Date of Award

January 2025

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Jacqueline M. Cook

Second Advisor

Martin D. Slade

Abstract

Background: Published reports and survey data indicate that workplace violence (WPV) in emergency departments (EDs) is on the rise. The severity of WPV incidents and extent to which this trend affects staff differentially by role is less well characterized. This study analyzed workplace violence reports from a nationwide integrated health system to evaluate this observation. Methods: Reports submitted to the Veterans Health Administration (VHA) Disruptive Behavior Reporting System (DBRS) were analyzed. The sample included all reports from over 170 VHA emergency departments across the United States, spanning fiscal years 2018 to 2023. The association between the severity of outcomes and incident characteristics documented in each DBRS report, including shift, tour, type of behavior, relationship to alcohol or substance abuse, use of physical containment, and year the report was filed was evaluated. Outcomes for VHA staff experiencing violence, distinguishing between those in “practitioner” based roles (licensed professionals such as physicians, physician assistants, nurse practitioners, and other advanced practice providers) and those in “non-practitioner” roles (including nurses, medical assistants, and other clinical and administrative staff) were compared. Results: Shift and tour were not significantly associated with greater outcome severity. Incidents involving criminal intent, physically disruptive behavior, alcohol or substance abuse, and the need for physical containment were significantly associated with greater outcome severity across all roles. Conversely, verbally disruptive incidents were associated with less severe outcomes. The severity of outcomes in reports involving practitioners was comparable to those involving non-practitioners. While the proportion of incidents involving practitioners significantly increased over time, the proportion of incidents with severe outcomes remained stable. Conclusions: The experience of WPV within the VHA aligns with findings from other published studies. The findings of this study support the perception that WPV involving practitioners is increasing in frequency.

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This is an Open Access Thesis.

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