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Violence in the ER

A Maryland man made headlines last week when he shot and wounded a doctor at Johns Hopkins Hospital in Baltimore. But unfortunately, his story is no longer a rarity. Hospital violence is increasing in frequency — and ER nurses bear the brunt of the hostility.

According to the International Association for Healthcare Security and Safety and the Emergency Nurses Association, more than half of all emergency room nurses have been spit on, pushed, scratched and/or verbally assaulted on the job. Almost a quarter of ER nurses say they’ve been assaulted more than 20 times in the past three years.

ER nurses are particularly at risk because they often deal with intoxicated, confused or violent patients. Add to that increasing frustration over ER wait times and the healthcare system, and it’s easy to see why nurses are vulnerable.

While some hospitals are installing metal detectors in an effort in improve safety, many experts say that proper training is key to decreasing ER-based violence. All staff working in the ER should know:

  • Warning signs — If a patient is pacing with clenched fists, watch out. Also pay attention to patients’ speech patterns, history (have had they problems with authority in the past?) and diagnoses. Patients with psychiatric disorders and those under the influence of drugs or alcohol are more likely to lash out.
  • How to get help — Call for help as soon as you sense a threat.
  • De-escalation techniques — ER staff should be trained in special techniques designed to diffuse a potentially volatile situation.
  • What to do if violence occurs — Safety, of course, is number one. But after violent incident, report it! Hospital administration needs to know about each and every incident so that steps can be taken to create a culture of safety.

Have you ever been assaulted at work? Do you feel adequately trained to meet the threat of violence?

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Jennifer Fink, RN, BSN

Jennifer is a professional freelance writer with over eight years experience as a hospital nurse. She has clinical experience in adult health, including med-surg, geriatrics and transplant; she also has a particular interest in women’s health and cancer care. Jennifer has written a variety of health and parenting articles for national publications.
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One Response to Violence in the ER

  1. TDK

    I have been a nurse for 32 years. Most of my years were spent in the ED or in psych. But it does not seem to matter where you work any longer because violence is everywhere. I worked for 5 years on a busy med surg unit and I cannot tell you the number of times that either I or a member of the staff were verbally abused by someone, mostly visitors. Hitting and scratching by patients were common (confused, elderly, psychotic). I have had visitors threaten to shoot me and I have been followed home from work. One nurse at our hospital recently had to have a guard and the police had to bring charges against a man who in the delivery room was going to name his newborn son after a famous Mafia kingpin. The nurse thought this was funny and made the mistake of laughing and asking the man if he was sure he wanted to name his son that. He was SO ANGRY that he began to stalk her. He was able to get her full name and address and began to threaten her. Obviously a very dangerous man. You absolutely never know what will anger a person.