Health and maternity care systems across Australia are facing challenges in ensuring the health, safety, and wellbeing of the nursing and midwifery workforce.
Workforce shortages, an ageing workforce, and challenging working conditions are affecting staff health, safety, and retention.1,2 Workplace violence can arise from complex interactions between patients and families, workers, and healthcare environments, but it should not be accepted as simply ‘part of the job’.3 Prevention requires looking beyond how individual nurses and midwives respond to violent incidents to the organisational conditions that may contribute to, prevent, or mitigate them.
This article examines what recent evidence tells us about workplace violence and aggression and some of the factors that shape risk. It also briefly explores practical strategies nurses, midwives, and their workplaces can use to create safer working environments including an opportunity to participate in and be funded through a national project to support nurses and midwives to lead local projects to address violence and aggression in their workplaces.
Workplace violence and workplace aggression refer to physical or non-physical behaviour in connection with work (eg. at work, or while carrying out work) in which a person is abused, threatened, intimidated or assaulted.4-6 Violence and aggression are closely related but are not necessarily the same. Workplace aggression includes non-physical behaviours such as yelling, swearing and verbal abuse, while workplace violence includes threats of physical assault and physical assault.6 It may be a single or repeated incident, occur in person or through verbal, written or online communication, and be perpetrated by patients, families or visitors, colleagues, managers or others encountered through work.4,5 Research suggests that non-physical aggression occurs more frequently and can precede physical violence; therefore, considering both is important when examining the extent, patterns and circumstances of workplace violence and aggression.6
There is no single explanation for why workplace violence and aggression occur in nursing and midwifery, with incidents shaped by a combination of individual, environmental and organisational factors. A review of 87 studies examining predictors of violence and aggression against nurses and nursing students grouped findings into three broad categories: (1) personal factors, (2) environmental and organisational factors, and (3) characteristics of violence perpetrators.7 Among personal factors, younger nurses, including nurses younger than the patient, appeared to be at greater risk of experiencing violence from patients, family members or visitors.7 Environmental and organisational factors associated with increased risk included scarce resources, such as inadequate staffing and high workload, long waiting times, and a lack of procedures for reporting violence.7 Patient, family member, or visitor factors associated with increased risk included alcohol or drug abuse, altered mental status, and aggressive behaviours.7
Understanding the factors associated with workplace violence is important, but not all risk factors are modifiable. A nurse or midwife cannot change their age, and some patient-related factors may arise from illness, distress or the circumstances in which care is being provided. Other factors, however, provide opportunities for prevention, including staffing and workload, improvements to care delivery and waiting times, reporting processes, communication and organisational responses to violence. It is also important that responsibility for preventing violence does not fall disproportionately on individual nurses and midwives. Education and training have a role to play, with research suggesting workplace violence prevention training can improve healthcare professionals’ confidence.8 Greater confidence, however, does not necessarily mean that workers will experience less violence. A well-trained clinician still works within the staffing, workload, environment, systems and culture of their workplace.
Rather than asking only, “How can we better prepare nurses and midwives to deal with violence?”, workplaces can also ask, “What is happening here that increases the risk of violence, and what can we change?” This creates opportunities for nurses and midwives to investigate their own workplaces and collaboratively test practical changes. Broadly, research examining workplace violence prevention interventions has grouped strategies into five areas: (1) training and education, (2) reporting and documentation, (3) policy and environmental strategies, (4) technology-based strategies, and (5) multi-component approaches.9 Practical examples of how some of these areas could be investigated at the local level are provided below.
| Risk factor identified | What might be worth investigating? | Example research project |
| Younger nurses | Why are younger nurses at higher risk for violence? Are appropriate and effective measures to protect them in place? | Explore younger nurses’ experiences of violence and aggression and identify what workplace supports exist and those they believe would reduce risk. |
| Inadequate staffing | Do incidents cluster during periods of lower staffing or higher workload? | Compare incident reports with staffing and workload data to identify higher-risk periods and wider evidence to inform potential changes. |
| Patient factors (eg. dementia, delirium, alcohol/drug use) | Are risks identified early and communicated between staff? Are risk screens completed and treatment initiated? Is current care best practice? | Audit violence/aggression risk identification, screening, and documentation, then work with staff to improve local processes. |
| Policies/ procedures | Do existing measures actually work in practice? | Work with your team to understand which violence-prevention controls are used, bypassed, ineffective, or needed, then collaboratively develop and evaluate improvements. |
If some of these ideas resonate with challenges in your workplace, there will soon be an opportunity to turn them into action. In 2027, the OWL-WELL project will launch a free action research and implementation training course to support nurses and midwives to develop and undertake small, local projects addressing health, safety and wellbeing challenges at work. Whether the issue is workplace violence or another challenge affecting your team, the course will provide practical research training and support to help you investigate the problem, identify opportunities for change and evaluate what works in your local context.
If you are interested in the free training course, please complete an expression of interest form online and we will contact you early next year with further information: https://forms.cloud.microsoft/r/DFZiWMVtDu
This online article forms part of the broader ‘OWL-WELL’ project, led by Associate Professor Micah Peters PhD from Adelaide University’s Rosemary Bryant AO Research Centre and the ANMF National Research and Policy Unit (Federal Office).
This project is supported by a grant from the Teachers Health Foundation.
References
- World Health Organization. (2026, August 11). Nursing and midwifery. Retrieved September 7, 2026, from https://www.who.int/news-room/fact-sheets/detail/nursing-and-midwifery
- Safe Work Australia. (2025, May). WHS Trade Profile – Nursing, Care and Support Workforce. Retrieved September 7, 2026, from https://data.safeworkaustralia.gov.au/sites/default/files/2025-05/Nursing_care_support_workforce_WHS_profile_May2025.pdf
- Safe Work Australia. (n.d.). Psychosocial hazards. Retrieved September 7, 2026, from https://www.safeworkaustralia.gov.au/book/health-care-and-social-assistance/hazards-risks-and-controls/psychosocial-hazards
- Safe Work Australia. (n.d.). Workplace violence and aggression – Overview. Retrieved September 7, 2026, from https://www.safeworkaustralia.gov.au/safety-topic/hazards/workplace-violence-and-aggression/overview
- The Australian Health Practitioner Regulation Agency [AHPRA]. (2023, July 18). Workplace violence and aggression policy. Retrieved September 7, 2026, from https://www.ahpra.gov.au/search.aspx?query=workplace%20violence%20and%20aggression%20policy
- LeBlanc, M. M., & Kelloway, E. K. (2002). Predictors and outcomes of workplace violence and aggression. Journal of Applied Psychology, 87(3), 444. https://doi.org/10.1037/0021-9010.87.3.444
- Pagnucci, N., Ottonello, G., Capponi, D., Catania, G., Zanini, M., Aleo, G., Timmins, F., Sasso, L., & Bagnasco, A. (2022). Predictors of events of violence or aggression against nurses in the workplace: A scoping review. Journal of Nursing Management, 30(6), 1724–1749. https://doi.org/10.1111/jonm.13635
- Chung, Y. F., Chang, Y. C., Fetzer, S. J., Tessmer, L., Tsai, M. H., & Feng, J. Y. (2025). The Effectiveness of Workplace Violence Prevention Education Training Programs on Healthcare Professionals’ Confidence: A Systematic Review and Meta‐Analysis. International Nursing Review, 72(4), e70107. https://doi.org/10.1111/inr.70107
- Fatai, A., Sattayarom, C., & Butdee, S. (2026). Effectiveness of Interventions to Reduce Workplace Violence Against Nurses by Patients and Visitors: A Systematic Review. Western Journal of Nursing Research, 48(7), 795–802. https://doi.org/10.1177/01939459261442054
