Emergency departments can be unsafe places for nursing staff due to patient aggression and violence. Patients presenting with intoxication, psychiatric issues, or long wait times are likely to become aggressive or violent. Over half of emergency nursing staff report verbal abuse and 1 in 10 report physical violence. To protect staff, hospitals need training in de-escalation techniques and self-defense, and should provide security with non-lethal weapons and authority to intervene. As psychiatric patient numbers in emergency rooms rise, aggression and violence toward nursing staff will likely continue without measures to ensure staff safety.

1. Addressing violence
and aggression in
hospital emergency
departments.
BY: BRANDON MCINTIRE

2. Are hospital emergency departments
safe?
 Patients presenting with intoxication, psychiatric disabilities, or psychiatric
emergencies are likely to become aggressive and in some cases violent.
 One in 10 emergency nursing staff have reported acts of physical violence
toward them.
 54% of emergency nursing staff surveyed over a seven day period reported
verbal abuse

3. What makes patients violent and/or
aggressive?
 Patients with psychiatric disabilities or psychiatric emergencies are likely to
exhibit aggression or violence.
 Patients intoxicated or using illegal substances are likely to exhibit
aggression or violence.
 Some patients can become aggressive or violent due to longer and longer
emergency department wait times.
 The increased wait time leads to an increased length of stay, which can
lead to aggression or violence.

4. Presentation of psychiatric disabilities
 Some common psychiatric disabilities are schizophrenia, depression, mood
disorders, bi-polar disorder, and generalized anxiety disorder
 While not all of these disorders have symptoms that include hostility,
violence, or aggression some of them do. Schizophrenia can have a
myriad of symptoms, positive symptoms which reflect an excess or
distortion of normal functions.
 Individuals with positive symptoms of schizophrenia would likely have
delusions, hallucinations, disorganized thinking, and disorganized
behavior. Positive symptoms of schizophrenia can present singularly or all
at once.

5. What can be done to protect
emergency nursing staff from violence
and aggression?
 Hospitals with emergency nursing facilities need to have required training
for verbal de-escalation techniques and self defense training.
 Hospital security should be given more authority and tools to keep staff
safe.
 Hospital security could be given non-lethal weaponry to protect staff with.

6. What’s in store for the future?
 The world has transformed in the last 30 years and hospital emergency
departments are no longer just treating the sick, injured, and dying.
 Increasing numbers of psychiatric patients being seen in hospital
emergency departments leads to an increased number of aggressive and
violent incidents among emergency nursing staff.
 Emergency nursing is an altruistic profession with all staff members
knowing the risks and continuing to provide compassionate empathetic
care of individuals with all kinds of needs and disabilities.