Patient/visitor violence and aggression (V&A) in the emergency department occurs daily. Few interventions exist to decrease V&A. Research describing prevalence, severity, and perceived safety among ED clinicians is limited.
A descriptive survey explored V&A against ED clinicians in one urban emergency department. A sample of nurses, ED technicians, physicians and advanced practice providers participated. Participants completed a demographic survey, Personal Workplace Safety Instrument for Emergency Nurses (PWSI-EN), and ENA V&A frequency checklist. Analysis of Variance (ANOVA) for unadjusted and Analysis of Covariance (ANCOVA) for adjusted associations were used to assess differences in the PWSI-EN survey composite score and “feeling safe in the ED” among ED roles. ANCOVA was adjusted for potential confounders: sex, race, years working in emergency department, and shift worked.
Sixty-five (46.4%) of the 140 ED clinicians returned surveys, which were almost evenly distributed between ED clinician roles and sex. Mean age was 37.2 (range: 21-64) years. All (100%) nurses and providers reported being verbally abused. More nurses reported physical violence (n = 21, 87.5%) than providers (n = 7, 36.8%) and ED technicians (n = 11, 55%). Nurses and ED technicians reported experiencing greater prevalence of physical violence than providers (P < .05). Nurses (mean 3.29, range 2.95 to 3.63) were more fearful for their personal safety than ED technicians (mean 3.88, range 3.48 to 4.28) (P < .03).
V&A are common creating a fearful environment. However, little research regarding clinician perceptions exists. Our study aids in identifying areas for clinician-targeted strategies to prevent ED V&A.
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- Violence against nurses in the triage area: a mixed-method study.J Emerg Nurs. 2020; 46: 384-397https://doi.org/10.1016/j.jen.2020.02.013
- Workplace violence against emergency nurses in Taiwan: a cross sectional study.J Emerg Nurs. 2020; 46: 66-71https://doi.org/10.1016/j.jen.2019.09.004
- Prevalence of workplace physical violence against health care professionals by patients and visitors: a systematic review and meta-analysis.Int Enviorn Res Public Health. 2020; 17: 299https://doi.org/10.3390/ijerph17010299
- Violence against emergency department nurses; can we identify the perpetrators?.PLoS One. 2020; 15e0230793https://doi.org/10.1371/journal.pone.0230793
- Workplace violence in the emergency: a systematic review and meta-analysis.Public Health. 2021; 196: 186-197https://doi.org/10.1016/j.puhe.2021.02.009
- Deriving a framework for a systems approach to agitated patient care in the emergency department.Jt Comm J Qual Patient Saf. 2018; 44: 279-292https://doi.org/10.1016/j.jcjq.2017.11.011
- A systematic review: effectiveness of interventions to de-escalate workplace violence against nurses in healthcare settings.Saf Hlth Work. 2021; 12: 289-295https://doi.org/10.1016/j.shaw.2021.04.004
- Leveraging a public health framework and Community Advisory Board to innovate workplace violence intervention strategies.Adv Nurs J. 2019; 41: 357-371https://doi.org/10.1097/tme.0000000000000263
U.S. Department of Labor. Guidelines for preventing workplace violence for healthcare and social service workers. Occupational Safety and Health Administration. Published 2016. Accessed February 8, 2022. https://www.osha.gov/Publicatio ns/osha3148.pdf
- American College of Emergency Physicians & Emergency Nurses Association. No Silence on ED Violence.(Accessed September 16, 2022.)
- American College of Emergency Physicians, Emergency Nurses Association. Emergency department assessment tool. 2019 (Accessed September 16, 2022.)
- Position statement: prevention and management of workplace violence. International Council of Nurses., 2017 (Accessed September 16, 2022)
- Workplace violence and perceptions of safety among emergency department staff members: experiences, tolerance, reporting, and recommendations.J Trauma Nurs. 2017; 24: 65-77https://doi.org/10.1097/JTN.0000000000000269
- Worker, workplace, and community/environmental risk factors for workplace violence in emergency departments.Arch Environ Occup Health. 2017; 72: 79-86https://doi.org/10.1080/19338244.2016.1160861
- Violence against emergency medical services personnel: a systematic review of the literature.Am J Ind Med. 2018; 61: 167-180https://doi.org/10.1002/ajim.22797
- Reassessment of violence toward emergency medicine physicians in Michigan.Am J Emerg Med. 2020; 38: 1582-1583https://doi.org/10.1016/j.ajem.2019.158427
- Workplace violence in emergency medicine: current knowledge and future directions.J Emerg Med. 2012; 43: 523-531https://doi.org/10.1016/j.jemermed.2012.02.056
- Perception of workplace violence in the emergency department.J Emerg Trauma Shock. 2019; 12: 179-184https://doi.org/10.1403/JETS.JETS_81_18
- Emergency department violence surveillance study. Emergency Nurses Association. 2011 (Published 2011. Accessed September 16, 2022.)https://www.ena.org/docs/default-source/resource-library/practice-resources/workplace-violence/2011-emergency-department-violence-surveillance-report.pdf?sfvrsn=5ad81911_6
- Violence in the emergency department.Psychiatr Clin North Am. 2016; 39: 557-566https://doi.org/10.1016/jpsc.2016.07.03
- A descriptive study of the perceptions of workplace violence and safety strategies of nurses working in level I trauma centers.J Emerg Nurs. 2005; 31: 519-524https://doi.org/10.1016/j.jen.2005.07.008
- Interventions for workplace violence prevention in emergency departments: a systematic review.Int J Enviorn Res Public Health. 2021; 18: 8459https://doi.org/10.3390/ijerph18168459
- Relationships between nurses’experience of workplace violence, emotional exhaustion, and patient safety.J Res Nurs. 2021; 26: 35-46https://doi.org/10.1177/1744987120960200
- Doctors and nurses: a systematic review of the risk and protective factors in workplace violence and burnout.Int J Environ Res Public Health. 2021; 18: 3280https://doi.org/10.3390/ijerph18063280
- Impact and prevalence of physical and verbal violence toward healthcare workers.Psychosomatics. 2018; 59: 584-590https://doi.org/10.1016/j.psym.2018.04.007
- Violence and aggression in the emergency department is under-reported and underappreciated.N Z Med J. 2018; 131: 50-58
- Nurses’ perspectives of violence in emergency departments: a metasynthesis.Int Emerg Nurs. 2020; 52100905https://doi.org/10.1016/j.ienj.2020.100905
- Addressing risks of violence against healthcare staff in emergency departments: the effects of job satisfaction and attachment style.Biomed Res Int. 2019; 20195430870https://doi.org/10.1155/2019/5430870
- Violence against emergency department workers.J Emerg Med. 2006; 31: 331-337https://doi.org/10.1016/j.jemermed.2005.12.028
- Research electronic data capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support.J Biomed Inform. 2009; 42: 377-381https://doi.org/10.1016/j.jbi.2008.08.010
- Psychometric testing of the Personal Workplace Safety Instrument for emergency nurses.Worldviews Evid Based Nurs. 2018; 15: 97-103https://doi.org/10.1111/wvn.12265
- Violence occupational hazards in hospitals. National Institute for Occupational Safety and Health. Published,
2014https://www.cdc.gov/niosh/docs/2002-101/Date accessed: June 1, 2022
- NJ. Recruitment strategies for nurse enrollment in an online study.Nurs Res. 2020; 69: 69-73
- Multicollinearity: how common factors cause type 1 errors in multivariate regression.Strateg Manag J. 2018; 39: 2362-2385https://doi.org/10.1002/smj.2783
Jean M. Boles is Clinical Nurse III, Penn Presbyterian Medical Center, Philadelphia, PA.
Diane Maccarone is Assistant Nurse Manager, Penn Presbyterian Medical Center, Philadelphia, PA.
Beverly Brown is Clinical Nurse III, Penn Presbyterian Medical Center, Philadelphia, PA.
Alexandra Archer is Clinical Nurse Educator, Duke Raleigh Hospital, Cary, NC.
Michael G. Trotter is Attending Physician, Penn Presbyterian Medical Center, Philadelphia, PA; and is Assistant Professor of Clinical Emergency Medicine, Penn Medicine, Philadelphia, PA.
Nicholas M.G. Friedman is Medical Student, Stanford Medical School, Stanford, CA. ORCID identifier: https://orcid.org/0000-0003-4805-0173
Jesse Chittams is Managing Director, Biostatistics Consulting Unit, University of Pennsylvania School of Nursing, Philadelphia, PA.
Leighann Mazzone is Nurse Manager, Emergency Department, Penn Presbyterian Medical Center, Philadelphia, PA. ORCID identifier: https://orcid.org/0000-0002-5143-9254
James Ballinghoff is Chief Nursing Officer, Associate Executive Director, Penn Presbyterian Medical Center, Philadelphia, PA.
Christian N. Burchill is Director of Nursing Research and Evidence-based Practice, Penn Medicine Lancaster General Hospital, Lancaster, PA. ORCID identifier: https://orcid.org/0000-0003-4310-9615
Pamela Z. Cacchione is Nurse Scientist, Penn Presbyterian Medical Center, Philadelphia, PA; is Ralston House Term Chair in Gerontological Nursing, Professor of Geropsychiatric Nursing, University of Pennsylvania School of Nursing, Philadelphia, PA; is Senior Fellow, Leonard Davis Institute of Healthcare Economics, Philadelphia, PA; and is Subject Matter Expert, Jonas Foundation, New York, NY. Twitter: @AgingSense1 ORCID identifier: https://orcid.org/0000-0003-1805-7091.
Published online: September 27, 2022
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