Document Type



Doctor of Nursing Practice



Date of Defense


Graduate Advisor

Susan Dean-Baar, PhD, RN, CENP, FAAN


Susan Dean-Baar, PhD, RN, CENP, FAAN

Nancy Magnuson, DSN, APRN, PCNS, FNP-BC

Judi Burgan, JD, CHRC



Problem: Emergency Department (ED) staff are not reporting patient and visitor episodes of aggression and violence. The rate of violence per patient visit is unknown.

Methods: An observational, descriptive quality improvement project about Type I and II workplace aggression and violence (WAAV) reporting by ED staff and security consisted of education, an anonymous survey of the previous six months of WAAV, and a monthlong anonymous WAAV audit in a Midwestern ED.

Results: The survey response rate was 59% with 65% never reporting WAAV, 13% reporting all WAAV occurrences, 9% reporting some occurrences, and 13% usually not experiencing WAAV. The most significant reason for not reporting was the lengthy time involved in the reporting process. In 2021, there were 33,380 ED presentations and eight formal incident reports concerning Type I and II WAAV episodes for a rate of .02% of episodes per 100 visits. During the monthlong audit, staff completed 37 audits for a rate of 1.3 per 100 ED visits. Twenty-eight (76%) of reporters experienced aggression or violence and nine (24%) observed the episodes. Physical assaults were an element of eight audits, and verbal abuse was a component of 29 audits. Staff reported threatening behavior was an element of 21 events. No formal incident reports were completed.

Implications for Practice: The audit rate illustrated a more realistic picture of typical WAAV encountered in real time, so future safety efforts can measure improvement.