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ED Nurses Still Wear a Bullseye for Workplace Abuse

 |  By John Commins  
   November 14, 2011


There isn't much good news in the latest nationwide survey of workplace violence against emergency department nurses. Despite the media attention generated by the 2009 survey, which showed that emergency nurses rank with cops and prison guards when it comes to on-the-job verbal and physical abuse, and the needle hasn't moved in the last two years.

The latest results from the ongoing Emergency Department Violence Surveillance Study of 7,169 emergency nurses nationwide found that 53% of nurses reported experiencing verbal abuse and 13% reported experiencing physical violence over any seven-day period in 2010. Those results are almost identical to those in the 2009 survey. 

"The only thing good I see coming out of this is that we continue to let people know that this is an issue. Public awareness is important because it's the public who is committing the violence," says AnnMarie Papa, RN, president of the Emergency Nurses Association, which compiles the survey and report.

What's frustrating is that although the number of zero -tolerance policies is up, Papa says, "the violence in those facilities with zero-tolerance policies is just a little down from what it was the two years ago when we last did the study."

Here are some other notable findings:

  • Of all the nurses surveyed who indicated experiencing physical assault, 48% said they were grabbed or pulled.
  • The most common forms of verbal abuse were yelling or swearing, with 89% of nurses reporting those forms of abuse.
  • Patients committed 98% of the physical violence and 92% of the verbal abuse.
  •  The patient's room was the most dangerous place for an emergency nurse, with 82% of physical assaults occurring there. 
  • More than half —56% —of patients who physically assaulted nurses were drunk, 47% were on drugs, and 45% were psychiatric patients.

What is more troubling, however, is that 66% of nurses did not file a formal report when they were physically assaulted, and 86% did not file a formal report when they were verbally abused. 

That means the perpetrator went unpunished. Most nurses did not even notify security personnel, their immediate supervisors, or physicians. I guess the good news is that most nurses didn't just keep the abuse to themselves—they told someone. Only 8% of nurses who were physically assaulted and 17% of nurses who were verbally abused did not tell anyone.

"The people who didn't report it said it was too cumbersome and too time-consuming," Papa says. "Organizations have to look at their reporting mechanisms and see what they can do to streamline it. Can they partner with security in their organization to have that help?"

No matter how time-consuming or burdensome, nurses have to take a greater responsibility to formally report violence, if not for themselves then for their colleagues, who are also potential victims. Also, even thorough and widely drawn surveys like the ENA's are essentially anecdotal. Tackling this issue will require hard data, and nurses are hurting the effort when they don't report the violence.

"We are working hard to make this happen because these zero tolerance policies require nurses and other healthcare workers to report the violence and that is not happening consistently," Papa says. "If the nurses aren't reporting it then we can't trend it. It becomes anecdotal data. But if they are reporting it in realtime we will have some real numbers."

It gets worse. The study found that in 47% of the cases of physical violence, no action was taken against the perpetrator.  In other words, they got away with assault once. So, they'll probably do it again.

And, worst of all, in 72% of cases, nurses received no response from hospital leadership about the assault. This is astonishing and utterly inexcusable. How can senior leadership in any organization—from a hospital to a tire plant—not make a personal and immediate inquiry into the health and well-being of an employee who was assaulted on the job?  If this is the policy at your hospital, change it.

Ignoring injured employees will make senior leadership appear callous and indifferent, and that would be correct.  

 "The key for senior administrators to recognize is the high-level buy-in, and the high-level visibility," Papa says. It's not just the name on a piece of paper and a note.  It's that personal phone call and personally reaching out. "That call alone makes the nurse or the healthcare worker feel valued, knowing that leadership is watching this, and they are working to make changes."

It's also a dumb business practice to ignore the plight of injured employees in this era of high employee turnover and widespread labor shortages, especially for nurses. The survey found that 37% of emergency nurses have considered leaving their job because of the violence.

Here are two points we can take away from this survey: First, nurses must make a formal report  when they are the victims of assault, especially physical assaults. If they don't report it, it will happen again to someone else, perhaps a colleague. Secondly, leadership needs to reach out to any employees who are the victims of assault.

That is just basic decency.

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.

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