and Love, 1992). Patients carrying hidden weapons are a concern in psychiatric and general emergency departments across the country.

Hospitals

Workplace-related violence has been increasingly recognized as a particular problem for nursing personnel, especially in settings located in inner cities, and particularly in emergency departments and psychiatric facilities. The committee heard many reports during site visits and in testimony about assaults in hospitals, especially those located in inner cities, and particularly in emergency departments. Witnesses who testified before the committee emphasized the crowded nature of emergency rooms, the characteristics of the patients coming in, and the lack of sufficient staff as contributory factors to the risk of violence directed at health care personnel.

The increase in violence in the health care setting reflects to a large extent the increase in violence in the community. In 1992, private industry reported about 22,400 incidents of nonfatal assaults and acts of violence requiring an average of 5 days away from work (BLS, 1994b). Most of the violent acts involved threats, hitting, kicking, beating, biting, stabbing, squeezing, pinching, scratching, twisting, rape, and shooting. Thirty-eight percent of workers subjected to nonfatal violence were health care givers in nursing homes and hospitals (BLS, 1995d). Most of these care givers were female NAs and licensed nurses. Typically they required 3 to 5 days away from work to recuperate from their injuries. Ironically, some of these workers were injured by patients who resisted their assistance or were assaulted by patients who were prone to violence (BLS, 1994b).

Until recently, studies of violence in health care settings have focused mainly on assaults on staff by patients in psychiatric care settings such as mental health hospitals, psychiatric hospitals, or psychiatric units of hospital. Around 70 to 80 percent of staff in mental facilities reported assaults on them by patients (Lanza, 1983; Poster and Ryan, 1989).

In response to its members' concerns, the Emergency Nurses Association conducted a national survey in 1994 of emergency department nurse managers (Emergency Nurse Association, 1994). In this survey, violence was defined to include verbal and physical assaults with or without weapons. Factors contributing to violence toward staff were alcohol abuse, drug abuse, anger and high stress, overcrowding of the department, open access to the emergency department, and psychiatric patients. Other relevant factors included prolonged waiting times, gang-related activities, increasing numbers of patients needing care for injuries resulting from violence, trauma, and staff-to-staff conflicts. Other studies of emergency and psychiatric departments of hospitals also found incidences of physical attacks on medical and nursing staff and carrying hidden weapons to the hospital (McCulloch et al., 1986; Lavoie et al., 1988; Goetz et al., 1991).



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