Workplace Violence

Workplace violence (WPV) has remained a major concern in the worldwide working environment today. The term “going postal” has become a well-known public phrase that indicates when an employee has mentally decompensated and demonstrates aggression towards others or the company. Aggressive acts can come from the public or from within the company itself.

Healthcare workers, especially nurses remain at the forefront of this problem. Emergency departments in particular experience the highest amount of aggressive acts against them by family members and patients. WPV includes verbal and non-verbal abuse, physical and non-physical hostility, stalking or a combination, all of which may be experienced by ED personnel. The problem of WPV is becoming a challenge globally and is growing at an exponential rate. It affects all ED workers, as well as all who enter the ED for care.

Violence as a Stressor
It has been found that aggression and violence remains an international issue in the emergency department, and that this problem remains the number one cause of feelings of powerlessness and stress for emergency department nurses.2 According to a study by the Emergency Nurses Association in 2013, 43% of emergency nurses reported having experienced verbal abuse from a patient or visitor during a seven day calendar period ; and 11% reported both physical abuse and verbal abuse and 1% reported physical abuse alone.3

Workplace violence accounts for 1.7 million nonfatal assaults each year, overall. There are also 900 reported homicides yearly.4 This abuse affects how nurses work and how the ED violence impacts nurse’s productivity. Most ED nurses fail to report verbal abuse and only report physical abuse when they are unable to return to work. 5

Safety for all remains the primary issue. According to Gates, Gillespie and Succop, WPV remains a significant stressor for ED nurses and in turn has a direct impact on the care they provide and on their productivity at work. 5 It has been found that there is a direct correlation between the negative experiences incurred with WPV and decreased productivity at work. It directly effects patient care. Some nurses are found to experience Post Traumatic Stress Disorder (PTSD). There is a direct impact on the nurses’ productivity and job performance, job satisfaction, staff morale and retention of nurses in the field.

High Cost
In general, WPV is believed to cost 4.2 billion dollars annually.4 One retrospective database review study reported that of the 106 nurses from 5016 hospitals who reported injuries obtained at work, the average provider lost time was 11 days. Restricted time was 55.3 days. All of the physical injuries reported were resolved with full return to work and no continuation of workman compensation 4 However, there is no direct cost of emotional injury and anxiety that may be an ongoing experience felt by the nurse who was subjected to violence in the workplace. Once physical injuries are resolved, the nurse is expected to return to work and function to full capacity.

This issue of WPV must remain at the forefront for change in our healthcare system. WPV should never be tolerated or accepted. Policies related to violence in the workplace should be instituted and ongoing education for all staff should be enforced. Policies must be in place to ensure that all violent episodes, verbal or physical get reported. The nurse should never feel embarrassed or be made to feel incompetent for reporting the WPV episode. Proper security should be maintained in the ED, and all employees and managers should be on board with safety precautions and be committed to the goal of reducing workplace violence. Once an incident is reported, it is imperative that debriefing be performed and further exploration into the problem be initiated. Although assisting in the reduction of WPV remains high priority, cost to the institution will be incurred and this may remain one obstacle in resolving the problem of violence in the ED.

SEE ALSO: Earn CE: Workplace Violence

Further research must be done to develop more effective ways to avert WPV. The American Academy of Emergency Medicine and the Emergency Nurses Association must remain diligent about research into the problem of WPV. Reducing WPV must remain a top priority goal in order to attract nurses and doctors to work in the ED. The correlation of WPV and work performance must be additionally examined. The stress incurred by ED nurses must be realized and assistance with the problem be offered. No longer can the hospital allow the ED personnel to endure abuse in the workplace and to have to come to work in fear for his/her safety.

Desensitization to violence cannot become commonplace. There is the need and desire for research to understand WPV completely and to develop strategies to reduce this pandemic problem. Hasn’t the time come to ensure the protection of the ED personnel so they can perform their job safely and to care for the emergent needs of the public?


1. Angland, S., Dowling, M., & Casey, D. (2014). Nurses’ perceptions of the factors which cause violence and aggression in the emergency department: a qualitative study. International Emergency Nursing, 22(3), 134-139.

2. Pich, J., Hazelton, M., Sundin, D., & Kable, A. (2011). Patient-related violence at triage: A qualitative descriptive study. International Emergency Nursing, 19(1), 12-19.

3. Emergency Department Violence Surveillance Study. (2013). Emergency Nurses Association. Retrieved from violence-statistics-2014.pdf?sfvrsn=2

4. Speroni, K.G., Fitch, T., Dawson, E., Dugan, L & Atherton, M. (2014). Incidence and cost of nurse workplace violence perpetrated by hospital patients or patient visitors. Journal of Emergency Nursing, 40(3), 218-228.

5. Gates, D.M., Gillespie, G.L, & Succop, P. (2011). Violence against nurses and its impact on stress and productivity. Nursing Economics, 29(2), 59-66.

6. 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.

Maryann Giacalone-Sadler, works as a nurse practitioner in the Emergency Department at University Hospital, Newark, N.J. Currently, she is working on her DNP from Rutgers University, Newark, NJ. She remains an active member of the nursing honor society, Sigma Theta Tau, Upsilon chapter.

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