New Research Assesses Workplace Violence in the Emergency Department Setting

Although verbal threats were the most common kind of workplace abuse reported by survey respondents, 34% of the ED healthcare workers also reported physical assaults by patients.

Violence toward emergency department healthcare workers is prevalent and underreported, and victimized ED healthcare workers experience emotional injury during and after assaults, a new research article found.

Earlier research has shown that EDs are a hotbed for workplace violence. A New York City study found that 97% of emergency medicine resident physicians had experienced verbal harassment in an ED. A study published in 2016 found that 78% of ED healthcare workers had reported a violent assault in the prior year.

The new research article, which was published by Annals of Emergency Medicine, is based on survey data collected from 123 ED healthcare workers at an academic medical center in North Carolina. The survey respondents included 27 resident physicians, who were hypothesized to be at greater risk of workplace violence than their older colleagues.

"Residents are in training, are often young, and frequently have minimal experience with such encounters. They may lack the skills or training needed to prevent, manage, or process incidents of abuse," the research article's co-authors wrote.

The research article includes several key data points.

• Among all survey respondents, 80% reported at least one verbal assault in the prior year. Among residents, 89% reported at least one verbal assault in the prior year.
   
• Among all survey respondents, 70% reported experiencing verbal assault multiple times. Among residents, 74% reported experiencing verbal assault multiple times.
   
• Among all survey respondents, 34% reported one incident of physical assault. Among residents, 22% reported one incident of physical assault.
   
• Among all survey respondents, 9% reported multiple physical assaults. No residents reported multiple physical assaults, which the researchers said was likely due to the clinicians working in the ED for less than 2.5 years.
   
• Among all survey respondents, 63% reported feeling unsafe in the workplace. Among residents, 67% reported feeling unsafe in the workplace.
   
• Among residents, 96% discussed workplace abuse only with a colleague or no one at all. None of the residents filed formal incident or police reports.
   
• The healthcare workers were asked whether there were specific reasons that led perpetrators to commit acts of violence or abuse. Among healthcare workers who experienced assault, 22% said they believed the incident was motivated by race or ethnicity, 21% said they believed the incident was related to their sex or gender identity, and 21% said they believed the incident was related to their age.

"Although verbal assault is most common, 34% of healthcare workers in this academic ED also reported incidents of physical assault by patients. Consistent with prior studies, only 20% of respondents filed formal incident reports or police reports, and when looking specifically at resident responses, there were no formal reports filed," the research article's co-authors wrote.

The survey responses generated 24 narratives about workplace violence and abuse. The narratives featured four themes: comments on assaults and threats, feeling unsafe, resignation, and influence on care. The following are examples of comments that fell into these four themes.

• Assaults and threats: "A patient was verbally assaulting. After many minutes of being yelled at, the patient hit me and swung at another nurse demanding IV pain medicine, then proceeding to scream that this was our fault, and threatening to kill us and our families."
   
• Feeling unsafe: "I was punched in the eye by a psych patient, did not file a police report because the officer made me feel like I contributed to the incident. I missed three days of work. Now I always feel unsafe on my job."
   
• Resignation: "Workplace violence is unfortunately part of the job. It's concerning that charges can be filed against a healthcare professional for too much force but nothing can be done when a patient punches, kicks, bites, scratches, pulls hair, or generally assaults you. I'm not here to get beaten up. This culture needs to change before a nurse gets killed by a patient."
   
• Influence on care: "I've experienced multiple encounters with intoxicated patients being verbally abusive and threatening. It has definitely impacted my ability to provide care."

Research insights

Verbal and physical abuse of healthcare workers takes an emotional toll, one of the research article's co-authors told HealthLeaders.

"The experience of abuse in the workplace can certainly contribute to burnout, lower job satisfaction, stress, and disengagement. In the worst cases, when there are physical threats, it can even lead to fear and a change in behavior such as canceling social media accounts or not driving directly home," said Christina Shenvi, MD, PhD, an associate professor of emergency medicine at the University of North Carolina School of Medicine in Chapel Hill, North Carolina.

An effective incident reporting system is crucial to addressing workplace violence in healthcare settings, she said. "It is important that healthcare workers know that if they report concerns, that action will be taken to help keep them safe and prevent future incidents."

Healthcare organizations should have a set of essential interventions and responses in place to address workplace violence, Shenvi said. "Institutions should have a process for assessing the reports and events, provide legal support when needed, and create policies and procedures to prevent future abusive episodes. In addition, institutions should have a means of providing emotional and personal support to healthcare workers to facilitate emotional recovery."

Related: Reduce Your Workplace Violence With Initiatives From VCU Health