Work place violence, is the ER safe?

ERlover7 · Feb 12, 2018

Hi Alex,

From my experience, workplace violence happens more often in the ER than people like to think. From what I have personally seen, it is typically from geriatric patients with dementia or drug users (not making any accusations, ANY patient can be violent). In many cases, violent patients may try to hit you or bite you, and I have often seen spitting. Verbal abuse is something that can occur quite often as well. I have also seen many patients begin to grab equipment, such as cardiac monitors or computers in the room and start throwing them or hitting them, often injuring themselves.

Calling security is important. Security is there for a reason, use them! They will come immediately and are great at handling these situations. I would also be cautious about wearing a stethoscope around your neck. This is something a patient can easily grab onto, and can be turned into a weapon. Keeping it in your pocket is a better option.

Here are the names of some interesting articles regarding this topic.

"Reducing violence and aggression in the emergency department"- by D. Prowley

"Workplace Violence in the Emergency Department:Giving Staff the Tools and Support to Report" - Stene, J., Larson, E., Levy, M., & Dohlman, M

"Stressful Incidents of Physical Violence Against Emergency Nurses" - Gillespie, L., Gates, D., Berry, P.,

I hope this helps!

Alexx_xox · Feb 12, 2018

Hi Alex,
From my experience, workplace violence happens more often in the ER than people like to think. From what I have personally seen, it is typically from geriatric patients with dementia or drug users (not making any accusations, ANY patient can be violent). In many cases, violent patients may try to hit you or bite you, and I have often seen spitting. Verbal abuse is something that can occur quite often as well. I have also seen many patients begin to grab equipment, such as cardiac monitors or computers in the room and start throwing them or hitting them, often injuring themselves.
Calling security is important. Security is there for a reason, use them! They will come immediately and are great at handling these situations. I would also be cautious about wearing a stethoscope around your neck. This is something a patient can easily grab onto, and can be turned into a weapon. Keeping it in your pocket is a better option.
Here are the names of some interesting articles regarding this topic.
"Reducing violence and aggression in the emergency department"- by D. Prowley
"Workplace Violence in the Emergency Department:Giving Staff the Tools and Support to Report" - Stene, J., Larson, E., Levy, M., & Dohlman, M
"Stressful Incidents of Physical Violence Against Emergency Nurses" - Gillespie, L., Gates, D., Berry, P.,
I hope this helps!

Wow,

Thank you so much for your response. It is quite surprising that people who are trying to only help you end up being abused.

Im praying I am not involved in too many violent situations because Im quite small. I will definitely be one to utilize security.

Thank you for your response.

ruby_jane, BSN, RN · Feb 12, 2018

Mr. Ruby Jane was an ER nurse for a decade in a small hospital, on a military base, and at a VA. He often stepped in when there was something escalating between a patient and another nurse but no violence. He does have some fine de-escalation skills.

On the other hand, as a school nurse I've been pinched, slapped, and one kid tried to hit me with a broom...

OldDude · Feb 12, 2018

Any facility that has open access by the public 24/7 offers the opportunity for bad stuff to happen. I worked in a pedi ER and we would have the occasional belligerent teen that we'd need to hog tie (officially called restraint) but the winner of all time was a 17 year old girl, weighing about 250 pounds, that decided she was going to leave AMA and against her parents will. It was obvious she would possibly harm herself or someone else if she was allowed to leave so the rumble began. There was another guy nurse working that night and she proceeded to kick our butt out of her room and down the ER hallway until finally a security guard and enough other bodies arrived to get her under control. Unfortunately she kicked this poor security guard into the ambulance bay doors and he never worked again; fractured a couple of lumbar discs.

So, one thing you always know is...you never know.

As ruby mentioned above, school nursing is a similar environment, but I avoid restraining kids until it can't be controlled by the other staff members.

allnurses Guide · Feb 12, 2018

I have been bitten by a wild person, (2 felony convictions for battery on a health care worker), still have a small scar. Bitten more by mistake than intent by an SI pt whose stomach we were pumping out (long time ago). Backhanded across the face by an alcoholic with high ammonia levels.

Verbal assaults, too many to count. I've backed down a few idiots who wanted to fight. Took down a woman about to jump on a coworkers back (grabbed her arm and swung around in circle to the floor). PUt a wrist lock on someone who swung at me while he was flat on a guerney.

Been in the ER for 20 years or so, these kind of stick out but not too bad for such a period of time.

Most of the time things are fairly calm, by ER standards. It is just the unpredictable ones, like the alcholic who had been fine and friendly, then sudden change in behavior. Never let them get between you and the door, leave the room at the first sign of aggression, and call security if you feel the least bit uncomfortable. They would rather prevent stuff than have to haul an assailant off of you.

RNewbieMA · Feb 12, 2018

I worked in the emergency room for five years as a tech before I became a nurse. I was fortunate enough not to be involved in any incidents, but I definitely saw some scary things. I happened to be walking by a room and a patient had jumped over the stretcher and was on top of a RN strangling her, which I'll never forget. The guy was 6'5, 300+ lbs ..that's when I yelled for help.

My advice (and my own person opinion) is to have good relationships with your security team. They are your saving grace in these circumstances. Also, never be afraid to call for help or ask for a second set of hands. Don't ever second guess your gut and try to be a hero. If you ever have a bad feeling just be careful and mindful of your surroundings. Don't think it's just the ER though, it happens everywhere, unfortunately. Hope this helps, good luck !

Alexx_xox · Feb 13, 2018

Mr. Ruby Jane was an ER nurse for a decade in a small hospital, on a military base, and at a VA. He often stepped in when there was something escalating between a patient and another nurse but no violence. He does have some fine de-escalation skills.
On the other hand, as a school nurse I've been pinched, slapped, and one kid tried to hit me with a broom...

LOL. I chuckled at the last sentence. Kiddos are definitely some violent little things haha

Alexx_xox · Feb 14, 2018

Any facility that has open access by the public 24/7 offers the opportunity for bad stuff to happen. I worked in a pedi ER and we would have the occasional belligerent teen that we'd need to hog tie (officially called restraint) but the winner of all time was a 17 year old girl, weighing about 250 pounds, that decided she was going to leave AMA and against her parents will. It was obvious she would possibly harm herself or someone else if she was allowed to leave so the rumble began. There was another guy nurse working that night and she proceeded to kick our butt out of her room and down the ER hallway until finally a security guard and enough other bodies arrived to get her under control. Unfortunately she kicked this poor security guard into the ambulance bay doors and he never worked again; fractured a couple of lumbar discs.
So, one thing you always know is...you never know.
As ruby mentioned above, school nursing is a similar environment, but I avoid restraining kids until it can't be controlled by the other staff members.

Wow, that is so sad. Poor security guy, that is absolutely terrible.

Alexx_xox · Feb 14, 2018

I have been bitten by a wild person, (2 felony convictions for battery on a health care worker), still have a small scar. Bitten more by mistake than intent by an SI pt whose stomach we were pumping out (long time ago). Backhanded across the face by an alcoholic with high ammonia levels.
Verbal assaults, too many to count. I've backed down a few idiots who wanted to fight. Took down a woman about to jump on a coworkers back (grabbed her arm and swung around in circle to the floor). PUt a wrist lock on someone who swung at me while he was flat on a guerney.
Been in the ER for 20 years or so, these kind of stick out but not too bad for such a period of time.
Most of the time things are fairly calm, by ER standards. It is just the unpredictable ones, like the alcholic who had been fine and friendly, then sudden change in behavior. Never let them get between you and the door, leave the room at the first sign of aggression, and call security if you feel the least bit uncomfortable. They would rather prevent stuff than have to haul an assailant off of you.

Nowadays ER's are so busy that sometimes they do not have doors, instead we have patients in like recliners within the halls. Thats how over crowded it has become.

Alexx_xox · Feb 14, 2018

I worked in the emergency room for five years as a tech before I became a nurse. I was fortunate enough not to be involved in any incidents, but I definitely saw some scary things. I happened to be walking by a room and a patient had jumped over the stretcher and was on top of a RN strangling her, which I'll never forget. The guy was 6'5, 300+ lbs ..that's when I yelled for help.
My advice (and my own person opinion) is to have good relationships with your security team. They are your saving grace in these circumstances. Also, never be afraid to call for help or ask for a second set of hands. Don't ever second guess your gut and try to be a hero. If you ever have a bad feeling just be careful and mindful of your surroundings. Don't think it's just the ER though, it happens everywhere, unfortunately. Hope this helps, good luck !

Thank you for your words of advice. I was also a tech and I loved our security guards. They always took our back and kept us protected

NuGuyNurse2b · Feb 14, 2018

In our ER we would get the drunks that the cops pick up on the streets. We're often prepared with the EMS team telling us who's a security risk and who's not. But sometimes they're docile in the ambulance and turn on you when they're sitting in the ER. I've had people spit at me, grab at me, etc, just plain battery. So I always assess the situation and make sure that if something does happen, I'm in full view of everyone else so help can arrive.