Aggression and hostility against pharmacists in community and hospital settings

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Pharmacists, both in hospital and community settings, may face aggression and hostility from patients, caregivers, or colleagues. This scoping review aims to synthesize evidence on the prevalence, types, risk factors, and consequences of such aggression, to inform workplace safety interventions, policy, and staff support strategies. Authors and affiliations Akhila Rajendran1, James Barlow3, Jakub Gwajewski2, Lorna Staines4, Tommy Kyawtun5, Mary Rose Sweeney1 Main author: Akhila Rajendran (akhila.rajendran22@rcsi.ie) Co-authors: Mary Rose Sweeney : maryrosesweeney@rcsi.ie Jakub Gwajewski : jakubgajewski@rcsi.ie James Barlow: jambarlow@rcsi.ie Lorna Staines : lorna.staines@mui.e Corresponding author: Akhila Rajendran (akhila.rajendran22@rcsi.ie) Faculty of Nursing and Midwifery, Royal College of Surgeons in Ireland, 121 St Stephen's Green, Dublin, Leinster, Ireland A Scoping review protocol exploring aggression and hostility directed at pharmacists in healthcare settings and community pharmacies. Abstract. Background: Aggression and hostility directed at pharmacists in healthcare settings and community pharmacies are increasingly recognised as significant occupational and public health concerns. Such behaviours may negatively impact pharmacists’ psychological well-being, job satisfaction, workforce retention, and the quality and safety of patient care. Despite growing reports internationally, evidence remains fragmented, with limited synthesis across practice settings. Objective: To map the extent, nature, contributors, and consequences of aggression and hostility against pharmacists across practice settings. Methods and Analysis: This scoping review will follow the Joanna Briggs Institute framework. Inclusion and exclusion criteria will follow the Population–Concept–Context approach. Electronic databases, along with a grey literature search, will be conducted. A data charting tool will be developed and applied through Covidence software. Qualitative and quantitative descriptive analyses will be undertaken. Conclusion: Findings will inform policy, practice, and future research addressing pharmacist workplace safety. Introduction Aggression and hostility directed towards healthcare professionals are widely recognised occupational hazards, with significant implications for staff wellbeing, patient safety, and workforce sustainability1. Such behaviours may include verbal abuse, threats, intimidation, and physical violence, and are increasingly reported across healthcare systems internationally2. Exposure to workplace aggression has been associated with adverse psychological outcomes, including stress, anxiety, burnout, reduced job satisfaction, and increased intentions to leave the profession, ultimately compromising the quality and safety of patient care. While substantial research attention has focused on aggression experienced by nurses and physicians—particularly in emergency, psychiatric, and acute care settings—pharmacists have received comparatively limited focused investigation. This gap is notable given the evolving scope of pharmacy practice and the increasing visibility of pharmacists in both community and hospital settings. The central role of pharmacists in medication optimisation, patient counselling, chronic disease management, and the safe supply of medicines across both hospital and community settings across Ireland has evolved in recent years3. Pharmacists frequently engage in interactions that may heighten the risk of aggressive or hostile behaviour. These include consultations involving medication access, prescription delays or refusals, opioid substitution therapy, controlled drugs, long waiting times, and encounters with patients or carers experiencing distress, pain, or frustration3. In community settings, pharmacists are often highly accessible and may be the first point of contact for system-level pressures within primary care. In hospital environments, pharmacists work within complex, high-acuity systems where communication breakdowns and workload pressures may contribute to conflict4. Within the Irish healthcare context, increasing service demand, workforce shortages, and expanding clinical responsibilities may further exacerbate exposure to aggression across pharmacy practice5. Aggression and hostility towards pharmacists may have consequences extending beyond individual harm. Repeated exposure can negatively affect morale, professional engagement, and mental health, while also influencing communication with patients and colleagues. Such impacts may increase the risk of medication errors, compromise therapeutic relationships, and reduce overall quality of care5. At an organisational level, unmanaged aggression contributes to absenteeism, reduced productivity, and workforce attrition, posing challenges to service delivery and health system resilience. Understanding the nature, prevalence, risk factors, and consequences of aggression and hostility against pharmacists is therefore essential to inform policy development, workplace prevention strategies, education, and staff support mechanisms. However, existing evidence remains fragmented across jurisdictions, settings, and methodological approaches6. Much of the emerging literature consists of cross-sectional studies, surveys, and national workforce or professional body reports, reflecting growing concern but lacking comprehensive synthesis. A scoping review is an appropriate methodological approach to address this evidence gap. Scoping reviews enable systematic mapping of the breadth and characteristics of available evidence, accommodate diverse study designs, and support clarification of key concepts and definitions. This approach is particularly suitable where the evidence base is evolving and where recent empirical data require integration. An updated review is timely to incorporate new evidence, highlighting knowledge gaps, and discover future research requirements7. An initial search of PubMed, the Cochrane Database of Systematic Reviews, PROSPERO, and the Open Science Framework registries identified no current or ongoing systematic or scoping reviews addressing aggression and hostility against pharmacists. This confirms the need for the proposed review to provide an in-depth overview of the available evidence and support policy and practice responses in Ireland and internationally. This scoping review is publicly available on the Open Science Framework (OSF)(URL: https://osf.io/cktbh/overview), to ensure transparency and reproducibility. Review question Sub questions: 1. What is the frequency of aggression and hostility experienced by pharmacists? 2. What forms and types of aggression (e.g., verbal abuse, physical violence, threats, intimidation) are reported? 3. Who are the perpetrators of aggression? 4. In what contexts or situations do incidents occur? 5. What are the reported psychological, professional, financial and clinical impacts of aggression on pharmacists? 6. How are incidents of aggression reported, and what strategies, policies, or interventions have been implemented to prevent or manage them and how effective are they? 7. What gaps exist in the current literature regarding aggression and hostility against pharmacists? Aims and objectives Aim To provide a comprehensive mapping and synthesis of the existing literature on aggression and hostility against pharmacists in hospital and community settings. Objectives 1. To identify the types and forms of aggression and hostility experienced by pharmacists. 2. To explore the frequency of aggressive incidents reported in the literature. 3. To identify risk factors, triggers, and contextual contributors to aggression. 4. To examine the reported impacts of aggression on pharmacists’ wellbeing, professional practice. 5. To examine the reported impacts of aggression on patients/patient care. 6. To identify interventions, policies, or strategies aimed at preventing or managing aggression and their effectiveness. 7. To ide

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