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MORE THAN HALF of nurses who provide emergency care have experienced physical violence on the job, and one in four has been physically assaulted more than 20 times in the last three years, according to a recent study from the Emergency Nurses Association.

Statistics like those don’t surprise healthcare and security professionals. In fact, Dick Sem, CPP, of Sem Security Management, thought the numbers sounded low, because the emergency department in most hospitals is a “focal point of stress and anger—those are the folks who usually are the most concerned about security and safety,” he says.

Sem, who interviews hospital staff during security assessments, says that he sees the violence worsening.

But at least hospitals no longer expect nurses to tolerate abuse. “When I was a young nurse…we were just told to suck it up, it just comes with the job,” says Dan Sheridan, an associate professor at Johns Hopkins’ School of Nursing. But “that’s no longer what we’re teaching,” he says.

Sheridan has been surveying hospitals regarding medical care issues, including workplace violence, as a part of Johns Hopkins University’s Safe at Work project. He notes that these new attitudes may not be fully integrated into practice in the workplace yet.

Sheridan says Johns Hopkins offers nursing courses that address workplace violence and teach how to respond to aggression with techniques such as de-escalation. Professors also stress the importance of reporting violent incidents, which are widely underreported.

Sheridan advocates calling law enforcement more often. “If somebody’s threatening to hurt you while you’re attempting to de-escalate, somebody else should be going to the closest phone and dialing 911,” says Sheridan.

University training of de-escalation techniques is not quite at the level he’d like it to be, but he says that hospitals are better equipped to provide hands-on training and should do more of it.

Sem is among those providing violence-related training for hospitals. He says that while hospitals have extensive emergency plans for accidents and disasters, their workplace violence plans tend to be short, pro forma documents. For a more robust plan, he recommends having prevention, mitigation, and response components.

Sem addresses three issues in training. The first is security awareness; the second is how to safely remove people from the situation; and the third is crisis response and intervention, such as how to restrain people. Sem says he always works with any security or police officer stationed in the emergency room as well as nurses and other hospital staff.

This emphasis on providing related training to security personnel and the nursing staff is integral to creating a safer work environment, says Sem, who notes that about half of the hospitals he has visited had failed to establish a good working relationship between security staff and nurses.

“There’s some alienation between the two, some resentment,” says Sem, adding, “Both sides feel that the others don’t really appreciate what they do or what they’re facing,” and so the relationship between the two needs improvement.

William H. Nesbitt, CPP, of Security Management Services International Inc., has also seen some tension between nursing and security staff in certain cases. “Healthcare workers by nature are pretty altruistic. They’re caregivers; they want to make people get better. And they sort of see anything that relates to security as being somebody else’s job,” he says.

Nesbitt recommends that nursing supervisors work hand in hand with security so that the jobs are not seen as quite so separate.

Hospitals have a lot to gain from addressing the problem of violence against nurses. The Johns Hopkins survey, for example, found that nurses who experienced workplace violence were more likely to miss work and to change jobs. Thus, beyond the human impact, there’s a financial cost.

(For more information on violence in the emergency department, see “Saving Lives Securely,” the June 2008 Security Management cover story.)