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ENA Aims to Prevent Violence Against Nurses

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   May 24, 2011

Imagine if every time you came to work, there was a pretty good chance you would face a threat of physical violence or verbal assault?

This is an everyday experience for emergency department nurses. According to the Bureau of Labor Statistics, 46% of all violent acts in the workplace that necessitated days away from work were against RNs. And in the HealthLeaders Media Industry Survey 2011, just 40% of healthcare professionals surveyed said nurse leaders have "effectively addressed" workplace hostility.

The Emergency Nurses Association is engaged in a multi-year study to examine workplace violence against ED nurses and recently released data from the first section. The study questioned more than 3,000 ENA members from across the country and asked whether they had experienced workplace violence in the past seven days. Eleven percent responded they had experienced physical violence in the last week. Fifty-four percent had been subjected to verbal abuse within the last week. Unsurprisingly, physical violence rarely occurred without verbal abuse.

The most prevalent types of violence are:
  • Physical violence
    • Grabbed or pulled
    • Hit
    • Spit on
  • Verbal abuse
    • Yelled or shouted at
    • Sworn or cursed at
    • Called names

I spoke with the ENA's President AnnMarie Papa, RN, who is also a clinical nurse specialist at the Hospital of the University of Pennsylvania in Philadelphia

The violence "most often occurs on nights and weekends," says Papa. "The place that it occurs most is in the patient's room. Typically they were doing triage at the time and when nurses triage, they are typically by themselves."

Most of the violence is from patients who are under the influence of drugs or alcohol, or are needing psychiatric care. Patients' families are also perpetrators of violence against nurses.

Papa says that violence has long plagued ED nurses but that it used to be barely talked about.

"In the past, nurses were victims of the violence but they didn't make a big deal of it. People thought it was part of the job," she says. "But it's not part of the job"

"You have to treat people with respect," she says, adding that patients should not be able to hide behind the defense of anger and frustration at medical care leading them to get angry and scream and punch a nurse. "This is not acceptable," she says.

Incidents of violence against nurses may not be more prevalent than in the past, but it appears to be, due to widespread mainstream media coverage. Alarmingly, some hospitals appear lackadaisical in their response to workplace violence when it occurs. It's not enough to employ security guards; hospitals must have a solid system in place for when violence occurs.

Many nurses do not report workplace violence because they believe nothing will be done and there's no use, or because the process is so cumbersome they would rather not get started.

The ENA survey asked nurses how their organization responded to reports of violence:

  • Physical violence
    • No response from hospital to nurse (74.4%)
    • No action taken against the perpetrator (44.9%)
    • Perpetrator was given a warning (23.4%)
  • Verbal abuse
    • No response from hospital to nurse (81.3%)
    • No action taken against the perpetrator (50.5%)
    • Perpetrator was given a warning (29.6%)

Papa says organizations should establish policies so that a smooth process is in place for when incidents happen. This will make it easier for nurses to report workplace violence and ensure they feel supported when it happens.

"It's important to have that response set up so you can offer them employee assistance," says Papa. "[Nurses] shouldn't need to take a sick day or vacation day if they need to take a day off?it shouldn't count as a sick occurrence."

She also recommends senior leadership make a point of checking in with nurses who have experienced violence. She relates a situation from her own hospital when a couple of nurses were subjected to violence. They were cared for and supported by their immediate supervisors, and senior administration didn't get involved because they knew the staff's supervisors were taking care of the nurses.

The nurses, however, "felt they wanted to hear from the senior administration," she says. "So we put a system in place so they would call and say, 'I understand this happened.' The nurses really appreciate it."

The study found that violence against nurses is far less likely to occur in hospitals that have reporting policies, especially ones that mandate reporting of incidents. It is twice as likely to occur in emergency departments with no reporting policy at all. It is also less likely to occur when nurses perceive there is a strong commitment by administration and management to eliminate workplace violence.

To help organizations set such procedures in place, the ENA has issued a free toolkit to help organizations combat violence and establish plans for responding to it. It comes complete with reporting forms, educational materials, and data collections tools.

While risk of violence against nurses cannot be completely eliminated, it can be mitigated and nurses can be supported. Organizations should make this a priority. As emergency care becomes ever more complex and EDs more crowded, organizations need engaged staff who are committed and who stay. They will only do that if they know the organization is watching their back.

Rebecca Hendren is a senior managing editor at HCPro, Inc. in Danvers, MA. She edits and manages The Leaders' Lounge blog for nurse managers. Email her at

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