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Zero Tolerance for ED Assaults

John Commins, for HealthLeaders Media, August 3, 2009

Other than cops, prison guards, bounty hunters, soldiers, pro wrestlers, and emergency nurses, there aren't many occupations where the expectation of violence and abuse comes with the job.

A disturbing online survey released last week of 3,465 emergency nurses found that more than half of them say they've been "spit on," "hit," "pushed or shoved," "scratched," and "kicked" while on the job. What's even more disturbing, the nurses say, is the culture of acceptance for violent behavior in the ED that exists nowhere else in the hospital, or in decent society.

"If you went to a restaurant and said you were angry about the wait and punched your waitress, you'd go to jail," says Bill Briggs, RN, president of the Emergency Nurses Association. "Why in hospitals should you be told, 'Well, he was frustrated. It's OK'? It's not OK."

One in four of the emergency nurses surveyed for the ENA's Violence Against Nurses Working in U.S. Emergency Departments has been assaulted more than 20 times in the past three years, and one in five nurses has been verbally abused more than 200 times during the same period.

Briggs tells HealthLeaders Media that ED assaults remain "way under-reported. They're discouraged from reporting because of staff feeling like it will look like a weakness, or the hospital administration or the local police don't want to deal with it as a crime. People who are concerned about customer perceptions and patient satisfaction don't want to deal with it," he says.

As troubling as those responses are, it's a wonder there isn't more violence in the ED. All the ingredients are in place for violence and abuse by a small percentage of the volumes of people that use the ED. Injured, sick people and their relatives enter an intimidating ED environment afraid, confused, and in pain. Some are drunk, drugged out, mentally ill, or all three. Often they face long waits for treatment. Of course, the vast majority of emergency patients are "respectful of the process," Briggs says. Given the increasingly important and growing role that the ED is playing as a healthcare entry point for many Americans, however, hospitals must adopt a Zero Tolerance policy toward ED violence.

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