Workplace violence and burnout among emergency medical service workers and nurses in Germany: a cross-sectional study

TL;DR

This study compares workplace violence and burnout among nurses and emergency medical service workers in Germany, finding high rates of abuse and burnout risk.

Contribution

This is the first comparative study examining the link between workplace violence and burnout risk in nurses and EMS workers.

Findings

59.9% of EMS workers and 44.7% of nurses reported frequent verbal abuse.

Burnout risk was high in both professions, particularly in emotional exhaustion and depersonalization dimensions.

Workplace violence was significantly associated with increased burnout risk in both professions.

Abstract

Nonphysician healthcare workers play a crucial role in patient care, often under challenging conditions. Workplace violence puts professionals such as nurses and emergency medical service (EMS) workers at risk for (emotional) stress. This study comparatively analyzed the burden of workplace violence, burnout risk, and their associations among nurses and EMS workers.

Two surveys were conducted using (i) a paper–pencil questionnaire for nurses and (ii) an online questionnaire for EMS workers in 2015. The surveys assessed experiences of workplace complaints, violence, and burnout risk measured by the Maslach Burnout Inventory (MBI). Data were analyzed descriptively (frequencies, means, percentages, Pearson correlation coefficients). Associations between workplace violence and burnout were estimated using binary logistic regression, adjusting for gender, employment status, work experience, education, and working conditions.

Data from 3,169 nurses (84.7% female) and 1,024 EMS workers (13.6% female) were analyzed. Frequent verbal abuse—ranging from daily incidents to several times a month—was reported by 44.7% of nurses and 59.9% of EMS workers, while 12.2% and 23.5%, respectively, experienced physical violence from patients or their families. Overall, a large proportion of employees in both professions have a moderate to high risk of burnout in the dimension of emotional exhaustion (EE) (nurses: 58.1%, EMS workers: 56.3%) and in the dimension of depersonalization (DP) (nurses: 58.4%, EMS workers: 74.4%). Logistic regression revealed that physical violence was significantly associated with a high risk of burnout in the dimensions EE and DP in nurses, and EE in EMS workers. Verbal abuse by patients was significantly associated with EE and DP in nurses, and with DP in EMS workers. In addition, an increased risk of burnout in both MBI dimensions was significantly associated with variables of working conditions and work experience for both professions.

This is the first comparative study to examine the association between workplace violence and the risk of burnout among nurses and EMS workers. These findings highlight the need for strengthened measures to address workplace violence, prevent burnout among employees, and support staff in coping with these challenges. Improvements in working conditions must also be considered.

The online version contains supplementary material available at 10.1186/s12960-025-01026-y.

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