Exploring Assaults on Nursing Personnel and Work Environment in Emergency Departments

Background/significance: Violence against nurses is prevalent across many healthcare settings, including emergency departments. Consequences of workplace violence include not only physical injury and damage to employee’s mental and emotional health, but also staff turnover. Factors contributing to violence may stem from individual factors, relationships, work environment, and organization. Many nurses feel that workplace violence is part of the job and thus assaults are under-reported.

Methods: Using data from a national nursing quality database, we examined the association between selected workplace environment items as reported by RNs and assaults on nursing personnel rates. The sample included 140 emergency services units in 140 U.S hospitals who submitted 2021 data on assaults on nursing personnel and nursing care hours, and whose RNs participated in a nurse survey in 2020 or 2021. Descriptive statistics were used to examine assaulted person and assailant characteristics. Correlations were used to explore relationships between total assault rate and RN-reported work context.

Results: Total assaults on nursing personnel per 10,000 nursing care hours in emergency services units ranged from 0 to 4.21. The mean rate was highest in emergency services units with 50,000 to 79,999 annual visits (0.72). Assaulted persons were female (70.56%), RNs (67.96%), hospital employee (97.96%), and injury level of none or minor (95.72%). Assailants were male (57.01%) patients (96.28%). Significant correlations were found with RN perception of quality of care and appropriate patient assignment as well as average number of activities RNs reporting leaving undone. No correlations were found with participation in hospital affairs nor nurse manager ability in leadership and support in emergency services units.

Conclusions/implications: Findings support previous research on assault characteristics. Barriers to reporting assaults on nursing personnel need to be addressed and eliminated. Once data is being monitored more consistently, healthcare entities can work to identify risk factors for workplace violence and develop prevention strategies which include target interventions aimed at broader cultural change and appropriate staffing resources.