Reporting is becoming more frequent as nurses recognize physical and verbal mistreatment is not part of their job description. Facilities also are offering training, which endorses nurses reporting incidents. , according to Jenessa Williams, BSN, RN, CEN, Adeptus Health regional nurse manager for Colorado. “We focus on training nurses in de-escalation techniques. This means looking for signs, then respecting the person’s space.”

Common signs, or alerts, signaling a potential violent outbreak, require nurses to develop situational awareness. “Be aware of little things, like the person avoiding eye contact, skirting answers to questions, avoiding any type of treatment for their healthcare needs. These are early signs,” Williams said.

“Remember, it’s not part of your job to have a patient be verbally or violent toward you,” Williams said. “Be empathetic toward patients, but hold them accountable.” Also being aware of one’s own nonverbal actions is important, said Williams. For example, a nurse should consciously choose not to react when an individual is starting to challenge or question them. They also can alert their team and others to the potentially violent person.

Most recent studies show the majority of workplace violence is related to patients who have some sort of alcohol or drug-related reason for their visit, according to Williams. “Everyone is at a high-level of anxiety in an ED, so anyone could have a trigger that could lead to a situation,” Williams said.

“Don’t become complacent with ‘typical’ patients; be consistently aware.”

— Kristine Powell, RN

At Baylor Scott & White, Powell said nurses are taught to recognize potential violence using the acronym

“We teach nurses to recognize some of those obvious indicators; the more that are present, the higher the risk,” Powell said.

As indicators develop toward violent behavior, nurses will deploy de-escalation and intervention tactics, Powell said. At Baylor, staff receive mandatory classroom training in addition to completing the ENA’s free workplace violence online training module.

She advocates that ED nurses pursue their own training. Nurses also can share the joint on mitigating violence with their nursing leadership.

“With the support of nursing administration, we can make better headway in reporting violence and improving safety,” Powell said. She also stressed every ED should have a no-tolerance for violence culture. According to Powell this means reporting must happen for any violent incident, including those with a co-worker or physician.