Free ENA program teaches ways to mitigate violence toward emergency healthcare providers
“I’m sorry. I was tired of waiting,” the teenage patient told Rita Anderson, BSN, RN, CEN, FAEN, the emergency nurse she struck a few hours earlier. Anderson approached the girl in the emergency department (ED) when, out of frustration, the teen hit Anderson so hard the blow to her face dislocated her jaw. Police were surprised Anderson pressed charges against a patient.
Unfortunately, this incident isn’t out of the norm in today’s ED. More than 70% of emergency nurses have been physically or verbally assaulted by patients or visitors while they provided patient care in the emergency setting.1,2 The 24/7 accessibility of EDs, overcrowding, long wait times, and patients under the influence are just some of the factors contributing to the epidemic of violence in healthcare.
Legal Progress is Not Enough
Emergency Nurses Association (ENA) members have been hard at work advocating for stricter penalties for violence against emergency care professionals. And progress is slowly being made. Anderson pioneered efforts in New York to make it a felony to assault a nurse, and said resistance is often strong – among both nurses and law enforcement officials.
In March, Utah Gov. Gary Herbert signed a bill increasing the penalty for assault against healthcare providers or emergency medical workers when the assault causes substantial bodily injury.
Shortly thereafter, Georgia Gov. Nathan Deal signed legislation increasing punishments for aggravated assault and aggravated battery when committed against hospital emergency department personnel and emergency medical services personnel. But stricter laws are just part of the solution. Twenty-six states still need to increase penalties for this type of violence.
Violence in EDs has become so widespread that in 2012 ENA set out to study the stories of nurses assaulted in emergency departments. Existing survey data provided the startling incidence and prevalence of violence in emergency departments.
ENA further explored the personal experiences of assaulted nurses, which informed the study “Nothing Changes, Nobody Cares: Understanding the Experience of Emergency Nurses Physically or Verbally Assaulted While Providing Care,” published in the Journal of Emergency Nursing in 2014. 3
Three common areas of concern emerged from the study’s data:
- The physical environment of the ED and the institutional culture of the ED
- The impact the event had on the nurse regarding job performance, coping, and feelings regarding the interaction with the legal and judicial systems, law enforcement, or institutional culture
- The precursors to the violent event either related to the perpetrator or the environment in which the event took place
In light of the study’s data, researchers recommended training staff nurses and managers in cue recognition to identify high-risk patients and situations. Interventions on both personal and institutional levels needed to be developed to address high-risk situations to recognize and mitigate violence, rather than manage the reaction after the violent event, researchers said.
De-Escalating Potential Crises
So ENA upped the ante on the search for solutions. The association, representing more than 41,000 emergency nurses worldwide, wanted to help emergency healthcare providers understand when situations are escalating, and provide tools to help mitigate what could quickly become a violent situation. ENA sought to provide nurses with an objective tool they could bring to administration and say, “This is a high-risk environment,” or “This is a high-risk person.”
Thanks to a grant from the Occupational Safety and Health Administration, ENA developed “Workplace Violence: Know Your Way Out,”4 a free, two-hour online course designed to teach nurses, managers, and staff who work in emergency care settings how to:
- Recognize workplace violence risk factors
- Apply prompt and appropriate responses
- Implement organizational prevention strategies, and
- Report and analyze patterns of violence
The course encourages clinical staff and hospital leadership to assess workplace violence challenges and create a proactive plan. And, just as important, remove the culture of acceptance around violence.
Identify Problems and Suggest Solutions
The course shows we need to take a critical look at both our patient population and the physical layout of our departments. If there’s one thing we can do today, it’s to identify the things that make our EDs high-risk, and proactively develop solutions. You may not be able to affect problem areas such as staffing and throughput, but you can consistently identify and report threats of violence. Monitor and record what is happening. The days of sweeping these incidents of violence under the rug are over.
Addressing violence in the ED requires a multidisciplinary team approach. A successful workplace violence prevention program requires a fundamental change in approach among hospital administrators, managers, the general public and emergency care providers.
Now’s the time to work together to stimulate change. What steps is your healthcare facility taking to recognize, mitigate and prevent violence?
“Workplace Violence Prevention: Know Your Way Out” was produced under grant number SH-23534-12-60-F-17 from the Occupational Safety and Health Administration, U.S. Department of Labor. It does not necessarily reflect the views or policies of the U.S. Department of Labor, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government.
- Gacki-Smith J, Juarez AM, Boyett L, Homeyer C, Robinson L, MacLean SL. Violence against nurses working in US emergency departments. J Nurs Adm. 2009;39(7-8):340-9.
- Emergency Nurses Association, Institute for Emergency Nursing Research. Emergency Department Violence Surveillance Study. Des Plaines, IL: Emergency Nurses Association; 2011. Available at: http://www.ena.org/IENR/Documents/ENAEDVSReportNovember2011.pdf. Accessed July 12, 2013.
- Wolf L, Delao A, Perharts C. Nothing Changes, Nobody Cares: Understanding the Experience of Emergency Nurses Physically or Verbally Assaulted While Providing Care. Journal of Emergency Nursing. 2014; (4): 305-310,
- Emergency Nurses Association. Workplace Violence: Know Your Way Out. Available: https://www.ena.org/education/onlinelearning/wvp/Pages/default.aspx.