Study finds 1 in 4 emergency care staff abused

Lancaster University| 2018 |One in four Emergency staff abused by patients

Researchers at Lancaster University have completed the first ever review into the experience of hospital A&E staff.  They studied the experiences of staff in eight countries. In the UK in 2016 UK, there were over 70,555 total reported assaults on NHS staff. 


It reveals that the most number of both verbal and physical aggression are in Accident and Emergency departments, with nurses subject to regular verbal and physical abuse.  The staff reviewed as part of the study found it difficult to be both a caregiver and the target of abuse; they also reported feelings of inadequacy and guilt.  Experiencing violence and aggression led to feelings of powerlessness, with some reluctant to work in Emergency Departments. (Lancaster University)



Patient and visitor violence or aggression against healthcare workers in the Emergency Department (ED) is a significant issue worldwide. This review synthesises existing qualitative studies exploring the first-hand experiences of staff working in the ED to provide insight into preventing this issue.


A meta-ethnographic approach was used to review papers.


Four concepts were identified: ‘The inevitability of violence and aggression’; ‘Staff judgments about why they face violence and aggression’; ‘Managing in isolation’; and ‘Wounded heroes’.


Staff resigned themselves to the inevitability of violence and aggression, doing this due to a perceived lack of support from the organisation. Staff made judgements about the reasons for violent incidents which impacted on how they coped and subsequently tolerated the aggressor. Staff often felt isolated when managing violence and aggression. Key recommendations included: Staff training in understanding violence and aggression and clinical supervision.


Violence and aggression in the ED can often be an overwhelming yet inevitable experience for staff. A strong organisational commitment to reducing violence and aggression is imperative.

Full reference:

Ashton, R. A., Morris, L., & Smith, I. |2018 | A qualitative meta-synthesis of emergency department staff experiences of violence and aggression | International emergency nursing |Doi:

The review is available to Rotherham NHS staff to request here

In the media: A&E abuse: Medical staff report more than 70,000 physical and verbal attacks that leave them working in fear


Impact of alcohol abuse on the emergency services


The All-Party Parliamentary Group on Alcohol Harm has published The Frontline Battle.

This report presents the results of an inquiry into the impact of alcohol on emergency services. It sets out the extent of the pressures and dangers of alcohol related problems placed on the emergency services and discusses the impact on staff, the impact on service provision and the effect on time and resources.

Workplace aggression as cause and effect

Wolf, L.A. et al. International Emergency Nursing. Published online: November 9, 2016


  • Fatigue compromises nurses’ personal lives and creates a toxic unit environment.
  • Fatigue compromises safe patient care.
  • Below-adequate staffing levels are a major source of fatigue.
  • Lateral violence (workplace bullying) is both a cause and effect of fatigue.

Read the abstract here

Personal Protective Equipment Guidelines for Health Care Facility Staff

The American College of Emergency Physicians (2016). Annals of Emergency Medicine 68(3). pp. 406-407

The American College of Emergency Physicians (ACEP) believes a critical component of emergency preparedness is for health care facility staff to use personal protective equipment (PPE) that is appropriate to protect themselves, patients, and others from chemical, biological, and radiologic elements Decisions about what type of PPE to use and when it should be used should be made only after thorough analysis of all available information. Guidance should then be appropriately reassessed and modified to ensure consistency with evolving information.

Hospitals have standard precautions for blood-borne and respiratory pathogens, but these may not necessarily protect against every hazardous exposure. At present, there is little available evidence to help determine the level of PPE needed for health care facility staff in every situation.

Essential protective measures depend heavily on the location of the decontamination area, the role of the health care facility in the community response to hazardous material incidents, and the hazard vulnerability analysis. Critical priorities include ensuring the safety of the health care facility staff, ensuring continuity of health care facility operations up to and including a possible determination for appropriately controlled hospital access, and providing initial triage and treatment for contaminated or exposed or potentially contaminated patients arriving at the health care facility and seeking treatment.

Key elements in the selection process for appropriate PPE levels and decontamination facilities include the following:

  • Forming strategic partnerships with response agencies, professional associations, accrediting bodies, governmental agencies, and others

  • Performing a hospital hazard vulnerability analysis consistent with community threats

  • Determining initial and ongoing training requirements and equipment needs appropriate to the PPE level required at a facility, meeting at least current essential standards as determined by the Centers for Disease Control and Prevention, and with consideration to other federal regulating and credentialing agencies, such as the National Institute of Occupational Safety and Health and the Occupational Safety and Health Administration, and other response agency partnerships

Read the full article here