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Patient Violence toward Nurses



Patient Violence Toward Nurses

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Patient violence negatively affects nurses in emergency room settings. Nurses have the highest rate of fatal and nonfatal assault injuries, and they are three times likely to experience patient violence than any other professional group. In emergency room settings, nurses are more likely to be victims of patient-related violence which includes both minor and major physical injuries, temporary and permanent physical disabilities, psychological trauma, and even death. The American Nurses Association reports that more than 80% of assaults on nurses remain unreported.

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Emergency room violence is caused by patients, their families, relatives, and close friends. These violent acts may be the result of frustrations, vulnerability, and lack of control over health emergencies. Weber & Kelley (2009) noted that patients with psychiatric illness, alcohol or drug abusers, patients in pain who have had to wait, and individuals who have been involved in gang violence are often seen in the emergency room. Emergency room nurses surveyed reported that 36% had experienced violence in the past year being at work and 63% related to assault during their careers.


The purpose of this study is to review the literature on patient violence toward nurses. The study will investigate, identify, and evaluate how patient violence towards nurses affects nurses in emergency rooms. In addition, the study will also evaluate the effects of patient-related violence on nurses and recommend the approaches, which healthcare organizations can use to prevent this type of violence in emergency rooms.


The objectives of the study are to assess the problem and interview nurses as victims of patient violence in emergency rooms. The second objective of the study is to explore the impact of patient-related violence and not only in terms of physical injury but also psychological harm that may lead to stress, burnout, anxiety, and depression. The study will examine how patient-related violence results in reduced job satisfaction, lower commitment to work, and increasing levels of absence for the individual, which clearly impacts the nurse.

Literature Review

Emergency rooms seem to be the epicenter of violent assaults. Emergency room psychiatric nurses are, particularly at risk. Often, violent patients devise weapons of any object they can find. Charney & Fragala (1998) in their 1-year study of injuries in a 973 bed California maximum-security hospital reported nurse injuries at the rate of 16 per 100 staff compared to 8.3 per 100 general full-time workers. In addition, they also studied that in a Veterans Administration (VA) Medical Centre, nursing assistants, followed by nurses and physicians were more likely to experience violence.

Gacki-Smith et al. (2009) in their research noted that 21.9% out of 1,000 nurses experienced violent attacks from patients in emergency room settings. In 2004, Gacki-Smith et al. (2009) noted that there were 46% of incidences of nonfatal attacks and violent acts committed to nurses in emergency room settings. In another study, Gacki-Smith et al. (2009) noted that 82% of nurses in emergency room settings reported that they were violently attacked.

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The prevalence of violence in the emergency room settings is attributed to the 24-hour accessibility of the Emergency Department in almost all hospitals and a lack of well-trained security staff to handle violence. In addition, the emergency room is a highly stressful setting and, therefore, it is a very hostile and threatening place to a patient or relative in an emotionally charged state. Dolan & Holt (2013) noted that from a psychological perspective the occurrence of a crisis resulting from a serious illness or accident, with the hurried removal of an individual to an emergency room can often trigger strong emotions.

Such emotions of fear, anxiety, confusion, and loss of control often result in stress reactions within the patient or relative and can be displayed through violence directed to nurses (Dolan & Holt, 2013). The major contribution made by physiological factors in the development of aggression in the emergency rooms has been identified as a result of high consumption or withdrawal from alcohol or drugs.



Cross-sectional research was carried out on 1,250 nurses in New York through the Emergency Nurses Association (ENA). The current sample represents the entire population of ENA members in the United States. A 15 item online survey was developed to explore patient violence and how it affects nurses in emergency departments. Nurses with Internet access participated in the survey. Data analysis was conducted using SPSS software version 15.0. Nurses reporting to experienced bodily violence more than 20 times in the last 3 years were grouped as frequent-bodily-violence victims (FBVV).

Those nurses who reported to have encountered verbal violence more than 200 times in the past three years were recorded as frequent verbal violence victims (FVVV). Patient violence on nurses was classified based on nurses threatened by weapons, nurses who incurred injuries requiring first aid, and injuries requiring medical treatment.

Determining the effects of patient violence on nurses in the emergency room was fundamental for this study. The online survey offered respondents the opportunity to indicate the adverse effects of patient-related violence. The current section categorized predominant psychological responses following exposure to violence on nurses. Four categories were conceptualized in the following manner; physiological, emotional, and cognitive effects.


Out of 1, 250 nurses surveyed, 850 emergency nurses responded to the survey questions. Of the respondents, 18% of emergency department nurses had been threatened by patients with a weapon, 11% had received injuries that required first aid, and 0.5% suffered injuries that required significant medical treatment. Of these injuries, 30% involved a weapon, and 10% of the nurses were admitted to a hospital for treatment. Further research shows that nurses working in psychiatric facilities were more likely than nurses in other health facilities to suffer violent attacks by patients.

It was established that 630 of 850 nurses who responded in the study were female in their late 30s, and had been in the profession for between 6 months and 10 years, with an average service of just under 8 years. Nearly two-thirds worked part-time. The type of violence varied depending on the type of patient received in the emergency room.

Based on physiological effects related to fear and anxiety, the study found out that fear ranged from 30% after the violence. Nurses reported that they experienced long-lasting anxiety following patient-related violence. They also indicated persistent symptoms of increased arousal such as difficulty falling or staying asleep. The results indicate that 15.5% of the nurses were cognitively affected with a feeling of threats to personal integrity, nurse victims perceiving themselves as disrespected, unappreciated, violated, robbed of their rights, humiliated, compromised, and intimidated.

The range of the percentage of nurse victims experiencing anger was the greatest in the emergency services, with rates of 68.6%. Emotional effects constituted the greatest variety of symptoms, are the most frequently reported alongside anger.


Understanding, why nurses report or do not report patient-related violence in emergency rooms, is very important as it can help educators and administrators develop programs that help reduce patient violence.

Less experienced staff who demonstrate a more authoritarian attitude was potentially more at risk of patient violence (Dolan & Holt, 2013). The key element in preventing patient violence is the nurses' ability to communicate in a positive and caring manner with the patient in the emergency room. Inadequate resources, low staffing levels, and inappropriate skill mix may form significant contributory factors. Dolan & Holt (2013) noted that healthcare organizations should address the issue of poor staffing, especially in emergency room settings with a considerable workload.

When healthcare organizations do not establish effective measures to prevent violence and protect nurses, the result is a compromised quality of patient care. Establishing a zero-tolerance policy for violence is the first step. Healthcare organizations should strive to ensure adequate staffing levels in emergency rooms. Staffing an emergency room with a patient advocate, who may be a trained volunteer, can help ensure that patients do not feel invisible and forgotten (Pyrek, 2011).

Procedures requiring that regular and frequent contact with patients noted on a chart can facilitate follow-up and reduce patient frustration. The communication and healthcare information supplied or interventions undertaken on behalf of the patient and relative whilst they wait for treatment or decisions to be made relative to their case is therefore very important in the prevention of patient violence. Simple measures that provide the patient or relative with information, such as clear displaying of waiting times and comfortable surroundings of waiting rooms, can relieve the anxiety and tension that may result in violence.

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In conclusion, the nature of emergency rooms presents increased risks for staff, patients, and visitors. Nurses may, therefore, find themselves victims of violence in these settings. Attacks on emergency room nurses by patients constitute a significant problem. Nurses at greatest risk, regardless of the emergence room setting are the young and inexperienced. Healthcare organizations should deal with this type of violence adequately due to side effects on the nurse practitioners. The provision of adequate numbers of medical and nursing staff in the emergency rooms prevents long waiting times and allows good communication and the development of good patient-staff relationships. The reduction of patient-related violence on nurses cannot occur in areas where patients and staff are under-resourced and under pressure.

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