Violence pushes psychiatric nurses out through the climate of the ward
- A cross-sectional survey of 1,337 psychiatric nurses across China (valid questionnaires out of 1,485 distributed in September and October 2024) linked workplace violence to the intention to leave the job.
- Ward atmosphere correlated with turnover intention at r = -0.423, with social distance from patients at r = -0.340 and with workplace violence at r = -0.307.
- Workplace violence had a direct effect on turnover intention (β = 0.181, p < 0.001) and an indirect effect of 0.259 (95% CI 0.207–0.313) through ward atmosphere and social distance, 58.863% of the total effect.
- The path through ward atmosphere alone accounted for 52.727% of the total effect (β = 0.232); the path through social distance alone was β = 0.010, and the serial path through both β = 0.017.
On many psychiatric wards, assault by a patient is treated as an occupational hazard with a protocol attached: restraint training, alarms, an extra pair of hands at night. A team from Central South University in Changsha looked at the route by which violence turns into a nurse's wish to quit.
A national sample of ward nurses
The questionnaire went out over WeChat via the Mental Psychological Care Alliance. Of 1,485 forms, 1,460 came back and 1,337 were valid. Respondents averaged 34.9 years of age and 12.88 years in nursing; 84.8% were women, 68.9% worked in tertiary hospitals and 62.7% were on contracts without a permanent post. Training was close to universal: 94.9% had been taught violence prevention and 98.7% protective restraint.
Violence over the past year was rated on Wang's five-item scale, ward climate on the Chinese EssenCES (patient cohesion, experienced safety, therapeutic hold), reluctance to engage with psychiatric patients on Link's Social Distance Scale, and the wish to leave on one five-point item. Violence showed a direct path to that wish, β = 0.181. The two mediators together carried 58.863% of the total effect, and the climate alone carried 52.727%. The route through social distance was small: β = 0.010 on its own, β = 0.017 in series with climate.
The ward as the unit of retention
My reading is that an assault costs a ward its nurses mainly through what happens to the ward afterwards. Cohesion among patients thins, the place feels less safe, the therapeutic frame weakens, and the nurse begins to measure the job by that atmosphere. Protocols deal with the incident itself. In this sample nearly everyone had the training, and the climate still accounted for more than half of the link.
For a psychologist on an inpatient unit, this is workable ground: a team debrief after every assault, community meetings that resume within days, and a regular check on how cohesive and safe the ward feels, kept next to the incident log.
More than half of the link between violence and a nurse's wish to leave ran through the climate of the ward, in a sample where almost everyone had already been trained in violence prevention.
The design is cross-sectional, so the paths are associations from one survey wave. Turnover intention was measured with a single item, and all data are self-report.