Original Research
Workplace Violence: A Survey of Emergency Physicians in the State of Michigan

https://doi.org/10.1016/j.annemergmed.2004.10.010Get rights and content

Study objective

We seek to determine the amount and type of work-related violence experienced by Michigan attending emergency physicians.

Methods

A mail survey of self-reported work-related violence exposure during the preceding 12 months was sent to randomly selected emergency physician members of the Michigan College of Emergency Physicians. Work-related violence was defined as verbal, physical, confrontation outside of the emergency department (ED), or stalking.

Results

Of 250 surveys sent, 177 (70.8%) were returned. Six were blank (3 were from retired emergency physicians), leaving 171 (68.4%) for analysis. Verbal threats were the most common form of work-related violence, with 74.9% (95% confidence interval [CI] 68.4% to 81.4%) of emergency physicians indicating at least 1 verbal threat in the previous 12 months. Of the emergency physicians responding, 28.1% (95% CI 21.3% to 34.8%) indicated that they were victims of a physical assault, 11.7% (95% CI 6.9% to 16.5%) indicated that they were confronted outside of the ED, and 3.5% (95% CI 0.8% to 6.3%) experienced a stalking event. Emergency physicians who were verbally threatened tended to be less experienced (11.1 versus 15.1 years in practice; mean difference −4.0 years [95% CI −6.4 to −1.6 years]), as were those who were physically assaulted (9.5 versus 13.1 years; mean difference −3.6 years [95% CI −5.9 to −1.3 years]). Urban hospital location, emergency medicine board certification, or on-site emergency medicine residency program were not significantly associated with any type of work-related violence. Female emergency physicians were more likely to have experienced physical violence (95% CI 1.4 to 5.8) but not other types of violence. Most (81.9%; 95% CI 76.1% to 87.6%) emergency physicians were occasionally fearful of workplace violence, whereas 9.4% (95% CI 5.0% to 13.7%) were frequently fearful. Forty-two percent of emergency physicians sought various forms of protection as a result of the direct or perceived violence, including obtaining a gun (18%), knife (20%), concealed weapon license (13%), mace (7%), club (4%), or a security escort (31%).

Conclusion

Work-related violence exposure is not uncommon in EDs. Many emergency physicians are concerned about the violence and are taking measures, including personal protection, in response to the fear.

Introduction

A 24-year-old patient who was intoxicated on cocaine wanted to know, “What do I have to do to prove it [the mental illness] to you … do I have to hurt some people here?” He punched the crisis intervention worker and 3 other female nurses. He was grabbed by the emergency physician and pulled off one of the nurses but not before hitting the physician twice in the face. The patient then calmly walked back into his room. The physician needed 8 stitches to close a cut on his forehead, 1 nurse had a broken nose, and the other 2 nurses were bruised. The patient was arrested and released the next day on $500 bail (anecdote related by an anonymous respondent to the survey).

Violence in our society is common, and violence in the workplace is likewise not uncommon. Certain occupations intrinsically involve violence directed at those who work in such environments (ie, the military or police). Deadly assaults by disgruntled employees have occurred in the workplace, including the corporate office and post office settings. In general, the hospital environment is not considered a place where health care workers are at particular risk of violence. However, the emergency department (ED) is an exception to this commonly held belief. Police and emergency medical services often bring violent patients to the ED. Violent intoxicated patients are commonly treated in EDs and are accompanied by family or friends who may also be intoxicated, violent, or both. Mentally ill patients also represent a group of patients who may demonstrate violent behavior in the ED. Often, these patients must be restrained to facilitate assessment and treatment. Patients and their family or friends are frequently under considerable stress, which may be exacerbated by long wait times. Patients or family and friends may lash out at ED personnel when they perceive their needs have not been met.

The potential for violence against emergency physicians exists, given the stressful environment, patient population, and accompanying visitors within the ED. Many emergency physicians believe the threat of workplace violence is “part of the territory” of working in the ED. A judge at a hearing in Massachusetts noted that an assault on an ED nurse “came with the territory.”1

Within the body of literature of emergency medicine, there are few studies about the experience of emergency physicians with workplace violence. There are several older studies about the experience of physicians in the ED outside of the United States.2, 3, 4, 5 Violence and assaults have also been studied among ED nurses and other ED personnel, with the conclusion that there is a significant incidence of workplace violence intrinsic to the ED.6, 7, 8, 9, 10 Emergency service providers have reported substantial and significant violent behaviors.11, 12, 13 There are no recent surveys of the experience of workplace violence among emergency physicians and specifically no studies of the experience of emergency physicians in the United States. The impact such violence has on those physicians has also not been studied. The problem of workplace violence in the ED is not well documented, researched, or managed.14 The purpose of this study is to assess the experience of attending emergency physicians within Michigan about violence in the workplace and to detail their reaction to such acts.

Section snippets

Materials and Methods

The accessible population was attending emergency physicians who were members of the Michigan College of Emergency Physicians. There were approximately 400 attending physician members and 200 resident members when the survey was completed.

The sampling frame focused on emergency physicians currently in practice. Resident members were eliminated from the sample group because they are less homogeneous in that many rotate at a number of institutions, and few do a complete year of emergency

Results

Of the 250 surveys sent, 177 (70.8%) were returned. Six surveys had no data, of which 3 were from physicians no longer practicing emergency medicine, leaving 171 (68.4%) surveys available for analysis. Men represented 122 (71%) of the respondents who had been in practice an average of 13.0 years (range 1 to 32 years). The 50 (29%) female respondents averaged 9.3 years (range 1 to 30 years) in practice. Residency-trained emergency physicians represented 74% of the entire group, with 90% of the

Limitations

This survey reported only those events that occurred in the past 12 months. This is a relatively small study, with 30% of emergency physicians not responding. Demographic data were not collected on nonresponders to determine whether they were a cohort similar to those that did respond. There are relatively small numbers of emergency physicians in each demographic group. The results are based only on attending emergency physicians who were members of the Michigan College of Emergency Physicians

Discussion

Violence in the workplace is not an uncommon phenomenon in the ED. In studies of physician experiences in countries outside of the United States, violence was found to be part of the workplace environment.2, 3, 4, 5 In a study done in 1995 of 221 hospitals in North America, the ED was the most common place in the hospital for violent incidents. This summary reported 42 homicides, 1,463 assaults, 67 sexual assaults, 165 robberies, and 47 armed robberies.15 In a study of an ED in Vancouver during

References (22)

  • M.A. Zahid et al.

    Violence against doctors, 2: a study of violence against doctors in accident and emergency departments

    Eur J Emerg Med

    (1999)
  • Cited by (219)

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    Supervising editor: Judith E. Tintinalli, MD, MS

    Author contributions: TK and BLW conceived the study, designed the survey, and obtained research funding. TK, BLW, and SC distributed the survey and managed the data. SC provided advice on study design and analyzed the data. TK and BLW drafted the manuscript, and RKK with the other authors contributed substantially to its revisions. TK takes responsibility for the paper as a whole.

    Funding and support: Sponsored by an American College of Emergency Physicians Chapter Grant to the Michigan College of Emergency Physicians Workplace Violence Task Force.

    Presented at the American College of Emergency Physicians annual meeting, Boston, MA, October 2003.

    Reprints not available from the authors.

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