Emergency department violence escalates more than 50 percent in parts of Australia

Aggression and violence against frontline workers in hospital emergency departments (EDs) is on the rise, with new research from Edith Cowan University (ECU) finding that current strategies in place to manage the issue are perceived to be insufficient.

In-hospital assaults in Australia have increased by 60% in Victoria, 48% in Queensland, and 44% in New South Wales from 2015 to 2018. This represents a continued and prevalent rise in aggressive behavior against nursing staff, with a 2017 survey conducted with members of the College of Emergency Nurses' Australasia stating 87% of nurses surveyed reported experiencing patient-related violence.

A recent survey of Queensland's health workers by the Australian Worker's Union found that close to 70% of staff had either been assaulted or witnessed an assault in the workplace.

"Participants in our study in Perth were overwhelmingly telling us that the occurrence of violence is on the increase. It is not a matter of if, but when," said Ph.D. candidate Mr. Joshua Johnson from ECU's Simulation and Immersive Digital Technology Group.

"Additionally, our participants were telling us that the style of violence has become more aggressive in nature. Over the last 20 or so years, it has progressed from verbal or occasional physical abuse, where someone might be throwing a cup at a front-line worker, to the assaults we're seeing now."

The study, which held focus groups with a number of medical doctors, nurses and health safety staff across five Perth EDs found that the factors that could be influencing the likelihood of aggression and violence could include drug and alcohol use, mental illness and psychiatric disorders.

Understaffing and overcrowding in the triage area of the EDs, which results in longer wait times and communication barriers, also contribute.

Mr. Johnson noted that while there were a number of initiatives in place in hospital EDs which aim to reduce the impact of violence or improve staff's ability to cope with the violence, these initiatives were perceived to be ineffective.

"Some of the training that staff receive at hospitals to manage aggression and violence is great. These training sessions span over a few days and include both lecture-based material and role-play or hands-on techniques.

"However, other participants in our study reported that they only received two hours of training once every year, and that this training is only lecture-based. This training could also happen during very busy work periods, meaning that staff are unable to step away from their duties, or it takes place on days when staff are not at work, meaning they have to attend the training on their day off," said Mr. Johnson.

"There appears to be quite a large variation in the quality of training that is being delivered at different hospitals, as well as the frequency of this training. There is a definite need for hospitals to focus on reducing those barriers to accessing effective training, and a standardized delivery of training should be investigated."

The current incident reporting process for instances of aggression or violence is cumbersome, requiring staff to take time away from their duties and resulting in a backlog of work.

"A number of participants also felt that when they were going through the process of incident reporting, oftentimes the changes that were implemented weren't very visible and were perceived to have no tangible effect to the participants," Mr. Johnson said.

Study participants identified exposure to aggression and violence in the workplace often leaves frontline workers with increased levels of stress resulting in burnout, with clinicians often reporting a reduction in job performance, impacts on their own mental health and an ultimate choice to leave the profession.

"Previous research has shown that student nurses who are planning on moving into the field often reconsider their chosen field when exposed to these aggressive and violent incidents while on clinical placement.

"This demonstrates that exposure to these events greatly impact staff and student mental health and could potentially lead to people leaving the field. This in turn puts greater stress on an already strained system, and further exacerbates the issue," said Mr. Johnson.

More information:
Joshua Johnson et al, Aggression and violence in the emergency department: A qualitative study exploring the perspectives of frontline healthcare professionals, Collegian (2024). DOI: 10.1016/j.colegn.2024.04.003

Provided by Edith Cowan University