The prevalence of verbal aggression against nurses I t has been suggested that verbal aggression is a common form of communication, accounting for a significant proportion of the violence and aggression that occurs in the nursing workplace (Health Service Executive (HSE), 2004; Farrell, 1997; 2001; Farrel et al, 2006; Health Service Advisory Committee (HSAC), 1997; Wells and Bowers, 2002; Brennan, 2003; Mckenna et al, 2003; Curtis et al, 2006; Royal College of Nursing (RCN), 2006; Foster et al, 2007). Coombes (1999) suggested that being a nurse in some areas is riskier than being a nightclub bouncer. The problem of verbal aggression has been repeatedly highlighted within the international literature on violence in health-care (Cox, 1991; Braun et al, 1991; Diaz and McMillin, 1991; Wondrak and Nolan, 1992; Zigrossi, 1992; Griffin, 2004; Celik and Bayraktar, 2004; Joubert et al, 2005; Oweis et al, 2005; Yusuf et al, 2006; Bowers et al, 2007; Wells and Bowers, 2002; National Audit Office (NAO), 2003; Lanza et al, 2006; Inoue et al, 2006; RCN, 2006; Abderhalden et al, 2007; Ferns and Meerabeau, 2007; Foster et al, 2007). It is well documented internationally that verbal aggression precedes and usually accompanies physical aggression and that it is often under-reported and perceived as ‘part of the job’. However it has also been shown to have, for some, greater psychological consequences than physical aggression (Adams and Whittington, 1995; Walsh and Clarke, 2003). Despite the growing interest in this problem from both a research and policy perspective, health-care professionals continue to have a limited understanding of all of the details and consequences of verbal aggression, and know even less about what they need to do, or can do, about it. Bowers (1999) suggested that a lack of attention has been paid to the finer details of verbal aggression due to the tendency of researchers to study this within the broader concept of violence and aggression. This remains the case within most of the literature. The purpose of this review is to identify and draw together findings from studies that have paid special attention to verbal aggression in nursing, separately from the study of physical violence and aggression. This information is urgently needed so that health-care professionals can begin to address the problem in a proportionate manner. Methods A structured literature review was undertaken by the authors. They did not adopt the principles of systematic Sue McLaughlin, Lyn Gorley, Laurence Moseley reviewing in full, for doing so would have meant that few of the articles would have been included. However, the authors believe that the work done in the past is useful, and wished to use what can be salvaged from it. Because of this, the authors consciously called their research a structured literature review. Literature searches were conducted in CINAHL, Proquest, PsychINFO and MEDLINE. The literature search was undertaken during the period June–Dec 2008. The search terms were chosen as they were identified as those commonly used within the violence and aggression literature: Verbal aggression and nursing Verbal abuse and nurses Workplace conflict and nurses A total of 392 hits were retrieved and individually scanned for possible relevance. From the abstracts, 73 were considered relevant and the full text of those 73 were obtained. Some of the articles included the term verbal ■ ■ ■ British Journal of Nursing, 2009,Vol 18, No 12 735 Sue McLaughlin is Senior Lecturer at Thames Valley University, Slough; Lyn Gorley is Learning Community Education Advisor at Thames Valley University, Slough; Laurence Moseley is Emeritus Professor of Health Services Research at the University of Glamorgan Accepted for publication: June2009 Abstract There have been many anecdotal and press reports of verbal aggression against nurses. The authors undertook a structured review of the published literature on the topic. They found that no consistent definitions or time periods had been used, a consistent estimate of prevalence was impossible to establish, studies had been retrospective, and the commonest form of measurement had been self-report. There had been no culmination of replicable knowledge. The claim of most studies is that verbal aggression is commonplace in nursing. The best available evidence suggests that verbal aggression is often viewed as ‘part of the job’. Consequences can range from emotional effects such as anger and humiliation, through to intent to leave the profession and for some it may have a negative psychological impact. Further research is needed to investigate the multi-faceted nature of verbal aggression. This must be guided by clear definitions and incorporate standardized measures of the effects of verbal aggression so that nurses can compare findings and fully understand all of the complexities and consequences. Key words: Literature review n Nursing n Verbal aggression WORKING CONDITIONS