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Workplace Violence Against Emergency Nurses Remains High

Des Plaines, Illinois, November 2, 2011—The latest release of an ongoing survey of more than 7,000 emergency room nurses nationwide finds that rates of physical violence and verbal abuse against nurses did not decrease between May 2009 to January 2011. In the 12 months from January 2010 to January 2011, more than half (53.4 percent) of nurses reported experiencing verbal abuse and more than one in ten (12.9 percent) reported experiencing physical violence over a seven day period, compared with 54 percent reporting verbal abuse and 11 percent reporting only physical violence in the first year of the Emergency Department Violence Surveillance Study. The study is being conducted by the Emergency Nurses Association (ENA), which surveys emergency nurses at three-month intervals.

Of all the nurses surveyed who indicated experiencing physical assault, nearly half (48.3 percent) said they were grabbed or pulled. The most common forms of verbal abuse were yelling or swearing, with nearly nine in ten (89 percent) nurses reporting these forms of abuse. Patients were the perpetrators in nearly all incidents of physical violence (97.8 percent) and verbal abuse (92.3 percent). The study also found that a patient’s room was the most dangerous place for an emergency nurse, with more than four out of five (82 percent) incidents of physical violence occurring in that location. More than half (55.7 percent) of patients who physically assaulted nurses were under the influence of alcohol, 46.8 percent were under the influence of illicit or prescription drugs and 45.2 percent were psychiatric patients.

In most cases of assault, nurses did not file a formal report, but did notify someone. Sixty-six percent of nurses indicated they did not formally report physical violence and 86.1 percent did not file a formal report when verbally assaulted. Most of the nurses surveyed who were physically assaulted did notify security personnel (65.7 percent), an immediate supervisor (64.2 percent), another emergency nurse (63.2 percent) and/or an emergency physician (54.6 percent). Only eight percent of those who experienced physical violence and 16.9 percent of those who experienced verbal abuse did not notify anyone.

The study also found that in almost half (46.7 percent) of the cases of physical violence, no action was taken against the perpetrator. In nearly three-quarters (71.8 percent) of cases, nurses received no response from the hospital about the assault.

Male emergency nurses, emergency nurses in urban settings and those who work in larger hospitals and in trauma centers all reported higher rates of physical violence and verbal abuse. The survey also revealed that rates of physical violence and verbal abuse were higher when security personnel were present. However, the survey did not address whether the security presence was a contributing factor to a higher level of reported violence.

The report also identifies several measures that are associated with lower rates of physical violence and verbal abuse. Verbal abuse rates were lower when emergency departments had locked entries, an enclosed nurses’ station, call code pseudonyms, security signs and well-lit areas. Physical violence rates were lower in emergency rooms with panic buttons.

Emergency departments in hospitals with higher commitment to safety and reporting policies, particularly those with zero tolerance policies, had lower rates of physical violence and verbal abuse. Of the nurses who reported not experiencing any physical violence or verbal abuse in the previous seven days, nine in ten (91.8 percent) worked in facilities with reporting policies.

“Violence in our emergency departments affects not only nurses, other health care providers and emergency department staff, it puts the safety and well-being of our patients at risk,” said ENA President AnnMarie Papa, DNP, RN, CEN, NE-BC, FAEN. “We need hospitals and hospital administrators to take steps now to increase the safety of their emergency departments so that patients can receive the care they need. Zero tolerance policies are showing great promise for reducing the incidence of violence and we would like to see more hospitals implement these policies in order to safeguard patients’ safety and health, as well as that of the people who care for them.”

According to the report, more than a third (36.7 percent) of emergency nurses have considered leaving their current jobs because of workplace violence. Nearly one in ten (9.5 percent) has considered leaving nursing entirely and the same proportion have considered looking for a job in another hospital. Almost one in five (17.7 percent) has considered looking for a job in non-emergency nursing.

The 2011 Emergency Department Violence Surveillance Study is based on data collected quarterly from May 2009 to January 2011 about the prevalence and nature of workplace violence experienced by emergency nurses during the previous seven days. A total of 7,169 nurses participated in the online survey.

The full report is available online at http://www.ena.org/IENR/Documents/ENAEDVSReportNovember2011.pdf .

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