Occupational Health & Safety

More than Half of Emergency Nurses Surveyed Report On-The-Job Violence

Emergency departments are the sources of injury for thousands of nurses, according to a new study by the Emergency Nurses Association (ENA) that finds more than half of emergency nurses report experiencing physical violence on the job, including being "spit on," "hit," "pushed or shoved," "scratched," and "kicked."

One in four has reported experiencing such violence more than 20 times in the past three years. Just as alarming, one in five nurses have experienced verbal abuse more than 200 times during the same period.

"People who work in helping professions shouldn't have to put their physical and emotional well-being on hold to do their jobs," said ENA President Bill Briggs, RN, MSN, CEN, FAEN. "Emergency nurses provide crucial health care services. Their departments and their hospitals depend on them being able to deliver high quality care. They can't do that if they're in danger of being verbally or physically abused."

More than half of the nurses surveyed for Violence Against Nurses Working in U.S. Emergency Departments, cited one or more of the following as precipitating factors when they experienced abuse: patients or visitors under the influence of alcohol or illicit drugs; psychiatric patients being treated in the emergency department, crowding, prolonged wait times, and shortage of emergency department nurses. Research indicates that such situations can cause frustration and feelings of vulnerability, which may result in physical and verbal abuse against emergency department staff.

More than two in three (67 percent) of emergency nurses rated their perception of safety in the emergency department at five or lower on a ten point scale and one in three said she or he had considered leaving her or his department or emergency nursing altogether because of the violence. Reports of violence were lowest among nurses in pediatric emergency departments and highest among nurses who worked night shifts and on weekends. Male emergency nurses were more likely than their female colleagues to indicate having experienced workplace violence.

The risk of experiencing workplace violence was lower for nurses who worked in facilities that had policies for reporting violence, facility responses to incidents, and hospital and emergency department administrations who were committed to eliminating workplace violence against emergency nurses.

The risk for experiencing violence was higher in facilities that had barriers to reporting violent incidents. Among those barriers are: the perception that reporting violent incidents might have a negative effect on customer service reports or scores; ambiguous policies for reporting incidents; fear of retaliation by emergency department management, hospital administration, nursing staff, or physicians; the perception that reporting incidents was a sign of incompetence or weakness; lack of physical injury as a result of an incident; the attitude that violence is to be expected; and lack of support from administration and management.

The report includes several recommendations to reduce emergency department violence and address the barriers to reporting that violence when it does occur. They include:

  • Ensuring that emergency department staff know that senior administration is aware of the issues and support efforts to prevent and mitigate violence.
  • Encouraging nurse executives to take steps to make the department safe.
  • Establishing a culture of acceptance for reporting violence incidents.
  • Developing clear and consistent procedures for reporting violent incidents.
  • Providing access to medical care and follow up counseling as needed for emergency department staff who are victims of workplace violence.
  • Appointing an interdisciplinary task force to identify vulnerabilities in the emergency department and develop a plan for preventing, mitigating, responding to and reporting violence.

ENA surveyed 3,465 emergency nurses nationwide. The 69-question survey was conducted online for one month in Spring 2007. The majority of respondents (87 percent) worked in general emergency departments; 64 percent worked as staff nurses and more than half (52 percent) worked a day shift. The mean years of emergency nursing experience among respondents was twelve. Nearly 84 percent of the respondents were women.

The report was published in the July/August issue of the Journal of Nursing Administration.

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