Establishing a Protocol to Address Workplace Violence and Increase the Perceptions of Safety Among Emergency Department Nurses: A Quality Improvement Initiative

Background: Violence against emergency department nurses has become a widespread phenomenon that can greatly impact a nurse\u27s job satisfaction and performance. Research has been scarce in examining the relationship between workplace violence and its underlying consequences. There remains a disconnect between precursors of violence against nurses perpetrated by patients and the cultural expectation that violence is a part of the nurses job and, subsequently, what they signed up for when going into the field. Nurses learn that having a greater understanding of the value in the lived experience of their patients leads to better quality delivery of care. However, culturally we have undervalued their lived experiences and have placed an expectation that violence is an acceptable consequence of their career choice. In doing so, we, as a culture, have also set a precedent that patients can continue to act in an aggressive and assaultive manner towards nurses with little to no consequence, of which, patients continue to engage in such behaviors and incidences of violence are on the rise. Local Problem: 70-90% of participants have experienced workplace violence in the emergency department within the last year. 30% of nurses believe that this violence is an expected consequence of their job. Methods: In this quality improvement project, answers from the validated Cooke-ENA Workplace Violence Assessment Tool were collected to assess the perception of safety among participatory staff nurses at a critical access hospital in rural New Hampshire in January 2023 and, again, in July 2023. Intervention: Endemic to the workplace, how do we address violence so that nurses are made to feel safe going to work just as we are made to feel safe when going to the hospital and being cared for by the nurse? Who will take care and advocate for them? A policy was implemented to enhance and require the presence of local law enforcement and/or facility security when caring for potentially aggressive and/or violent patients in the emergency department. Results: The results yielded that from January 2023 to July 2023, the perception of overall safety in the emergency department after policy implementation increased slightly with a mean change from 5.8 to 6.0 (SD 0.8944, range 1-10). In January 2023, 30% of the participants reported that workplace violence in the emergency department was to be considered “part of the job.” However, this number was decreased by half after implementation in July 2023 with results at 16% who believe violence is considered part of the job. Conclusion: The ability to sustain the results of this project may vary depending on the patients who arrive at the emergency department, the continued cooperation and support from local law enforcement, and diligence of the microsystem to continue to make strides to mitigate workplace violence and its effects. Success of this quality improvement project was imperative on addressing workplace violence from within the culture of the hospital and decreasing its tolerance as a cultural norm among healthcare agencies