Workplace Violence and Harassment Against Emergency Medicine Residents

Benjamin H. Schnapp, MD; Benjamin H. Slovis, MD; Anar D. Shah, MD, MBA; Abra L. Fant, MD, MS; Michael A. Gisondi, MD; Kaushal H. Shah, MD; Christie A. Lech, MD


Western J Emerg Med. 2016;17(5):567-573. 

In This Article

Abstract and Introduction


Introduction: Several studies have shown that workplace violence in the emergency department (ED) is common. Residents may be among the most vulnerable staff, as they have the least experience with these volatile encounters. The goal for this study was to quantify and describe acts of violence against emergency medicine (EM) residents by patients and visitors and to identify perceived barriers to safety.

Methods: This cross-sectional survey study queried EM residents at multiple New York City hospitals. The primary outcome was the incidence of violence experienced by residents while working in the ED. The secondary outcomes were the subtypes of violence experienced by residents, as well as the perceived barriers to safety while at work.

Results: A majority of residents (66%, 78/119) reported experiencing at least one act of physical violence during an ED shift. Nearly all residents (97%, 115/119) experienced verbal harassment, 78% (93/119) had experienced verbal threats, and 52% (62/119) reported sexual harassment. Almost a quarter of residents felt safe "Occasionally," "Seldom" or "Never" while at work. Patient-based factors most commonly cited as contributory to violence included substance use and psychiatric disease.

Conclusion: Self-reported violence against EM residents appears to be a significant problem. Incidence of violence and patient risk factors are similar to what has been found previously for other ED staff. Understanding the prevalence of workplace violence as well as the related systems, environmental, and patient-based factors is essential for future prevention efforts.


Nearly two million assaults occur annually as a result of workplace violence in the United States, with 12% occurring in the healthcare industry.[1] Workplace violence is defined as any act or threat of physical violence, harassment, intimidation, or other threatening and disruptive behavior at one's place of employment.[2] One of the highest risk areas in the hospital for workplace violence is the emergency department (ED).[3] Staff members care for acutely ill and injured patients with a broad spectrum of undifferentiated medical conditions, social issues, and psychiatric disease that may cause these individuals to become unpredictably aggressive or violent during their stay.

In a recent survey of ED staff, 51% of physicians reported being physically assaulted by a patient or visitor.[4] In 20% of EDs, guns or knives are present daily or weekly,[5] and the ED is the most frequent site for hospital shootings.[6] Even verbal threats can be a serious problem, as they have been shown to increase the risk of future serious incidents of violence.[7] Despite these risks, 50% of residents feel that their hospital security is inadequate.[8] To our knowledge, there has been only one previous study that focused exclusively on the resident experience with physician harassment, where McNamara et al demonstrated nearly universal harassment (98%) with an associated increased risk of physician burnout.[9] For over 20 years, there has been no new research that focuses exclusively on violence against residents in the ED.

Physicians with fewer years of training have been shown to be more often subjected to workplace violence,[10] and are likely to have less experience and training in managing such difficult situations. Residents may also be less inclined to document violent events for fear of consequences, and are known to experience significant barriers to reporting these sentinel events.[11] The purpose of this study was to quantify and describe the current incidence of violence and harassment against emergency medicine (EM) residents by patients and visitors, as well as identify current perceived barriers to safety in the ED.