Workload, sacrificed quality of care work, and workplace violence among nurses. A work environment perspective

Background : Workload and time pressure increase the risk of patient-initiated workplace violence. However, the mechanism through which workload influences workplace violence remains unclear. Moreover, understanding the interactions between workload and the work environment related factors is important to implement preventive measures.Objective : This study aimed to explore the relationship between workload and workplace violence by patient. In particular, we examined the mediating role of sacrificed quality of care work in this relationship. In addition, we sought to determine whether organizational resources (instrumental resources, autonomy, supervisor support and colleagues support) moderated the risk of exposure to workplace violence.Design: A secondary analysis of cross-sectional French survey data was conducted.Participants: The sample consisted of 1,329 nurses working in French hospitals.Methods: A hierarchical modeling approach and a mediation analysis were conducted to assess how workload affects the risk of workplace violence. Further, moderation analyses were conducted to assess the moderating effects of organizational resources. Finally, the data were analyzed using moderated mediation regressions with the PROCESS macro on SAS.Results: Our findings confirmed that workload was positively related to workplace violence. Our study extended previous research by examining how workload relates to workplace violence. Sacrificed quality of care work fully mediated this relationship. Several organizational resources moderated the indirect relationship between workload and workplace violence through sacrificed quality of care work. In poor work environments, high workload was more strongly related to a decline in the quality of care provided, and subsequently to workplace violence.Conclusions: This study supports the work environment hypothesis, showing that poor and stressful work environments provide fertile ground for patients’ aggressive behaviors. High workload clearly increases the risk of workplace violence. One of the originalities of this article is to documented that this effect can be largely attributed to a decline in the quality of care provided by nurses when they face high workloads and time pressure. Nevertheless, instrumental resources, job autonomy and supervisor support appeared to be viable protective factors.