Emergency Department or Battleground? Confronting Workplace Violence Against Staff in Emergency Departments Through...

Emergency medicine (EM) is increasingly dangerous for physicians and healthcare workers. Workplace violence (WPV) against staff is frequent and underreported and contributes to burnout, moral injury, and workforce attrition. EM clinicians face disproportionate WPV due to the unpredictable, high-pressure work environment, complex patients, and limited systemic protections.

This concept paper aims to explore major challenges and reposition WPV from operational nuisance to critical systems-level priority. It builds on SAEM Wellness Committee efforts and highlights a SAEM 2025 presentation that featured real-world stories, national data, educational initiatives, and interventions to prevent and mitigate WPV.

A multi-institutional SAEM Wellness Committee workgroup reviewed literature and national data related to WPV, collected EM lived experiences, and analyzed ongoing anti-WPV efforts to frame the current state of WPV in EM and key challenges and initiatives. These insights contributed to creating a conceptual framework designed to guide educational reform, policy development, and systems-level strategies to address WPV in EM.

Exploration of WPV-related literature, lived EM experiences, and exemplar initiatives reveals numerous challenges related to WPV, including persistent underreporting, cultural normalization, inadequate education and training, and fragmented or insufficient institutional responses. Clinician narratives highlight WPV's long-lasting psychological toll and perceptions of inadequate support, protection, and institutional betrayal. We propose a tiered "Pyramid of Intervention" framework emphasizing psychological safety, clear reporting, institutional accountability, and prevention, alongside educational strategies such as de-escalation training, structured debriefings, and leadership development, intentionally embedded throughout EM residency and lifelong professional development.

Addressing WPW demands cultural, systemic, and educational transformation. By embedding WPV education during residency training and reinforcing it through institutional commitment, EM can empower clinicians to lead safety efforts, drive systems improvement, and change culture. Embedding WPV mitigation into training and leadership efforts is essential to transforming EDs from battlegrounds into safe, healing environments.