(Re)Thinking Violence in Health Care Settings: A Critical Approach. 3rded (review)

During the past decade, workplace violence has emerged as a major public policy priority. While workers have always confronted violence on the job, through physical assaults, harassment, harmful exposures, and accidents, the concept of “work-place violence” as a discrete problem and body of knowledge did not exist until the late 1980s, after several well-publicized shootings at US workplaces prompted a wave of anxiety. Now concerns about violence at work are being reflected in Canadian public policy, most recently Ontario’s Bill 168, a 2009 statute that requires employers to assess the risk of violence in their workplaces and develop appropriate policies. Since the 1980s, policy about workplace violence has gone from non-existent to burgeoning efforts to respond to a perceived “epidemic” backed by a new “industry in workplace violence prevention” (p. 73) composed of specialists and consultants.

But what do we actually know about workplace violence? Have experts and policy-makers defined violence correctly? Are workplace policies actually protecting workers, or do they hinder while achieving no real increase in workers’ safety? These foundational questions inform (Re)Thinking Violence in Health Care Settings, an edited collection of articles that belongs on any list of essential books on the subject of violence at work.

While most of the literature in this field has been written by psychologists and management theorists, this volume’s editors, David Holmes and Amélie Perron of the University of Ottawa, and Trudy Rudge of the University of Sydney, are scholars of nursing and public health. Both Perron and Rudge are registered nurses. The perspective thus provided avoids the traditional research priorities of identifying possible offenders and mitigating risk; instead, it proceeds from an understanding of the everyday work and caring done by nurses, combined with the critical approaches of Foucault, Goffman, Žižek, and others.

Violence in the health care sector is “omnipresent and often subtle” (p. 1), a diagnosis that would serve for all work under capitalism. While most policy and literature on violence and health work considers only violence directed by patients toward workers, (Re)Thinking Violence in Health Care Settings explores “how violence is also directed by employers and health care providers against both patients and health care providers themselves” (p. 1). The volume considers structural and institutional violence, which allows for an understanding of violence as more than just an individual transgression, but something that flows from the practices and policies of facilities and employers.

The book is divided into three sections. The first section considers institutional and managerial violence directed toward workers; the second, horizontal violence between workers; the third, patients’ violence.

Crucially, the editors themselves refuse to put forth a single definition of workplace violence. Instead, they favour an open-minded and questioning approach that allows a broad consideration of the “chameleon-like” (p. 7) characteristics of this multifaceted phenomenon. The contributors’ willingness to interrogate the definitions of violence and consider the multiple directions in which violence travels is one of the book’s major contributions. For example, Penny Powers’s analysis of the discourse of hospital policies regarding violence reveals that these policies are informed by the business language of risk assessment and management, rather than concerns for the health of nurses and patients or values of care. Violence is no longer defined by the individuals involved, consensus, legal precedent, or social context, but by policies created by consultants and hospital administrators, with little input from nurses.

The result is a bureaucratic system that contains many protocols for reporting incidents but little or no guidance to nurses on how to defend themselves during a violent incident, leading to an environment offering little support beyond “fend for yourself then fill out the forms” (p. 83). Powers also criticizes British Columbia’s Workplace Health Indicator Tracking and Evaluation system for monitoring employees affected by violence from a purely managerial perspective, gathering knowledge on workers while...