Workplace Violence, Self-Perceived Resilience and Associations with Turnover Intention Among Emergency Department Nurses: A Cross-Sectional Study.

Background/

Objectives

Workplace violence remains an important vocational psycho-social risk for nurses employed in the emergency department (ED). We investigated the characteristics of workplace violence against ED nurses, and associations with self-assessed resilience, socio-demographic and vocational parameters, including turnover intention.

Methods

ED nurses employed in all public hospitals in the Republic of Cyprus (RC) participated. After obtaining informed consent, data were collected using census sampling (January-June 2024) via the translated 2016 Italian National Survey on Violence towards Emergency Nurses Questionnaire (QuINVIP16) for investigating workplace violence characteristics, and the Connor-Davidson Resilience Scale (CD-RISC-25) for assessing self-perceived resilience.

Results

A total of 132 nurses (53.0% response rate) participated. Verbal violence was reported by 70.5% to 92.4% of participants. Long waiting times, overcrowded EDs, and perception of inadequate attention from healthcare professionals were reported as the primary triggers for violence towards participants by patients/visitors. One-third of participants reported that violence-reporting systems were unclear, while 1 out of 4 reported inadequate safety measures against violence. Participants with higher scores of self-perceived resilience were less likely to report turnover intention due to workplace violence (p < 0.001), while those with lower self-perceived resilience reported a significant decrease in work motivation (p = 0.005). Those who experienced decreased work motivation after exposure to a violent episode were more likely to consider a) leaving the profession [OR (95%CI): 79.1(17.7-353.2); p < 0.01], and b) moving to a different work setting [OR (95%CI): 17.0(3.8-76.2); p < 0.01], and actually applying to be transferred to a different work setting [OR (95%CI): 19.6(4.2-91.5); p < 0.01]. Moreover, those who had not attended communication skills training were 4 times more likely to consider leaving the profession following exposure to violence [OR (95%CI): 4.2(1.1-16.2); p = 0.04].

Conclusions

This study is among the few to link workplace violence with both resilience and actual turnover behaviors among emergency nurses, in general and particularly in the post-pandemic era. By showing how personal resilience in the face of violence is shaped by organizational support, such as reporting systems and training, the present findings move beyond individuals-level explanations, and highlight workplace violence as a systematic administrative challenge. This insight represents an important advance in current knowledge, and calls for multifaceted interventions that strengthen both personal and institutional capacity to address violence.