'Culture of Tolerance' Enables Violence Against Nurses, Says Hospital Administrator

By Carlton Purvis

SILVER SPRING - Last November, the Emergency Nurses Association (ENA) published the latest results of an ongoing survey aimed at examining the scope of emergency room violence. From January 2010 to January 2011 ENA surveyed more than 7,000 emergency room nurses nationwide. Thirteen percent reported experiencing physical violence in past seven days. More than 53 percent of nurses reported experiencing verbal abuse at work.

The study found that most of the incidents weren’t being formally reported. It also found that among hospital workers, physical and verbal abuse rates weren’t changing.

“And until the culture at hospitals changes, those numbers aren’t going to change,” said Lawrence Jefferies, RN, an emergency department clinical coordinator and the ENA Maryland state delegate. 

Jefferies discussed the results of the survey Wednesday at a workplace violence prevention seminar hosted by Allied Barton Security Services in Silver Spring, Maryland. For many hospital emergency departments, violence is an accepted occupational hazard, Jefferies said.

Of the nurses who reported physical violence, 48 percent said they were grabbed or pulled. Patients perpetrated 98 percent of the assaults.

“If a police officer is assaulted, it’s a crime. To a nurse, it’s just part of the job. Don’t get in that mindset. Workplace violence goes up when a culture of tolerance is promoted,” Jefferies said.

But it’s often difficult for nurses when deciding whether to report an incident. In some cases, actions that may legally constitute an assault, nurses attribute to patient stress.

“A lot of times patients in hospitals are confused. They’re out of their normal environments, and they’re sick,” said Cathy, a nurse at one of the nation’s top hospitals whose last name is being withheld because she wasn’t authorized to speak to media. “In those types of cases filing a report is just not worth it most of the time. We already do a lot of paperwork and filing in addition to patient care.”

Sixty-six percent of nurses who were physically assaulted never formally filed a report, according to the ENA survey. However, most did inform hospital security, a supervisor, or another nurse.

Cathy said nurses will always file a formal report for incidents that result in injury, involve bodily fluids, or if they feel a patient is a danger to themselves or others, but reporting every time they are grabbed, pushed, or verbally abused just doesn’t happen. Eighty-six percent of survey respondents didn’t file a report when verbally assaulted.

Jefferies says that culture has to change. Nurses should get into the habit of reporting every incident that takes place, he said. “That’s the only way something is going to get done, and educating staff, managers, and administration, and working together as a group is how you do it.”


Violence against RNs

As a psychiatric RN who rotates to the Crisis Unit (pysch ER), I cannot count the number of times I have been verbally assaulted.  If I filled out a form every time that happened I would never get my regular work done.  And, yes, I have been physically assaulted as well.  With psychiatric nursing, there is always the chance of an assault.  THe key is to observe the warning signs but sometimes the situation gets out of hand too quickly.  WIth that said, I would never do any other type of nursing.  You just have to be smart about it and leave yourself an escape route and keep your distance at times.  As for the ER, folks are usually at there worst there.  Then again, I've never been a fan of ER RNs; they're pretty full of themselves.

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