18 Workplace Violence Reporting Behaviors in Emergency Departments across a Health System

Abstract

To establish reporting behaviors of workplace violence among multidisciplinary emergency department (ED) staff within a regional health system. Anonymous survey study of all multidisciplinary ED staff at twenty Midwestern EDs encompassing a large health system between 11/18/2020 and 12/31/2020. Cohort included clinicians, nursing staff, care team assistants, ancillary testing services, registration/finance staff, paramedics/emergency medical technicians, social workers, respiratory therapy, environmental services (janitorial) staff, management, and security officers. Frequency and methods of reporting of workplace violence were solicited, as well as respondent beliefs on why violence goes unreported. Chi-squared and Fisher’s exact tests were used to analyze the results. This study was deemed exempt by Mayo Clinic Institutional Review Board. A total of 833 respondents completed the survey with 598 (71.6%) indicating some form of violence experienced in the preceding 6 months. The majority (77.3%) indicated never (57.0%) or rarely (20.3%) reporting incidents in the preceding 6 months. Security personnel had the highest rates of reporting, with only 4% indicating that they never report violence, compared with 60% for non-security personnel (p < .001). Additionally, 32% of security personnel indicated that they always report violence compared with 3% for non-security personnel (p < .001). Sixty-two percent of security personnel indicated being extremely familiar with reporting procedures, compared with 7% of non-security personnel (p < .001). When asked how they would report (or have reported) workplace violence, 59.0% indicated with hospital security, 53.2% to their supervisor, 43.0% ED charge nurse, 37.1% through the employee incident report (EIR), 25.6% through the Medical Information Data Analysis System (MIDAS) event reporting (a tool used for patient safety incident reporting), 27.1% to law enforcement, and 3.4% through some other means. Respondents were asked to indicate why they felt abuse in the ED is not typically reported with responses including no physical injury sustained (52.7%), abuse comes with the job (47.4%), too busy during shift (47.3%), inconvenience (41.2%), report won’t be taken seriously (22.3%), not wanting perpetrator to have full name (17.2%), fear of retaliation (16.8%), and may affect customer service scores (7.1%). Our findings indicate poor reporting behaviors of workplace violence among multidisciplinary ED staff, including unfamiliarity with proper reporting methods with less than 2 out of 5 respondents indicating the compliant institutional process of reporting incidents (through the EIR). Respondents indicated that longstanding beliefs towards violence (eg, “being part of the job”) persist. As health systems seek to prioritize the safety of their employees in violence-prone areas, including EDs, it is imperative that they understand staff barriers to violent incident reporting and that continued education and encouragement is needed to adapt longstanding sentiments held by staff that contribute towards underreporting.