摘要：Objectives. We examined risk factors for injuries to nursing assistants from assaults by nursing home residents at both the individual and the organizational level. Methods. We analyzed data from the 2004 National Nursing Assistant Survey that were linked to facility information from the 2004 National Nursing Home Survey by use of multilevel modeling that accounted for the complex survey design effect. Results. Thirty-four percent of nursing assistants surveyed reported experiencing physical injuries from residents' aggression in the previous year. Mandatory overtime (odds ratio [OR] = 1.65; 95% confidence interval [CI] = 1.22, 2.24) and not having enough time to assist residents with their activities of daily living (OR = 1.49; 95% CI = 1.25, 1.78) were strongly associated with experiencing injuries from assaults. Nursing assistants employed in nursing homes with Alzheimer care units were more likely to experience such injuries, including being bitten by residents. Conclusions. Reducing mandatory overtime and having a less demanding workload may reduce the risk of workplace violence. In particular, prevention activities should be targeted at those nursing homes that care for cognitively impaired patients. As life expectancy increases, the need for long-term care services provided both in the recipient's home and in institutional settings such as assisted-living facilities and nursing homes is projected to more than double by 2050. 1 In 2006, nursing assistants (including orderlies and attendants) made up approximately 72% of the direct care workforce in nursing homes. 2 As the main provider of hands-on care in these institutional settings, nursing assistants help residents with their activities of daily living and keep records of services delivered and changes in the patient's condition. It is projected that the number of nursing assistants, orderlies, and attendants will need to increase by 18% by 2016 (from 1.45 million in 2006 to 1.71 million in 2016). 2 To meet this increasing demand for long-term care providers, it has become a major policy priority for nursing homes to improve nursing assistant retention rates. 1 Nursing assistants are at high risk of injury from violent assault at work, 3 and their risk exceeds that of other health care workers. 4 Nursing personnel who were subjected to work-related violence on at least a monthly basis reported higher intent both to leave the nursing profession and to change institutions. 5 The organizational characteristics of nursing homes, including facility ownership and chain membership, turnover of top management and registered nurses, and staffing patterns and levels, influence nursing assistants' perceptions of job satisfaction as well as their turnover and retention. 6 Research on organizational characteristics associated with workplace violence among nursing assistants is lacking. We attempted to fill this gap by examining both individual and organizational factors associated with assault injuries experienced by nursing assistants by using data from the 2004 National Nursing Assistant Survey (NNAS) that were linked to facility information from the 2004 National Nursing Home Survey (NNHS). Both surveys were conducted by the National Center for Health Statistics. By linking these 2 surveys, we intended to avoid the potential bias that can arise from collecting self-reported organizational-level information from individuals who might be affected by the health outcomes of interest.
