ER nurses decry silence after violence
Little support from leadership
"Nothing changes, nobody cares." That bleak title of a recent journal article tells the story of workplace violence through the eyes of emergency room nurses.1
Reams of surveys have documented the frequency of verbal and physical assaults in the nation’s emergency rooms. But researchers with the Emergency Nurses Association (ENA) went beyond the statistics to learn about the nature of these assaults — and the impact they have on nurses.
The qualitative study gathered narratives from 46 emergency nurses. The researchers asked them simply: "Tell me about your experience of violence in the emergency setting." Their responses ranged from a single page to 15 pages.
A common frustration ran through the narratives related to a lack of support from hospital leadership to address violence and unwillingness of public officials to pursue charges against violent patients.
"This perceived lack of concern about nurses’ safety resonated throughout the narrative accounts," the authors stated. "Participants described unsafe work environments, where safety measures were put into place (such as security cameras or panic buttons) but were not maintained or enforced A few participants had been assaulted more than once and were frustrated by the lack of any real change in security or environmental protective measures."
The narratives also reflected a failure to recognize or address cues related to high-risk patients or situations. Incidents often involved patients under the influence of alcohol or drugs, with a history or violence or mental health issues. Long wait times and overcrowding were common issues.
Understanding the nature of violence in the emergency room is a first step toward addressing the problem, says Deena Brecher, MSN, RN, APN, ACNS-BC, CEN, CPEN, ENA president.
"No silence on violence," she says. "We can’t stop talking about it. In order to effect a change, it’s really important to understand why is this so prevalent and why is it not changing."
Many nurses themselves accept verbal and minor physical assaults as part of the job, says Brecher. That attitude can change with a "zero tolerance" policy toward assaults and an emphasis on reporting incidents, she says. "Any health care provider in any organization should not be assaulted, period," she says.
ENA advocates training of nurses and periodic assessment of the workplace violence hazard. (A free toolkit is available at www.ena.org/practice-research/Practice/ViolenceToolKit/Documents/toolkitpg1.htm.)
The response of ER nurses to violence varied from fear and trauma to resignation. Some nurses reported injuries that caused recurring pain.
ENA supports workplace violence prevention laws, which have been passed in 10 states, Brecher says.
"If we all start talking about it and we all work to change the culture, then we’ll change it," she says.
- Wolf LA, Delao AM, and Perhats C. Nothing Changes, Nobody Cares: Understanding the Experience of Emergency Nurses Physically or Verbally Assaulted While Providing Care. Journal of Emergency Nursing 2014 (online in advance of publication). Available at www.jenonline.org/article/S0099-1767(13)00561-8/abstract.