Violence Against Nurses in the Emergency Room

In the present day situations of the health care sector, among the highly complicated as well as perilous risks faced in the workplace is the violence encountered by employees in the place of work. The general idea is formulated partly from the pre-meditated and imaginary fact that violence that is related to patients and the gratification that comes with it are part and parcel of the job of providing health care.

According to Collins (2001), nurses are involved in multidisciplinary practices that are skewed in helping patients come out of their current predicaments. The lack of efficient as well as effective violence preventative and protective rules and regulations play a major role partly in bringing forth the complications that abound thereafter, in the health care provision sector.

Hurdles of immense proportions in the elimination of violence in the workplace situations nowadays, are formed by these aspects coupled with institutional truths for example, added patient perception as well as shortages related to members of staff. These are among the general origins of physical as well as oral violence carried out against the nursing fraternity as well as other diverse providers of health care.

The main purpose/ objective of carrying out this study was basically to scrutinize the awareness as well as the experiences of violence, that emergency room nurses endure from visitors as well as patients in the United States emergency department. The field of emergency nursing is a much tapered one in the profession of nursing where the nurses are taught how to be able to cope and deal with patients who are in a very critical stage of their ailments or injuries. Emergency room nurses are very highly adapted to the swift tempo environment of their work situations. These emergency room nurses may on very many occasions be seen multitasking so as to be able to balance as well as attend to patients who require urgent attention as well as their time.

On the background of this study, it can be stated that the emergency department is considered as a meticulously susceptible locale that is highly conducive for violent behavior and also due to the fact that there is the need for consistent dimensions as well as the machinery for the exposure with regards to violence in healthcare surroundings, the statistics are rather inadequate.

The method used was the completion of a sixty nine piece survey by the participants mostly emergency room nurse members, who are registered and numbering 3,465 and are catalogued with the Emergency Nurses Association. The results attained affirm that roughly 25% of the respondents stated that they went through violence of a physical nature for more than twenty times during the previous three years, and also about 20% stated that they underwent oral/ verbal mistreatment or abuse in the course of the same period. The need for support from the administrators of the hospital as well as the emergency department management are regarded as major hurdles to the due process of exposing violence that is related to the work place, by a majority of the respondents who had gone through either regular abuse physically and/ or verbal or oral mistreatment on a regular basis and who had also expressed the trepidation of reprisal.

The conclusion that was derived from this study was that aggression as well as violence that are unleashed upon the nurses in the emergency departments in the United States of America is very highly rampant. The impulsive issues towards violent or aggression related episodes that were acknowledged by the respondents of the study are regular and in line with the research literature.

These issues may however be alleviated seeing as there is a sizeable probability of doing so. To be able to make sure that the working environment is much safer for the emergency room employees, the emergency room managers as well as the security in the hospital and also most importantly, the administration of the hospital should all exude commitment in those regards.


Aggression in the place of work is a very somber harzard in any occupation, that happens in the present day home as well as worlwide labor force situations and this accounts for a total of around 900 deaths with approximately 1.7 million assaults that are not mortal, in the United States of America alone, every year. In the year 2007 alone, 15% of all the sufferers who were hurt physically due to the nature of the job that they perform were basically caused by physical attacks as well as violent actions against them.

According to Townsend (1993), nursing research engages in making specific and systematic inquiry to help develop, refine as well as extend knowledge on nursing. Nurses are endowed with abundant knowledge that can be used to address issues such as nursing practices, education and administration. Townsend (2007) stated that, nursing research specifically touches on issues that affect the nurses, patients’ families and other stakeholders in the clinical practices.

Violence that is work related may actually be much more rampant than is shown by this data due to the vital need for a standardized description of the issue of workplace violence, the lack of directive laws as well as the lack of full reporting of instances of violence, in the prevention of occurences of violence in the workplace, make the whole process intricate to evaluate the extent of work situation aggression. Any actions of aggression that may be aimed at individuals who are on duty or at their work which may range from murder to intimidating or distasteful verbal communication, is defined by the National Institute for Occupational Safety and Health (NIOSH) as “workplace violence”.

The general definition of workplace aggression/violence is that, it is any form of forceful behavior or threatening, harassement, expressive or oral abuse, as well as any sort of physical harm that is carried out in the work station. In the past few years, violence in the workplace has been documented as violent crime and is in urgent need of aimed replies from the society at large as well as employers and the law enforcement authorities too.

Literature Review

Due to the need for the machinery for reporting as well as consistent measurement for violence in the place of work in the health care sector, statistics are insufficient, making necessary the want for study that investigates cases of violence carried out on emergency room nurses. The E.N.A (Emergency Nurses Association), was given responsibility by the members, to deal with the issue of violence or aggression of any kind that is aimed at emergency room nurses through support as well as research.

In a comeback, this particular study was carried out so as to be able to explore the nurses insight as well as their experiences in the emergency department, the number of times that assaults occur as well as the mode of aggressive behavior in the emergency department and also the other various factors that may act as contributing aspects to the violence within the emergency room and the nurses, and also to present a general view of the whole study.

Data collection & analysis

ENA, the Emergency Nurses Association which had an approximate number of 31,905 active members at the time the study was carried out and is also a non-profit society, carried out this cross-sectional study. According to Varcarolis (2008), in qualitative research, a clinician may decide to use qualitative methods such as interviews or the narratives to help in understanding particular issues while in the quantitative research, quantifiable data inform numerical is used to survey instrument to measure knowledge beliefs and attitudes. A survey on workplace related violence was developed by a work force team of the E.N.A (Emergency Nurses Association), and was appraised by a panel of experts who checked for content validity and they also did a pilot test on a model of fifteen emergency room nurses.

The survey that was done online, being a 69 item survey, was mainly concerned with the respondents individual experiences that they encountered whether the attacks were oral or physical type aggression in the emergency room, the respondents’ hospital processes as well as their policies that they implement in addressing the issue of aggression at the place of work as well as the beliefs of the respondents concerning the impetuous aspects of aggression as well as the hurdles that impede testimonials on violence within the emergency room.

Sampling strategy

An expediency sampling plan was implemented. The members who were all employed in the emergency departments in the United States of America when the survey was being carried out and also were accessible to the internet, were suitable for taking part in the research. The internet based survey was made possible via Survey Select Expert adaptation 5.6. The one time review was reachable by the internet in the course of 2007 spring for a period of one month. Through e-mail proclamations, the website as well as the Emergency Nurses Association newsletter, paticipation was implored in the same period of time.


Incidences of aggression in the place of work in most cases go unreported to either the employers or the authorities concerned with implementation of the law. Especially in the industry of health care, these cases may be reported in very minimal amounts due to the lack of policies that are related to reporting within institutions and the view that violence is part of the duty. The emergency room employees maintain the belief that if they report the incidences they may not benefit from it as well as concerns of the same employees that attacks on them may be seen as a verification of carelessness on their part or also reduced job performance.

In another unrelated study on emergency room nurses in the emergency room, in the general divisions of a regional center of medical care as well as the intensive care unit, around 50% of the respondents stated that attacks of physical nature as well as oral or verbal attacks carried out by members of the families as well as by the patients themselves, on the nurses, went unreported in written form. Several of the nurses had the pre-meditated notion that those particular types of occurrences were considered as part and parcel of the job description thus rendering the issue of reporting them useless. Added to that fact, was the issue of how several of them had the feeling that, compassion towards the anger that was articulated by the family individuals or the patients themselves as well as the need for proof of individual injury of a physical nature were considered as good enough reasons not to testify about the occasions of aggression.

According to OSHA, which is the Occupational Safety and Health Administration, the “Guideline for Prevention of Workplace Violence for Health Care and Social Service Workers” incorporates procedure approval as well as realistic means to aid in the prevention as well as reduction of workplace related violence.

Considering the fact that the guidelines that are provided are applied voluntarily, health care providing institutions that do so, may not be having efficient programs while others may not have any programs at all in effect. So as to be able to address the want for dependable as well as worthy programs, health care professional institutions as well as nursing organizations and others like unions, have requested for centralized/federal laws that ask for health care providing organizations to be able to give better safety in their stations of work.

The duration of the research may have also acted as a restriction even though the Emergency Nurses Association was unable to control the number of submissions by an individual nurse. Chesapeake Research Review, Inc., helped by supplying Institutional appraisal board consent for the research to be carried out and also delegated as not being liable.

Research Design

SPSS Windows adaptation 14, was implemented for management of the statistics as well as data evaluation. Due to the fact that the data had statistically abnormal allocations, non-parametic statistical techniques were implemented so as to enable them evaluate the data. Among the groups, nurses who responded in the affirmative to the fact that they had undergone a high rate of violence often i.e. more than 20 times, this from people visiting the patients as well as the patients themselves in the previous three years within the emergency department, were grouped in the category of frequent, physical, violence experience nurses(FPVE).

The nurses who gave positive replies to the question of whether they had under gone a high rate of oral or verbal molestation i.e. more than 200 times, from the people visiting the patients or from the patients themselves, were grouped in the category of frequent, verbal, abuse experience nurses (FVAE). The chi square test of connection and also the Fisher exact test which was used in certain incidences where anticipated frequencies were somewhat minuscule so as to tolerate for the deployment of the chi square test, were the methods that were both utilized and to facilitate an evaluation of the autonomous blocs with percentages put in consideration. So as to compare autonomous factions with deference given to the variables that were non-categorical, the implementation of Mann Whitney U as well as the Kruskal-Wallis tests was effected. As for the entire data evaluation, an important level of.05 was utilized. Among the tests carried out, no one sided test was carried out. The data were presented in the form of – (negative) or + (positive) SD.


There is a marked increment in aggression that is directed towards registered nurses who work in the emergency room. One question abounds; what methods may be used so as to be able to ensure the security of more medical personnel from the various forms of aggressive manners from people who may show violent manners together with what additional constraints can be put in use in helping their own wellbeing? The “Council of Community Health Nurses and the Congress of Nursing Practices” states that the “American Nurses Association” (ANA, 2000), up holds teaching health care givers as well as nurses, the skills that are needed to enable them avoid aggression against females, the evaluation of women within the health care organizations, the societal settings as well as studies on aggression that are anti-women.

According to Videbeck (2010), healthcare nurses and other clinicians follow specific procedures in the application of evidence based practice in their day to day activities. This form of teaching may be very vital for nurses in the emergency department. They require to learn the ability to enable them prevent aggressive manners to them, so as to secure themselves against these acts of aggression. The nerve-wracking environment that is encountered in an emergency room visit, adds to the possibility of aggressive acts catalyzed by a variety of reasons. General reasons may involve the fact that the ill person is probably in pain, as in many occasions they may have to wait for quite a long time so as to be able to either see a doctor or to get medication to ease the pain, and also family members as well as the patients themselves may at times get frustrated due to the health care scheme which they may deem inefficient.

Several patients may have acute ailments of continual problems of a medical nature which may not be totally attended to because of a couple of reasons majorly, non- compliance with the preferred treatment or inaccessibility to a primary health care giver. Even so, the number of patients who may be attended to in the emergency department includes too, people who may have a natural tendency towards aggression. In most cases these patients are ill people and may either be looking for, or using drugs. Also to be considered is the fact that there are quite a number of cantankerous patients who may be under police supervision and are brought into the emergency room and who are under the influence of either alcohol or drugs. On top of this, ill people who may have hidden cases of neurosis or dementia may often attend the emergency room for delicate modes of treatment. Canvassing this state of affairs is the actuality that the emergency room is open at all times of the day as well as night to all people. These aspects all put together, heighten the probability of aggressive actions happening in the emergency room.

In hospitals, violent behavior transpires for the largest part, commonly in the wards for patients with psychiatric disorders, geriatric units, emergency rooms as well as waiting rooms. According to Pernanen (1991), evidence based best practice in nursing involves the use of scientifically proven research evidence to make decisions regarding to care and treatment of patients. Pernanen further states that “research has indicated that between around 35% and 80% of staff at hospitals have encountered physical attacks at least one time in the course of their careers”.

The elevated susceptibility to sadism at the workplace principally in the hospitals, may be originated, in part, by terribly low echelons of staffing, the want for training of labor force in distinguishing and smoothing out patients who may reveal signs of prospective aggression, the call for enrichment of aggression deterrence curriculums, the increased need for sufficient security/ precautions within the emergency departments, also the opinion by criminals’ that these pharmacies and infirmaries as well as treatment centers can be good supplies for cash as well as drugs and possession of weaponry by aggressive hospital guests as well as patients which may be used against the hospital team.

Access on a 24 hour basis to the emergency rooms and the need for well trained and visible security who are armed as well as a very strenuous aura in the emergency rooms are but a few of the rationale as to why emergency rooms are mostly susceptible to acts of aggression.

The overpowering greater parts of the person responsible for violence in the emergency rooms are among others, the visitors, patients as well as members of the families. Patient hurting and soreness, as well as the apprehension, tension, and irritation of the patients, members of the family and visitors, are regularly spiraled by overcrowded room, the need for privacy, as well as lengthy waiting times and queues. The consequential dissatisfaction and susceptibility may perhaps goad bodily and oral mistreatment against the emergency room personnel. In accumulation to that, oral viciousness and bodily attacks within the emergency department can come from disorderly and drunk patients who may at times be escorted by other inebriated or troublesome persons.

The sector of nursing has acknowledged the ever-increasing insight as being a profession of major threats for aggressive assault. The National Crime Victimization Survey (1993-1999) recognized the actuality that the customary twelve-monthly rate for non-serious antagonistic misdemeanors rested at a consistent number of 21.9 per 1,000 staff in favor of nurses, distinguished with merely 12.6 for every 1,000 staff for all the other added diverse vocations. Also accredited was the verity which stated that going by information from the “Bureau of Labor Statistics” (BLS), before the end of the year 2004, approximately 46% of non-serious shows of aggression and antagonistic acts intended for practitioners of health care which were concerned with their days on duty, were committed on (RNs) listed nurses. Nursing workers are key targets of violent behavior within the emergency department. In one study, 82% of urgent situation nurses pointed out that they had been battered physically while at work for the period of the prior year. The prevalence of oral ill-treatment is escalating as well, and such mistreatments impinge on 100% of emergency room nurses in a number of amenities.

The American Nurses Association established that an amount, less than 20%, of nurse’s appraised in 2001 felt out of harm’s way in their present job setting. Investigations have over and over again established the fact that nurses are anxious with reference to violent behavior and belligerence, contemptible wellbeing procedures, as well as individual susceptibility in their places of work. A lot of nurses plainly do not believe that they are safe at their places of work.

A superficial need for institutional sustainability is a major aspect in the discontent that nurses sense. This sense of managerial desertion may perhaps result from insufficient employment echelons, unfulfilled guarantees to perk up their environmental wellbeing, disregarded apprehension, unsatisfactory learning and preparation, as well as the need for support from co-workers, general practitioners as well as supervisors in the after effects of a confrontation. Just and constant measures as well as a culture of assistance, rather than retribution, for sufferers are significant.


The results attained expose the fact that an approximate number of 25% of the respondents stated that they went through violence of a physical nature. Appraisal of the validity of the finding, according to Varcarolis (2008), is then carried out to authenticate the relevance of the findings and the research evidence. This occurred more than twenty times during the previous three years, and also about 20% stated that they underwent through oral/ verbal mistreatment or abuse in the course of the same period.


The conclusion that was derived from this study was that aggression as well as violence that are unleashed upon the nurses in the emergency departments in the United States of America is very highly rampant. The impulsive issues towards violent or aggression related episodes that were acknowledged by the respondents of the study are regular and in line with the research literature. These issues may however be alleviated seeing as there is a sizeable probability of doing so. To be able to make sure that the working environment is much safer for the emergency room employees, the emergency room managers as well as the security in the hospital and also most importantly, the administration of the hospital should all exude commitment in those regards.


As pointed out by the nurses in this research, a tough directorial dedication is crucial in dropping the number of incidences in the emergency department of aggression and also eradicating obstacles to exposure of such confrontations of violent behavior. According to McDowell (1998) evidence based practice, research utilization; nursing research and quality improvement are all practices that have been used in health intervention with much success. Employees and managers in the emergency department should be acquainted with the fact that higher-ranking administrators are conscious of the aggression problem and support efforts to check and alleviate violent behavior. Nursing executives ought to be hands-on, in taking strides to formulate safety in the place of work. McDowell, (1998) stated, nurses are supposed to know and understand evidence for any intervention that is provided to the patient. They also should focus on providing intervention for the highest achievable outcome for the patients, family and nurses themselves. Ascertaining a way of life of receipt for the exposure of sadistic happenings is an affirmative step in the direction of crafting a much safer occupational atmosphere. Procedures for exposure of sadistic confrontations should be unambiguous and reliable, and staff of the emergency department ought to have the right to use to health check care as well as follow-up counseling in any case it may be required by them.

An additional indispensable approach to addressing violence in the emergency room is calling together an interdisciplinary commission that will be able to make out vulnerabilities within the emergency department (ED) as well as to build up an arrangement that may enable them diminish, avert, act in response to, as well as report violent behavior. This task force should mainly consist of the chief operating executive, the chief nurse administrator, the emergency room medical directors, emergency department manager/director, the security personnel representatives, the risk management personnel as well as the local police, and most significantly, the nurses who work in the emergency department.


Counseling of victims is an issue that is given high priority so as to enable the victims deal with the experiences much easier. Medical care accorded to the nurses after assault cases may also be of benefit to them.


Collins, J. (2001). Drinking & crime: Perspectives on the relationships between alcohol consumption & criminal behavior. London; Taylor & Francis.

McDowell. D. M. (1998). Violence against nurses. Ohio; Wright State University Press.

Pernanen, K. (1991). Alcohol in human violence: Substance abuse. New York; Guilford Press.

Townsend, C. M. (1993). Psychiatric/mental health nursing: Concepts of care. Michigan; University of Michigan Press.

Varcarolis, M. E. (2008). Foundation of psychiatric mental health nursing. Michigan; University of Michigan.

Videbeck, L. S. (2010). Psychiatric: mental health nursing. Philadelphia; Lippincott, Williams & Wilkins.

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