The emergency department is highly susceptible to abuse due to its nature of services. Research indicates that provision of services to patients with factors like 24-hour accessibility, the presence of a highly stressful environment and the lack of sufficiently trained armed and present at all times guards to intervene and respond to the violence of patients towards the nurses increases incidents of abuse and violence. The increase in workplace violence especially in the ER has led to the nursing being perceived as the occupation which is highly at risk of patient related to violence. Studies conducted on ED violence reveals that nurses are subjected to physical, emotional, verbal abuse and have come to accept violence as part of their job.
Safety in the nurse-patient ratio
The emergency department is vital in ensuring the provision of efficient, safe and quality care. For example working in the ED comes with increased demand for emergency services which compromises the safety of care as a result of delays and overcrowding in the emergency departments and waiting areas. Studies show that increasing nurse to patient ratio has improved patient outcomes (Burns & Grove, 2011). Many health care organization face nursing staffing challenges decreasing the recommended rates of nurse-patient ratio. Hospitals and health care centers also frequently increase the ED care times for nurses and wish to reduce costs by limiting nurses overtime hours. Due to these factors shortages arise which raise significant gaps in nursing services within the ED due to staffing deficiencies increasing vulnerability to violence (Centers for Disease Control, 2014).
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Research problem, improvement of health care and patient outcomes
The study of violence towards nurses in the emergency departments is significant due to the great concern of risk exposure of nurses. Studies on the use of force and aggression ranked careers of nurses in the ED as those with the highest threat of exposure to workplace violence. Nurses are prone to physical and verbal abuse experiencing intimidation harassments, threats assaults and sexual violence (Burns & Grove, 2011). The problem in the ED exists due to lack of violence prevention programs in healthcare institutions. Also, the voluntary nature of federal regulation in the implementation of rules and guidelines in the provision of environmental safety for nurses in the ED (McCusker et al., 2014). A focus on the violence towards nurses in the ED is crucial as it will help in the improvement of the working environment for nurses which has a direct impact on patients’ outcomes and the delivery of quality care.
Summary
Significance of study
The examination of violence against emergency department nurses is critical to enhancing their working environment. The increase in cases of abuse has increased nurses’ performance as they feel insecure in their work environment. Violence results in concerns about aggressiveness and the inadequate safety measures put in place exposure the nurses to personal vulnerability (Burns & Grove, 2011). Violence and aggression in the ED lead to the feeling of insecurity in the work environment lack of support from the organization, dissatisfaction and a decrease in quality of care delivery.
Purpose of study
The purpose of the study is to evaluate violence and its impact on nurses, patients and quality of care. The analysis of violence in the ED will help in the development of fair and consistent plans and procedures as well as the development of a culture of support on health care institutions administration and management. The study will inform the administration on their contribution to violence in the workplace by examining actors such as inadequate staffing levels, failure to improve environmental and workplace safety for nurses. The analysis of violence in the ED will bring the administration of health care institution to the attention to on their ignorance of concerns of nurses working in that environment and the various measures to address the arising issues (AHRQ, 2011).
The study on violence addresses questions on the role of institutions and the various initiatives in addressing the environmental safety of nurses in performing their duties. It addresses issues on the performance of nurses in their delivery of quality care and the limiting actors in their workplaces. The study provides answers on the increased risks and cases of assaults of nurses in hospitals and the different interventions, preventive and interdisciplinary approaches that can be instituted to deal with the complicated situations and improve the healthcare outcomes.
Results of the study
The study reveals the need for stern measures to eliminate the problem of assault and address violence as a matter of urgency. The research shows that the prevention of violence against nurses in the emergency department is possible and the reduction of risks through the improvement of workplace safety would increase patient outcomes and service delivery. The findings are useful in the nursing practice through the reduction of risks and in the provision of a suitable environment and safe workplace. The implementation of a comprehensive and robust workplace violence prevention program will reduce the complexity of service delivery improving performance and satisfaction (Burns & Grove, 2011). The introduction of preventive strategies will address the existing and potential hazards arising from violence and provide opportunities for nurses through safety and health training. The studies also ensure the provision of safe working environments through the regulation of nursing requirements in staffing, improving security measures as well as the recognition and management of potential assaults.
Limitations
The study is however limited by lack of data due to underreporting of violence cases. Despite the vulnerability of the ED to violence, there are no established standardized measurement and reporting mechanisms in the health care settings which limits the availability of data for analysis and evaluation. The study is also limited by the lack of a definitive standard of ED violence towards nurses which triggers the underreporting of incidents despite the occurrence of assaults and violent acts (Centers for Disease Control, 2014).
Nurses as the significant victims fail to report to law enforcement authorities and the employers due to fears and the adoption of attitudes which embrace violence as part of the job Health institutions also lack elaborate reporting policies on violence leading to perceptions that reports on violence are non-beneficial and portray nurses as incompetent and inadequate in the performance of their jobs. Nurses’ views on reporting as unhelpful and their empathy on patients lead to excusing of their behavior. The incidents also lack tangible evidence in cases physical or verbal abuse influencing the reporting and hence accumulation of data on violence incidents.
Ethical considerations of the study
Ethical consideration of violence in the ED focus on both nurses and patients. Ethics dwell on autonomy, beneficence, and justice. The code of ethics calls upon nurses to practice competency, sound judgment and the protection of lives and privacy of patient through the principle of beneficence which places the obligation on the nurse to improve the patient outcomes (AHRQ, 2011). Violence compromises ethics of justice and autonomy. Thus ethical considerations regarding violence in the emergency department affect the delivery of fair treatment to all by causing harm physical or mental through verbal abuse (Centers for Disease Control, 2014). Nurses adhere to ethical considerations when protecting themselves their coworkers and patients from violence perpetrators such as other patients’ visitors and family members.
Conclusion
Emergency departments are called upon to address violence and aggressiveness towards nurses. The implementation of stringent measures and the establishment of high commitment to safety and reporting of abuse will help in tackling the violence menace. Introduction of zero tolerance policies where, hospitals and institutions administrators engage in safety increase in the emergency departments will improve service delivery and reduce violence incidences. Such systems safeguard both nurses and patients safety and health and raise the quality of care and service delivery.
References
Agency for Healthcare Research and Quality. (2011). Improving patient flow and reducing emergency department crowding: A guide for hospitals. Retrieved from www..ahrq.gov/research/findings/final-reports/ptflow/index.html
Burns, N., & Grove, S. (2011 ). Understanding Nursing Research (5th Ed.). St. Louis, MO: Elsevier.
Centers for Disease Control. (2014). Emergency department visits . Retrieved from http://www.cdc.gov/nchs/fastats/emergency-department.htm
McCusker, J., Vadeboncoeur, A., Levesque, J.F., Ciampi, A., Belzile, E. (2014). Increases in emergency department occupancy are associated with adverse 30-day outcomes. Academic Emergency Medicine , 21, 1092–1100.
