Staff perspectives of violence in the emergency department: Appeals for consequences, collaboration, and consistency.

ABSTRACT

BACKGROUND: Violence committed by patients and their families and visitors against Emergency Department staff in the United States is common and detrimental to staff well being, morale, and care practices. Hospitals losses occur due to decreased staff retention, prestige, and patient and visitor satisfaction. OBJECTIVE: The purpose of the baseline survey reported here was to identify and describe staff experiences, concerns, and perceptions related to violence and abuse perpetrated by patients, family, and non-family visitors in a Level 1 emergency department. PARTICIPANTS: The survey sample was composed of 41 registered nurses and 10 paramedics. The majority of the participants (84%, n= 41) were female and worked full time (82%, n= 41) on the 7P-7A (49%, n= 25) shift. METHODS: The cross-sectional mixed-method descriptive design used a survey to measure violence experiences and interviews with key informants. Specific analytical methods included descriptive and inferential statistics and ethnography. RESULTS: The findings are summarized by a model that portrays 1) Contributing factors to the development of violence in the ED, 2) maladaptive reactions to workplace violence of Cynicism, Concern for focus on customer service, and Conflict, and 3) three themes that, depending on their presence or absence, serve as barriers or facilitators to violence Consistency, Consequences and Collaboration. CONCLUSIONS: Interventions developed to minimize violence in the ED must focus on modifiable risk factors and address what is in the department's control including staff education in recognizing escalating anxious or aggressive behavior, policy development and implementation, and environmental changes.