Emergency Nurses Association president: Violence has reached level ‘I’ve never seen’

Terry Foster, the president of the Emergency Nurses Association, has been around a bit.

He’s been a nurse for 45 years. And he tells Chief Healthcare Executive® that he doesn’t recall the level of violence that nurses are seeing in emergency departments.

“Violence in the emergency department for nurses is a tremendous problem,” Foster says. “It's something that I've never seen before at this level. And especially since COVID, there is a level of incivility that is very troubling to me, and I don't know where it came from, I honestly don't.”

Sometimes it’s a patient, or a family member frustrated by a long wait to get into a room.

Foster says he’s also frustrated at the lack of attention hospital violence has received. If a passenger on an airplane punches or gets aggressive with an airline employee or a restaurant customer assaults a server, the incidents are sometimes captured on a video and spread on social media like wildfire.

“That happens in the emergency department on a regular basis,” Foster says. “We just don't film it, nor do we want to.”

(See part of our conversation with Terry Foster. The story continues below.)

• Read more: If hospitals want to improve safety, start by talking to employees

While some assaults inside hospitals don’t get widespread public attention, nurses and doctors say they’ve encountered more and more violence since the COVID-19 pandemic. Some of the most horrific incidents involving violence and hospitals have garnered headlines for the worst reasons.

An unarmed security guard was fatally shot in the maternity ward of an Oregon hospital last month. A hand surgeon was shot and killed in an orthopedic clinic in Tennessee. A nurse and a social worker were fatally shot in a Dallas hospital last year.

More than two nurses are assaulted every hour, and 57 assaults on nurses occur each day, according to a report from Press Ganey.

About half of hospital nurses said they’ve seen more violent incidents, according to a 2022 poll from National Nurses United. Most emergency physicians say they’ve seen increased violence, according to a September 2022 poll by the American College of Emergency Physicians.

Beyond the high-profile crimes, nurses face hostility with alarming regularity, Foster says. While he says he has not been a victim of an assault, he has witnessed plenty of aggressive behavior.

“When I talk about violence or instability, I'm not talking about a little 85-year-old man who's confused and disoriented, or a little old lady who's mixed up and thinks somebody's in her house or whatever,” Foster says. “I'm talking about people who become physically violent and threatening, because they are not in a room yet, or their family member isn't in a room, or they didn't like what somebody said.”

In the spring, the Emergency Nurses Association brought emergency nurses from around the country to meet with lawmakers and legislative staff in Washington, D.C. They pressed for stiffer penalties for those who attack nurses.

Healthcare groups have been pressing Congress to approve legislation that would impose tougher sentences on those who assault healthcare workers. Hospital and healthcare advocacy groups have been seeking federal protections along the lines of those in place for airline workers. Lawmakers introduced a bill last year but Congress didn’t pass it.

Lawmakers have also introduced a bill that would direct the Occupational Safety and Health Administration to require healthcare facilities to have workplace violence prevention plans. Lawmakers have introduced similar measures in previous years but they haven’t managed to get through Congress.

Hospitals and health systems need to offer support to nurses if they are assaulted. Some advocates say that includes pressing more aggressively for authorities to pursue criminal charges on anyone attacking nurses and doctors.

Beyond that, Foster says health systems need to provide nurses support after an attack, whether it’s counseling or other employee assistance. He says he knows some nurses who have been attacked “have not felt supported.”

“I think offering that support means a tremendous amount to that nurse,” Foster says.

Foster, who works in the emergency department at St. Elizabeth Healthcare in northern Kentucky, says he gets very angry when he sees one of the younger nurses treated badly. “I’m like, ‘Oh, hell no.”

“You hit me, you might knock the hell out of me,” Foster says. “But I don't want you hitting one of our young nurses. And that's a protective father stance or whatever it is. But that poor girl or young guy is trying to help you. And you're going after them? No way. No way. It's very, very frustrating.”

Foster says he stresses to fellow nurses the importance of trying to de-escalate tense situations. If a patient is showing incivility, he says, “Don’t match it.”

“If they come at you like that, try to de-escalate it,” Foster says. “If you match that, it's just going to escalate, and it has the potential to escalate to violence. And that's something you have to just keep in check. Don't argue with the patient. Don't argue with a family member.”

“I use the line, do you want to be right? Or do you want to be at peace?”

Read more: Better communication can curb violence in hospitals