Work Hours, Emergency Department Context, and Workplace Violence Among Nurses

Importance Workplace violence is common in high-risk health care settings, with consequences for clinician well-being and care delivery. Less is known about multilevel work-system factors associated with workplace violence in emergency department (ED) nurses. Objective To characterize workplace violence among ED nurses and identify multilevel work-system factors associated with workplace violence. Design, Setting, and Participants This cross-sectional study used nurse survey data combined with administrative and electronic medical record data collected in 2023 from nurses working in 11 EDs in a multisite health system in the southeastern US. Exposure Multilevel work-system factors, with primary exposures of interest including overtime, shift type, and ED type (freestanding vs in-hospital); additional covariates included individual, team, and ED-level characteristics. Main Outcomes and Measures Any self-reported workplace violence in the prior month (threats, physical violence, verbal abuse, unwanted sexual attention, or bullying) from patients, visitors, and/or coworkers. Associations were estimated using mixed-effects logistic regression with a random intercept for emergency department site and factor selection using cross-validated least absolute shrinkage and selectrion operator regression. Nurses in the supplemental staffing team were excluded from this analysis. Results Among 337 ED nurses (mean [SD] age, 34.9 [9.5] years; 289 [85.8%] female; 287 [85.2% white; mean [SD] nursing experience, 9.0 [8.2] years), 296 (87.8%) reported workplace violence in the prior month. Incidents of WPV involved patients or visitors (292 of 296 [98.6%]) and coworkers (60 of 296 [20.3%]). In adjusted mixed-effects models (n = 299), overtime was associated with higher odds of workplace violence (OR, 3.21; 95% CI, 1.30-7.93), while night shift (OR, 0.28; 95% CI, 0.10-0.78) and employment in a freestanding ED (OR, 0.25; 95% CI, 0.09-0.76) were associated with lower odds. Conclusions and Relevance In this cross-sectional study of ED nurses, workplace violence was common and was associated with overtime and ED context. These findings support further evaluation of work-hour practices and context-specific approaches to workplace violence prevention.