Workplace Violence in a Large Urban Emergency Department

Workplace Violence in a Large Urban Emergency Department

Authors: Marla C Doehring, Megan Palmer, Ashley Satorius, et al.
Journal: JAMA Network Open, 2024

Conclusions

1. WPV Frequency: HCWs in the ED experienced WPV once every 3.7 shifts.
2. Risk Factors:
• Nurses are 3 times more likely to experience WPV.
• Younger HCWs (≤40 years) are at 2 times higher risk.
3. Bias in WPV: Sexist and racist bias were frequently reported.
4. Emotional Impact: Moderate to severe impact occurred in 1 out of 4 WPV incidents, regardless of event severity.

Implications for Practice:

1. Workplace Safety Interventions: Develop tailored strategies for nurses and younger staff to prevent and address WPV.
2. Bias Training Programs: Address sexist and racist biases in healthcare interactions.
3. Emotional Support Systems: Provide counseling and mental health resources for HCWs impacted by WPV.
4. Incident Reporting: Encourage transparent and consistent reporting of WPV events.
5. Policy Changes: Advocate for legislative protection and workplace violence prevention protocols in ED settings.

Methods

• Design: Cross-sectional study conducted over 2 months (Aug–Oct 2023).
• Setting: Large, urban, academic safety-net hospital ED in the U.S.
• Participants:
• 72 HCWs, including ED physicians, nurses, and other healthcare staff.
• Demographic data collected: role, age, sex, and race/ethnicity.
• Data Collection:
• HCWs completed shift sheets after each shift, documenting experiences of WPV.
• WPV incidents classified into Types 1–5 severity levels:
• Type 1: Shouting, yelling, insults
• Type 2: Threats of physical/sexual violence or slurs
• Type 3: Physical violence
• Type 4 & 5: Severe physical injuries or permanent disability/death
• Events also assessed for sexist/racist bias and emotional impact.

Results

1. Frequency of WPV Events:

• 575 shift sheets returned out of an estimated 1,250 (46%).
• 155 WPV events reported:
• Type 1: 77 events (50%) – shouting, insults
• Type 2: 29 events (19%) – threats of violence
• Type 3: 39 events (25%) – physical violence
• No Type 4 or 5 events reported.
• Frequency: 1 WPV event occurred every 3.7 shifts.

2. Bias in WPV Events:

• Sexist bias: Reported in 25% of events.
• Racist bias: Reported in 7% of events.

3. Emotional Impact of WPV:

• Moderate to severe emotional impact: Reported in 24% of events.
• Mild to no impact: Reported in 76% of events.
• Impact severity did not correlate with WPV event type or severity.

4. Risk Factors for WPV:

• Nursing Role: Higher likelihood of experiencing WPV (OR = 3.1, 95% CI: 1.9–5.0).
• Age ≤40: Higher likelihood of experiencing WPV (OR = 2.0, 95% CI: 1.2–3.5).