Violence facing nurses and the threats they pose to autonomy and justice

Nurses experience various types of violence in healthcare. This violence can be perpetrated by doctors, other nurses, patients, and their families, as well as other members of the healthcare team. While traditionally thought of as physical, violence may also be non-physical, that is, verbal, emotional, and psychological in nature. In this paper, we outline three categories of violence experienced by nurses: vertical, lateral, and angular. When violence occurs by someone in a position of authority like physicians, it is vertical, when occurring by someone in an equal position like other nurses, it is lateral, and when violence occurs by someone in an adjacent position like patients, it is angular. Violence may carry violations of autonomy and justice for nurses. Autonomy and justice are two principles of healthcare ethics, which have traditionally been applied primarily to patients. We expand the application of these principles to healthcare workers and highlight how violence obstructs autonomy and justice for nurses. Some instances of violence obstruct autonomy by undermining nurses’ everyday decision-making while aggregate violence obstructs autonomy by causing some to leave the field altogether. Some instances of violence violate justice by undermining nurses’ epistemic capacities while others concern unfairness produced by unjust distributions of resources.