Violence against hospital nurses prompts call for education, planning

Hospital violence is at the forefront of many healthcare safety conversations after recent assaults on two New York-area nurses, one of whom suffered a critical head injury, according to

Nurses feel unprepared to recognize warning signs that patients may become violent, said Elizabeth Mizerek, R.N., New Jersey State Council of the Emergency Nurses Association (ENA) chairwoman for research and practice. Nurses also feel there is a culture of acceptance that violence is part of the job, according to the article.

"You need to be able to recognize when things are starting to escalate," said ENA President Deena Brecher, R.N. "We know our behaviors can help escalate a situation, not intentionally."

But educational programs may help nurses recognize and identify risks and warning signs of when a patient is likely to lash out. About 80 percent of emergency department nurses get such training, but half the time it didn't come from hospitals, Brecher said. The Centers for Disease Control and Prevention offers a free program to prevent violence against nurses.

Hospital leaders can employ the ENA tool kit to help assess their hospital violence policies and:

  • Understand the issue of emergency department workplace violence

  • Evaluate the emergency department's present status

  • Describe the desired outcomes for the emergency department

  • Design a practical action plan that will help the organization achieve these outcomes

  • Evaluate how the plan is working and what to do next

Nurses should constantly scan the environment for mounting patient frustration associated with long ED wait times, intoxication and drug-seeking behavior. Controlled access, managing the number of bedside visitors, panic buttons and bulletproof glass are some environmental interventions that can keep staff safe as well. Staff should consider flagging files of patients who were violent in the past, according to the article.

Many nurses must also deal with verbal abuse, which can create mental and emotional anguish, as well as hinder a person's ability to make clear choices, wrote Patricia Evans in an opinion piece published in Confident Voices in Healthcare. A quarter of doctors and surgeons and a third of nurses surveyed have been bullied to behave in ways that hurt patient care, according to a 2013 U.K. survey, FierceHealthcare previously reported.

To learn more:
- here's the article
- check out ENA's research on hospital violence (registration required)
- here's the ENA tool kit for workplace violence
- read the opinion piece
- here's a link to the CDC course