Violence breeds violence: burnout as a mediator between patient violence and nurse violence.

The present study examines whether patient-perpetrated violence triggers anger, hatred and other negative emotions that, under certain circumstances, might motivate nurses to behave violently with patients. In doing so, this study considers burnout as a mediator in the patient violence-nurse violence relationship. To test the causal paths, data were collected from 182 nurses working in two government-sector teaching hospitals of Pakistan's Punjab province. Results confirm that patient violence toward nurses leads to nurse violence toward patients through the mediating effect of burnout. The study advises hospitals to provide wellness and stress management programs to nurses who regularly experience events involving patient violence. Hospitals may consider allowing nurses to take short breaks after an encounter with violently behaving patients. In addition, hospitals should conduct empathy-promoting training, emotional intelligence training and 'lens of the patient' training programs to sensitize their nursing staff.