Management of agitation and violence

According to the National Institute of Occupational Safety and Health, approximately 1.7 million people are assaulted in the workplace annually, with a significant percentage occurring in the health care environment. Professionals like police and firefighters are associated with higher rates of fatal violent events. Although health care violence is usually non-fatal, it is more frequent and pervasive. Violence is four times more common in health care settings than in other private industries. The most common settings for these assaults include hospitals (particularly emergency departments (EDs), intensive care units, geriatric and psychiatric floors), nursing homes, and social service agencies. A survey of over 250,000 private industries found that 45% of non-fatal occupational injuries occurred as a result of a health care violence. Even more concerning is that these rates appear to be on the rise. Nurses are the most frequently assaulted health care workers. Campbell et al., in a survey of health care workers, found over 30% of nurses reported an incident of physical assault. Other research also suggests nurses experience a high incidence of workplace violence. Internationally, similar rates of health care-related violence have been reported. The ED is often the site of violence and is clearly a very high-risk area of the hospital. A survey of over 3000 registered nurses from the Emergency Nursing Association revealed 25% had experienced physical assault more than 20 times over the preceding three-year period.