Mental Injury: Exploring the Factors Related to Abusive Behavior Among Health Professionals

Friday, 28 July 2017

Leah Phillips, PhD, MA
School of Public Health, University of Alberta, Edmonton, AB, Canada


In Canada, Licensed Practical Nurses (LPNs) are a self - regulated profession; they are accountable to the public, the profession, to other members of the healthcare team, and to their employers. LPNs work as part of health care teams that include Registered Nurses, Physicians, Allied Health Professionals, and unregulated care providers.

“Mental injury (or mental suffering) is harm to a person(s) for which some other person(s) is held responsible in whole or in part. It can take the form of either mental distress or mental illness. Mental injury results from negligent, reckless or intentional acts, or omissions” (Samra, 2009). First recognized by Roberts in 1983, and subsequently studied by many nursing researchers, mental injury caused by bullying and lateral violence are harmful pervasive practices in healthcare work places (Croft and Cash, 2012). Research demonstrates that the effects of psychological hazards on the mental health of nurses can significantly affect their ability to perform their work in a safe manner. Performing professional practice while mentally injured on the job threatens public safety therefore making this an important and serious issue. This study aims to understand the complex nature of workplace mental injury for Licensed Practical Nurses (LPNs) in Alberta Canada.

Methods: Cross sectional descriptive.

The College of Licensed Practical Nurses of Alberta, the regulatory college responsible for licensing LPNs in Alberta, conducted a cross sectional study to investigate the incidence of mental injury due to bullying, (hierarchal and lateral) perceived by LPNs in Alberta. The study also aimed to understand what factors (organization, personal, or environmental) contributed to these perceptions and how these factors were associated with increased risks of mental injury.


The survey was sent out to approximately, nine-thousand six hundred practicing LPNs. One thousand eighty-six (n=1086) LPN completed the survey (8.4%). The results indicated the following:

  •  70% experienced intimidation and other forms of abuse behavior as students (by practicing nurses, instructors, other team members and preceptors).
  • 89.7% witnessed abusive behavior among nursing colleagues (24.7% witnessed the behavior within the last shift cycle worked).
  • 85.1% experienced abusive behavior from another nurse (LPN, RN and RPN).
  • 14.6% experienced abusive behavior within the last shift cycle worked.
  • 80% experienced abusive behavior from health professionals outside of their nursing peers including immediate supervisor, physicians, healthcare aides and other professionals.
  • 60% did not report the abuse due to feeling nothing would happen/change anyway, fear of retaliation, the abuser was the supervisor
  • When asked if they believed their work setting tolerated abusive behavior among colleagues, 62% said “yes”.


 Although these results are partially affected by selection bias, (the likelihood of responding is higher if one has experienced the phenomena) the survey clearly demonstrates that perceived abusive behavior is prevalent. When abusive behavior is perceived among co-workers it can create a toxic work environment with significant consequences to the organization. The overall ‘health’ of the organization is affected. An ‘unhealthy’ workplace can have many effects. According to the Canadian Centre for Occupational Health and Safety, these effects include:

  • Decreased morale
  • Decreased job satisfaction
  • Decreased productivity and motivation, which may, in turn, lead to
  • Increased absenteeism and presenteeism
  • Increased turnover
  • Increased retention and recruitment issues
  • Increased costs for recruitment, employee assistance programs, disability, etc.
  • Increased risk for accidents / incidents and patient adverse events

The nursing workforce in Canada is under threat due to increased demand for care and too little human resources to meet that demand. Changing population dynamics mean that more people will require nursing care in multiple care settings and at multiple levels of care. This issue is integral to health human resource planning as nurses represent the largest profession in healthcare. Previous research demonstrated that one in three nurses plans to leave his or her position because of co-worker abuse (McMillan, 1995). Approximately 60 per cent of newly graduated nurses leave their first position within six months because of horizontal violence (Griffin, 2004) and some decide to leave the profession altogether (McKenna, 2003).

This study and its results reflect a need for concerted efforts to begin a dialogue about abusive behavior in the workplace. Nursing leaders concerned about this issue can strive to work collaboratively in a shared commitment to address the issue of co-worker abuse. Nursing regulators can work towards supporting the ability of regulated members to meet the professional standards of practice within the work setting. Engaging with employers is key. Collaborative efforts are needed to make the necessary changes to prevent the negative consequences of workplace mental injury.