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Reducing workplace violence against emergency nurses

With recent data from the Bureau of Labor Statistics indicating that assaults on health care workers are the most common cause of injury or illness requiring time off, the Emergency Nurses Association (ENA) launched a study to review assaults on emergency nurses in particular.

The results surface concerns that ED nurses have known about and suffered with for years. These assaults from patients and visitors have long-standing negative effects and yet, sadly and unsurprisingly, they are commonplace and accepted.

The study, published in the Journal of Emergency Nursing included a sample of emergency room nurses who were recruited from a roster of ENA nurses. Of those recruited, eight men and 37 women responded. The question posed to the study participants was, “Tell me about your experience of violence in the emergency setting.” The study participants’ answers were then forwarded and analyzed by the Institute for Emergency Nursing Research.

The most common forms of violence/abuse reported were:

  • physical assault: being grabbed or pulled
  • verbal assault: yelling or swearing
"Assaults on emergency nurses have lasting impacts on the nurses and the ability of emergency care facilities to provide quality care," said 2014 ENA President Deena Brecher, MSN, RN, APN, ACNS-BC, CEN, CPEN. "More than 70 percent of emergency nurses reported physical or verbal assaults by patients or visitors while they were providing care. As a result, we lose experienced and dedicated nurses to physical or psychological trauma for days or sometimes permanently. Health care organizations have a responsibility to nurses and the public to provide a safe and secure environment."

The study found a culture of acceptance prevalent, including among hospital administrators, law enforcement, prosecutors, and judges, due to three recurring themes:

  • environment
  • personal experience
  • lack of cue recognition
One emergency nurse assault victim reported being told by a judge: "[W]ell, isn't that the nature of the beast, being in the emergency room and all?" Another nurse told researchers, the "administration will only take action when some lethal event happens."

The ENA concluded that there needs to be a change in the culture of acceptance, as well as a need to properly train nurses and hospital personnel to recognize cues for violent behavior.

"It is imperative that hospitals and emergency care workers address the issue preemptively through adoption of violence prevention education, zero-tolerance policies, safety measures and procedures for reporting and responding to incidents of workplace violence when they do occur," the researchers noted. "Such actions are necessary to help nurses recognize incipient violence."

In the culture of safety that focuses on patients, this study casts needed light on a willfully ignored aspect of working in the ED.