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Abstract
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Definition
Workplace violence occurs when a person is physically or verbally abused, threatened, intimidated, harassed or assaulted in her or his employment. In Canada, employees have the right to a safe work environment, and it is the duty of the employer to provide it [1].
Nature and magnitude of the problem
The problem of workplace violence in the emergency department (ED) is grave. Healthcare providers have an estimated fourfold higher rate of workplace violence and fully half of such attacks occur in the ED [2,3,4,5,6,7,8,9,9]. Studies suggest that 43% of hospital nurses will be sexually harassed or assaulted this year [4] including over 50% of those working in the ED [10,11,12,13,14,15]. Over half of ED nurses are physically or verbally abused in any given week [10, 11]. The Canadian Federation of Nurses Unions (CFNU) reported in 2017 that "the number of violence-related lost-time claims for frontline health care workers has increased by almost 66% over the past decade, three times the rate of increase for police and correctional service officers combined" [8]. It is shocking that the risk of violence for a doctor or nurse working in a Canadian emergency department is increasing so dramatically and intolerable that it be left to rise unabated. The level of ED violence can reasonably be expected to continue to increase in the future due to the changing ED population, the prevalence of guns and paucity of services available to those prone to violence due to underlying medical, substance abuse or mental health disorders.
The increasing trend noted by the nursing profession is echoed by emergency physicians. Nearly 70% of emergency physicians say that ED violence has increased in the past five years, with 25% reporting it has increased greatly [16]. This high level of ED violence is undoubtedly a contributing factor in the already high ED physician burnout rate [17,18,19]. ED violence negatively affects both the quality of care which can be offered and the financial cost to the health care system [20]. In Ontario alone, ED violence costs $23.8 million annually [21].
The increasing pattern of violence against health care workers is disturbing not only because of its prevalence but also because of the culture of silence surrounding it and lack of effective mitigating action, despite its incredibly high human and financial cost. The CFNU's recent poll highlighted that, although violence in the ED is common, few people report the incidents and fewer still seek help from their unions. Many assume it is an occupational hazard they must accept and yet, not surprisingly, two thirds (66%) of nurses have thought of leaving their job in the past year [8]. The unhealthy work environment contributes to nurse absenteeism, which is higher than all other occupations. In 2016, the annual cost of absenteeism due to illness or disability was at least $989 million" [8]. ED violence costs Canadians billions of dollars annually, money which could otherwise be spent constructively on necessary health and social services.
Changing the prevailing culture
The prevailing culture in the hospital system has implied that ED violence is part of the job, an inherent risk that it is futile to try to address [22]. The Canadian Association of Emergency Physicians (CAEP) seeks to change this perception and increase ED safety for physicians, hospital staff and patients. CAEP finds the level of ED violence unacceptable, the dearth of available mitigation techniques dangerous, the lack of effective recourse neglectful and callous, and the wasted human and financial resources unconscionable.
The most important component of any violence prevention program is a clear commitment by management. CAEP expects unequivocal support from hospitals...
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