon, 2013). The only way to truly determine if an article has been properly peer reviewed is to perform due diligence—such as researching the editors and staff of the journal and following up on the list of peer reviewers mentioned in the publication. It also helps to differentiate between predatory academic journals and credible sources. Just because a journal has a professional-sounding name does not mean that it has established credentials or is staffed and edited by experts in the field. Unfortunately, even credible journals are sometimes forced to use non-expert "peer reviewers" to cut costs or maintain a competitive advantage (Bohannon, 2013).