Hospitals must work to better prevent, detect and respond to violence in the emergency department and beyond.
Nearly half of U.S. nurses say workplace violence has increased, more than double the percentage a year ago.
It’s a factor that discourages some healthcare professionals from remaining in the healthcare profession, contributing to high turnover rates at a time when hospitals can’t afford to lose more talent. It’s also an issue we must solve now to protect employees as well as access to care.
Consider the stresses endured by emergency department (ED ) professionals. The ED has long been the path of least resistance for care: When people can’t see their regular physician and an alternate care setting, like urgent care, is closed, the ED is almost always an option. The pressures of providing care in an emergency environment run deep, with 47% of physicians reporting feelings of burnout last year, up 5% since 2020.
Yet while administrative overload and the dangers of providing care in a pandemic are commonly cited as contributors to burnout, new research indicates workplace violence plays a role, too. Seven out of 10 ED workers who have been victims of workplace violence report moderate to high levels of burnout, according to the study.
These are just a few reasons why hospitals must work to better prevent, detect and respond to workplace violence in the ED and beyond.
The need for a more responsive approach
Physicians and nurses didn’t go into medicine to be yelled at, kicked, bit or punched by those whose medical conditions or mental health outlook make them prone to volatility in stressful situations. They entered the healthcare field to take care of people. There are few professions where employees are willing to enter an environment that could put their lives and welfare at risk each day, yet healthcare workers—especially those who work in EDs and the ICU—do it daily.
Despite the increase in workplace violence in healthcare, few hospitals or health systems have “zero tolerance” policies for acts of violence. This threatens their ability to recruit and retain ED nurses, who are in short supply. It also adds to stress levels among ED physicians at a time when physicians are leaving the profession at a record rate. Ultimately, shortages of ED physicians and nurses could constrain healthcare organizations’ ability to provide emergency care for their communities.
Some states, like Texas, Georgia, and Iowa, have enacted penalties for assaulting nurses in healthcare settings. Others do not have good avenues for addressing patient-related violence. This means that even when a hospital enacts a zero-tolerance policy for violence, the potential for assailants to face ramifications for their behavior depends largely on the type of act committed. This leaves ED workers in the perilous position of being faced with a repeat occurrence if the act of aggression wasn’t dealt with swiftly and securely the first time.
And it's not just EDs that are struggling with recruiting and retention challenges amid increased threats of workplace violence. So are behavioral health facilities and units. Furthermore, shortages of qualified healthcare workers “will not dissipate quickly,” according to the American Hospital Association.
A path to action
These are issues that hospitals and health systems can’t afford to ignore—not when ED crowding has reached crisis levels. Instead, healthcare organizations need to take a firm stance on workplace violence—one that is backed by action.
My organization, Sturdy Memorial Hospital, a 126-bed community hospital in Attleboro, Mass., is taking action through a new initiative for addressing healthcare workplace violence. Our program not only supports a more tightly coordinated response, but also helps prevent workplace violence before it occurs.
Last year, Sturdy Memorial formed a Threat Assessment Team to establish practices for notifying staff of a patient’s risk for violence at the point of registration and care, especially in the ED and ICU, where risk and vulnerability are especially high. The team draws from professionals across disciplines, from case management to nursing, risk management, security and occupational services, to develop practical strategies for workplace violence prevention.
Sturdy Memorial also leverages an ADT-based care collaboration network that integrates with our EHR to better identify patients with the potential to exhibit violence and those that have been involved in past violent encounters.
Once a month, the Threat Assessment Team reviews cases from such patients and determines whether each patient truly presents a risk for violence. From there, a notation is made to the patient's record in the EHR, identifying the patient as a threat risk and sharing guidelines for future interactions with the patient. When those patients present in the ED or an inpatient unit, staff receive a real-time alert from the network via the EHR—prompting staff to notify security so a team member can be close at hand.
With these alerts, nursing and ED staff have a better understanding of the risk for violence and can monitor the patient, as appropriate. They also gain a clear view of the types of precautions they should take to protect themselves and others, such as how to approach a specific patient.
Just over a year into the program, these measures have decreased recurrent episodes of violence in the ED and ICU. Just as important: They give staff greater confidence that the right precautions are being undertaken to protect their health and the well-being of other patients and their families.
The time Is now
The safety of healthcare teams in vulnerable situations—and the willingness of healthcare workers to expose themselves to risk—depends on a proactive approach to preventing and responding to violence in the workplace. Initiatives that leverage data to anticipate the potential for violence and feedback from team members on ways to mitigate these threats are an excellent place to start.
Brian Patel is senior vice president for medical affairs, chief medical officer & chief quality officer for Sturdy Memorial Hospital, Attleboro, Mass., and a clinical advisory board member for PointClickCare.