By Ryan Basen

Most nurses experience violence in emergency departments (EDs), but they seldom report it to anyone, according to Mayo Clinic researchers.

Over 6 months prior to being surveyed, 72% of healthcare workers and other ED staff said they had personally experienced violence (71% verbal abuse and 31% physical assault), Sarayna McGuire, MD, chief resident of Mayo Emergency Medicine in Rochester, Minnesota, reported in a series of three studies.

Nurses and clinicians -- along with security personnel -- endured the most attacks: 94% of nurses and 90% of clinicians reported experiencing verbal abuse, and 54% of nurses and 36% of clinicians reported experiencing physical assault.

"The whole team is impacted by workplace violence," said McGuire. "Even people coming in to draw blood are being assaulted physically and verbally abused."

But 77% of all respondents said they never or rarely report violence, while only 10% said they often or always do.

Yet 58% noted being at least moderately familiar with reporting policies. One possible explanation: Only 7% of non-security staff said they were "extremely familiar" with the procedures (P<0.001). And when participants were asked why ED abuse is not usually reported, the top four reasons cited were:

-No physical injury was sustained (53% of respondents)

-"It comes with the job" (47%)

-Staff are too busy (47%)

-Reporting is inconvenient (41%)

Because of the violence, 18% of respondents said they are considering leaving their position, and 48% said violence has changed how they view or interact with patients.

In terms of feeling prepared to handle the violence, men and more experienced staff reported feeling significantly better prepared compared with women.

When asked which factors staff thought were most responsible for the violence, the following earned at least 70% of responses: alcohol, illicit drugs, and significant mental illness.

A total of 86% of respondents said they felt at least moderately prepared to handle verbal abuse, while 68% said they felt prepared to handle physical assault.

"Everyone's feeling right now that violence has increased in healthcare [during the pandemic], and our data have showed that," McGuire said. "How is this sustainable? ...There is a critical issue in healthcare."

She said that because reporting of violence is so low, exposure to violence is probably much higher than what the study found.

In addition, said study co-author Casey M. Clements, MD, PhD, also of Mayo Emergency Medicine, "we know this isn't isolated to emergency departments."

He explained that while the study encompassed the pandemic era, violence "has been a problem for some time in healthcare" -- violence is a major threat to the healthcare workforce, Clements said. He added that another problem is that physicians typically do not receive any training in de-escalation -- "we learn this on the job."

For the study, the researchers sent an anonymous survey to all multidisciplinary ED staff at 20 midwestern EDs encompassing a large health system between Nov. 18 and Dec. 31, 2020. Also included in the multidisciplinary cohort were social workers, management, and security staff. Women made up 73% of the 833 respondents. Nursing staff (31%) comprised the largest medical discipline, and 16% were clinicians. The team used Chi-squared and Fisher's Exact tests to analyze the results.

McGuire suggested that a centralized reporting system would help augment reporting of violence.

"We need to change the mindset that it's anybody's job to be assaulted at work," Clements said. "We cannot go on having our emergency department workers being abused and assaulted on a daily basis."