Workplace Violence: A Survey of Emergency Physicians in the State of Michigan
Received 7 April 2004; received in revised form 29 September 2004; accepted 7 October 2004. published online 15 February 2005.
Study objective
We seek to determine the amount and type of work-related violence experienced by Michigan attending emergency physicians.
Methods
A mail survey of self-reported work-related violence exposure during the preceding 12 months was sent to randomly selected emergency physician members of the Michigan College of Emergency Physicians. Work-related violence was defined as verbal, physical, confrontation outside of the emergency department (ED), or stalking.
Results
Of 250 surveys sent, 177 (70.8%) were returned. Six were blank (3 were from retired emergency physicians), leaving 171 (68.4%) for analysis. Verbal threats were the most common form of work-related violence, with 74.9% (95% confidence interval [CI] 68.4% to 81.4%) of emergency physicians indicating at least 1 verbal threat in the previous 12 months. Of the emergency physicians responding, 28.1% (95% CI 21.3% to 34.8%) indicated that they were victims of a physical assault, 11.7% (95% CI 6.9% to 16.5%) indicated that they were confronted outside of the ED, and 3.5% (95% CI 0.8% to 6.3%) experienced a stalking event. Emergency physicians who were verbally threatened tended to be less experienced (11.1 versus 15.1 years in practice; mean difference −4.0 years [95% CI −6.4 to −1.6 years]), as were those who were physically assaulted (9.5 versus 13.1 years; mean difference −3.6 years [95% CI −5.9 to −1.3 years]). Urban hospital location, emergency medicine board certification, or on-site emergency medicine residency program were not significantly associated with any type of work-related violence. Female emergency physicians were more likely to have experienced physical violence (95% CI 1.4 to 5.8) but not other types of violence. Most (81.9%; 95% CI 76.1% to 87.6%) emergency physicians were occasionally fearful of workplace violence, whereas 9.4% (95% CI 5.0% to 13.7%) were frequently fearful. Forty-two percent of emergency physicians sought various forms of protection as a result of the direct or perceived violence, including obtaining a gun (18%), knife (20%), concealed weapon license (13%), mace (7%), club (4%), or a security escort (31%).
Conclusion
Work-related violence exposure is not uncommon in EDs. Many emergency physicians are concerned about the violence and are taking measures, including personal protection, in response to the fear.
From the Department of Emergency Medicine, University of Michigan Medical Center, Ann Arbor, MI (Kowalenko); the Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, MI (Walters); the Department of Emergency Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL (Khare); and the Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI (Compton)
Address for correspondence: Terry Kowalenko, MD, Department of Emergency Medicine, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-0305; 734-936-3007, fax 734-763-9298
Supervising editor: Judith E. Tintinalli, MD, MS
Author contributions: TK and BLW conceived the study, designed the survey, and obtained research funding. TK, BLW, and SC distributed the survey and managed the data. SC provided advice on study design and analyzed the data. TK and BLW drafted the manuscript, and RKK with the other authors contributed substantially to its revisions. TK takes responsibility for the paper as a whole.
Funding and support: Sponsored by an American College of Emergency Physicians Chapter Grant to the Michigan College of Emergency Physicians Workplace Violence Task Force.
Presented at the American College of Emergency Physicians annual meeting, Boston, MA, October 2003.
ABSTRACT