Violence Against Nurses in the ED
Kim McAllister, RN, has worked as a staff nurse in the San Francisco Bay Area emergency departments for the past 17 years. She is the author of Emergiblog.com, a blog about ED nursing.
Scary.
That was my first response to the results of the study by the Emergency Nurses Association titled "Violence Against Nurses Working in U.S. Emergency Departments." I participated in the survey, as did 3,464 of my nursing colleagues. Fifty percent of us had experienced physical violence while working, including being "spit on," "hit," "pushed or shoved," "scratched" or "kicked." As noted in the report, "one in four has experienced such violence more than 20 times" in 3 years, with "one in five ... experiencing verbal abuse more than 200 times during the same period."
Wow.
We are talking violence emanating from environments that have 33 percent of surveyed ED nurses considering leaving their departments, or nursing in general, to escape the threat of violence.
That it is what is scary. So, are we just sitting ducks, or can we do something to decrease our chances of being a victim?
The study noted the risk of violence was higher where there were barriers to reporting, so it makes sense that breaking down barriers decreases the risk. First, there is the impression that reporting violent incidents leads to lower customer service scores. To that I say our safety trumps patient satisfaction every time. Why? Because nothing will drop those vaunted patient scores faster than not having nurses to care for patients, and one-third of us are considering quitting! The next barrier was listed as "ambiguous policies for reporting." Here, we can be proactive. Next time you are at work, ask how you would report an act of violence. No policy? Write one, and then take it through every committee until it is adopted. No time for that? Every facility has an incident report procedure. Use it.
Fear of retaliation by management, nursing staff or physicians can be a significant barrier. Reporting is not easy in this environment, but if we don't report, we are being victimized twice: once by the incident and again by not being allowed to talk about it. By reporting, we make it easier for others to do the same and make it harder to ignore problems.
The idea that reporting shows incompetence was yet another barrier. While it may be true we learn from our experiences and may, in retrospect, learn something that we may have done differently, that does not mean that we did anything wrong. If we don't have any physical scars or evidence, we are less likely to report the incident. Feeling threatened and/or intimidated can be just as traumatic as a physical injury. It is more insidious and it is still an act of violence that should be documented.
The issue of workplace violence in the ED is frightening. We can't change the situation overnight, but we do have the power to bust through some of the barriers that keep us from reporting incidents and we can work to make the cultures of our departments more supportive, with a zero tolerance policy for violence against nurses.
Let's stay safe out there.