Workplace Violence in the ED

Workplace violence can have significant effects on an emergency nurse's career. It can lead to physical and emotional trauma, resulting in burnout, stress, and post-traumatic stress disorder (PTSD). Such experiences might cause the nurse to reconsider their career choice or result in decreased job satisfaction. Additionally, repeated exposure to violence could increase absenteeism and negatively impact overall job performance. While there is existing literature on this topic, nursing must continue collaborating with providers and healthcare organizations to reduce workplace violence. 

A literature review reveals several items that discuss a nurse's perception of workplace violence but little regarding identifying risk periods or strategies for violence prevention. The two studies have determined that measure when violence is more likely to occur and the impact on staff. Violence was most likely to happen when:

• 3 involuntary mental health holds
• End of the month [patients with increased social stressors]
• 12noon-23:59 daily [highest volume periods in an Emergency Department] (Sachdeva et al. 2019).

Other contributing factors discussed by these studies:

• Acceptance that verbal assault by patients/visitors is part of the job, poor adherence to a zero-tolerance policy by the organization.
• Significant delays in getting to mental health beds, especially for specialty populations like geriatric, pediatric, and developmentally delayed.
• Behavioral Health population cohort-ed in a high stimulus area (Costumbradoa, Nikroob, Gec, & Guldne, 2022).

There are limitations. The studies are limited to single sites and were conducted before the COVID-19 pandemic. In addition, both offered a few ideas on mitigation strategies. Healthcare organizations must provide proper training, support, and safety measures to address and prevent workplace violence and its effects on emergency nurses.

Experiencing workplace violence in an emergency setting can lead to biases and potential risks of providing poor care. The nurse might develop a heightened sense of vigilance or hyperarousal, making them more prone to perceive potential threats in similar situations. This heightened alertness can lead to overestimating the danger, which may result in unnecessary interventions or misinterpreting patient behavior.

On the other hand, the nurse might also become desensitized to violence over time, leading to underestimating potential risks. This desensitization could result in dismissing subtle warning signs or failing to assess potentially dangerous situations adequately.

These biases can influence decision-making and patient care in various ways:

1. Overuse of Interventions: The nurse might become more inclined to use restrictive measures or interventions out of an abundance of caution, even when they might not be necessary. This could lead to unnecessary discomfort for patients and potentially escalate tense situations.
2. Underestimating Risks: Conversely, if the nurse becomes desensitized to violence, they might downplay the seriousness of a situation or overlook cues that indicate a patient might turn violent. This could compromise their ability to respond appropriately to escalating problems.
3. Communication and Trust: Biases from prior violent encounters might affect the nurse's contact with patients. They might unintentionally convey suspicion or mistrust, which can hinder effective patient-nurse relationships and impact the quality of care.
4. Emotional Withdrawal: Repeated exposure to violence can lead to emotional exhaustion and detachment as a coping mechanism. This withdrawal might lead to decreased empathy, compromising the nurse's ability to provide compassionate care.
5. Inaccurate Assessments: Preconceived notions about certain patient behaviors might cloud the nurse's ability to assess a patient's condition accurately. This could delay proper treatment or lead to misdiagnoses.

To mitigate these biases and risks, healthcare organizations should implement comprehensive support systems, including:

• Ongoing Training: Providing training in de-escalation techniques, communication skills, and recognizing warning signs of potential violence can help nurses respond more effectively.
• Mental Health Support: Offering access to counseling and psychological services can aid in coping with the emotional toll of workplace violence.
• Open Communication: Creating an environment where nurses can discuss their experiences and concerns without judgment can help prevent biases from becoming ingrained.
• Peer Support: Encouraging peer support and mentorship can help nurses process their experiences and learn from others who have dealt with similar situations.

Addressing biases and the potential for poor care resulting from workplace violence requires a multifaceted approach focusing on individual support and systemic change.

Works Cited:

Sachdeva, S., Jamshed, N., Aggarwal, P., Kashyap, SR. (2019). Perception of workplace violence in the emergency department. Journal of Emergencies, Trauma, and Shock. 12:179-84. Retrieved from https://doi.org/10.4103/JETS.JETS_81_18

Costumbradoa, J., Nikroob, N., Gec, S., & Guldne, G. (2022). Emergency department psychiatric holds are linked to increased emergency department violence. Ethics, Medicine and Public Health, 20. Retrieved from https://doi.org/10.1016/j.jemep.2021.100731