Exploring verbal and physical workplace violence in a large, urban emergency department

Doehring, Marla C.; Curtice, Hanan; Hunter, Benton R.; Oaxaca, Derrick M.; Satorius, Ashley; Reed, Kyra; Beckman, Andrew; Vaughn, Tabitha; Palmer, Megan

doi:10.1016/j.ajem.2023.01.036

Cited by 10 publications

(2 citation statements)

References 17 publications

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“…While some similarities exist between the literature on WPV and this study, there were differences identified which can be attributed to the rural setting of this study. One recent study performed in a large urban ED identified comments that were racist, sexist, and homophobic as a common example of WPV (Doehring et al, 2023). Verbal abuse was noted in the rural setting but did not specifically focus on these subjects.…”

Section: Discussionmentioning

confidence: 99%

Rural Emergency Department Nurses’ Experiences with Workplace Violence

Garren-Grubbs,

Hendrickx

2023

OJRNHC

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Purpose: Workplace violence (WPV) includes acts or threats of physical violence along with harassment, intimidation, or other threatening disruptive behavior that occurs at the worksite.WPV, especially in the emergency department (ED), is often underreported as many nurses consider violence inevitable and a part of the job. There is a perception of a lack of consequences when reporting, and lack of support from organizational administration. Most of the research on WPV has occurred in urban settings and research in rural hospitals is limited. The purpose of this study was to gain an understanding of rural South Dakota ED nurse's experiences with workplace violence.Sample: Ten registered nurses employed at Critical Access Hospitals across SD participated in the interviews. Years of experience ranged from 2 to 25 years. Methods:A descriptive, phenomenological approach with snowballing technique was utilized.Interviews were conducted independently with each participant. Participants were asked to respond to five pre-determined questions. Interviews were transcribed verbatim and analyzed for themes.

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Section: Discussionmentioning

confidence: 99%

Rural Emergency Department Nurses’ Experiences with Workplace Violence

Garren-Grubbs,

Hendrickx

2023

OJRNHC

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“… 13 Furthermore, instead of reporting the real‐time collection of patient data, most of the reported studies showing effectiveness are either descriptive or derived from healthcare providers’ experience using their subjective recalls of violent events, which may have introduced recall bias. 14 , 15 …”

Section: Introductionmentioning

confidence: 99%

A workplace violence prevention program targeting high‐risk patients in emergency departments

Kim,

Kaiser,

Hosford

et al. 2024

JACEP Open

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ObjectivePatient violence in emergency departments (EDs) may be prevented with proactive mitigation measures targeting potentially violent patients. We aimed to evaluate the effects of two interventions guided by a validated risk‐assessment tool.MethodsA prospective interventional study was conducted among patients ≥10 years who visited two EDs in Michigan, USA, from October 2022 to August 2023. During triage, the ED nurses completed the Aggressive Behavior Risk Assessment Tool for EDs (ABRAT‐ED) to identify high‐risk patients. Following the baseline observational period, interventions were implemented stepwise for the high‐risk patients: phase 1 period with signage posting and phase 2 period with a proactive Behavioral Emergency Response Team (BERT) huddle added to the signage posting. Before ED disposition, any violent events and their severities were documented. The data were retrieved retrospectively after the study was completed.ResultsOf 77,424 evaluable patients, 546 had ≥1 violent event. The violent event rates were 0.93%, 0.68%, and 0.62% for baseline, phase 1, and phase 2, respectively. The relative risk of violent events for phase 1 compared to the baseline was 0.73 (95% confidence interval [CI]: 0.59‒0.90; p = 0.003). The relative risk for phase 2 compared to phase 1 was 0.92 (95% CI: 0.76‒1.12; p = 0.418).ConclusionThe use of signage posting as a persistent visual cue for high‐risk patients identified by ABRAT‐ED appears to be effective in reducing the overall violent event rates. However, adding proactive BERT huddle to signage posting showed no significant reduction in the violent event rates compared to signage posting alone.

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Workplace Violence in a Large Urban Emergency Department

Doehring,

Palmer,

Satorius

et al. 2024

JAMA Netw Open

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ImportanceWorkplace violence (WPV) against health care workers (HCWs) is common and likely underreported. Reliable data on the incidence of WPV and its impact on victims are lacking.ObjectiveTo prospectively define the frequency of WPV against HCWs in the emergency department (ED), examine whether HCW demographics are associated with increased risk, and explore the impact of these events on HCWs.Design, Setting, and ParticipantsThis cross-sectional study was conducted over 2 months in 2023 (August 28 to October 22, 2023) in the ED of a large, urban, academic safety net hospital in the US. Participants included ED physicians, nurses, and other HCWs, who were asked to complete a brief so-called shift sheet for every ED shift worked during the study period.ExposureWPV as recorded on shift sheets.Main Outcomes and MeasuresThe primary outcome was the number of events per shift. Events were coded for severity (types 1-5) and gender- or race and ethnicity–related bias. Shift sheets asked for the participant’s demographics and whether they experienced verbal or physical abuse during the shift. If so, they were asked to provide a description; rate the impact the event had on them; and indicate whether they felt the event was sexist, racist, or otherwise biased. Perceived impact was recorded, and demographic characteristics associated with the likelihood of experiencing WPV were explored using multivariable logistic regression analysis.ResultsAmong 72 HCWs who participated in the study, 52 were female (72%). A total of 575 shift sheets were returned of an estimated 1250 possible (46%), with 155 events, including 77 type 1 events (50%; shouting, yelling, or insults), 29 type 2 events (19%; threats of physical or sexual violence, death threats, or use of slurs), and 39 type 3 events (25%; physical violence); there was a mean (SD) of 3.7 (1.9) shifts per 1 event. No type 4 or 5 events, which involve physical violence causing grievous injuries requiring medical attention and, in the case of type 5 events, permanent disability or death, were recorded. Ten events could not be coded. Sexist or racist bias occurred in 38 events (25%) and 11 events (7%), respectively. Participants reported how the event impacted them in 133 events. Of those, moderate or severe impact was reported in 32 (24%) and mild to no effect in 101 (76%). There was no association between self-reported impact and coded severity of events. In a multivariable logistic regression analysis, a higher likelihood of experiencing WPV on any given shift was independently associated with being in the nursing role (odds ratio, 3.1; 95% CI, 1.9-5.0) and being age 40 years or younger (odds ratio, 2.0; 95% CI, 1.2-3.5).Conclusions and RelevanceIn this cross-sectional study of HCWs in the ED, participants experienced WPV once every 3.7 shifts. The nursing role and younger age were associated with increased risk. These results highlight an urgent need to identify interventions to support and protect HCWs.

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Exploring verbal and physical workplace violence in a large, urban emergency department

Cited by 10 publications

References 17 publications

Rural Emergency Department Nurses’ Experiences with Workplace Violence

Rural Emergency Department Nurses’ Experiences with Workplace Violence

A workplace violence prevention program targeting high‐risk patients in emergency departments

Workplace Violence in a Large Urban Emergency Department

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