Workplace Violence in the Emergency Department


Workplace violence from patients and visitors is a significant concern in emergency departments due to the nature of the work done there. Furthermore, it is frequently underreported, as some workers see the incidents as an inevitable part of the environment. The issue has become particularly relevant in recent years, as a debate around possible interventions has arisen. A variety of possible solutions has been proposed, but there is no specific evidence-based practice that is recommended for use across most care settings. As such, research into the matter to discover the best intervention is vital. This paper discusses a possible response and its associated research question.

Issue Discussion

Emergency departments are currently seeing an increased rate of violence compared to their past statistics as well as other medical divisions. According to Gacki-Smith et al. (2009), the primary reasons are the escalation of pain and negative emotions of patients and the frequent presence of disruptive individuals, who are sometimes not alone. Sometimes, these factors can lead to verbal abuse or outright assault, which may potentially escalate further, with Taylor and Rew (2010) noting patient access to firearms as a concern. As a result, Gacki-Smith et al. (2009) note that the non-fatal violent crime rate for emergency departments is much higher than overall and that nurses are the foremost victims. The second conclusion can likely be explained by the fact that nurses interact with patients more frequently than other staff.

Many emergency department staff members have accepted the situation as usual and are determined to handle it without external intervention. However, in doing so, they may take unnecessary risks and perpetuate the dangerous work environment by delaying change. Brown (2016) notes that ED staff are sometimes uneducated about reporting, de-escalation, and hazard assessment. As a result, they may not be competent enough to prevent or stop violent incidents and determine that the situation was not important enough to file a report to the police. The lack of punishment for the assault would then be remembered by both the patients present and the staff, setting a precedent for a repeat offense. Over time, emergency department violence has become normalized in many institutions, possibly due to these considerations.

Population of Interest

Nurses should be the foremost recipients of the interventions intended to reduce workplace violence in emergency departments, as they constitute the most significant proportion of victims. Nevertheless, other medical workers should benefit from the changes as well, as the minimization of overall violence is the primary goal. The intervention will likely require a systematic effort, and therefore, the involvement of the leadership will be necessary. Patients will probably not be involved in the process, as it is likely that visitors that resort to violence will not return to the same location for fear of being recognized. Overall, all healthcare personnel that works in emergency departments should be considered the population of interest, as their workplace violence rates are the primary concern of this paper.

Significance to Nursing Practice

The violence in emergency departments is making work there an unattractive prospect for nurses. As Taylor and Rew (2010) state, understaffing, which may be caused by this unpopularity, is a significant contributor to the prevalence of dangerous incidents. As such, once violence levels are reduced to a level that is closer to the average across all medical divisions, emergency departments may see an influx of new personnel. They would then be able to provide a higher standard of care, serving patients better, and increasing their satisfaction. The reduced stress, waiting time, and quality would contribute to a further de-escalation of workplace dangers and have a positive influence on outcomes.

Relevant Nursing Theory

The nursing theory that is relevant to this situation is Jean Watson’s Philosophy and Science of Caring. It is impossible to eliminate the negative emotions associated with pain and the overall need to visit the emergency department. As such, patients should be able to express their state of mind as per Watson’s carative factors (Alligood, 2018), but escalation into violence is an issue. Nurses should not be harmed as a result of their efforts to help patients, especially when the damage is avoidable. The problem should be solved through the scientific methods of experimental inquiry and evidence-based practice. Nurses that work in emergency departments should learn to understand the specific states of their patients and care for them in a trusting relationship.

PICOT Question

The (P)opulation in this scenario is the nursing staff at emergency departments, as identified above. However, the (I)ntervention requires further discussion, as multiple options have been proposed. Ramacciati, Ceccagnoli, Addey, Lumini, and Rasero (2016) discuss scenario-based training, rapid education programs, hybrid learning programs, the use of rapid response teams, and comprehensive as well as action research approaches. All of these methods have merit, but some of them may be overly specialized or challenging, and expensive to implement. An optimal intervention should be accessible to most emergency departments, regardless of their situation or financial condition. As such, it should be primarily concerned with information and accessibility.

The intervention that has been chosen in this paper is increasing the workers’ reporting capabilities. There are mechanisms in place, such as the police, that are designed for dealing with violence. Increased employment of their capacities is likely to reduce the number of incidents, especially in the long term. Ramacciati et al. (2016) report that a hybrid education program can have a significant effect and be a useful strategy. Furthermore, Martinez (2016) notes that education programs can be delivered at least partially via online tools. As such, the method may be recommended to all medical institutions, and the deployment of sufficient resources would not be prohibitively expensive.

The (C)omparison in the PICOT question will be the new rate of violent incident reports against the old data. If the intervention is valid, the (O)utcome will be that it should increase in the short term and decline later on, as workplace violence subsides. For the current discussion, however, the (T)ime should be restricted to the period soon after implementation, namely one year. With a definition of each of the five components, it is possible to frame the question. In emergency department workers (P), does training on workplace violence and reporting (I) lead to the increase (O) of the numbers of violent incident reports (C) within one year (T)?


Workplace violence is a prevalent concern in emergency departments across the United States. It is caused by stress and belligerent patients and exacerbated by the understaffing of these divisions. Nurses constitute a significant portion of the healthcare workers affected by the situation. However, they tend to underreport harmful incidents due to the belief that such events are parts of their jobs. Education about workplace violence and reporting may help them change such perceptions and raise awareness about existing dangers. The changes that would follow should contribute to making emergency departments a safer place for healthcare workers.


Alligood, M. (2018). Nursing theorists and their work (9th ed.). St. Louis, MO: Elsevier.

Brown, A. H. (2016). Workplace violence prevention program to improve nurses’ perception of safety in the emergency department. Retrieved from .

Gacki-Smith, J., Juarez, A. M., Boyett, L., Homeyer, C., Robinson, L., & MacLean, S. L. (2009). Violence against nurses working in US emergency departments. The Journal of Nursing Administration, 39(7), 340-349.

Martinez, A. J. S. (2016). Managing workplace violence with evidence-based interventions: A literature review. Journal of Psychosocial Nursing, 54(9), 31-36.

Ramacciati, N., Ceccagnoli, A., Addey, B., Lumini, E., & Rasero, A. (2016). Interventions to reduce the risk of violence toward emergency department staff: current approaches. Open Access Emergency Medicine, 8, 17-27.

Taylor, J. L., & Rew, L. (2010). A systematic review of the literature: workplace violence in the emergency department. Journal of Clinical Nursing, 20, 1072-1085.

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