Violence in the Emergency Department

“You don’t have a backbone.”

“You need thicker skin.”

“You need to suck it up.”

“It happens.”

“They didn’t actually hit you so it’s pointless to press charges.”

“She’s a really good nurse, I think you’re just over-reacting.”

These are some of the phrases that have been said to me over the past month or so. The emergency room is a fast-paced, intense environment that requires you to be quick on your feet, control your emotions, and be 10 steps ahead at all times.

A lot is “tolerated” in the ER. You have frequent fliers who waste resources by hitting the call light every five minutes asking for food, a blanket, to change the channel, etc. You have a population of people who use the emergency room as a primary care office, also wasting resources and complaining that they aren’t being seen fast enough. You have people who come in for drug overdoses, alcohol intoxication, and “incarceritis”.

I don’t know the exact number, but there is a small percentage of emergency room patients who actually need to be there – those that need admission to the hospital, need resuscitation, need a bone put back into place, etc. In theory, a majority of resources should be poured into this category.

Regardless of why someone is coming to the ER, we do our best to help them. We prioritize based on ABC’s and Maslow’s hierarchy of needs. If someone is having trouble breathing, the turkey sandwich that another patient is requesting has to wait. It is not a first come first serve environment.

ENA believes emergency nurses have the right to education and training related to the recognition, management, and mitigation of workplace violence. The mitigation of workplace violence requires a “zero tolerance” environment instituted and supported by hospital leadership.

Emergency nurses association

Violence should be a zero tolerance occurrence, according to ENA. It is a felony in 31 states to assault an emergency department healthcare worker. So why are there so many unreported incidents? I myself have been kicked in the head, verbally abused, lunged at, and had furniture thrown towards me all in the past nine months. I officially reported one of those incidents to the hospital, but I didn’t file any charges or report the other ones. Why is this? Why is there a culture of tolerance where I work?

After the most recent incident, where a patient began verbally abusing me and another staff member, then proceeded to start throwing things, threatening to punch me, and lunged at me, I finally had enough. I wasn’t physically harmed in this instance, but it could have gone very differently.

I’ve been thinking about that incident every day since it happened. What could I have done to prevent this escalation? Looking back, some people just get angry, put up wall, and don’t let anybody in. I did my best to use my therapeutic communication, but that didn’t work for her. She got angrier.

At the first sign of verbal abuse toward me, I immediately put up a boundary. “I understand that you are frustrated, but I will not be spoken to that way.” This did not go over well. It was time for discharge anyway. I left the room to get the papers. I handed them her and she threw them back in my face. “I don’t need your advice, you b*tch. I’m going to start punching people, starting with you!” At this point, I’m done. Security is called and she continues to escalate as she is escorted out of the building.

Although I’m leaving a lot of details out, this type of escalation occurs all too often.

It needs to stop.

Let me bring in another type of violence – lateral violence. Also known as bullying or harassment in the workplace. We all have those toxic co-workers, and if you don’t, consider yourself lucky. You know, the ones who are passive aggressive, who spread gossip, and who are condescending. Unfortunately I have fallen into the trap of being bullied by a colleague. So much so that one night I cried my eyes out in my car. The shift itself wasn’t terrible – my patients were fine. It was the way I was treated.

The culture in the ER is often lead by the phrases that began this post. “You need thicker skin.” But why? Why should I tolerate this type of behavior? Why are nurses treating other nurses this way? Why am I being punished for being a new nurse? I do not have to sit there and take it. I have every right to confidently stand up for myself.

I do have a fear of standing up for myself. I don’t know if it’s the society we’re living in or the way I was raised, but if I stand up for myself, I’m either labeled as “sensitive” or a “b*tch.” There is no inbetween in my head. Maybe a few therapy sessions could do some good with that battle in my head.

Words hurt. Words have always hurt me. I can take physical pain, no problem. But the words of a bully will fester in my mind for weeks. Now I find myself being nervous around these particular colleagues. I feel as though asking for help shows weakness. I don’t feel like myself. It’s causing anxiety so much so that I request to switch assignments if I am too close to this person.

I said something to a supervisor and I made things worse for myself. I feel as though I’m not believed because this person is experienced. Of course I don’t talk about it with other people because I’m not the type to spread gossip or get everyone in my business.

If you have any advice, let me know, because I’m at a loss here.

There are hundreds of resources, studies, and articles out there about both types of violence. If you “google” it, thousands of entries appear. Yet it is still happening.

The Journal of Emergency Nursing posted an article about lateral violence in 2012, you can find it here. Another great resource is

Help me create a culture of celebrating each other, lifting each other up, and encouraging your peers to report workplace incidents. Under no circumstance should you allow someone else to violate your personal space or mind without your permission.

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