Behind the White Coat: The Unseen Burden of Emergency Department Violence

In 2017, a landmark study by Bayram et al. revealed a startling truth: over 78% of physicians working in Turkey’s emergency departments (EDs) had experienced workplace violence in the past year. Many encountered verbal abuse, threats, physical assault every shift! This isn’t just a healthcare crisis. It’s a systemic failure with direct implications for HR and safety professionals.

A Crisis of Scale — and Silence

Workplace violence in EDs is alarmingly routine. Of the 713 physicians surveyed:

• • 94.5% had been insulted

• • 76.4% received threats

• • 31.1% were physically assaulted

• • 5.6% were attacked with weapons

• • Over 65.9% experienced multiple incidents over the year

Yet nearly half of these incidents were never reported. Why? Because staff believed policies were ineffective, consequences unlikely, or feared retaliation.

For HR and Safety leaders, underreporting isn’t just a data gap — it’s a signal of cultural dysfunction. When systems don’t feel safe, people stay silent.

 Who’s Most at Risk?

The data exposes a harsh reality: violence is not distributed evenly. Certain characteristics put physicians at significantly higher risk:

• • Age under 30: 5.6x more likely to face violence

• • 1–4 years of experience in EDs: 5.2x increased risk

• • Resident doctors and GPs: 4–6x more likely than senior specialists

• • State and research hospitals: significantly higher prevalence

• • Working outside regular hours and in high-volume EDs: major risk amplifiers

These findings aren’t just helpful for academic insight—they’re directly actionable. Risk factors tied to demographics and workplace conditions give HR teams a roadmap for proactive interventions.

Systemic Enablers.  Not Just “Bad Days”

Contrary to popular assumptions, violence wasn’t just driven by individual patient aggression. Instead, Bayram et al. point to organisational gaps and policy failures:

• • Security presence didn’t correlate with reduced violence
    
    • • Despite 94% of EDs having guards, incidents remained high
    • • Presence without enforcement offers false reassurance

• • Policies lacked trust, clarity, and accessibility
    
    • • Most staff didn’t believe internal protocols worked
    • • “Code White” (official report mechanism) was used by only 54% of affected physicians

• • Cultural normalization of harm
    
    • • Many physicians continued work after an incident without pause
    • • Staff relied more on colleagues than administrators for support

As a safety leader, accepting workplace violence as inevitable is a dangerous stance. It builds trauma into culture and teaches teams that harm goes unchecked.

Emotional Fallout — Beyond Physical Risk

Physicians reported symptoms ranging from anger and depression to sleep disturbances, burnout, and requests for department transfers. Violence isn’t just an operational issue—it’s a psychosocial hazard that directly affects retention and patient care.

ED workers are expected to act with precision under pressure. But when pressure comes from unpredictable threats within the workplace, performance suffers. The burden isn’t just emotional—it’s professional.

What HR and Safety Leaders Can Do

Bayram et al. highlight physician recommendations for change:

1. • Advocate for tougher legal consequences — Over 72% called for harsher penalties for perpetrators

• • Transform leadership attitudes — 62% believed hospital admins and national policymakers needed urgent culture shifts

• • Alleviate ED overcrowding — 44% highlighted environmental stressors as key drivers

• • Reform entry access — Only 2% of hospitals had systems to restrict access to EDs

Building on these insights, HR and Safety teams should:

• • Implement trauma-informed leadership practices
    Recognize, respond to, and prevent re-traumatization in policies and communication.

• • Invest in trusted, fast-track reporting systems
    Systems must be accessible, supported, and offer visible outcomes—not just paperwork.

• • Integrate psychosocial risk factors into rostering, support and workforce planning
    Focus on at-risk staff groups: newer hires, younger clinicians, shift workers, and high-volume teams.

• • Redesign safety protocols with staff
    Involve frontline workers in designing practical, protective strategies that reflect reality.

Final Thoughts: Don’t Build Culture on Crisis

Violence in emergency departments isn’t an isolated issue—it’s embedded in workflows, architecture, and management norms. Bayram et al.’s study should be a rallying point for change, especially for HR and Safety professionals committed to wellbeing.

Every shift without safety is a shift with systemic risk. It’s time to rebuild trust, rewrite policy, and create cultures where care isn’t compromised by fear.