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Peer-reviewedCC BY 4.0JAMA Network Open

Work Hours, Emergency Department Context, and Workplace Violence Among Nurses

  • Lindsay Thompson Munn1,2
  • Nathaniel Sean O’Connell3
  • Carolyn S. Huffman1,4
  • Esita Patel1,5
  • Kristie L. Foley1
  • Cheryl B. Jones6
  • Jason P. Stopyra1,2,7
7 affiliations
  1. 1Department of Implementation Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina
  2. 2Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
  3. 3Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina
  4. 4Department of Obstetrics and Gynecology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
  5. 5Center for Advanced Practice, Atrium Health, Charlotte, North Carolina
  6. 6School of Nursing, University of North Carolina, Chapel Hill
  7. 7Public Safety, Advocate Health, Charlotte, North Carolina
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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.

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Cite

BibTeXRIS
BibTeX
@article{munn2026work,
  title = {{Work Hours, Emergency Department Context, and Workplace Violence Among Nurses}},
  author = {Lindsay Thompson Munn and Nathaniel Sean O’Connell and Carolyn S. Huffman and Esita Patel and Kristie L. Foley and Cheryl B. Jones and Jason P. Stopyra},
  journal = {JAMA Network Open},
  year = {2026},
  month = nov,
  doi = {10.1001/jamanetworkopen.2026.44016},
  url = {https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2856635},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Work Hours, Emergency Department Context, and Workplace Violence Among Nurses
AU  - Lindsay Thompson Munn
AU  - Nathaniel Sean O’Connell
AU  - Carolyn S. Huffman
AU  - Esita Patel
AU  - Kristie L. Foley
AU  - Cheryl B. Jones
AU  - Jason P. Stopyra
PY  - 2026
DA  - 2026/11/13
JO  - JAMA Network Open
DO  - 10.1001/jamanetworkopen.2026.44016
UR  - https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2856635
AB  - 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.
SN  - 2574-3805
ER  -