Open research questions in Workplace Violence and Bullying

What the literature leaves open

• Future research should examine leadership strain and implementation challenges across multiple ACT programs and organizational contexts to better assess the consis- tency of these findings. Burnout among health care profes- sionals: A call to explore and address this underrecognized threat to safe, high-quality care.

  Leadership strain and role ambiguity in assertive community treatment teams and their association with workforce functioning · 2026 · DOI

• • There needs to be comprehensive communication around BWC, including training, adoption, and psychological safety. • People who talk positively about BWCs should be invited to workshops, in particular, where there is a negative view. • • Internal communication with frontline staff could be made more innovative, acknowledging they are time-poor and reading their emails is challenging. Innovation could mean using communication channels, such as radios, in the ambulance to remind frontline staff to use BWCs. Internal communication needs to be strengthened to mitigate the organisational culture of mistrust. Clear communication of the ‘Operating procedure’ with an emphasis on the usage of footage can be the first step, followed by team and supervisory discussions. Having the opportunity for questions and answers could settle staff doubts about the usage of footage, particularly when they contact aggressive patients. • For external purposes, if funding allows, a commercial media campaign could be an effective approach to reach the public, including advocacy through social media. • Communication should be focused on engaging people, which can be reached by sending regular messages to ‘Champions’ with the proportion who have done the training, motivating others to do the training too, and information about how the stations are meeting Evaluation of the NSW Ambulance Body-Worn Camera Trial | 2023 Regional Work and Organisational Resilience Research Group Page 75 of 108 their KPIs. Furthermore, having trainers and managers visit the stations to answer questions is a powerful face-to-face interaction to reach staff and promote engagement. • Senior managers need to be enthusiastically on board, be able to pull out statistics and talk about OV, their concerns, and possible alternatives. • Pushbacks may arise when communication is confusing, for example, when the unclear distinction is made between the optional and mandatory sign-out of BWCs. Therefore, clear communication and guidance are needed in the training around policy as BWCs can only be used under certain circumstances, and some staff members are hesitant about whether a situation is ‘aggressive enough’ to turn their BWCs on and how to justify it. A better understanding of the processes and the accountabilities of the process may increase BWC uptake. • Staff feedback helps to better understand communication preferences as NSWA has a diverse workforce. Communication style and how staff like to engage exceeds the one-sizefits-all approach. Before a statewide rollout, a targeted understanding of communication preferences would be beneficial. 3.6.

  Paramedics are facing more danger on the job. Here’s how to protect them · 2026 · DOI

• Given the complex nature of the program, a robust formal training package is needed for an effective statewide BWC implementation. Such a training package should contain the following features: • It should start from the beginning of employment at NSWA and must be continuing through a paramedic’s progression. BWC training should be offered as a recurring course that staff must do periodically instead of a one-off. Short follow-up refresher training could help staff maintain their BWC and OV-related skills and refresh them if they did the initial training long ago. • If BWCs are to be rolled out more generally to all stations, then training should be compulsory (e.g., basic training) with some voluntary elements (e.g., advanced training) to provide staff with options. • Training can be provided by paramedics who are project officers with subject matter expertise and does not need to be delivered by technical specialists. Evaluation of the NSW Ambulance Body-Worn Camera Trial | 2023 Regional Work and Organisational Resilience Research Group Page 71 of 108 • Emerging knowledge gaps signal that the organisation must take a more supportive approach towards frontline workers in OV matters. For example, it is challenging for staff to remember how to turn on a BWC in an unsafe situation; it takes a long time to build ‘muscle memory’ around activating a BWC automatically while processing a difficult situation. Therefore, BWC training should be embedded in general soft skill training focusing on OV, such as risk management, situational awareness, conflict resolution and de-escalation, and strategies for managing and reaching a better understanding of OV. • There is a need for a comprehensive approach to BWCs as they are not a ‘silver bullet’ able to fully prevent OV. BWC training therefore should be combined with clear internal communication and revisions of incident reporting. BWC training can also be integrated into existing training programs, such as leadership training and soft skills development (e.g., communication training). BWCs are then used as a backup. • Connecting in practical-oriented face-to-face training with one-on-one or small groups of people is better retained than online learning modules, in particular, to develop situational awareness of risky situations. Such difficult situations need a ‘gut instinct’ that develops over time and cannot be learned from books. • Frontline staff should increasingly get dedicated time to do training, check out BWCs and categorise captured footage instead of relying on staff putting in their own time, which is occasionally done. Online learning modules make sense for busy staff, however, managers should allow frontline staff to participate in practical face-to-face training, such as simulations, which should be organised when there is a reasonable number of staff at the station to prevent having a trainer at a location with no one to talk to. • Alternative training methods, such as scenario-based work, roleplay and storytelling, and peer-to-peer training, allow consolidation of theoretical and technical knowledge and reinforce skills. There is much information, and a two-part session, including theory and practice, may be beneficial. • Station-based managers should encourage frontline paramedics to do their training. A training report allows for mapping out training needs, and people, who according to the database need to do the training, can be approached. 3.5.4.

  Paramedics are facing more danger on the job. Here’s how to protect them · 2026 · DOI

• • • In addition to training, technical support and problem-solving assistance with the device should be provided. It should be made clear that much nuance and context are lost in BWC recordings. Evaluation of the NSW Ambulance Body-Worn Camera Trial | 2023 Regional Work and Organisational Resilience Research Group Page 62 of 108 • Appropriate wireless or satellite technology could be used for direct uploads of the recording to the cloud to prevent the loss of footage. • NSWA should explore options for BWCs to be a standard item in ambulance equipment, with information collation linked to ambulance identifiers rather than individual officers. This may require reviewing legislative provisions surrounding individual recording processes and privacy. • NSWA should review their technical specifications in any procurement documents to ensure that the technical issues raised by paramedics are addressed in any service-wide implementation program. 3.5. Organisational approach to introducing BWCs 3.5.1.

  Paramedics are facing more danger on the job. Here’s how to protect them · 2026 · DOI

• Excessive cognitive load, decision fatigue, and the related psychological strain could be minimised by mandating the use of BWCs by all staff. However, developing a roll-out strategy with clear communication and training support will be important to minimise the impact on team dynamics and patient relations. 3.4. Paramedic perceptions of BWCs’ impacts on work practices 3.4.1.

  Paramedics are facing more danger on the job. Here’s how to protect them · 2026 · DOI

• BWCs must be seen as just one element in a range of strategies to address OV towards paramedics. BWCs must be seen as just one element in various strategies to address burnout and emotional exhaustion among paramedics. NSWA needs to encourage a culture of change that supports consistent reporting of OV incidents across stations. This must be communicated consistently from all levels of management across the organisation. Evaluation of the NSW Ambulance Body-Worn Camera Trial | 2023 Regional Work and Organisational Resilience Research Group Page 6 of 108 A future BWC program needs to acknowledge that there is a spectrum of experienced OV, and staff need support to identify a low-threshold level of OV that should trigger the activation of BWCs. Staff training in BWC use should be tailored to the needs of particular cohorts, recognising the skills and autonomy of experienced staff and sharing their knowledge with less experienced staff. BWC training needs to be embedded in broader OV management training that includes situational awareness, risk management strategies, conflict management and de-escalation strategies. Training should also address muscle memory and practical training. Excessive cognitive load, decision fatigue, and the related psychological strain could be minimised by mandating the use of BWCs by all staff. However, developing a roll-out strategy with clear communication and training support will be important to minimise the impact on team dynamics and patient relations. The range of technical and practical challenges to using BWCs should be addressed before any large-scale roll-out and in the contract specifications for the supply of future BWCs. NSWA should explore options for BWCs to be a standard item included in ambulance equipment, with information collation linked to ambulance identifiers rather than individual officers. This may require reviewing legislative provisions surrounding individual recording processes and privacy. A broader roll-out to all stations should also be supported with a communication strategy aimed at stakeholders in the public to raise awareness of why BWCs are necessary. This could be combined with existing communication strategies designed to remind the public that paramedics deserve their respect and support and are there to support the community. The use of high-quality data is critical to gain an accurate insight into the benefits of the BWC program, and thus, it would be desirable for NSWA to collect more data over a longer period to allow for a more comprehensive study. This report does not consider intangible costs such as fatigue, stress, and burnout. The exclusion of these costs may underestimate the actual costs or benefits of the BWCs program, which raises opportunities for further research into these areas. NSWA could work with other government agencies to identify potential economies of scale and cost savings related to BWC technology.

  Paramedics are facing more danger on the job. Here’s how to protect them · 2026 · DOI

• In addition, future studies could explore teachers’ responses and coping strategies in relation to the violence they experience. Further research on violence perceived and experienced by teachers could be advanced by examining the multifaceted impact of violence on teachers’ professional and personal lives, including its implications for their personal development and change.

  Subjective Perception of Violence: How Teachers Understand Violence Against Them · 2026 · DOI

• The low number of study participants is a limitation to this study. We would have wished to include more informants in our study, but despite efforts, recruitment proved difficult. All individuals fulfilling inclusion criteria were informed about the study, and invited to participate, on several occasions. Possible reasons for the reluctance to participate include a high workload among unit staff, and fatigue associated with continuous development work in the units. However, it must also be considered that staff members who were critical to the intervention might have been reluctant to volunteer. It is a strength of the study that those who did volunteer to be interviewed contributed generously with different perspectives which point towards our results being of value. However, despite any objections they had, all of them displayed a positive attitude to the intervention as a whole. It is possible that the inclusion of a greater number of respondents would have resulted in a wider representation of viewpoints, includ- ing more negative views of the ethicality of structural violence risk screening. Possibly, staff members with more negative views could also have different perceptions on, for instance, which interests that are at stake, or how they should ideally be balanced. These aspects makes it important to read the results with a certain caution, and it calls for further studies of this aspect of violence risk screening. However, even though more participants with a potentially wider representation of views on ethicality could have made for a broader and perhaps more nuanced analysis, we still believe that the analysis as it stands highlights central aspects of how psychiatric staff may perceive the ethicality of violence risk assessment. This study con- cerned the ethicality of violence risk screening as perceived by intervention developers and staff members in acute psychiatry settings. It says nothing about either its effectiveness or attitudes towards such interventions among patients. Future research could look at screening results, outcomes, and patient experiences. decided in a process of complex balancing of interests, weighing against each other individual and collective interests, as well as conflicting interests of the individual patient. However, the problems staff members recognized suggest that the ethical acceptability of structured violence risk screenings can be enhanced both by a wide dissemination throughout the organization of knowledge on how to interpret screening results, and by the provision of clear guidelines on how they should shape the management of violence risk.

  Ethicality forms a challenge in the implementation of structured violence risk screening: a qualitative study of an intervention in two Swedish emergency psychiatric units · 2026 · DOI

• The current study was designed to uncover experiences with workplace bullying and factors that impacted decisions about reporting bullying among GTAs from one US university. Future research should include GTAs from multiple institutions to further examine how individual and institutional characteristics might influence experiences with bullying and decisions about reporting bullying experiences. For example, international student status arose as a possible contributor to bullying experiences in our data, but because the current study was not designed specifically to explore the impact of international student status, future research should explore this topic more intentionally and in greater detail. The interview questions used in the current study were not designed to inquire about perceptions of departmental or university climate, yet this arose as a theme in responses. Future studies should consider exploring organizational climate at multiple levels (e.g., program, department, university) to make connections between perceived climate and reporting dynamics. Additionally, GTAs reported experiences with bullying from sources at differing levels of power and authority, consistent with research suggesting that “upwards” bullying in the workplace (e.g., of supervisors by subordinates) may be more frequent than commonly realized and is an important process to examine (Branch et al., 2021; Lampman et al., 2009). Future research should explore the ways in which perceptions of power and power differentials relate to GTAs’ experiences with bullying, reporting decisions, and perceptions of organizational climate.

  Graduate Teaching Assistants’ Experiences with Workplace Bullying: Factors that Encourage and Discourage Reporting · 2024 · DOI

• Positive Behavior Support (PBS) is a framework that attempts to help reduce challenging behaviors displayed by service users however, little is known about the role of nurses and their perceptions of PBS.

  The Role of Nurses in the Implementation of Positive Behavior Support in a Secure Forensic Setting · 2024 · DOI

• However, the effective strategies used by nurses confronted by WPV did not emerge from having been trained or educated for such crises and therefore WPV remains underestimated and underreported.

  Nurses' experiences of workplace violence in the emergency department · 2022 · DOI

• Given the significant harm RRA poses for long-term care residents, this meeting is an important milestone, as it is the first organized effort to mobilize knowledge on this under-studied topic at the research, clinical, and policy levels.

  Developing a Research Agenda on Resident-to-Resident Aggression: Recommendations From a Consensus Conference · 2015 · DOI

• Although the validity of estimates of aggression prevalence with the POPAS instrument needs to be investigated further, such a survey may be helpful in gaining insight rather quickly into the level of day-to-day contact with aggressive behavior.

  Psychiatric nurses' experiences with inpatient aggression · 2005 · DOI

• What happens after a nonviolent victory has not been studied systematically, but the case of India could provide some suggestions. The remaining two have been classified as techniques for facilitating internaliza- tion, although little is known of a systematic nature about the precise mechanisms at work.

  On the Meaning of Nonviolence · 1965 · DOI

• While prior research has demonstrated their harmful effects, the mechanisms through which these stressors influence psychological outcomes are still not well understood.

  The Impact of Workplace Bullying and Organizational Incivility on Nurses' Emotional Distress: Exploring Parallel Mediation Through Life Satisfaction and Functional Impairment—A Cross‐Sectional Study · 2026 · DOI

• Role clarity has been considered an important organizational resource, yet its item-level associations with CCB remain insufficiently understood.

  The relationship between role clarity and compulsory citizenship behavior among junior nurses: evidence from network analysis and simulation-based network modeling · 2026 · DOI

• Workplace violence (WPV) against staff is frequent and underreported and contributes to burnout, moral injury, and workforce attrition.

  Emergency Department or Battleground? Confronting Workplace Violence Against Staff in Emergency Departments Through Education and Systems Reform · 2026 · DOI

• Behavioral Emergency Response Teams (BERTs) have emerged as an alternative, yet their implementation and outcomes in nonpsychiatric, inpatient settings remain poorly characterized.

  Behavioral emergency response teams in the hospital setting: A scoping review · 2026 · DOI

• Additionally, alternative measures to assess social safety could be explored, such as including neurophysiological measures, as feeling socially unsafe can impact an individual’s cognition and emotions.

  Social Safety of PhD Candidates: Risk Factors and Strategies · 2025 · DOI

• The fact that mobbing is rarely reported is worrying, and it is particularly problematic that older employees are more likely to be exposed to this problem.

  Mobbing in Communications – Experiences of Female Employees in Croatian National Television Newsrooms · 2025 · DOI

• Despite this, comprehensive studies investigating the factors that predispose public sector EMTs' to workplace violence in Gauteng Province are lacking.

  Factors Predisposing Emergency Medical Technicians to Workplace Violence: A Cross Sectional Study · 2024 · DOI

• Through this holistic review, we identify several conceptual and measurement issues associated with abusive supervision differentiation and find contradictory findings regarding the effects of abusive supervision differentiation.

  Abusive supervision differentiation and work outcomes: An integrative review and future research agenda · 2024 · DOI

• While existing nursing literature links abusive supervision to a wide range of work-related outcomes in the nursing workforce, little is known regarding the mechanism underlying this relationship.

  Stress as a mediator between abusive supervision and clinical nurses’ work outcomes · 2024 · DOI

• To date, limited data exist to document client‐initiated WPV experienced by professional counselors.

  Incidence of client‐initiated workplace violence among counselors: A national study · 2023 · DOI

• Although workplace bullying has been long recognised as an organisational level phenomenon, few studies have explored how different organisational factors come together to influence bullying risk.

  Workplace bullying as an organisational issue: Aligning climate and leadership · 2021 · DOI

Most-cited papers in Workplace Violence and Bullying

• ORGANIZATION-MOTIVATED AGGRESSION: A RESEARCH FRAMEWORK · Academy of Management Review · 1996 · 477 citations
• A review of abusive supervision research · Journal of Organizational Behavior · 2013 · 472 citations
• Exploring the role of individual differences in the prediction of workplace aggression. · Journal of Applied Psychology · 2001 · 373 citations
• Relationships between stressful work environments and bullying: Results of a large representative study · Work & Stress · 2007 · 345 citations
• Abuse of Patients in Nursing Homes: Findings from a Survey of Staff · The Gerontologist · 1989 · 250 citations
• Workplace violence in the emergency department: a systematic review and meta-analysis · Public Health · 2021 · 208 citations
• Psychiatric nurses' experiences with inpatient aggression · Aggressive Behavior · 2005 · 125 citations
• Identifying Key Factors Associated with Aggression on Acute Inpatient Psychiatric Wards · Issues in Mental Health Nursing · 2009 · 121 citations
• Workplace violence against healthcare workers: an umbrella review of systematic reviews and meta-analyses · Public Health · 2023 · 120 citations
• Workplace violence against nurses in health care and the role of human resource management: A systematic review of the literature · Journal of Advanced Nursing · 2020 · 118 citations

Most recent work

• When the Remedy Is the Weapon: Covert Bullying and Weaponised Complaints in Nursing Academia · Issues in Mental Health Nursing · 2026
• Behavioral emergency response teams in the hospital setting: A scoping review · Journal of Hospital Medicine · 2026
• Pandemic Periods and Their Reflection on Violence Against Healthcare Workers: Analysis of Nine Years of “White Code” Data · Anatolian Journal of Emergency Medicine · 2026
• Face-to-Face with Violence: Experiences of Emergency Nurses: An Interpretative Phenomenological Analysis · Anatolian Journal of Emergency Medicine · 2026
• Hospital culture: Defensive medicine as perceived by medical students · Deutsches Ärzteblatt international · 2026
• Exploring the Link Between Abusive Supervision and Medical Errors in Nursing Interns: The Role of Emotional Exhaustion and Emotional Intelligence · Hospital Topics · 2026
• Micro- and Macroaggressions Experienced by Physicians and Trainees: A Nationwide Qualitative Study. · Southern Medical Journal · 2026
• Evaluation of mobbing experiences among family medicine residents. · BMC Medical Education · 2026
• Reducing workplace violence in emergency medical services: a Finnish delphi study to develop prevention guidelines · International Journal of Emergency Medicine · 2026
• Improving primary care’s role in facilitating access to violence-related care: preliminary findings from a participatory study · British Journal of General Practice · 2026

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