The propensity for violence in nursing, particularly in the Emergency Room (ER), is abnormally high. After all, emotions are extremely volatile and judgment is often clouded. In turn, most facilities have instituted a respective “violence-prevention” program to monitor work related assaults but unfortunately, while this intervention can reduce the number of incidents, not all can be prevented.

So, what is workplace violence? Most people think of it as solely being physical but consider the following forms of violence which are often dismissed:

  • Threatening behavior – Shaking fists, destroying property or throwing objects.
  • Verbal or written threats – Any expression of intent to inflict harm.
  • Harassment – Any behavior that demeans, embarrasses, humiliates, annoys, alarms or verbally abuses a person and that is known or would be expected to be unwelcome. This includes words, gestures, intimidation, bullying or other inappropriate activities.
  • Verbal abuse – Rumors, swearing, insults or condescending language.
  • Physical attacks – Hitting, shoving, pushing or kicking.

We, as nurses, are the frontline staff and therefore it is important to understand the risk factors associated with a situation that might increase the likelihood for violence. Think about these risk factors which set the stage for such acts:

  • In the healthcare arena, emotions are heightened.
  • When violence in nursing erupts, staff in the healthcare sector are usually unequipped to fully respond. If there is security, it might take time for them to respond and this time might be longer than the time it takes to commit an act of violence.
    • As nurses, we are focused on patient care—we and other healthcare providers are often able to handle violent behavior when it escalates.
  • In some settings, such as in the ER or inner city hospitals, there is an increased prevalence of the use of handguns by patients and their families.
  • Often, drug use by patients and or their family members comes into play. Such activity clouds rational judgment.
  • In the neighboring parking lots, there is typically poor lighting and decreased security. Hence, there is an increased likelihood for such activity.

What Can Nurses Do?

  • Review policies related to violence in the workplace.
    • Memorize the number for security.
  • Recognize if there is a volatile situation between patients and guests and notify security.
  • When leaving the premises at night or in the early hours, assess the surroundings, and park in an area with good lighting.
  • Walk out to your car with another staff person.
  • Work with your co-workers and management team to help to develop a nursing culture whereby there is a no-tolerance policy for violence and related behavior.

Acts of violence are not always “physical acts”. It is important to remember that everyone has a role in safety promotion so we can all prevent violence in nursing.

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