Citation

Gillespie GL, Tamsukhin S. J. Emerg. Nurs. 2023; 49(3): 310-316.

Copyright

(Copyright © 2023, Emergency Nurses Association, Publisher Elsevier Publishing)

DOI

10.1016/j.jen.2023.02.001

PMID

37150553

Abstract

Workplace violence by patients and visitors against emergency nurses has been ongoing for over 40 years. In 1981, Dubin reported on the conditions most associated with patient violence, including substance use, intoxication, and withdrawal; acute psychosis; paranoia; borderline personality; and organic brain disease. He further warned clinicians to watch for signs of escalation, such as aggressive body posture, speech, and motor activity. These patient conditions and "warning signs" have not changed in the last 40 years, although the catalog of conditions and signs has increased. Additional considerations are patients dissatisfied with care, diagnosed with cornoavirus disease-2019, with a chief complaint of injury, and over the age of 60 years, as well as environmental factors such as emergency department crowding and staffing shortages. Given that emergency nurses have had this knowledge for over 40 years, why is workplace violence still a problem? Why hasn't it stopped?

Workplace violence in emergency care persists for a myriad of reasons. As the number of inpatient beds and outpatient treatment centers has decreased over the decades, access to mental health services also has decreased.4
These changes created a health care system where the emergency department has become the safety net for mental health care.5
However, the emergency department continues to be ill-prepared for managing mental health emergencies due to a lack of expert clinicians to provide diagnoses, treatment, and care, as well as limited availability of rooms to provide the care safely. An additional aspect of this problem is the lack of funding to support mental health services in the emergency department for patients reporting both physical and mental health problems

Language: en