Work Hours, Emergency Department Context, and Workplace Violence Among Nurses – Psychiatry AI: Real-Time AI Scoping Review

AI Summary

87.8% of emergency department nurses reported workplace violence in the prior month, predominantly from patients or visitors.
Overtime was associated with higher odds of workplace violence, adjusted OR 3.21 (95% CI 1.30 to 7.93).
Night shift work (OR 0.28) and employment in freestanding emergency departments (OR 0.25) were associated with lower violence odds.

JAMA Netw Open. 2026 Nov 2;9(11):e2644016. doi: 10.1001/jamanetworkopen.2026.44016.

ABSTRACT

IMPORTANCE: Workplace violence is common in high-risk health care settings, with consequences for clinician well-being and care delivery. Less is known about multilevel work-system factors associated with workplace violence in emergency department (ED) nurses.

OBJECTIVE: To characterize workplace violence among ED nurses and identify multilevel work-system factors associated with workplace violence.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used nurse survey data combined with administrative and electronic medical record data collected in 2023 from nurses working in 11 EDs in a multisite health system in the southeastern US.

EXPOSURE: Multilevel work-system factors, with primary exposures of interest including overtime, shift type, and ED type (freestanding vs in-hospital); additional covariates included individual, team, and ED-level characteristics.

MAIN OUTCOMES AND MEASURES: Any self-reported workplace violence in the prior month (threats, physical violence, verbal abuse, unwanted sexual attention, or bullying) from patients, visitors, and/or coworkers. Associations were estimated using mixed-effects logistic regression with a random intercept for emergency department site and factor selection using cross-validated least absolute shrinkage and selectrion operator regression. Nurses in the supplemental staffing team were excluded from this analysis.

RESULTS: Among 337 ED nurses (mean [SD] age, 34.9 [9.5] years; 289 [85.8%] female; 287 [85.2% white; mean [SD] nursing experience, 9.0 [8.2] years), 296 (87.8%) reported workplace violence in the prior month. Incidents of WPV involved patients or visitors (292 of 296 [98.6%]) and coworkers (60 of 296 [20.3%]). In adjusted mixed-effects models (n = 299), overtime was associated with higher odds of workplace violence (OR, 3.21; 95% CI, 1.30-7.93), while night shift (OR, 0.28; 95% CI, 0.10-0.78) and employment in a freestanding ED (OR, 0.25; 95% CI, 0.09-0.76) were associated with lower odds.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of ED nurses, workplace violence was common and was associated with overtime and ED context. These findings support further evaluation of work-hour practices and context-specific approaches to workplace violence prevention.

PMID:43024235 | DOI:10.1001/jamanetworkopen.2026.44016

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