Blog Posts

violence in the ED

Violence in the Emergency Department Isn’t Just Part of the Job

Posted on Wed, Feb 08, 2017
Violence in the Emergency Department Isn’t Just Part of the Job

By Jenice Forde-Baker, MD, FACEP
Walk through any emergency department and you will find signs of violence. In fact, emergency physicians are trained to care for victims of violent trauma in a systematic fashion to provide the best chances of survival. We are used to seeing patients as victims. Patients may be subject to intimate partner domestic violence, child abuse/neglect and gang violence. The victims we often forget to think about are ourselves.
Workplace violence is very common in healthcare. In fact, second only to law enforcement, healthcare professionals experience the most episodes of workplace violence in the general workforce.
Factors contributing to workplace violence in emergency departments include:

  • Overcrowding
  • Understaffing
  • Limited security
  • Patient pathology
  • Intoxication 

We are in a precarious situation where we must give care at the risk of our safety. A survey conducted by the New Jersey chapter of the American College of Emergency Physicians (ACEP) in 2015 found that 80 percent of emergency department colleagues felt that violence is part of the job.
Recently, an act of violence occurred in my own emergency department, and although no staff were hurt physically, the emotional wounds are still fresh. The pervasive culture and acceptance of violence leads to anxiety and fear that you or your co-worker will be subject to violence’s grip.
So what can you do? Speak up! To change the culture, we as emergency physicians must acknowledge that we are victims and that this is not acceptable. We need to be vocal with our staff, committees and hospital administration to collaborate and implement safety precautions so we can best take care of all patients. We must not let violence to be “part of the job.”
Experiencing violence in the workplace can lead to post-traumatic stress disorder (PTSD), burnout and early attrition. Anyone who has experienced workplace violence should take advantage of these resources because the effects of a violent episode may manifest in delayed and obscure ways. There are protocols in place to deal with the physical and emotional results of violence. If you or a colleague experiences workplace violence, please report the incident to your supervisor and emergency department director.
The Effects of Workplace Violence
Critical incident stress management is crucial to dealing with a traumatic event. The effects of violence on a clinician can be physical, cognitive, emotional and/or behavioral.
  • The physical effects of an incident can include nausea, sweating, elevated heart rate and blood pressure, hyperventilation, dizziness and headaches.
  • Cognitive effects can include impaired thinking/decision making, poor concentration, memory problems, flashbacks and nightmares.
  • Emotional effects can include anxiety, guilt, fear, emotional numbness, anger, denial and irritability.
  • Behavioral effects can include withdrawal, suspiciousness, alcohol consumption, change in appetite and inability to rest. 

Taking advantage of the resources available at your hospital for dealing with traumatic events is important to begin the healing process. ACEP and its local chapters also have resources that you can tap into.
Victims of violence are cared for in emergency departments every day. Let's be mindful that emergency department staff also can be victims, and it’s not “just part of the job.”

Jenice Forde-Baker
Jenice Forde-Baker M.D., FACEP, received her bachelor’s degree and medical degree from Cornell University, Ithaca, N.Y. She completed a four-year emergency medicine residency at Cornell and Columbia's NewYork-Presbyterian teaching hospitals. Since then, Dr. Forde-Baker has been an attending physician at Our Lady of Lourdes Hospital in Camden N.J. In 2014, she became the assistant medical director of the emergency department and is active in the education of faculty and nursing at Our Lady of Lourdes. Dr. Forde-Baker is a fellow of the American College of Emergency Physicians (ACEP) and in 2015 was elected to the Board of Directors of NJ-ACEP. Dr. Forde-Baker is currently working on initiatives that address women leadership in emergency medicine and workplace violence in the emergency department via NJ-ACEP chapter grants.