The Issue of Violence in the ED

On January 15, 2014, Dr. Lisa Wolf and her team at the Institute of Emergency Nursing Research published a study “Nothing Changes, Nobody Cares. Understanding the Experience of Emergency Nurses Physically or Verbally Assaulted While Providing Care”. When you read the study, you can’t help but feel several emotions. The first is anger. Anger that so many of our colleagues have experienced violence in the workplace. Anger that their stories are so similar when it comes to lack of organizational or institutional support for reporting incidents of violence. The second is despair. Violence in the ED is not a new issue. ENA has been advocating for safe work environments for years. Our violence research has been occurring for nearly a decade. And yet, here we are, still trying to get people to understand that violence in the ED is an issue. Heck, we are still trying to convince ED nurses that being a victim of violence in the ED is not an expected part of the job. In the past few weeks, I have done interviews both on camera and off about the topic of workplace violence. Many of these reporters end by telling me what a shame it is that this stuff happens to nurses. And yet, have we made a difference? How is it possible to make a difference with this issue that no one wants to discuss, no one wants to admit is happening in their department, and no senior hospital leadership team wants to acknowledge goes on under their watch? The despair I feel when I read these stories is real. And while it’s easy to point fingers at what everyone else isn’t doing, it can be hard to turn the finger on yourself and recognize that in order to tackle the behemoth of the issue we each have to be willing to change our own perceptions and attitudes.

The issue of violence in the ED is real. It is occurring daily, in virtually every ED in this country. It impacts all members of the team, including the patients and families we care for as well as our friends and families at home. Our colleagues suffer life long physical and emotional scars as a result of the violence. And it’s not just limited to the ED. Just this week there have been at least two nurses in New York who were assaulted. One of whom is still in the ICU. We can’t hide from it. We can’t ignore it. And we can’t run away from it. So, what can we do about it?

First, we have to decide it’s not ok. It’s not ok to come to work and be assaulted. Ever. Period. Next, I want you to find someone in your ED who feels the same way you do. Then click here. Addressing the issue of violence in your department requires a multidisciplinary team approach. To be successful, a group of both clinical staff and hospital leadership need to sit together to assess the issue and create a plan to move forward. The ENA Workplace Violence Toolkit has a wealth of information, tools and resources to help your team address violence.

Second, we need to do a better job of sharing what works. I know there are departments out there who have come together to address the issue of violence. I know you have created best practices, zero tolerance policies, and support systems for nurses who are victims of violence. I encourage those of you who have been successful to help those who haven’t started yet tackle this issue. The more we work together, the sooner we will all be safer in our departments.

One of the most common questions I get asked by reporters is “what’s the most surprising statistic related to workplace violence?” For me, it is that we have created this culture of acceptance in our profession. We have decided that workplace violence is part of our job in the ED. The culture of acceptance expands beyond the back doors of the ED throughout the hospital and healthcare, through law enforcement and the judicial process. “You work in the ED…what do you expect would happen?”. What do I expect? I expect to work in an environment where violence is not tolerated by anyone, anytime. I expect to be given the tools and resources I need to be safe at work. If I do become the victim of violence at work, I expect to be fully supported in my decision to report the episode, press charges, and seek whatever assistance I may need to recover. Is that too much to ask?



  1. Excellent summary of the issues and sentiment about ED violence. I would add that ED leaders be encouraged to become certified in the prevention of workplace violence and that certification be developed.

    I would also encourage that research include, to understand how lateral violence contributes to injury and dangerousness of the environment.

    Example: assignments made to endanger a nurse because she is currently the target of bullying. These violent patients are used as a type of weapon against the nurse. They are assigned agitated patients in an unsafe way and not sent the help when needed.

    I wrote an article in 2012 about nurse bullying and that was the type of responses I received from ED RNs. We cannot look the other way when the staff themselves are part of the problem.

    Thank you for your excellent work in this important area.

  2. This has been a passion of mine for 4 years, presented the surveys as given to us through the ENA toolkit… Attended conference’s, provided “evidence” presented our findings to the Excutive Board, which by the why, The Chief of Staff said, ” This is laughable … We all know how unsafe the ER is”…Still 4 years later…. Waiting for ” improved” safety measures…. I have since transferred…35 year ER nurse.. Can’t fight politics anymore …

  3. i was looking at this issue from the other a RN i see powerless,pain-filled,pts with difficulties communicating, understanding, confronting insurance problems, pain. we have studies of iatrogenic PTSD. i was recently tx for a tib/fib fx in an ED and not offered pain med. what is the point of rating pain and not tx it. i know violence isn’t the solution, but armed guards isn’t either.

  4. I appreciate the importance of this topic. I myself have had a gun pulled on me on two separate occasions, once in the ED and once in the hospital hallway. I was lucky, I was not injured. I am personally aware of two nurses that were raped by a patient who had disarmed a guard while in the ED. This doesn’t even capture the more routine acts of violence such as verbal threats, verbal abuse, etc. While we strive to take care of those in need, it is not acceptable to be victims of violence in the work place. We should do what we can to minimize the violence and create a zero tolerance environment. Safe Practice and Safe Care is not just for our patients.

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