Violence Against ED Nurses Remains High, But Remedies Exist

Another week, another hospital shooting.

This time it was Omaha, NE. You can read the local news accounts here.  

It sounds callous, but I really don't care what prompted the gunman's bout with irrationality. My sympathy and concern for him ended when he picked up a gun to solve his troubles. Two police officers suffered "minor" gunshot wounds in the shootout that fatally wounded the gunman. Fortunately, no patients, visitors, or healthcare providers suffered physical injuries.

I hate to sound like a One Note Johnny on the issue of hospital violence, because there are a lot of other topics I would prefer to write about. But this just won't go away. It's hard to ignore this very disturbing trend when we're getting weekly reports of gunplay and other violence in places of healing.

A timely Emergency Nurses Association nationwide survey has found that between 8% and 13% of ED nurses say they are victims of physical violence every week. More than half (54.8%) of the 3,211 nurses ENA surveyed at three-month intervals between May 2009 to February 2010 reported physical or verbal abuse at work in the week before taking the survey. 

The ENA's Emergency Department Violence Surveillance Study also found that 15% of the nurses who reported physical violence—slapping, shoving, spitting, punching, kicking, etc.—said they were injured as a result.

To me, the most disturbing factoid in the survey was that no action was taken against the perpetrator in 45% of the cases. In other words, the attacker went unpunished.
Three in four nurses who were victims of physical violence reported that the hospital gave them no response regarding that violence.

"We are extremely alarmed that there are so many cases in which hospitals do not respond to violence in the emergency department," said Diane Gurney, RN, president of the 37,000-member ENA.

"These incidents are not only frightening and dangerous for nurses, but also for patients in the emergency department. Hospital administration has a responsibility to keep patients and the healthcare providers who care for them safe. Every hospital should be required to adopt and implement policies to keep their emergency departments safer."

Gurney is exactly right. Hospital leadership can no long cling to the excuse that hospital violence is a random event that is impossible to prepare for, nor can leadership provide any excuse for failing to respond to acts of violence against staff.

Measures can be taken.

For example, the ENA survey found that ED nurses at hospitals with policies regarding violence reported experiencing fewer incidents of physical or verbal violence. Hospitals with zero-tolerance reporting policies had an 8% physical violence rate; hospitals with a non-zero-tolerance policy had a 12% physical violence rate; and hospitals with no policy had an 18% physical violence rate. Raise your hand if you spot the trend.

"These data underscore what nurses know first-hand," Gurney said. "Hospitals that have policies in place to respond to violence and to prevent it are safer for the healthcare professionals that work in them and the patients who seek treatment in them."

The survey revealed that simply strategies such as a panic button or silent alarm lower physical violence, and enclosed nurses’ station, security signs, and well-lit areas lower verbal abuse. 

The survey also found that:

• Patients and their relatives perpetrated nearly all physical violence (97%) and verbal abuse (91%).   

• Most physical violence occurred in patients' rooms (81%). Nearly a quarter (23%) occurred in corridors, hallways, stairwells or elevators and 15% occurred at the nurses’ station. *
• The most frequently reported activities that emergency nurses were involved in when they experienced physical violence were triaging a patient (38%), restraining or subduing a patient (34%) and performing an invasive procedure (31%). *
• Male nurses reported higher physical violence rates than female nurses (15% versus 10%); and physical violence rates tended to decline with older nurses.
• Physical violence rates were higher in large urban areas (13%) than in rural areas (8%). Nurses working in EDs with more beds and treatment space, and those with higher numbers of visits were more likely to experience physical and verbal abuse than nurse in lower-traffic departments.

The ENA survey doesn’t provide a vaccine for the epidemic of hospital violence. It does give us a good idea of where hospital violence occurs, who the victims are, who the perpetrators are, and some basic strategies to reduce violence. It's a good starting point. Look at the survey and see how your hospital's antiviolence policies compare. You owe it to your employees. What are you waiting for?   

* (Math majors may notice that these responses add up to more than 100%. ENA explains that for several of the survey questions respondents were allowed to select more than one response. For example, a violent incident could start in a patient’s room and spill out into the hallway as the incident progresses.)