Do hospital leaders tolerate violence against emergency staff?

The risk of violence toward emergency department (ED) staff persists in large part because their supervisors perceive it as part of the job, according to MedPageToday.

Violent hospital incidents, such as January's fatal shooting at Boston's Brigham and Women's Hospital, have restarted the conversation about hospital violence, writes Nicholas Genes, M.D., Ph.D., an emergency physician at New York's Mount Sinai Hospital. Prior research indicates ED nurses have the second most dangerous civilian job in the country, after New York City cab drivers, and that up to 78 percent of ED staff report physical assault at least once in the past 12 months.

Some risks of violence are common to the ED setting, according to Genes, citing a position statement from the Emergency Nurses Association. Contributing risks include patient factors (such as substance access) and environmental factors (including limited security, tempers running high due to care delays, crowding and the presence of dangerous patients or their family members).

Leadership's level of tolerance for violence is another major factor, Genes writes, citing a 2014 paper that describes an atmosphere in which administrators discouraged ED workers from pressing charges against perpetrators of violence. In 2014, the Occupational Safety and Health Administration cited Brooklyn, New York's Brookdale University Hospital and Medical Center, saying it did not provide its staff with sufficient protection from violence, FierceHealthcare previously reported.

One potential solution to widespread violence against ED staff is to provide them with body cameras, emergency physician Jeremy Brown, M.D., writes for Emergency Physicians Monthly, citing the long-used practice of informing aggressive patients they are being recorded as a way of de-escalating tense situations. Not only is there precedent for such a step, the majority of patients say they would support it, according to Brown. "This kind of recording will be good for patients, their families and the medical teams who care for them," he writes. "We all behave better when someone is watching."

To learn more:
- read Genes' article
- here's Brown's piece