Nurse, Provider, and Emergency Department Technician: Perceptions and Experiences of Violence and Aggression in the ED

Published:September 27, 2022DOI:



      Patient/visitor violence and aggression (V&A) in the emergency department occurs daily. Few interventions exist to decrease V&A. Research describing prevalence, severity, and perceived safety among ED clinicians is limited.


      A descriptive survey explored V&A against ED clinicians in one urban emergency department. A sample of nurses, ED technicians, physicians and advanced practice providers participated. Participants completed a demographic survey, Personal Workplace Safety Instrument for Emergency Nurses (PWSI-EN), and ENA V&A frequency checklist. Analysis of Variance (ANOVA) for unadjusted and Analysis of Covariance (ANCOVA) for adjusted associations were used to assess differences in the PWSI-EN survey composite score and “feeling safe in the ED” among ED roles. ANCOVA was adjusted for potential confounders: sex, race, years working in emergency department, and shift worked.


      Sixty-five (46.4%) of the 140 ED clinicians returned surveys, which were almost evenly distributed between ED clinician roles and sex. Mean age was 37.2 (range: 21-64) years. All (100%) nurses and providers reported being verbally abused. More nurses reported physical violence (n = 21, 87.5%) than providers (n = 7, 36.8%) and ED technicians (n = 11, 55%). Nurses and ED technicians reported experiencing greater prevalence of physical violence than providers (P < .05). Nurses (mean 3.29, range 2.95 to 3.63) were more fearful for their personal safety than ED technicians (mean 3.88, range 3.48 to 4.28) (P < .03).


      V&A are common creating a fearful environment. However, little research regarding clinician perceptions exists. Our study aids in identifying areas for clinician-targeted strategies to prevent ED V&A.

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      Jean M. Boles is Clinical Nurse III, Penn Presbyterian Medical Center, Philadelphia, PA.


      Diane Maccarone is Assistant Nurse Manager, Penn Presbyterian Medical Center, Philadelphia, PA.


      Beverly Brown is Clinical Nurse III, Penn Presbyterian Medical Center, Philadelphia, PA.


      Alexandra Archer is Clinical Nurse Educator, Duke Raleigh Hospital, Cary, NC.


      Michael G. Trotter is Attending Physician, Penn Presbyterian Medical Center, Philadelphia, PA; and is Assistant Professor of Clinical Emergency Medicine, Penn Medicine, Philadelphia, PA.


      Nicholas M.G. Friedman is Medical Student, Stanford Medical School, Stanford, CA. ORCID identifier:


      Jesse Chittams is Managing Director, Biostatistics Consulting Unit, University of Pennsylvania School of Nursing, Philadelphia, PA.


      Leighann Mazzone is Nurse Manager, Emergency Department, Penn Presbyterian Medical Center, Philadelphia, PA. ORCID identifier:


      James Ballinghoff is Chief Nursing Officer, Associate Executive Director, Penn Presbyterian Medical Center, Philadelphia, PA.


      Christian N. Burchill is Director of Nursing Research and Evidence-based Practice, Penn Medicine Lancaster General Hospital, Lancaster, PA. ORCID identifier:


      Pamela Z. Cacchione is Nurse Scientist, Penn Presbyterian Medical Center, Philadelphia, PA; is Ralston House Term Chair in Gerontological Nursing, Professor of Geropsychiatric Nursing, University of Pennsylvania School of Nursing, Philadelphia, PA; is Senior Fellow, Leonard Davis Institute of Healthcare Economics, Philadelphia, PA; and is Subject Matter Expert, Jonas Foundation, New York, NY. Twitter: @AgingSense1 ORCID identifier: