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There are two emergency department (ED) nurses who have been injured trying to restrain an intoxicated patient; neither are seriously hurt but still enough to be painful and disconcerting.

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 There is an angry boyfriend who has threatened one of the ED technicians and an emergency medicine resident because his girlfriend has not been seen on a busy shift. He has demanded that they “get in there right now or else!” The implied threat of violence in his voice and aggressive posture is unmistakable.

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 Finally, one of the ED attending physicians has retreated to the charting alcove to get away from an angry family, one of whom has directly threatened her life should she not be able to save his brother who has been seriously injured in a motor vehicle accident.

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While possibly not a typical day, it is not an unusual one in the ED.

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It seems strange to those who choose to work in EDs that they are so frequently subjected to verbal abuse, threat, and violence from the very people they are trying to help. Yet, those in emergency medicine really should not be all that surprised as the ED represents one of the most common places in the healthcare system for such violence to occur.1-8

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Workplace assaults are common in American society with the Bureau of Justice statistics showing that it represents 18% of all violent crime and approximately 1.7 million injuries a year.9 The victim was a healthcare worker in 12% of those incidents.10,11 From 1997 to 2009 there were 73 homicides that occurred in a healthcare setting of which 12 were physicians and 15 were nurses.12 The rate of assault in the healthcare industry is estimated to be 8/10,000 workers compared to 2/10,000 workers in private sector occupations.12

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Healthcare workers are at one of the highest risks for injury from assault, at a risk level approximately that of a police officer. Nurse aides, orderlies, and patient care attendants have the highest assault injury rates among healthcare workers at 27.3/100,000 workers; healthcare support occupations were 17.1/10,000 and nurses and physicians were 4.2/10,000 compared to 1.8/10,000 for the general sector.12 Those who work in EDs, extended care facilities, and psychiatric facilities report the highest rate of assault within the healthcare system.13

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Emergency nurses in Minnesota reported a rate of physical assault 4 times that of nurses in any other area of the hospital.13 In Florida almost three-quarters of those surveyed reported being assaulted at some point in their career in the ED and 41.5% in just that past year.14 In 2009 Gacki-Smith et al reported that 25% of nurses were physically assaulted greater than 20 times within a 3-year time frame and 20% were verbally abused over 200 times in that same 3-year period.6 In a survey of 1000 ...

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