The Issue of Violence in the Emergency Setting

Abstract

Two recent examples of violence against nurses in the emergency setting have brought the issue to the public’s attention. Although very different with regard to the injuries sustained and the perpetrators of the violence, what they have in common is that the violence in both cases was directed at RN’s in their workplace. The first example was an emergency nurse slashed by a mentally disturbed patient. She sustained numerous physical and emotional injuries. The second example of violence was at the hands of a police officer because the nurse protected the patient’s rights rather than acquiesce to his unlawful demands. These events spotlight the reality that emergency nurses work in an environment where violence is an ever-present potential. So how do we respond to this reality? And how should we respond? Is there a way to minimize the threat? Because violence in the emergency setting disproportionately affects emergency nurses, I want to draw attention to some articles in this issue of the Journal of Emergency Nursing (JEN) that address the effects of violence in the emergency department on nursing staff and include some information that might be useful to the reader. The articles of which I speak are: Occupational disappointment: Why did I even become a nurse; Hardiness mediates stress and impact level in ED nurses who experience a violent event; and Influences on patient satisfaction among patients who use emergency departments frequently for pain-related complaints. For additional reflection on the precursors and sequelae of workplace violence in the emergency department, I refer the reader to an article in the July 2014 issue of JEN by Wolf et al that addresses similar concerns, Nothing changes, Nobody Cares: Understanding the experience of emergency nurses physically or verbally assaulted while providing care.1Wolf L.A. Delao A.M. Perhats C. Nothing changes, Nobody Cares: Understanding the experience of emergency nurses physically or verbally assaulted while providing care.J Emerg Nurs. 2014; 40: 305-310Abstract Full Text Full Text PDF PubMed Scopus (78) Google Scholar It is difficult to quantify the experiences of workplace violence because most events are not reported. Why is this? Some reasons postulated in the literature as to why emergency nurses don’t report violence, especially verbal workplace violence (VWPV), include:•a culture of acceptance (it’s part of the job);•nothing will be done about it anyway;•it happens so often it would take too much time to report;•reporting mechanisms are too complex;•reluctance to hold patients accountable; and•fear of being blamed. Do we emergency nurses have some culpability in normalizing violence (especially VWPV) in our workplace? The best solution to the violence problem is prevention of course. Many states have mandated violence prevention education for RN license renewal, and many health care facilities also require annual education in the hopes that increased knowledge will lead to prevention. Clearly the problem is recognized, but it takes more than a course once a year to reduce the occurrence of violence and its effect on nursing staff. While education about violence prevention is helpful and necessary, it is not sufficient to resolve the issue of violence that emergency nurses face every day. Environmental risk factors such as public access, objects such as furniture or equipment that can be used as weapons, noise, or lack of metal detectors must be addressed. Low staffing levels, long wait times, or inadequate security personnel and/or procedures can increase the risk for violence. Certain types of patients also present increased risk, especially persons under the influence of alcohol or other drugs. I question whether the emphasis on patient satisfaction survey results has contributed to this increase in violence toward emergency nurses—especially verbal workplace violence. Do we allow ourselves to be yelled at, threatened, challenged in frightening ways for the sake of patient satisfaction? Has the societal debate about “political correctness” been mistaken or used by some as permission to be verbally violent? In my many years as an emergency nurse, the extant threat level has changed. Early in my career, violence was a rarity. Appreciation and gratitude for nurses’ caring and expertise was the norm. While happily that nurse-patient relationship continues for the most part, the fact that violence is an everyday occurrence reflects an appalling societal change. Given that reality, hospitals and other emergency settings must take seriously their obligation to do everything possible to provide a safe environment for their employees, patients, and visitors. Anne Manton is Editor-in-Chief, of Journal of Emergency Nursing.