Impact of medical center complexity on Veterans Health Administration nursing staff incidence rates for reported assaults

OBJECTIVE: Ascertain whether Veterans Health Administration administrative medical center complexity ratings could be used to help identify potential sites for targeted nursing staff workplace violence intervention activities. PARTICIPANTS: VHA field nursing staff, classified among the nurse, practical nurse, and nursing assistant series, who administratively reported a grand total of 9,964 occupational assault incidents that occurred between October 1, 2003 and September 30, 2011. METHODS: Outcome measures were population-based standardized assault incidence rates, as differentiated by fiscal year, medical facility complexity level, gender, and nursing staff occupation. Subgroup measures included age, highest educational attainment level, location of injury, body part most affected, day of week, and time of day. RESULTS: Across eight fiscal years, standardized incidence rates for reported assaults among females were 6.0 and 2.3 times higher for nursing assistants and practical nurses, respectively, as compared with nurses; for males, the corresponding rates for nursing assistants and practical nurses were 3.5 and 1.5 times higher, respectively. Across occupation and gender, standardized incidence rates for assaults were consistently higher among medium- and low-level facility complexity levels. Findings suggest that more attention is needed for ascertaining the potential role and functioning of facility-specific staff training for preventing assaultive behavior on VHA nursing staff.