Other Titles
Rapid Presentation Round
Abstract
Background: Nurses in many healthcare facilities frequently feel unsafe and threatened due to workplace violence (WPV) which is a serious and persistent problem across the United States, (American Nurses Association, 2015; Center for Disease Control and Prevention, 2019). While all nurses are at risk for experiencing WPV, the emergency department (ED) is considered an especially high risk unit due to factors such as the acuity of illness, traumatic events, victims of violence, and the 24/7/365 days open door policy, (Emergency Nurses Association, 2020; Morrison & Joy, 2016). Patients with substance use disorders (SUDs) generate unique challenges for ED nurses since these patients often present with aggression. There is evidence that substance abuse plays a significant role in the escalation of violent behavior from patients with SUDs towards nurses in the ED, creating an unhealthy and potentially dangerous workplace environment.
Purpose: To examine the experiences and perceptions of ED nurses who have encountered WPV specifically from patients with SUDs.
Methods: This descriptive qualitative study utilized Braun and Clarke (2013) thematic analysis with a sample of Registered Nurses (n=53; 45 females and 8 males) working in a Level I trauma center ED. Nurses participated in 24 focus groups between October 2019 — February 2020. All of the group discussions were transcribed verbatim and the Atlas.ti8TM software was used in the analysis.
Results: ED nurses discussed their interactions and experiences of WPV within the context of treating patients with active SUDs. Most described their perceptions of violent patient interactions and their emotions surrounding these incidents, along with nurse responses and measures of self protection. Four themes emerged from the data: 1) feeling verbally and physically abused, 2) feelings of frustration, 3) actions taken to feel safe, and 4) setting healthy boundaries. These themes come from WPV directed at nurses while the patient is directly under the influence of a substance, or not getting something they desire such as certain pain medication, or after Narcan (naloxone) is administered. Strategies nurses used to mitigate the violence include communication with the patient, wearing protective items, planning ahead for a dangerous situation, utilizing restraints, and calling security.
Conclusions: Acts of WPV in the ED undermine the health and safety of the nurses, providers, and staff. These experiences often lead to physical, psychological, and social repercussions with outcomes causing nurses to lose enjoyment and satisfaction in their job. Nurses who leave the ED and the profession altogether often cite WPV as a factor, (Cho et al., 2020). Healthcare organizations and nursing leaders have an obligation to address WPV in order to create a culture of safety. ED nurses should be supported by implementing effective strategies and providing active reporting programs to keep their staff safe. Fostering a healthy work environment in which the staff is confident, supported, and prepared for high-risk situations will reduce instances of violence in the ED by patients with SUDs, (The Joint Commission, 2018). Recognizing the experiences of ED nurses in the workplace is essential to developing solutions to prevent violence in the future.
Notes
References:
American Nurses Association. (2015). Incivility, bullying, and workplace violence. \nhttps://www.nursingworld.org/practice-policy/nursing-excellence/official-position-statements/id/incivility-bullying-and-workplace-violence/
Center for Disease Control and Prevention. (2019). Occupational violence.\nhttps://www.cdc.gov/niosh/topics/violence/default.html
Cho, H., Pavek, K., & Steege, L. (2020). Workplace verbal abuse, nurse-reported quality of care and patient safety outcomes among early-career hospital nurses. Journal of Nursing Management, 28(6), 1250-1258. http://doi-org.ezp1.villanova.edu/10.111/jonm.13071
Emergency Nurses Association. (2020). Workplace violence. https://www.ena.org/practice-resources/workplace-violence
Morrison, L. E., & Joy, J. P. (2016). Secondary traumatic stress in the emergency department. Journal of Advanced Nursing, 72(11), 2894–2906. https://doi.org/10.1111/jan.13030
The Joint Commission. (2018). Sentinel event alert: Physical and verbal violence against health care workers. https://www.jointcommission.org/-/media/tjc/documents/resources/patient-safety-topics/sentinel-event/sea_5 9_workplace_violence_4_13_18_final.pdf
Sigma Membership
Non-member
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Descriptive/Correlational
Research Approach
Qualitative Research
Keywords:
Acute Care, Workplace Violence, Violence Against Nurses
Recommended Citation
Holland, Emily M. and Dowdell, Elizabeth B., "Voices of Emergency Department Nurses and their Experiences of Workplace Violence" (2025). Creating Healthy Work Environments (CHWE). 35.
https://www.sigmarepository.org/chwe/2023/presentations_2023/35
Conference Name
Creating Healthy Work Environments
Conference Host
Sigma Theta Tau International
Conference Location
Austin, Texas, USA and Virtual
Conference Year
2023
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2025-10-15
Funder(s)
Villanova Undergraduate Research Fellows Program
Voices of Emergency Department Nurses and their Experiences of Workplace Violence
Austin, Texas, USA and Virtual
Background: Nurses in many healthcare facilities frequently feel unsafe and threatened due to workplace violence (WPV) which is a serious and persistent problem across the United States, (American Nurses Association, 2015; Center for Disease Control and Prevention, 2019). While all nurses are at risk for experiencing WPV, the emergency department (ED) is considered an especially high risk unit due to factors such as the acuity of illness, traumatic events, victims of violence, and the 24/7/365 days open door policy, (Emergency Nurses Association, 2020; Morrison & Joy, 2016). Patients with substance use disorders (SUDs) generate unique challenges for ED nurses since these patients often present with aggression. There is evidence that substance abuse plays a significant role in the escalation of violent behavior from patients with SUDs towards nurses in the ED, creating an unhealthy and potentially dangerous workplace environment.
Purpose: To examine the experiences and perceptions of ED nurses who have encountered WPV specifically from patients with SUDs.
Methods: This descriptive qualitative study utilized Braun and Clarke (2013) thematic analysis with a sample of Registered Nurses (n=53; 45 females and 8 males) working in a Level I trauma center ED. Nurses participated in 24 focus groups between October 2019 — February 2020. All of the group discussions were transcribed verbatim and the Atlas.ti8TM software was used in the analysis.
Results: ED nurses discussed their interactions and experiences of WPV within the context of treating patients with active SUDs. Most described their perceptions of violent patient interactions and their emotions surrounding these incidents, along with nurse responses and measures of self protection. Four themes emerged from the data: 1) feeling verbally and physically abused, 2) feelings of frustration, 3) actions taken to feel safe, and 4) setting healthy boundaries. These themes come from WPV directed at nurses while the patient is directly under the influence of a substance, or not getting something they desire such as certain pain medication, or after Narcan (naloxone) is administered. Strategies nurses used to mitigate the violence include communication with the patient, wearing protective items, planning ahead for a dangerous situation, utilizing restraints, and calling security.
Conclusions: Acts of WPV in the ED undermine the health and safety of the nurses, providers, and staff. These experiences often lead to physical, psychological, and social repercussions with outcomes causing nurses to lose enjoyment and satisfaction in their job. Nurses who leave the ED and the profession altogether often cite WPV as a factor, (Cho et al., 2020). Healthcare organizations and nursing leaders have an obligation to address WPV in order to create a culture of safety. ED nurses should be supported by implementing effective strategies and providing active reporting programs to keep their staff safe. Fostering a healthy work environment in which the staff is confident, supported, and prepared for high-risk situations will reduce instances of violence in the ED by patients with SUDs, (The Joint Commission, 2018). Recognizing the experiences of ED nurses in the workplace is essential to developing solutions to prevent violence in the future.
Description
Summary: This project examines the experiences of emergency department nurses who have encountered work place violence within the context of treating patients with active substance use disorders. The nurses described their perceptions of violent patient interactions and emotions surrounding these incidents, along with their responses and measures of self protection.
Topic: Caring/holistic
Presentation Pertains To: Clinical Work
Setting: Urban/city/metropolitan
Topic Category: Acute care
Target Group: Clinical and Students
Topic Subject: Adult Abstract
Topic Demographics: Nurses
Is Body System / Disease Process: No
Completed: Completed Work/Project