Emergency nurses — critical healthcare workers — are disproportionately impacted by violence on the job.
Ryan Oglesby, Ph.D., M.H.A., RN, CEN, CFRN, NEA-BC
President, Emergency Nurses Association (ENA)
The patient screamed vulgarities in my direction as I stood at my workstation and, within seconds, threw my computer monitor at me.
This, unfortunately, is normal in the emergency department. Data and news headlines paint a chilling picture, but the healthcare professionals who go to work worried about their safety will tell you workplace violence in the emergency department (ED) has reached epidemic levels.
A threat to quality care
A 2024 survey of Emergency Nurses Association members revealed more than half of respondents had been physically assaulted, verbally assaulted, or threatened with violence in the previous 30 days. According to 2023 Bureau of Labor statistics, healthcare workers account for about 10 percent of the U.S. workforce, yet they represent approximately 48 percent of missed workdays due to violence.
Assaults and batteries occur at especially high rates in emergency departments, which operate 24 hours a day as the front door to hospitals and a healthcare safety net to many people. No one in need of care is turned away. From the most critically injured trauma patient to the infant who spikes a fever in the middle of the night, emergency nurses stand ready to use their clinical expertise and compassion to help and heal.
At a time when more nurses, not fewer, are needed, nearly 10 percent of ENA survey respondents said they were considering leaving nursing altogether because of workplace violence.
The 2020 documentary “In Case of Emergency” put it bluntly: “Without them, we don’t stand a chance.”
Simply put, the shadow of violence in emergency departments looms over the ability of ED nurses and their peers to deliver the best care possible when patients need it most. Whether a nurse leaves their shift early — or the profession entirely — because of violence, the impact on patient care is real.
Less simple are the solutions, but everyone can do their part to reverse this trend of violence.
Tackling ED violence
Patients and their families who experience stress and emotion in the emergency department must understand that incivility and disrespect toward emergency nurses and other care providers interferes with treatment, and they will be held accountable for their actions.
Nurses and health professionals need to know their employers have their backs by implementing zero-tolerance policies, safety-focused workplaces, additional education and training in the care of potentially violent patients, and best practices for supporting staff after incidents, including assistance pressing charges against offenders.
Reducing the frequency and severity of workplace violence has long been an ENA priority. The association is a strong advocate for state and federal laws to require workplace violence prevention programs, while also urging legislators to make assaulting healthcare workers a felony.
ENA partners with organizations such as the American Organization for Nursing Leadership, American College of Emergency Physicians, and American Nurses Association to develop workplace violence prevention resources and increase awareness about the problem’s depth. ENA also offers a variety of its own resources, including an online course to help in the prevention and mitigation of emergency department violence. Since 2019, ENA and ACEP have championed the “No Silence on ED Violence” campaign.
The emergency department exists to care for the sick and injured, but the pervasive threat of violence has emergency nurses and their peers fearful. Incivility and violence are not “part of the job” in any workplace, let alone one of critical importance to the health of the community. No healthcare provider should ever wonder whether they’ll end their shift helping a patient or becoming one. The time for change is now, before more lives are impacted by preventable violence.
