'Out of My Control'-Emergency Nurses' Experiences of Violence From Patients and Visitors in China: A Qualitative...

To explore emergency nurses' experiences and perceptions of violence from patients and visitors in China, focusing on its nature, contributing factors, and consequences.

A qualitative descriptive design was employed.

Thirteen emergency nurses from eight tertiary public hospitals in a provincial capital city in northern China were recruited using purposive and snowball sampling; most were female and had several years of emergency nursing experience. Data were collected through semi-structured, face-to-face interviews conducted in Mandarin and analysed using latent content analysis.

Two overarching themes were identified. The first theme, Nurses as Healers or Targets: Confronting Misplaced Anger, described how violence from patients and visitors emerged in high-pressure emergency environments, often involving verbal abuse, threats, or physical aggression, and was shaped by situational stressors and perceived power imbalances. The second theme, Healing in Shackles: Maintaining Professional Composure and Emotional Desensitization, captured nurses' efforts to remain professional while experiencing fear, exhaustion, and emotional distancing following repeated exposure to violence.

Violence from patients and visitors represents a persistent occupational challenge for emergency nurses, with cumulative effects on their emotional wellbeing and professional functioning. The findings highlight the need to shift responsibility for managing violence from individual nurses to organizational and systemic levels.

Strengthening organizational responses, such as emotional support mechanisms, clear visitor management policies, and accountability for violence prevention, may help create safer and more sustainable emergency care environments.

This study adhered to the COREQ reporting guidelines.

1. What problem did the study address? This study addressed the persistent problem of violence against emergency nurses in urban tertiary hospital emergency departments in northern China, particularly incidents perpetrated by patients and visitors. It explored how nurses perceive the nature of such violence, the factors contributing to its occurrence, and its consequences for their professional and personal well-being. 2. What were the main findings? Violence against nurses by patients and visitors in the ED was often driven by enabling factors, such as high-pressure environments, nurses' visibility, and perceived power imbalances, as well as by reward-based motivations. Nurses responded with professional composure but reported limited peer and managerial support. Over time, cumulative exposure led to physical harm, lingering emotional distress, heightened vigilance, and emotional detachment. 3. Where and on whom will the research have an impact? The findings will inform nurse leaders, policymakers, and hospital administrators by reframing resilience as an organizational responsibility. Embedding structured emotional support, transparent visitor management, and violence-prevention accountability within hospital governance can foster safer and more sustainable work environments.

This study did not include patient or public involvement in its design, conduct, or reporting.