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 [1]. 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 [2].

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.”

Jefferies pointed to the shift from standard needles to safety needles in the late 80s and early 90s as an example. During that time, nurses were often victims of accidental pricks or assaults by patients involving needles.

“There was a big concern about AIDS at that time and nurses kept being stuck by needles,” he said. It took “a lot of education of hospital administration and staff,” he said, but eventually hospitals moved toward using safety needles and needles with retractable syringes.

Ken Bukowski said he remembers that time well. He was working for a company who sold safety needles. Now he serves as Allied Barton’s vice president of healthcare.

“We really need nurses to report these incidents,” Bukowski said. “We know the problem is bad, but we won’t know how big, or the severity of it, if they don’t report. And managers want to hear about the issues so they can address them.”

Bukowski said more hospitals are finding ways to make it easier to report assault incidents, which should take away some of the burden of reporting. Some are using computer software, for example. “That way, nurses don’t have to fill out a bunch of paper reports…. [Reporting electronically] also lets a hospital do trend analysis,” he said.

Mangers should also get familiar with legislation aimed at protecting hospital staff, Jefferies said.

Thirty-eight states have laws aimed at protecting nurses [3] and healthcare workers. In New York, it’s a felony to assault a nurse, for example.

The complete results of the Emergency Department Violence Surveillance Study [2] are posted on the ENA Web site.

photo: U.S. Army [4]

Thumbnail: