Violence Against Nurses in the Emergency Department
Kimberly L. Kirk Professional Nursing Practice of the Baccalaureate Nurse
August 8, 2014

Violence against Nurses in the Emergency Department
According to the National Institute for Occupational Safety and Health, workplace violence is defined as “an act of aggression directed toward persons at work or on duty, ranging from offensive or threatening language to homicide” (Wolf, Delao & Perhats, 2014, p.305). Workplace violence (WPV) can include verbal, physical, and emotional abuse, or any type of threatening behavior that can cause physical or emotional harm. According to the Emergency Nurse’s Association Position Statement (2010), “workplace violence is a serious occupational risk for the emergency nursing workforce and has been recognized as a violent crime that requires targeted responses from employers, law enforcement, and the community.” Due to the lack of research concerning workplace violence and other barriers such as underreporting, failure to prosecute, and lack of management support the enormity, of this issue is grossly underrepresented. Individuals who assault ER nurses should be prosecuted. Without increased and consistent prosecution for assault on emergency nurses, patients and families will still think it’s acceptable to physically or verbally assault a nurse. As the ENA position statement (2010) proposes, stronger legislation is necessary to help decrease the view that violence is just part of the job and all assaults against emergency nurses should undoubtedly result in felony charges in every state. By implementing increased legislation and adequate research, we can begin to move towards a safer working environment.
Having specific policies and procedures creates a concrete standard of practice in reporting violence, which removes management bias or personal opinion. Organizational standards have developed around the views that violence is tolerable (Pich, Hazleton, Sundin, Kavel, 2010). According to Gates et. al (2011), 67% of emergency nurses report being assaulted at least once in the last six months. Under-reporting results in a lack of reliable evidence and research regarding the true extent of the problem. Pich, et al, indicate several reasons for under-reporting to include the extensive lack of support and assumption that violence is just part of the job. One notable reason for lack of reporting was the fear of retaliation from management (Gates, et al, 2012, p. 201). The importance of knowing that administration will support and back up an employee’s reports of violence and having the assurance of no retribution from a management perspective is important. Despite the reason for choosing not to report an incident, underreporting appears to be the norm (Gates, et al, 2012, p. 201). Wolf, et al, pointed out that in cases where there was a lack of support from public officials regarding an assault, nurses voiced their aggravation and impression that the workplace was unsafe. As a judge stated to a nurse regarding an episode of violence, “well, isn’t that the nature of the beast, being in the emergency room and all?” (Wolf, et al, 2014, p. 307). As healthcare professionals and organizations alike, our accountability to fellow employees and patients relies on the preservation of a secure environment” (Gillespie, et al, 2012, p. 376).
WPV is a serious risk for the emergency nursing workforce. Due to the gross underrepresentation of workplace violence in the emergency department, the true scope of the problem is unknown. Despite the lack of reporting, it is clear that emergency department nurses are frequently victims of violence perpetrated by patients and visitors (Gates et al., 2012, p. 203). Prosecution to the full extent of the law is necessary to decrease the perception that violence against nurses is acceptable. Greater support from public officials and management is necessary to combat this growing problem, with the institution of specific policies and procedures. Movement toward a nonviolent workplace will result in higher nurse satisfaction and retention. To effectively establish and address the issue, more research, support from hospital management, and stronger legislation is necessary.

References
Violence in the Emergency Care Setting. (2010, January 1). Retrieved , from http://www.ena.org/about/position/position/Pages/Default.aspx
Gates, D., Gillespie, G., Smith, C., Rode, J., Kowalenko, T., & Smith, B. Using action research to plan a violence prevention program for emergency department. (2011). Journal of Emergency Nursing, 37, 32-39.
Gillespie, G., Gates, D., Mentzel, T., Al-Natour, A., & Kowalenko, T. Evaluation of a Comprehensive ED Violence Prevention Program. (2013). Journal of Emergency Nursing, 39, 376-383.
Pich, J, Hazelton, M., Sundin, D., & Kable, A. Patient-related Violence Against Emergency Department Nurses. (2010). Nursing & Health Sciences, 12, 268-274.
Wolf, L., Delao, A., & Perhats, C. Nothing Changes, Nobody Cares: Understanding the Experience of Emergency Nurses Physically or Verbally Assaulted While Providing Care. (2014). Journal of Emergency Nursing, 40, 305-310.