A survey of violence toward nursing staff in one large Irish Accident and Emergency Department.

INTRODUCTION

Nurses in Ireland are increasingly concerned about the escalating incidence of verbal and physical abuse, particularly in Accident and Emergency (A&E) Departments. This first detailed survey of violence in A&E departments in Ireland was conducted at St. James's Hospital, Dublin, the largest hospital in the Republic of Ireland. The aims of the survey included determining the following factors: (1) what proportion of staff had experienced physical or verbal violence while on duty in the hospital, (2) the frequency of such attacks, (3) whether the violence was officially reported and sick leave taken, (4) whether age and experience changed attitudes to violence, or the reporting of it, and (5) the level of staff training, if any, in dealing with violence.

METHODS

A wide-ranging questionnaire was designed and confidentially offered to nurses and attendants (patient care assistants). Standard definitions of physical and verbal violence were framed.

RESULTS

Of 36 nurses on staff, 27 responded; nine of 13 attendants responded. Doctors were not included because only one is a permanent, non-contract employee. The responding nurses ranged in experience from newly qualified to senior nurses and unit managers with more than 15 years A&E service. The survey found that half of the nurses had been assaulted physically, or verbally, one third within the past 12 months. Only two of the 27 respondent nurses were not worried about being physically assaulted--both were psychiatric-trained male nurses and neither had ever been assaulted. Most verbal abuse was not reported--despite availability of an official report book--and 29% of nurses had not even reported their last physical assault. The likelihood of reports of verbal violence being made increased with age and experience. Staff criticised hospital managers, the police, and the courts for their attitude about assaults on nurses. Respondents believed assaults on nurses were treated less seriously than similar incidents involving private citizens.

DISCUSSION

The results of this study mirrored those of similar surveys in Britain and the United States. Nonreporting was revealed as a major problem, whereas reporting violence was often seen as an empty gesture because of a lack of institutional support for the nurse/attendant victims. Staff reported feeling vulnerable to abuse and there was a general desire for training in self-protection. Since the survey was first presented to hospital managers, St James's Hospital has made a number of changes to improve staff security. These include teaching staff breakaway techniques, increasing the number of security officers on duty, issuing personal alarms, and encouraging staff to officially report all incidents.