Emerging Issues in Security

Violence Against Nurses Causes Morale, Retention Issues

Hospitals are like small cities, and the violence that plagues our communities mirrors what often goes on in our emergency rooms (ERs). The 24-hour environment is hard to control completely, even with perimeter and access controls, identification (ID) badges and key cards, the use of metal detectors accompanied by armed security, and the constant presence of the police. The medical staff can feel vulnerable to threats, assaults, or attacks.

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Nurses make up the largest medically trained portion of any hospital. They are often vocal in their complaints to the leadership team about their safety, especially in the always-stressful ER. Nurses must provide quality medical care to patients who are angry, fearful, disoriented, impatient, entitled, threatening, drug-seeking, in withdrawal from opiates or alcohol, or mentally ill. This leads nurses to have to give care using what could be called “high-risk customer service.” These service protocols can lead nurses to feel frightened to come to work or do their work, angry that their bosses don’t really understand the environment where they work, and feeling like they want to leave the ER environment or even quit the profession completely.

A survey from the Emergency Room Nurses Association tells the story of the morale and retention issues facing the profession, even now, as the Occupational Safety and Health Administration (OSHA) and hospital administrators are starting to call for significant changes in the safety of the healthcare environment:

  • Over 50% of emergency nurses report experiencing physical violence on the job.
  • Over 25% have been physically assaulted more than 20 times in the past 3 years.
  • Over 20% have been verbally abused more than 200 times in the last 3 years.
  • Over 67% rated their perception of safety at 5 or lower on a 10-point scale.
  • Violence was lowest among nurses in pediatric ERs and highest among nurses who work night and weekend shifts in main ERs.
  • Male ER nurses were more likely than their female colleagues to report having experienced workplace violence.
  • Over 66% considered leaving his or her department or emergency nursing altogether because of violence.
  • Violence factors that impacted their survey answers: patients or visitors under the influence of alcohol or drugs; psychiatric patients in the ER; long waits; ER overcrowding; and a shortage of ER nurses.

Forward-thinking hospitals are addressing these concerns, both to keep their nurses safe and to retain current nursing employees and attract new ones. This includes the creation of ER Crisis Response Teams to help the general nursing and ER staff deal with high-risk patients who made need physical or chemical restraints or an immediate psychiatric intervention. These teams often include a nurse with psychiatric response training, a security officer, and an ER technician skilled in patient control. These early identification and crisis response teams can help the ER staff lessen the impact of patient, family member, or visitor threats and can offer compassionate but firm treatment.