Instrument: Violence Against Nurses Working in U.S. Emergency Departments
Introduction
The following surveyis an adapted version of the original survey developed by the Emergency Nurses Association (ENA) for use in the study “Violence Against Nurses Working in U.S. Emergency Departments” as published in the July/August 2009 issue of The Journal of Nursing Administration. The Arizona Emergency Nurses Association’s revised version is 35-items where as the original version was a 39-item survey concerning the respondent’s personal experience with physical violence and verbal abuse from patients/visitors in the emergency department, the policies and procedures of the respondent’s hospital and emergency departmentfor addressing workplace violence, and the respondent’s beliefs about the precipitating factors of violence from patients/visitorsand barriers to reporting violence in the emergency department.Some questions were changed be committee recommendation and some questions were deleted.
The revised survey was presented to the Arizona Board of Directors for review and validation. After AZBOD approval, the survey was presented at an open membership meeting for approval.
Per ENA’s request we have noted that the original survey above and have noted that this survey is a modified version of the original. Should an individual choose to utilize this survey for research, education or other purposes, ENA requests that the study be properly cited in the research proposal, thesis, manuscript, and any otherwrite-up of the study or use of the survey.Additionally, if the survey is modified, ENA requests that it be clearly statedthat the study utilized a modified version of ENA’s original survey.
Please bring completed survey to the AZENA sponsored class you are attending.
You can also return completed survey to Tiffiny Strever either via email at or via mail at
Tiffiny Strever
c/o Trauma Services
Maricopa Medical Center
2601 E. Roosevelt Str
Phoenix, AZ 85008
Suggested citation:
Gacki-Smith, J., Juarez, A., Boyett, L., Homeyer, C., Robinson, L., & MacLean, S. (2009).Violence against nurses working in U.S. emergency departments. The Journal of Nursing Administration, 39(7/8),340-349.
Definitions:
- In the emergency department(ED) – This area includes all of the following: the patient/visitor waiting area, triage area, ED registration area, treatment area, the ambulance bay, and the area immediately outside of the entrance to the ED from the street.
- Violence in the workplace – An act of aggression directed toward persons at work or on duty, ranging from offensive or threatening language to homicide. Workplace violence is commonly understood as any physical assault; emotional or verbal abuse; or threatening,harassing, or coercive behavior in the work setting that causes physical or emotional harm.
- For the purpose of this survey, consider only those violent acts that are attributable to the patient, the patient’s family, or non-family visitors and are directed at registered nurses working in an emergency department.
1.What type of security does your hospital have? (Select all that apply)
None...... 1 (Skip to Q7)
Hospital-employed Security...... 2 (Continue)
Police/Sheriff with Law Enforcement Agency...... 3 (Continue)
Private Security Company...... 4 (Continue)
Other (specify)...... 5 (Continue)
2. Please rate the type of security your hospital has using a 1 to 10 scale with 1 meaning it's not at all effective and 10 meaning it's extremely effective in preventing violence against RNs in your ED(select only one answer):
Not at all Effective / Extremely Effective1 / 2 / 3 / 4 / 5 / 6 / 7 / 8 / 9 / 10
3.Are security personnel stationed or based in the ED? (Select only one answer)
Yes...... 1
No...... 2
4. Is your ED provided with security personnel 24/7 (24 hours per day, seven days per week)?
Yes...... 1 (Skip to Q8)
No...... 2 (Continue)
5. On average, how many hours is security provided in your ED on the following days? (Enter a whole number between 0 and 24 for each day listed. Do not enter a range, e.g., 8-10 hours.)
SundayThursday
MondayFriday
TuesdaySaturday
WednesdayHolidays
6. Using a 1 to 10 scale with 1 meaning not at all adequate and 10 meaning completely adequate, please rate how adequate the amount of time security is provided in your ED is in preventing violence against RNs (select only one answer):
Not at all Adequate / Completely Adequate1 / 2 / 3 / 4 / 5 / 6 / 7 / 8 / 9 / 10
7. Please indicate how efficient or inefficientthe following environmental controls are in providing ED security.(Select one response for each control)
Not at all Efficient / Somewhat Inefficient / Somewhat Efficient / Very Efficient / Not Used in ED / Not Sure if Used in EDBatons / 1 / 2 / 3 / 4 / 5 / 6
Bullet-proof vests / 1 / 2 / 3 / 4 / 5 / 6
Cell phones / 1 / 2 / 3 / 4 / 5 / 6
Gun / 1 / 2 / 3 / 4 / 5 / 6
Handcuffs / 1 / 2 / 3 / 4 / 5 / 6
Pepper spray/mace / 1 / 2 / 3 / 4 / 5 / 6
Personal belongings search / 1 / 2 / 3 / 4 / 5 / 6
Restraints / 1 / 2 / 3 / 4 / 5 / 6
Small hand-held personal alarm / 1 / 2 / 3 / 4 / 5 / 6
Tasers / 1 / 2 / 3 / 4 / 5 / 6
Visitor tag/badge / 1 / 2 / 3 / 4 / 5 / 6
Bullet-proof glass / 1 / 2 / 3 / 4 / 5 / 6
Enclosed nurses’ station / 1 / 2 / 3 / 4 / 5 / 6
Limits on number of visitors / 1 / 2 / 3 / 4 / 5 / 6
Locked treatment room / 1 / 2 / 3 / 4 / 5 / 6
Locked/coded ED entries / 1 / 2 / 3 / 4 / 5 / 6
Metal detectors / 1 / 2 / 3 / 4 / 5 / 6
Mirrors / 1 / 2 / 3 / 4 / 5 / 6
Panic button/silent alarm / 1 / 2 / 3 / 4 / 5 / 6
Safe for cash payments from patients / 1 / 2 / 3 / 4 / 5 / 6
Security cameras / 1 / 2 / 3 / 4 / 5 / 6
Security signage / 1 / 2 / 3 / 4 / 5 / 6
Well-lit/bright areas in the ED / 1 / 2 / 3 / 4 / 5 / 6
Other (specify)______/ 1 / 2 / 3 / 4 / 5 / 6
8. Please rate what is your overall perception of RN safety from workplace violencein your ED using the following 1 to 10 scale with 1 meaning not at all safe, and 10 meaning extremely safe (select only one answer):
Not at all Safe / Extremely Safe1 / 2 / 3 / 4 / 5 / 6 / 7 / 8 / 9 / 10
9.In your hospital, is training for the prevention/diffusion of violence in the ED mandatory? (Select only one answer)
Yes...... 1
No...... 2
Don’t Know...... 3
10.What methods of workplace violence prevention/diffusion traininghave you had? (Select all that apply)
Staff meetings...... 1
Formal course - electronic/on-line method ...... 2
Formal course – paper/hardcopy materials...... 3
Self-study – electronic/on-line method...... 4
Self-study – paper/hardcopy materials...... 5
Conference/Seminar...... 6
Other (specify)______7
11.Please rate how well this course(s) met your needs as an emergency nurse overall using a scale of 1 to 10 with 1meaning the course(s) did not at all meet your needs, and 10 meaning the course(s) completely met your needs (select only one answer):
Not at all / Completely1 / 2 / 3 / 4 / 5 / 6 / 7 / 8 / 9 / 10
(If rating in Q11 is “10” – “Completely” – Skip to Q12) otherwise please explain why this course(s) did not completely meet your needs as an emergency nurse:
______
12.Given your education and training in violence intervention, please rate the comfort level you are to handle violence against yourself or other RNs in your ED using a scale of 1 to 10, with 1 meaning not at all prepared and 10 meaning extremely prepared (select only one answer):
Not at all Prepared / Extremely Prepared1 / 2 / 3 / 4 / 5 / 6 / 7 / 8 / 9 / 10
(Respondents who put 10 “Extremely prepared” to Q12 should skip to Q17)
13.Why have you not attended workplace violence prevention/diffusion training? (Select all that apply)
Co-workers teach me what I need to know...... 1
Courses are too expensive...... 2
Don’t have time...... 3
Don’t need training to know how to handle workplace violence...... 4
Don’t think it would help/be beneficial...... 5
Location of courses not convenient/too far...... 6
Training not required by facility...... 7
Violence not a problem in my ED/No reason to attend...... 8
Other (specify)______9
14.Approximately how often is RN safety discussed in your ED staff meetings? (Select only one answer)
Daily...... 1
Weekly...... 2
Monthly...... 3
Quarterly...... 4
Semi-Annually...... 5
Annually...... 6
Never...... 7
15. Does your facility have a policy in place regarding the use of occurrence/incident reports? (Select only one answer)
Yes...... 1
No...... 2
Don’t know...... 3
16.Does your facility have a policy in place for reporting workplace violent incidents? (Select only one answer)
Yes...... 1 (Continue)
No...... 2 (Skip to Q18)
Don’t know...... 3 (Skip to Q18)
17.Is this a zero tolerance policy, that is, a policy mandating thatany and all violent incidents directed at an RN in the ED are to be reported? (Select only one answer)
Yes...... 1 (Skip to Q19)
No...... 2
Don’t know...... 3
18.Have you been instructed to report incidents of workplace violence you experienceregardless of the type of violence or level of severity or harm?(Select only one answer)
Yes...... 1
No...... 2
19.What is your hospital’s response or recommendation to an RNwho reportsthat a violent incident was directed at her/him? (Select all that apply)
Administrative leave...... 1
Critical incident stress management (CISM) training...... 2
Debriefing – individual...... 3
Debriefing – team...... 4
Employee assistance program (EAP)...... 5
Employee Counseling (not including CISM or EAP)...... 6
Employee drug screening...... 7
Filing a police report...... 8
Nothing/No response to incidents of violence...... 9
Don’t Know...... 10
Other (specify)______11
20.Do you believe that your hospital administration is committed to eliminating workplace violence against RNs in the ED? (Select only one answer)
Yes...... 1
No...... 2
21.Do you believe that your ED management is committed to eliminating workplace violence against RNs in the ED? (Select only one answer)
Yes...... 1
No...... 2
22.What are the barriers to reporting a violent incident that takes place in the ED?(Select all that apply)
May affect customer service scores/reports...... 1
Ambiguous reporting policies...... 2
Don’t want to draw attention to self...... 3
Fear of retaliation from ED management...... 4
Fear of retaliation from hospital administration...... 5
Fear of retaliation from nursing staff...... 6
Fear of retaliation from physicians...... 7
Fear of personal humiliation...... 8
Inconvenient/don’t want to deal with it...... 9
No one reports these incidents...... 10
No proof of injury...... 11
Perceived as sign of incompetence...... 12
Perceived as a sign of weakness...... 13
Staff did not sustain any physical injury...... 14
Violence comes with the job...... 15
None/no barriers...... 16
Other (specify)______17
23.Do you feel that violence from professional colleagues, patients and/or visitors is simply a part of practice in the ED?
Yes...... 1
No...... 2
24.Have you seen any of the following physically violent incidents from a patient, the patient’s family, or by other non-family visitor(s) while at work in the ED?(Select all that apply for each incidentlisted)
ByPatient / By Patient’s Family / By Non-Family Visitor / Has Never Happened
Bitten / 1 / 2 / 3 / 4
Hair pulled / 1 / 2 / 3 / 4
Hit / 1 / 2 / 3 / 4
Hit by thrown objects / 1 / 2 / 3 / 4
Kicked / 1 / 2 / 3 / 4
Pinched / 1 / 2 / 3 / 4
Pushed/Shoved / 1 / 2 / 3 / 4
Scratched / 1 / 2 / 3 / 4
Sexually assaulted / 1 / 2 / 3 / 4
Shot / 1 / 2 / 3 / 4
Spit on / 1 / 2 / 3 / 4
Stabbed / 1 / 2 / 3 / 4
Voided on / 1 / 2 / 3 / 4
Other (specify) ______/ 1 / 2 / 3 / 4
25.Approximately how often do you experience or witness patient/visitor physical violence in the ED? (Select only one answer)
On each shift I work...... 1
Weekly...... 2
Monthly...... 3
Quarterly...... 4
Semi-annually...... 5
Annually...... 6
Less than annually...... 7
Never...... 8
26.Which of the following verbal incidents have you experienced from professional colleagues, a patient, the patient’s family, or by other non-family visitor(s) while at work in the ED? (Select all that apply for each incidentlisted.)
Once a shift / Weekly / Monthly / Quarterly / Annually / NeverCalled names / 1 / 2 / 3 / 4 / 5 / 6
Harassed with sexual language/innuendo / 1 / 2 / 3 / 4 / 5 / 6
Intimidated / 1 / 2 / 3 / 4 / 5 / 6
Sworn or cursed at / 1 / 2 / 3 / 4 / 5 / 6
Threatened with physical harm / 1 / 2 / 3 / 4 / 5 / 6
Yelled or shouted at / 1 / 2 / 3 / 4 / 5 / 6
Pushed/Shoved / 1 / 2 / 3 / 4 / 5 / 6
Other (specify) / 1 / 2 / 3 / 4 / 5 / 6
27.Approximately how often do you experience patient/visitor verbal abuse in the ED? (Select only one answer)
On each shift I work...... 1
Weekly...... 2
Monthly...... 3
Quarterly...... 4
Semi-annually...... 5
Annually ...... 6
Less than annually...... 7
Never...... 8
28.Overall, do you feel that workplace violence against RNs has increased, decreased, or remained the same in your ED over the past year?(Select only one answer)
Increased...... 1
Decreased...... 2
Remained the same...... 3
29.In your opinion, what are the precipitating factors to workplace violence against RNs in your ED? (SelectTop 5)
Psychiatric patients being cared for in ED...... 1
Collecting cashpayment for ED visit...... 2
Crowding/high patient volume ...... 3
Cultural barriers...... 4
Dementia/Alzheimer patients being cared for in ED...... 5
Drug seeking behavior ...... 6
Grieving families/visitors...... 7
Holding/boarding patients...... 8
Implementation of medical screening exams at triage...... 9
Insufficient/no quiet rooms...... 10
Insufficient/no seclusion rooms...... 11
Lack of patient privacy...... 12
Limited/no access to food and beverages ...... 13
Location of your facility (rural, urban, suburban, etc.)...... 14
Misconception by patients/visitors of staff behavior (i.e., nurses
seen/heard laughing)...... 15
Not keeping patients/visitors informed...... 16
Patients/visitors’ language/illiteracy problems...... 17
Patients/visitors under the influence of alcohol...... 18
Patients/visitors under the influence of illicit drugs...... 19
Patients/visitors’ perception that staff is uncaring...... 20
Perceived prejudice from nursing staff...... 21
Prolonged wait times...... 22
No, or poorly enforced, visitor policy...... 23
No smoking policy affecting patients and families waiting in ED...... 24
Shortage of ED registered nurses...... 25
Shortage of ED physicians...... 26
Situations involving critically ill children...... 27
Staff removing personal items from patients...... 28
Violent crime rates (locally)...... 29
Other (specify)______30
30.Has the level of violence in your ED (select one only one answer):
Led you to consider working in a different unit in your hospital/
facility...... 1 (Continue)
Led you to consider looking for employment with another
hospital/facility ED……...... 2 (Skip to Q31b)
Led you to consider entirely leaving the emergency nursing
profession...... 3 (Skip to Q31c)
Have not considered leaving my ED...... 4 (Skip to Q32)
31a.How likely is it that you would leave emergency nursing to work in a different unit in your hospital/facility due to workplace violence in your ED? (Select only one answer)
Very likely...... 1 (Skip to Q32)
Somewhat likely...... 2 (Skip to Q32)
Somewhat unlikely...... 3 (Skip to Q32)
Very unlikely...... 4 (Skip to Q33)
31b.How likely is it that you would leave your hospital/facility and seek employment with another hospital/facility ED due to workplace violence in your ED? (Select only one answer)
Very likely...... 1 (Skip to Q34)
Somewhat likely...... 2 (Skip to Q34)
Somewhat unlikely...... 3 (Skip to Q34)
Very unlikely...... 4 (Skip to Q34)
31c.How likely is it that you would entirely leave the emergency nursing profession due to workplace violence in your ED? (Select only one answer)
Very likely...... 1
Somewhat likely...... 2
Somewhat unlikely...... 3
Very unlikely...... 4
32.Would you support state legislation that providesstiffer penalties for violence against nurses similar to penalties for violence against other public servants such as police officers, postal workers, firefighters, etc.? (Select only one answer)
Yes...... 1
No...... 2
33. Does the state in which you work already have this type of law in place? (Select only one answer)
Yes...... 1
No...... 2
Don’t know...... 3
34.What is the one most important policy, procedure or environmental control your ED uses, or could use, to prevent workplace violence against RNs?
______
35.What other comments do you have, or issues you would like to see addressed, concerning violence against RNs in the ED?
______
© Emergency Nurses Association, 2007. 1