1. Chappell, Stacey BA


Violence in the workplace, including violence toward staff from patients and families as well as lateral violence, has become a serious safety issue for hospitals in the United States. Concerned about this issue, the Emergency Nurses Association and the American Organization of Nurse Executives convened a Day of Dialogue to discuss ways to mitigate violence in the workplace. The result of the discussion was the development of guiding principles and a toolkit to assist nurse leaders in systemically reducing lateral violence and patient and family violence in hospitals.


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Workplace violence is an increasingly recognized safety issue in the healthcare community. Workplace violence is generally defined as any act or threat of physical assault, harassment, intimidation, and other coercive behavior.1 It includes lateral violence, or bullying, between colleagues (eg, nurse/nurse, doctor/nurse). In 2010, the Bureau of Labor Statistics data reported healthcare and social assistance workers were the victims of approximately 11,370 assaults by persons.2 While workplace violence against healthcare professionals can and does happen everywhere, the hospital emergency department (ED) is among the most vulnerable settings.

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According to a 2011 study by the Emergency Nurses Association (ENA), 54.5% of 6,504 emergency nurses experienced physical violence and/or verbal abuse from a patient and/or visitor during the past week.3 The actual rate of incidences of violence is much higher because many incidents go unreported, due in part to the perception that assaults are "part of the job."4


Last year, the American Organization of Nurse Executives and ENA convened a Day of Dialogue to discuss the issue of violence against nurses in healthcare settings. The group, composed of ED nurses and nurse leaders in the acute care setting, discussed how incidents of violence are currently addressed in hospitals; the need for partnership between hospital leaders, especially nurse leaders, and staff; and the need to create an environment where healthcare professionals, patients, and families feel safe. Through facilitated dialogue, the group developed guiding principles and prioritized areas to assist all hospital leaders in systematically reducing lateral and patient and family violence in hospitals.


The Guiding Principles on Mitigating Violence in the Workplace (Figure 1) and priority areas (Figure 2) are listed. Additional resources, including a toolkit to address workplace violence in healthcare settings, are available at




1. Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health. Violence: occupational hazards in hospitals. Accessed July 1, 2014. [Context Link]


2. US Department of Labor. Occupational Safety & Health Administration. Safety and Health Topics. Workplace Violence. Accessed December 1, 2014. [Context Link]


3. Emergency Nurses Association. Emergency Department Violence Surveillance Study. Des Plaines, IL: Emergency Nurses Association; 2011. [Context Link]


4. Gacki-Smith J, Juarez A, Boyett L. Violence against nurses working in US emergency departments. J Nurs Adm. 2009; 39( 7/8): 340-349. [Context Link]