Identification of processes that mediate the impact of workplace violence on emergency department healthcare workers in the USA: results from a qualitative study

BMJ Open. 2019 Aug 27;9(8):e031781. doi: 10.1136/bmjopen-2019-031781.


Objectives: Violence towards emergency department healthcare workers is pervasive and directly linked to provider wellness, productivity and job satisfaction. This qualitative study aimed to identify the cognitive and behavioural processes impacted by workplace violence to further understand why workplace violence has a variable impact on individual healthcare workers.

Design: Qualitative interview study using a phenomenological approach to initial content analysis and secondary thematic analysis.

Setting: Three different emergency departments.

Participants: We recruited 23 emergency department healthcare workers who experienced a workplace violence event to participate in an interview conducted within 24 hours of the event. Participants included nurses (n=9; 39%), medical assistants (n=5; 22%), security guards (n=5; 22%), attending physicians (n=2; 9%), advanced practitioners (n=1; 4%) and social workers (n=1; 4%).

Results: Five themes emerged from the data. The first two supported existing reports that workplace violence in healthcare is pervasive and contributes to burn-out in healthcare. Three novel themes emerged from the data related to the objectives of this study: (1) variability in primary cognitive appraisals of workplace violence, (2) variability in secondary cognitive appraisals of workplace violence and (3) reported use of both avoidant and approach coping mechanisms.

Conclusion: Healthcare workers identified workplace violence as pervasive. Variability in reported cognitive appraisal and coping strategies may partially explain why workplace violence negatively impacts some healthcare workers more than others. These cognitive and behavioural processes could serve as targets for decreasing the negative effect of workplace violence, thereby improving healthcare worker well-being. Further research is needed to develop interventions that mitigate the negative impact of workplace violence.

Keywords: accident & emergency medicine; burnout; qualitative research; wellness.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adaptation, Psychological
  • Adult
  • Burnout, Professional / psychology*
  • Emergency Service, Hospital / organization & administration*
  • Female
  • Health Personnel / psychology*
  • Humans
  • Job Satisfaction
  • Male
  • Qualitative Research
  • United States
  • Workplace
  • Workplace Violence / psychology*