Nurse managers in a Victorian aged-care study described workplace violence as daily and part of the job. Nurses and personal care assistants described serious physical violence daily. Across the interviews, participants unanimously reported stress and fatigue after workplace violence and negative effects on their mental health. Every participant also discussed under-resourcing, while managers, nurses and personal care assistants described understaffing and difficulty providing consistently high-quality care.
A routine exposure, hard to report
Violence was part of a broader daily workload. Job demands and negative work events were reported as occurring every day for nurse managers, nurses and personal care assistants. The authors associated heavy workloads and inadequate staffing with mental-health challenges, presenting that link as an association rather than a quantified effect.
Managers said many incidents were under-reported because workers lacked time to report every episode. Nurses and personal care assistants also appeared to rely on their own personal resources amid perceived lack of management support and poorly enacted anti-violence human-resources practices.
A system that can normalise violence
The paper’s abstract reports limited perceived formal and informal management support, along with evidence of what it calls symbolic violence by senior management. The authors describe that pattern through budget constraints and service targets taking priority over staff safety, incidents being minimised as part of the job, reports being discouraged, post-incident psychological support being absent and a culture of silence.
The authors say these practices create a workplace where violence is tolerated and normalised in everyday work. They also report no management support for nurses and personal care assistants against workplace violence or for implementing anti-violence human-resources practices.
All nurse managers said their concern after incidents was to keep staff working. Their own mental health was described as affected by stress, burnout and anxiety. The discussion says workplace violence affected all 60 interviewed participants, with different impacts for managers compared with nurses and personal care assistants.
The toll went beyond the incident
Workers described feeling panicky, scared, frightened and anxious when recounting workplace violence. Participants also reported negative feelings that left them wanting to resign, and all expressed concern about withdrawing compassion from residents.
The authors report some evidence of a possible relationship between these experiences and an intention to leave aged-care facilities. They do not present a proportion of workers planning to leave.
What the study captured
The researchers used a qualitative case-study approach with in-depth interviews. Participants were recruited through the Australian Nursing and Midwifery Federation and came from public, private and not-for-profit facilities across metropolitan, regional and rural Victoria.
The methodology reports 60 participants: 10 nurse managers and 50 nurses or personal care assistants. Those 50 workers included 13 registered nurses, 14 enrolled endorsed nurses, 10 enrolled nurses and 13 personal care assistants.
Interviews lasted 50 to 60 minutes and were held in person or by telephone. Researchers used NVivo-assisted thematic analysis to identify recurring patterns, while two coders reviewed the final coding framework and interview analyses. Repeated stories and the absence of new themes were used to judge that the data had reached saturation.
The paper contains an internal counting inconsistency. Its methodology reports 60 participants, but the abstract describes narratives from 50, while Table 1 contains a conflicting nurse-manager total of 50. The detailed role breakdown totals 50 workers alongside the 10 managers.
A warning, not a population measure
Because this was a qualitative interview study, the findings describe participants’ experiences and perceived workplace practices; they do not establish that workplace violence caused mental-health problems or provide a sector-wide rate. Non-ANMF members were not included as a comparison group, so the study cannot determine whether the reported experiences were unique to aged care.
The study also was not designed to compare public, private and not-for-profit facilities. The authors recommend stronger human-resources engagement, post-incident debriefing and counselling, management interventions, anti-violence training and security measures. Those proposals arose from the interviews; the study did not test whether they improve outcomes.
Paper data and sources
Original title: Nurse managers and workplace violence: the mental health and well-being of nurses and personal care assistants in aged care
Authors: Cavanagh J, Bartram T, Pariona-Cabrera P
Journal/Repository: Journal of health organization and management
Status: Peer-reviewed
First online: 2026-08-19
DOI: Not available
Original paper · Full text