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Researchers Explore Ways to Curb ED Violence


Reprinted with permission from

Registered nurses who work in hospital emergency departments are at greater risk of violence from patients than nurses in other specialties, experts say.

The University of Cincinnati School of Nursing has received a $1.3 grant to research ways of curbing violence in this type of work environment.

The grant comes from the National Institute for Occupational Safety and Health, a division of the Centers for Disease Control and Prevention. The four-year project will address physical violence and verbal threats by patients and visitors against direct care providers, such as physicians, nurses and aides in adult EDs.

“Emergency departments (EDs) have been identified as extremely high-risk settings for workplace violence,” said principal investigator Donna Gates, EdD, MSPH, MSN, FAAN, professor and endowed chair of nursing.

A number of factors contribute to the violence. Among them is the prevalence of patients with drug and alcohol abuse, psychiatric disorders or dementia. Other reasons include 24-hour open access, inadequate screening of weapons and the flow of community violence into an already stressful ED, Gates said.

The Emergency Nurses Association conducted a survey in 2006 revealing that 86 percent of 1,000 members reported having been victims of violence in the past three years. The violent acts were committed by patients or patients’ family members while the nurses worked in the ED. Nearly 20 percent of the nurses disclosed that they had encountered workplace violence frequently.

Workplace violence and the nursing shortage, combined with escalating use of the ED, can lower the quality of emergency care for patients. Although Gates noted that it’s impossible to completely eliminate violence, it should never be tolerated or accepted.

Verbal assaults are the most common type of violence and may include harassment and threats. “Some ED nurses experience verbal assaults on a daily basis,” said Gates, whose earlier study—Violence: Recognition, Management and Prevention—was published in the Journal of Emergency Medicine in 2006.

Her main co-investigator for the current study is Gordon Gillespie, RN, Ph.D., an assistant professor at the Cincinnati nursing school. Other co-investigators include Terry Kowalenko, MD, an emergency department physician at University of Michigan Medical Center in Ann Arbor. Kowalenko has experience researching verbal threats and physical confrontations in the ED.

Many experts suspect that violence against workers is on the rise in hospital emergency departments, Gates said. However, “there is no way to say for sure that the incidence of assaults is increasing due the historical lack of underreporting of events,” she added.

ED nurses can’t turn away patients seeking care, according to the federal Emergency Medical Treatment and Active Labor Act. When assaults occur, staff members should enlist the help of security personnel. Some hospitals allow security workers to assist in physically restraining violent patients, Gillespie said, while others only permit them to call the local police.

“Typically, hospital security officers do not have arrest or detain authority. Only police officers possess this ability,” he said.

Six hospital emergency departments in the Midwest are participating in the study funded by the grant, which was awarded in October 2008. Researchers are conducting focus groups with managers, employees and patients. Then they will survey about 200 direct care providers.

Data will be collected via monthly electronic surveys, Gillespie said. Investigators also will spend time at the intervention sites implementing changes conducive to safer work environments.

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