A Cross-Sectional Study Exploring the Nature, Contributing Factors and Consequences of Violence Against Nurses in Emergency Departments

To explore the nature, contributing factors, and consequences of violence against emergency department nurses by patients and visitors in tertiary hospitals in a major city in China.

A cross-sectional descriptive study.

Data were collected between December 2023 and February 2024 using a translated and adapted questionnaire examining the prevalence, forms, contributing factors, and consequences of violence. Data were analysed using descriptive statistics and exploratory logistic regression.

A total of 336 emergency nurses were included, of whom 66.7% reported violence exposure within the past year. Visitor-perpetrated violence was reported more frequently than patient-perpetrated violence. Psychological violence was more common than physical violence and most frequently involved verbal abuse, disruptive speech, and blame. Illness-related impairment was prominent in patient-perpetrated physical violence, whereas alcohol impairment was frequently reported in visitor-perpetrated violence. Dissatisfaction with medical staff outside the emergency department and delayed or inadequate security responses were also commonly reported as contributing factors. Among the variables included in the exploratory regression model (n = 298), uncertainty or absence of workplace violence policies was the only factor significantly associated with reported lifetime violence exposure. Peer support was more commonly reported than managerial assistance following incidents, and visitor-perpetrated incidents generally received higher short-term impact ratings, including impacts on work motivation and personal and psychological well-being.

Violence against emergency department nurses was common, with visitors reported more frequently as perpetrators than patients. Patient- and visitor-perpetrated violence showed different patterns, particularly in the circumstances surrounding incidents and in short-term impact ratings. The findings support differentiated prevention and response strategies, together with clearer workplace violence policies, timely security responses, and structured post-incident organisational support.

Emergency nursing education and organisational responses should distinguish between patient violence associated with illness-related impairment and visitor violence occurring in contexts such as alcohol impairment, dissatisfaction, or unmet expectations. De-escalation for patient-perpetrated violence should consider the patient's clinical condition, whereas visitor-related incidents may require expectation-focused communication, behavioural boundaries, and timely security involvement. Structured post-incident support should form part of the organisational response to both types of violence.

This study adhered to the STROBE reporting guidelines.

There was no patient or public involvement in the design, conduct, or reporting of this study.

WHAT PROBLEM DID THE STUDY ADDRESS?: Violence against emergency nurses is a persistent global problem, yet limited evidence has examined patient- and visitor-perpetrated violence separately in Chinese emergency care settings. WHAT WERE THE MAIN FINDINGS?: Visitor-perpetrated violence was reported more frequently than patient-perpetrated violence and generally received higher short-term impact ratings. Illness-related impairment was prominent in patient-perpetrated physical violence, whereas alcohol impairment was frequently reported in visitor-perpetrated violence. Among the variables examined in the exploratory regression, uncertainty or absence of workplace violence policies was associated with reported lifetime violence exposure. WHERE AND ON WHOM WILL THE RESEARCH HAVE AN IMPACT?: The findings may inform nursing educators, hospital administrators, and policymakers developing differentiated prevention, visitor management, and organisational response strategies for emergency nurses.