This was a cross-sectional study; thus it is not possible to identify the cause and effect of relationships among productivity, stress symptoms, and violent events. In addition, there was no measurement of the perceived severity of the violent event, and thus, no way to examine the relationship among severity, symptoms, and productivity. As is common with survey studies, the use of self-report data may be limited by errors due to the nurses’ poor recall of violent events and their perception of post-event stress symptoms and productivity. Another potential limitation of the results is the response rate of 8% and the inability to compare the responses of the responders with the non-responders. A post hoc power analysis was conducted to determine if the study had an adequate sample size to perform the planned statistical analyses. Achieved power was 85% for workplace violence data with the sample size of 220 in addition to using a two-sided statistic, a small to medium effect size of 0.20, and an alpha level of 0.05. So, even though only 8% responded, the findings are still powerful.
Workplace violence is a significant problem for ED nurses and has a direct relationship to experiences of negative stress, decreased work productivity, and quality of patient care. It is critical prevention and management of violence be a priority for hospital administration and ED management. Foremost, violence should never be accepted and tolerated as part of the job. Second, workplace policies and procedures are needed that focus on the security of the environment, reporting and surveillance, and education for all employees and managers on how to prevent and manage violence. When violence does occur, it is critical that formal or informal debriefing be offered to ED nurses experiencing violence.
Future research should be conducted to identify best practices for preventing violence and for the provision of stress debriefing after a violent incident. Research also needs to be conducted to determine the relationship of violence severity to the change in work productivity. In addition, it is not clear why some ED nurses appear to be cognitively resilient to the stressful effects of violence and the consequences it has on work performance. It is also important to examine how violence affects the stress and work productivity of nurses working in other hospital departments.