Emergency nurses are seeing more violence and abuse

Even as nurses are being justifiably recognized during National Nurses Week, the reality is that emergency nurses are facing violence all too often.

More than half of all emergency nurses say they have been physically assaulted, verbally harassed or threatened with violence in the past 30 days, according to a survey by the Emergency Nurses Association.

Ryan Oglesby, president of the Emergency Nurses Association, tells Chief Healthcare Executive® that violence in hospitals is making it harder to get nurses to work in emergency medicine.

He calls violence in hospitals “the greatest challenge” to recruit and retain emergency nurses.

“Certainly that really creates a challenge for us, not only in our ability to keep our nurses safe and well, but also in our ability to recruit people into nursing, and more specifically, in emergency nursing,” Oglesby says.

Oglesby is serving a one-year term as president of the Emergency Nurses Association, which has 50,000 members. He says he’s not seeing improvement in the amount of violence in emergency departments.

“I'd say, if anything, it's getting worse,” he says. “I think it's getting more and more common.”

“You know, one of my duties as president is to reach out to those members and to those facilities that have been impacted by violence. And it seems like it's a multiple-times-a-week occurrence where we're reaching out to someone that has been either assaulted or been involved in … a firearm incident at one of our hospitals. And it just seems to be more and more devastating.”

(See part of our conversation in this video. The story continues below.)

Inadequate support

Nurses in different parts of the hospital have had to deal with violence, but attacks and aggressive behavior are more common in the emergency department.

But Oglesby expresses disappointment with the idea that emergency nurses should expect or be accustomed to hostility.

“The kind of common misconception is, well, it's the emergency department, and you should expect to have patients that are upset or dealing with behavioral health challenges and things like that,” he says. “But that level of tolerance and acceptance is what has made it so, so much harder to deal with.”

Many emergency nurses also say they don’t see an adequate response to an attack. In some cases, nurses say the hospital response to the incident has been lacking, and in some instances, local law enforcement opts against pressing charges.

Emergency physicians say they have also seen a rise in violence in recent years, and few incidents lead to prosecution.

“It's one thing to be abused, but then it's another to not have your abuse documented and followed through with and charges pressed,” Oglesby says.

“Emergency nurses do so much, and then to have this level of violence in their workplaces, it shouldn't be tolerated,” he says.

Nurses are pushing for “zero tolerance” policies for attacks in hospitals. But Oglesby says nurses are also advocating for hospitals to establish structures in place to deal with the aftermath of an attack.

Hospitals need to be “making sure there are strong debriefing opportunities, making sure that we're allowing the caregivers to step away from the bedside, whether it be for a minute, an hour or the rest of their shift,” he says. “Having processes in place where people can step away when something like that has happened, and then resources for them to follow up to deal with the impact that it's had on them.”

• Read more: Too many nurses are being assaulted. Some say they are being blamed for the attacks

Adding to burnout

Many emergency nurses grapple with burnout and stress, and much of it is driven by the violence or aggressive behavior they are seeing, Oglesby says.

“Burnout, anxiety, depression, are just at heightened levels. Insecure working conditions and risk for violence can certainly have an impact on that,” he says.

“The other thing that we also know is that that those insecure workplaces and the risk for violence also contribute to a higher suicide rate among healthcare workers,” he adds.

Too many nurses are struggling with substance abuse, and Oglesby says that also can be tied to feeling unsafe at work.

The Emergency Nurses Association has supported the Dr. Lorna Breen Health Care Provider Protection Act, which provides funding for hospitals to support the mental health of their workers. Oglesby points to the development of peer support programs and behavioral health treatment for nurses.

“There's still lots of work to do, certainly to make sure that our individual emergency nurses are healthy and safe,” he says.

• Read more: Nurses in hospitals: Burnout by the bedside

Pushing for legislation

The Emergency Nurses Association and the American College of Emergency Physicians have teamed up on a campaign, “No Silence on ED Violence,” that’s aimed at raising public awareness and persuading state and federal officials to take steps to make hospitals and health systems safer.

Emergency nurses have been pressing for federal legislation that would increase the penalties for those who attack healthcare workers, similar to protection for airline employees. Thirty states have approved such laws at the state level, but hospital workers don’t have such protection at the federal level.

Lawmakers have pushed such legislation in recent years, but it hasn’t gained enough traction in Congress. Oglesby says the inability to pass the federal law has been confounding.

Nurses would also like to see strong standards from the federal Occupational Safety and Health Administration compelling healthcare organizations to have strong workplace violence prevention standards.

Some lawmakers may be leery of additional regulations that could impose added costs on a financial system that’s strained, Oglesby says.

But he says the health system is dealing with shortages of nurses and healthcare workers, and the threat of violence is a factor.

“It’s something we certainly have to figure out,” Oglesby says. “Because no nurse or healthcare provider in any facility or any specialty area of practice should go to work afraid or concerned that they may not come home or they may be injured on shift.”