"There is a barrier when hospital administration and hospital leadership don't support nurse reporting," Brecher says, adding that although nurses' direct managers might support them, that support might disappear higher up the chain of command.
The new study illustrates these kinds of barriers. Some leaders, for instance, might be afraid of bad publicity for the hospital. One nurse who experienced violence said, "[The Chief Nursing Officer] seemed to be more concerned that I was filing a police report than over the fact that I was assaulted." Another nurse said that the hospital wanted to appear "friendly" so it didn't secure the doors or install weapon detectors: "Administration will only take action when some lethal event happens."
Brecher says despite barriers like these, she believes that hospitals can change the culture of complacency and acceptance around violence in the ED. In fact, she's seen it happen.
"The ones that were successful had a multidisciplinary team who were not afraid to look back…and assess the culture of their organization," she says. They define violence clearly (for instance, is spitting violence?) and educate staff about what it is.