Emergency Nurses: An Overabundance of Violence

As part of a normal workday, emergency nurses witness the injuries and human suffering that result from violence. They treat victims of gunshot wounds, car wrecks, bar fights, domestic abuse, etc. As critical members of hospital healthcare teams, ER nurses triage, move fast and keep working.

As part of a normal workday, emergency nurses witness the injuries and human suffering that result from violence. They treat victims of gunshot wounds, car wrecks, bar fights, domestic abuse, etc. As critical members of hospital healthcare teams, ER nurses triage, move fast and keep working.

But what about when emergency nurses become victims of violence? In a survey of nurses published in the “Journal of Emergency Nursing,” 76 percent had experienced violence by patients and visitors in the past year. 

Within the survey group, emergency nurses reported a greater number of violent incidents. The survey also indicated that workplace violence (WPV) was underreported at an institutional level.

Emergency nurse and paramedic Gary Busby, RN, BSN, CEN, shared his insight and experience in a letter to the editor:

“I agree with the reported precipitating factors for WPV in the emergency department, such as large volumes of patients, along with drug-seeking behavior, alcohol intoxication, and drug use. I was not surprised that 14.1 percent of the 17.1 percent nurses participating in the study who did not report the most serious career WPV incident were emergency nurses. The study showed that ‘consistent with the literature and this study was underreporting of WPV.’ I have never reported an incident of WPV simply because the reporting tool is too cumbersome to navigate. Therefore, to report would take precious time away from patient care in a busy emergency department, and by the end of the shift, I just want to go home.”

Robert Wood Johnson Foundation scholar Gordon Gillespie, PhD, RN, FAEN, also experienced abuse at the hands of patients and visitors when he worked as an emergency nurse. “This is not something that should be part of the job,” he says. While he agrees that the violence often originates with people who suffer from mental illness, substance abuse and dementia, as well as family members experiencing a great deal of stress, these individuals are not the only sources of violence in the ER. “If we take the stance that everyone has the potential to be violent, then nurses will interact with people differently and be more likely to protect themselves,” he says.

Researching violence against nurses and other healthcare workers, Gillespie and his colleagues are developing interventions, strategies and training to prevent this violence going forward. Recommendations so far include: “designing work environments that allow for the quick egress of employees, establishing and consistently enforcing policies aimed at violence prevention, and maintaining positive working relationships with security officers. While patients with mental health or substance use complaints are deemed most likely to commit physical violence, they are not the only patients to become violent. Risk reduction efforts should target all patients and visitors.”

More resources are available from the American Organization of Nurse Executives and the Emergency Nurses Association, these two organizations have developed toolkits and information to help prevent workplace violence in the hospital setting.