Vic election: Doctors, nurses call for action on rising ED violence

The Australasian College for Emergency Medicine (ACEM; the College) and the College of Emergency Nursing Australasia (CENA) have jointly called for action to support ED staff who are increasingly subject to physical and verbal abuse while caring for patients. 

Emergency physician and ACEM Victoria Branch Chair Associate Professor Mark Putland said that ED staff regularly face dangers including punching, kicking, biting, spitting, verbal abuse and threats.
 
“Violence against emergency department staff is getting worse. It’s causing profound harm and physical and psychological trauma to people who have dedicated their lives and careers to caring for others when they need it most,” A/Prof Putland said.
 
“Emergency departments are places of care. They should not be workplaces where staff routinely fear being threatened or attacked.”
 
CENA National President Associate Professor Kelli Innes said that healthcare workers should never accept ED violence as “just part of the job”, no matter how common it becomes. 
 
"I've had colleagues physically and verbally attacked simply for trying to do their jobs,” A/Prof Innes said.
 
“ED violence must be treated as the serious safety issue that it is. We cannot allow it to become just part of the background noise of emergency care.  Nurses, doctors and clinicians are specialists, trained to work in a specific environment. They need ED security officers as part of their team, available at all times."
 
To support safer, more sustainable care, the Colleges have jointly called for:

• Dedicated security in every ED: Ensure every Victorian ED has dedicated security officers, trained specifically to work in healthcare settings and skilled in de-escalation, employed as part of the ED clinical team and available 24/7, with dedicated funding to support appropriate FTE for these roles.
• Statewide leadership and accountability: Re-establish the Victorian Violence in Healthcare Taskforce, with a direct reporting line to the Minister for Health. The taskforce would bring together frontline clinicians, health services, government and key agencies to drive a more coordinated statewide response to violence against healthcare workers and help ensure this remains a clear government priority.

Emergency doctors and nurses have emphasised that:

• Clinician engagement and consultation is essential in designing solutions to ED violence.
• ED security officers should be dedicated to the ED rather than shared with other parts of the hospital, so they are always available when needed.
• ED security officers should be integrated within the ED team, working in close collaboration with clinical staff as part of a broader health-led response.
• Any security presence must be skilled in empathetic, trauma-informed communication and de-escalation, and trained to recognise factors such as delirium, withdrawal or psychiatric crisis.

According to ACEM’s Breaking Point report, one of the primary drivers of occupational violence within the ED is bed block, and ACEM sees the reduction of bed block as an integral part of any strategy to improve ED safety.
 
To reduce the danger posed to ED staff and patients, ACEM has called for:

• Reducing unsafe ED overcrowding and bed block: Issue a Ministerial Directive that no patient should remain in a Victorian ED for more than 24 hours, establish a $60 million Victorian Hospital Flow Innovation Fund to support local solutions, and commit to at least 2000 additional staffed inpatient beds by 2030–31.

“In the ED, patient and staff safety go hand in hand. Chronic bed block and ED overcrowding are a risk to patient safety and they also contribute to rising levels of occupational violence against staff,” A/Prof Putland said.
 
“As emergency physicians, we’re seeing more situations where people become distressed or frustrated because they’re waiting too long in overcrowded, high-pressure spaces.

“It’s harming staff, delaying care, and putting other patients at risk.”
 
A/Prof Innes said that concerted action was required to address ED violence.
 
“Violence and aggression take an enormous physical and psychological toll on emergency nurses and other clinicians. Unless government acts, we risk losing more highly skilled and experienced people from an already pressured workforce,” A/Prof Innes said.
 
ACEM and CENA look forward to working together with the next Victorian government to address this urgent issue. ED doctors, nurses, patients and their loved ones all deserve a safe place to give and receive high-quality emergency care.

Read ACEM and CENA’s Victorian Election Priorities document here.