This study tested the hypothesis that poor organizational justice and collaboration among nurses are associated with increased stress among nurses, which, in turn, increases the likelihood of violent assaults by patients.

A cross-sectional survey was conducted of nurses in 90 psychiatric inpatient wards in five hospital districts and one regional hospital in Finland. A total of 758 nurses (registered nurses or enrolled/mental health nurses) responded to the survey. Self-administered postal questionnaires were used to assess organizational justice, collaboration, nurses’ stress, and violent assaults by patients. Structural equation modeling (SEM) was used in model testing.

SEM did not support a role for stress in mediating between organizational justice, collaboration between nurses, and violent assaults by patients, given that stress levels were not dependent to a significant degree on organizational justice, nor were patients’ assaults dependent on stress levels. However, low organizational justice and poor collaboration between nurses were associated with increased reports of violent assaults by patients in psychiatric inpatient settings (p<.05 for both). The model explained 5.7% of violent assaults at nearly significant levels (p=.052).

These findings suggest that organizational justice, collaboration between staff members, and violent assaults by patients are linked in psychiatric inpatient settings. Evaluating a variety of factors, including issues related to organizational justice and collaboration among nurses, may be useful to minimize assaults by patients in psychiatric settings.