Free Essay

Week 8

In: Business and Management

Submitted By edydelgado
Words 6804
Pages 28
JONA Volume 39, Number 7/8, pp 340-349 Copyright B 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

THE JOURNAL OF NURSING ADMINISTRATION

Violence Against Nurses Working in US Emergency Departments
Jessica Gacki-Smith, MPH Altair M. Juarez, MPH Lara Boyett, MSN, RN, ACNP-BC, CEN Objective: The objective of this study was to investigate emergency nurses’ experiences and perceptions of violence from patients and visitors in US emergency departments (EDs). Background: The ED is a particularly vulnerable setting for workplace violence, and because of a lack of standardized measurement and reporting mechanisms for violence in healthcare settings, data are scarce. Methods: Registered nurse members (n = 3,465) of the Emergency Nurses Association participated in this cross-sectional study by completing a 69-item survey. Results: Approximately 25% of respondents reported experiencing physical violence more than 20 times in the past 3 years, and almost 20% reported experiencing verbal abuse more than 200 times during the same period. Respondents who experienced frequent physical violence and/or frequent verbal abuse indicated fear of retaliation and lack of support from hospital administration and ED management as barriers to reporting workplace violence. Conclusion: Violence against ED nurses is highly prevalent. Precipitating factors to violent incidents identified by respondents is consistent with the research literature; however, there is considerable potential to mitigate these factors. Commitment
Authors’ Affiliations: Senior Research and Practice Associate (Ms Gacki-Smith); Senior Research Associate (Ms Juarez), Emergency Nurses Association, Des Plaines, Illinois; Director Midlevel Providers (Ms Boyett), Traditions Emergency Medicine, College Station, Texas; Administrative Director (Ms Homeyer), Cox Health, Springfield, Missouri; Team Leader (Ms Robinson), St Elizabeth Medical Center, Covington, Kentucky; and Former Nursing Officer (Dr MacLean) Emergency Nurses Association, Des Plaines, Illinois. Corresponding author: Ms Gacki-Smith, Emergency Nurses Association, 915 Lee St, Des Plaines, IL 60016 (jgacki-smith@ena.org). Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web Site (www.jonajournal.com).

Cathy Homeyer, MSN, RN, CEN Linda Robinson, BSN, RN, SANE, DVNE, CEN, CFN Susan L. MacLean, PhD, RN from hospital administrators, ED managers, and hospital security is necessary to facilitate improvement and ensure a safer workplace for ED nurses. Workplace violence is a serious occupational risk for the domestic and global workforce,1,2 accounting for approximately 900 deaths and 1.7 million nonfatal assaults each year in the United States.3 In 2007, 15% of all work-related fatalities in the United States were due to assaults and violent acts.4 Workplace violence may be even more common than these statistics indicate because a lack of a uniform definition of workplace violence,5,6 incident underreporting,6-9 and absence of mandated regulations for workplace violence prevention5,9-15 make it difficult to assess the prevalence of workplace violence.6 The National Institute for Occupational Safety and Health (NIOSH) defines workplace violence as an act of aggression directed toward persons at work or on duty, ranging from offensive or threatening language to homicide.16 Workplace violence is generally defined as any physical assault, emotional or verbal abuse, or threatening, harassing, or coercive behavior in the work setting that causes physical or emotional harm.5,14,16-19 In recent years, workplace violence has been recognized as a violent crime that requires targeted responses from employers, law enforcement, and the community.19 Barriers to Addressing Violence in the Healthcare Setting Violent incidents in the workplace are often not reported to law enforcement authorities or employers.3,7-9 Particularly in the healthcare industry, incidents may be underreported because of the absence of institutional reporting policies, the perception that assaults are part of the job, employee

340

JONA  Vol. 39, No. 7/8  July/August 2009

Copyright @ 2009 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

beliefs that reporting will not benefit them, and employee concerns that assaults may be viewed as evidence of poor job performance or worker negligence.6-9 In a study of nurses in the emergency department (ED), intensive care unit, and general units of a regional medical center, about 50% of the respondents indicated that verbal and physical assaults by patients and family members against nurses were never reported in writing.8 Many nurses believed that such incidents were part of the job and reporting them would not be helpful. In addition, many felt that empathy for the anger expressed by the patient or family member and lack of evidence of personal physical injury were reasons for not reporting violent incidents.8 The Occupational Safety and Health Administration’s9 (OSHA’s) Guidelines for Preventing Workplace Violence for Health Care & Social Service Workers includes policy recommendations and practical methods to help prevent and reduce workplace violence. Because the guidelines are voluntary, some healthcare institutions may not have violence prevention programs in place or those that do may not have effective programs. To address the need for consistent and quality programs, nursing and other healthcare professional organizations and unions have asked for federal regulations that require healthcare institutions to provide improved environmental safety.5,10,12,13,15 Violence in the ED In the hospital, violence occurs most frequently in psychiatric wards, EDs, waiting rooms, and geriatric units.16 Studies have found that 35% to 80% of hospital staff have been physically assaulted at least once during their careers.20 The high vulnerability to workplace violence in the hospital may be due, in part, to low staffing levels; lack of staff training in recognizing and defusing potentially dangerous patients; lack of violence prevention programs; inadequate security; the perception by criminals that hospitals, clinics, and pharmacies are sources of drugs and money; and possession of weapons by violent hospital patients and visitors.5,9,12 The 24-hour accessibility of EDs; the lack of adequately trained, armed, or visible security guards; and a highly stressful environment are some of the reasons why EDs are especially vulnerable to violence.21-23 The overwhelming majority of perpetrators of ED violence are patients and their family members and visitors.5,14-17 Patient pain and discomfort, as well as the tension, stress, and anger of patients, family members, and visitors, are often escalated by cramped space, lack of privacy, and long waiting times.5,8,19,23 The resulting frustration

and vulnerability may incite physical and verbal abuse against ED staff.16,19,22 In addition, verbal abuse and physical assault in the ED can come from disruptive, intoxicated patients who are sometimes accompanied by other intoxicated or disruptive individuals.7,21 Violence Against Nurses Nursing has received increasing attention as an occupation at high risk for violent attacks.2,5,7,9-11,19,22-26 The National Crime Victimization Survey (19931999) found that the average annual rate for nonfatal violent crime was 21.9 per 1,000 workers for nurses, compared with only 12.6 per 1,000 workers for all occupations.3 According to the Bureau of Labor Statistics,27 in 2004, 46% of nonfatal assaults and violent acts against healthcare practitioners that involved days off work were committed against registered nurses (RNs). Nursing staff are primary targets of violence in the ED.15,17 In one study, 82% of emergency nurses indicated that they had been physically assaulted at work during the preceding year.8 The incidence of verbal abuse is increasing as well, and such abuse affects 100% of emergency nurses in some facilities.6,8,26 The American Nurses Association found that less than 20% of nurses surveyed in 2001 felt safe in their current work environment.28 Research has consistently found that nurses are concerned about violence and aggression, inadequate safety measures, and personal vulnerability in the workplace.7,8,13,26,29 Many nurses simply do not feel safe at work.8,26,28 A perceived lack of institutional support is a key factor in the dissatisfaction that nurses feel.8,13 This sense of administrative abandonment may result from inadequate staffing levels, unfulfilled promises to improve environmental safety, ignored concerns, insufficient education and training, and lack of support from peers, physicians, and administrators in the aftermath of an incident.13 Fair and consistent procedures and a culture of support, not punishment, for victims are critical.6,19,30 The Need for Institutional Initiatives As assaults in the ED continue to be a serious problem, interventions and preventive measures are urgently needed.2,5,9,12,31 A significant amount of workplace aggression is preventable.18 Lack of a violence prevention program, for example, is associated with an increased assault risk in hospitals.5,9 A strong, comprehensive violence prevention program requires an interdisciplinary team approach with clear goals and objectives suitable for the size and complexity of the workplace.9,10,12,16,19 The OSHA recommends a violence prevention program

JONA  Vol. 39, No. 7/8  July/August 2009

341

Copyright @ 2009 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

that includes management commitment and employee involvement, worksite analysis of existing or potential hazards for workplace violence, measures for violence hazard prevention and control, safety and health training for staff, and record keeping and program evaluation to determine program effectiveness.5,9,12 The NIOSH also delineates prevention strategies for reducing exposure to violence risk factors in hospitals, including environmental designs to provide a safe workplace, administrative controls to ensure safe staffing patterns and adequate security measures, and training workers to recognize and manage potential assaults.16 Study Objective Because of the lack of standardized measurement and reporting mechanisms for workplace violence in the healthcare industry,15 data are scarce, necessitating the need for research that explores violence against emergency nurses.6-8,14,15,17,19,21,22,26,29,32 The Emergency Nurses Association (ENA) was charged by its membership to address violence against ED nurses through advocacy and research. In response, this study was conducted to investigate emergency nurses’ experiences and perceptions of ED violence, the types and frequencies of assaults in the ED, and contributing factors to ED violence (See Presentation, Supplemental Digital Content 1, which presents an overview of the study, http:// links.lww.com/A1415). To view a PowerPoint presentation given at the ENA 2008 Annual Conference, go to http://www.ena.org/conferences/annual/ 2008/handouts/339-C.pdf.

sible online during the spring of 2007 for 1 month. Participation was solicited through ENA newsletters, the Web site, and e-mail announcements during the same period. Although ENA could not restrict multiple submissions by the same nurse, the length of the survey may have served as a deterrent. Institutional review board approval for the study was obtained from Chesapeake Research Review, Inc, and designated as exempt. SPSS Windows (version 14) was used for data management and statistical analysis. Because the data had statistically nonnormal distributions, nonparametric statistical methods were used to analyze the data. Nurses whose responses indicated that they had experienced a high frequency of physical violence (920 times) from patients/visitors in the ED during the past 3 years were classified as frequentphysical-violence-experience (FPVE) nurses. Nurses whose responses indicated that they had experienced a high frequency of verbal abuse (9200 times) from patients/visitors during the past 3 years were classified as frequent-verbal-abuse-experience (FVAE) nurses. The # 2 test of association and Fisher exact test (when expected frequencies were too small to permit use of the # 2 test) were used to compare independent groups with respect to percentages. The Kruskal-Wallis and Mann-Whitney U tests were used to compare independent groups with respect to noncategorical variables. For all statistical analyses, a .05 significance level was used. No 1-sided tests were done. Data are presented as mean T SD.

Results Methods
This cross-sectional study was conducted by ENA, a nonprofit association of approximately 31,905 US members at the time the study was conducted. A survey about workplace violence was developed by an ENA work team, evaluated by experts for content validity, and pilot tested on a sample of 15 emergency nurses. The 69-item online survey concerned the respondent’s personal experience with physical violence and verbal abuse in the ED, the policies and procedures of the respondent’s hospital and ED for addressing workplace violence, and the respondent’s beliefs about the precipitating factors of violence and barriers to reporting violence in the ED. A convenience sampling strategy was used. All ENA members who were RNs working in US EDs at the time of the survey and who had Internet access were eligible to participate in the study. The online survey was developed using Survey Select Expert (version 5.6). The 1-time survey was accesA total of 3,465 (10.9%) emergency nurses completed the survey. This sample of nurses was representative of all 50 states and the District of Columbia. Table 1 describes the characteristics of the respondents and the EDs and facilities at which they worked. The overwhelming majority (87.4%) worked in general EDs, 63.6% worked in a trauma center, 59.7% worked as staff nurses, and 52.1% primarily worked the day shift. The mean T SD nursing experience was 16.5 T 10.7 years, emergency nursing experience was 12.1 T 8.8 years, and experience in the respondent’s current ED was 7.6 T 7.2 years. Most respondents (84.4%) were women. Some of the most common types of physical violence experienced by more than 50% of respondents were ‘‘spit on,’’ ‘‘hit,’’ ‘‘pushed/shoved,’’ ‘‘scratched,’’ and ‘‘kicked.’’ In terms of verbal abuse, 70% or more of respondents experienced being ‘‘yelled/cursed at,’’ ‘‘intimidated,’’ and ‘‘harassed with sexual language/innuendo.’’ Sixty-seven percent rated

342

JONA  Vol. 39, No. 7/8  July/August 2009

Copyright @ 2009 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

Table 1. Characteristics of Emergency Nurses and the Emergency Departments (EDs)/Facilities at Which They Worked
Characteristica Emergency nurses Sex (n = 3,446) Female Male Age, y (n = 3,451) 18-24 25-34 35-44 45-54 Q55 RN role (n = 3,461) Staff nurse Charge nurse ED manager Clinical/staff educator Clinical nurse specialist Administrator/director Nurse practitioner Other Shift primarily worked (n = 3,452) Day Night Evening Rotating Days primarily worked (n = 3,434) Weekdays Weekends Both weekdays and weekends EDs/facilities ED type (n = 3,460) General Adult only Pediatric only Community population (n = 3,262) e10,000 10,001-30,000 30,001-100,000 100,001-500,000 Q500,001 Facility type (n = 3,447) Nongovernment, not-for-profit Investor owned, for-profit State or local government Federal government, military, or Veterans Affairs a % (n)

84.4 (2,910) 15.6 (536) 1.7 (58) 17.7 (612) 29.6 (1,022) 38.2 (1,317) 12.8 (442) 59.7 (2,066) 16.1 (556) 11.0 (379) 4.9 (169) 1.3 (44) 1.2 (42) 1.0 (33) 5.0 (172) 52.1 (1,798) 25.7 (888) 13.0 (448) 9.2 (318) 21.9 (752) 7.4 (255) 70.7 (2,427) 87.4 (3,025) 8.9 (308) 3.7 (127) 10.0 16.7 27.1 27.0 19.2 (325) (545) (884) (881) (627)

69.5 (2,397) 19.1 (657) 9.0 (310) 2.4 (83)

Sample size fluctuates because of missing data.

their perception of safety at 5 or below on a 10-point scale (1, not at all safe to 10, extremely safe). Onethird had considered leaving their ED or emergency nursing because of ED violence. Frequent Physical Violence Experience Twenty-three percent (n = 811) of respondents were FPVE nurses. Table 2 describes the factors found to be related to FPVE. As expected, nurses in pediatric EDs were less likely to experience frequent physical violence, whereas nurses who primarily worked the night shift and nurses who worked on weekends

were more likely to experience frequent physical violence. Female nurses were less likely than male nurses to indicate that they had experienced frequent physical violence. A reduced risk of experiencing frequent physical violence in the ED was associated with having facility policies for reporting workplace violent incidents, facility responses to such incidents, and hospital and ED administration commitment to eliminating workplace violence against emergency nurses. Nurses who felt that violence from patients/visitors is an unavoidable part of practice were more likely to have experienced frequent ED physical violence. The following barriers to reporting ED violent incidents were associated with an increased risk of experiencing frequent physical violence in the ED: the perception that reporting ED violent incidents might have a negative effect on customer service scores/reports; ambiguous ED violence reporting policies; fear of retaliation from ED management, hospital administration, nursing staff, or physicians for reporting ED violent incidents; failure of staff to report ED violent incidents; the perception that reporting ED violent incidents was a sign of incompetence or weakness; lack of physical injury to staff; the attitude that violence comes with the job; and lack of support from administration/ management. Nurses who felt that there were no barriers to reporting ED violent incidents were much less likely to have experienced frequent ED physical violence (ie, 920 times in the last 3 years) than were other nurses: 15.4% versus 28.5% (P G .001). Nurses also were asked whether 29 factors precipitated workplace violence against RNs in their EDs. The precipitating factors listed in the survey were identified through a review of the research literature and input from emergency nurse content experts. Table 3 lists the most important factors (those specified by 950% of nurses). The factors that can potentially be altered by the ED or facility were: care of psychiatric patients in the ED, crowding/high patient volume, prolonged wait times, misconception by patients or visitors of staff behavior (such as nurses laughing), patients’ or visitors’ perception that staff is uncaring, holding or boarding patients, shortage of ED RNs, no or poorly enforced visitor policy, and care of patients with dementia or Alzheimer disease in the ED. Nurses in the FPVE group were significantly more likely than those in the non-FPVE group to perceive all but 4 of the 29 factors as precipitators of ED violence. Frequent Verbal Abuse Experience Similar results were obtained for verbal abuse. Almost 20% (n = 604) of respondents were FVAE

JONA  Vol. 39, No. 7/8  July/August 2009

343

Copyright @ 2009 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

Table 2. Factors Related to Experience of Frequent Physical Violence by Emergency Nurses
Non-FPVE Nurses, %b (n) 74.8 (1,908) 66.9 (329) 90.8 (99) 72.9 (2,149) 76.1 (1,214) 72.1 (289) 68.7 (540) 74.2 (198) 78.9 (525) 72.1 (160) 71.9 (1,563) 74.4 (1,602) 63.8 (243) 63.0 (308) 75.5 (1,941) 82.6 (737) 69.7 (1,500) 77.9 (1,226) 68.8 (1,013) 67.8 (1,004) 78.8 (1,236) FPVE Nurses, %b (n) 25.2 (643) 33.1 (163) G.001 9.2 (10) 27.1 (798) .002 23.9 27.9 31.3 25.8 (382) (112) (246) (69) .001 21.1 (140) 27.9 (62) 28.1 (603) G.001 25.6 (551) 36.2 (138) G.001 37.0 (181) 24.5 (630) G.001 17.4 (155) 30.3 (651) G.001 22.1 (348) 31.2 (460) G.001 32.2 (476) 21.2 (332) G.001 68.2 (763) 76.5 (1,486) 69.1 (635) 75.4 (1,614) 63.6 (295) 75.3 (1,954) 66.5 (468) 75.6 (1,781) 63.4 (83) 74.0 (2,166) 63.8 (88) 74.0 (2,161) 68.2 (503) 75.2 (1,746) 68.0 (344) 74.6 (1,905) 31.8 (355) 23.5 (456) G.001 30.9 (284) 24.6 (527) G.001 36.4 (169) 24.7 (642) G.001 33.5 (236) 24.4 (575) .007 36.6 (48) 26.0 (763) .008 36.2 (50) 26.0 (761) G.001 31.8 (235) 24.8 (576) .002 32.0 (162) 25.4 (649)

Factora Sex (n = 3,043) Female Male ED type (n = 3,056) Pediatric only Adult only or general Shift primarily worked (n = 3,050) Day Evening Night Rotating Days primarily worked (n = 3,033) Weekdays Weekends Both weekdays and weekends Facility policy for reporting workplace violent incidents (n = 2,534) Present Absent No facility response to workplace violent incidents (n = 3,060) Yes No Hospital administration committed to eliminating workplace violence against emergency nurses (n = 3,043) Yes No ED management committed to eliminating workplace violence against emergency nurses (n = 3,047) Yes No Feel that violence from patients/visitors is part of practice (n = 3,048) Yes No Barriers to reporting ED violent incidents Reporting ED violent incidents might affect customer service scores/reports (n = 3,060) Yes No Ambiguous ED violence reporting policies (n = 3,060) Yes No Fear of retaliation from ED management for reporting ED violent incidents (n = 3,060) Yes No Fear of retaliation from hospital administration for reporting ED violent incidents (n = 3,060) Yes No Fear of retaliation from nursing staff for reporting ED violent incidents (n = 3,060) Yes No Fear of retaliation from physicians for reporting ED violent incidents (n = 3,060) Yes No No one reports ED violent incidents (n = 3,060) Yes No Reporting ED violent incidents perceived as a sign of incompetence (n = 3,060) Yes No

P G.001

344

JONA  Vol. 39, No. 7/8  July/August 2009

Copyright @ 2009 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

Table 2. Continued
Non-FPVE Nurses, %b (n) 70.2 (428) 74.3 (1,821) 71.5 (894) 74.9 (1,355) 64.8 (608) 77.3 (1,640) 63.6 (105) 74.1 (2,144) FPVE Nurses, %b (n) 29.8 (182) 25.7 (629) .040 28.5 (356) 25.1 (455) G.001 35.2 (330) 22.7 (481) .003 36.4 (60) 25.9 (751)

Factora Reporting ED violent incidents perceived as a sign of weakness (n = 3,060) Yes No Lack of physical injury to staff (n = 3,060) Yes No Attitude that violence comes with the job (n = 3,059) Yes No Lack of support from administration/management (n = 3,060) Yes No
Abbreviations: ED, emergency department; FPVE, frequent physical violence experience. a Sample size fluctuates because of # 2 analyses and missing data. b Row percentages.

P .037

nurses. Factors related to FVAE are shown in Table 4. Nurses were more likely to experience frequent verbal abuse if they worked in general or adult-only EDs, primarily worked the night shift, or worked on weekends. Female nurses were slightly less likely than male nurses to indicate that they had experienced frequent verbal abuse. Facility policies for reporting workplace violent incidents, facility responses to such incidents, and hospital and ED administration commitment to eliminating workplace violence against emergency nurses were all associated with a reduced risk of experiencing frequent verbal abuse. Barriers to reporting ED violent incidents were often associated with an increased risk of experiencing frequent verbal abuse. Nurses who felt that there were no barriers to reporting ED violent incidents were much less likely

to have experienced frequent ED verbal abuse (ie, 9200 times in the last 3 years) than were other nurses: 9.78% versus 21.5% (P G .001). Strategies and Interventions The effectiveness of strategies such as security, environmental controls, and violence prevention education/training cannot be determined from cross-sectional data of this type because such strategies are often initiated in EDs after violence becomes a problem. This confounding can make it appear as if such strategies increase ED violence. For example, nurses who indicated that their hospital had no security personnel were significantly less likely to have experienced frequent physical violence (P = .002) or frequent verbal abuse (P = .007) than were other nurses. However,

Table 3. FPVE and Non-FPVE Nurses’ View of Factors Related to ED Violence
Perceived as Precipitator of ED Violence, % (n) Factor Patients/visitors under influence of alcohol Drug-seeking behavior Patients/visitors under influence of illicit drugs Care of psychiatric patients in ED Crowding/high patient volume Prolonged wait times Misconception by patients/visitors of staff behavior Patients/visitors’ perception that staff is uncaring Holding/boarding patients Shortage of ED RNs No/poorly enforced visitor policy Care of patients with dementia/Alzheimer disease in ED Total Sample 90.2 90.2 88.4 88.2 87.0 83.5 66.1 65.6 59.1 58.6 56.2 54.6 (3,126) (3,124) (3,063) (3,055) (3,015) (2,892) (2,289) (2,272) (2,048) (2,031) (1,949) (1,893) FPVE Group 94.7 94.0 94.3 91.9 91.1 86.3 69.7 71.8 68.3 66.2 69.1 59.1 (768) (762) (765) (745) (739) (700) (565) (582) (554) (537) (560) (479) Non-FPVE Group 90.0 89.4 87.7 86.7 86.5 84.0 65.9 64.6 56.3 55.8 52.9 53.8 (2,023) (2,010) (1,972) (1,950) (1,945) (1,890) (1,481) (1,452) (1,267) (1,256) (1,189) (1,209) P G.001 G.001 G.001 G.001 .001 NS .048 G.001 G.001 G.001 G.001 .009

Abbreviations: ED, emergency department; FPVE, frequent physical violence experience; NS, not statistically significant.

JONA  Vol. 39, No. 7/8  July/August 2009

345

Copyright @ 2009 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

Table 4. Factors Related to Experience of Frequent Verbal Abuse by Emergency Nurses
Non-FVAE Nurses, %b (n) 80.9 (2,065) 77.0 (381) 88.2 (97) 80.0 (2,360) 82.8 (1,317) 77.5 (306) 76.1 (606) 81.7 (223) 83.8 (560) 76.0 (174) 79.5 (1,795) 81.7 (1,767) 71.9 (269) 71.5 (353) 82.0 (2,107) 88.5 (799) 76.8 (1,647) 84.0 (1,325) 76.2 (1,123) FVAE Nurses, %b (n) 19.1 (488) 23.0 (114) .034 11.8 (13) 20.0 (590) .001 17.2 22.5 23.9 18.3 (274) (89) (190) (50) .012 16.2 (108) 24.0 (55) 20.5 (440) G.001 18.3 (395) 28.1 (105) G.001 28.5 (141) 18.0 (463) G.001 11.5 (104) 23.2 (497) G.001 16.0 (253) 23.8 (351) G.001 75.0 (834) 83.3 (1,626) 76.1 (687) 82.0 (1,773) 72.7 (335) 81.6 (2,125) 74.6 (523) 82.0 (1,937) 77.2 (873) 82.1 (1,587) 75.0 (548) 82.0 (1,912) 74.6 (379) 81.4 (2,081) 74.0 (444) 81.8 (2,016) 76.6 (951) 82.8 (1,509) 73.6 (680) 83.2 (1,779) 25.0 (278) 16.7 (326) G.001 23.9 (216) 18.0 (388) G.001 27.3 (126) 18.4 (478) G.001 25.4 (178) 18.0 (426) .001 22.8 (258) 17.9 (346) G.001 25.0 (183) 18.0 (421) G.001 25.4 (129) 18.6 (475) G.001 26.0 (156) 18.2 (448) G.001 23.4 (290) 17.2 (314) G.001 26.4 (244) 16.8 (360)

Factora Sex (n = 3,048) Female Male ED type (n = 3,060) Pediatric only Adult only or general Shift primarily worked (n = 3,055) Day Evening Night Rotating Days primarily worked (n = 3,039) Weekdays Weekends Both weekdays and weekends Facility policy for reporting workplace violent incidents (n = 2,536) Present Absent No facility response to workplace violent incidents (n = 3,064) Yes No Hospital administration committed to eliminating workplace violence against emergency nurses (n = 3,047) Yes No ED management committed to eliminating workplace violence against emergency nurses (n = 3,052) Yes No Barriers to reporting violent incidents Reporting ED violent incidents might affect customer service scores/reports (n = 3,064) Yes No Ambiguous ED violence reporting policies (n = 3,064) Yes No Fear of retaliation from ED management for reporting ED violent incidents (n = 3,064) Yes No Fear of retaliation from hospital administration for reporting ED violent incidents (n = 3,064) Yes No Inconvenient/do not want to deal with it (n = 3,064) Yes No No one reports ED violent incidents (n = 3,064) Yes No Reporting ED violent incidents perceived as a sign of incompetence (n = 3,064) Yes No Reporting ED violent incidents perceived as a sign of weakness (n = 3,064) Yes No Lack of physical injury to staff (n = 3,064) Yes No Attitude that violence comes with the job (n = 3,063) Yes No

P .045

346

JONA  Vol. 39, No. 7/8  July/August 2009

Copyright @ 2009 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

Table 4. Continued
Non-FVAE Nurses, %b (n) 65.4 (106) 81.1 (2,354) FVAE Nurses, %b (n) 34.6 (56) 18.9 (548)

Factora Lack of support from administration/management (n = 3,064) Yes No
Abbreviations: ED, emergency department; FVAE, frequent verbal abuse experience. a Sample size fluctuates because of # 2 analyses and missing data. b Row percentages.

P G.001

as evidenced by nurses’ comments in the survey, having inadequate security personnel to effectively mitigate violence was a major concern.

Limitations
As is true for most studies based on self-report, this study is limited by the potential inaccuracy of selfreported data. No self-report study can conclusively identify factors related to ED violence. Because a convenience sampling method was used and all respondents were ENA members, the generalizability of the study is limited. Despite these limitations, the results indicate the extent and severity of workplace violence experienced by emergency nurses and the substantial barriers that remain to preventing, mitigating, and reporting ED violence. Opportunities to address these barriers exist. Further research is needed to identify best practices for preventing and mitigating ED violence.

Discussion
As the first national study of emergency nurses’ experiences and perceptions of workplace violence, this study provides significant contributions to our understanding of ED violence. As evident from the survey findings, workplace violence is highly prevalent among the ED nurses in our study, highlighting the seriousness of the issue. Findings from this study are consistent with the research literature involving nurses in other disciplines and emergency nurses internationally. Our findings further support the research literature in that nurses indicated not feeling safe in the workplace, a perception that violence is an unavoidable aspect of the job, barriers to reporting violence, a desire for improved security measures, and a lack of administrative commitment to addressing ED violence. The results of this study have important implications for strategies to reduce ED violence. Inno-

vative approaches are needed to modify factors that emergency nurses believe are precipitators of ED violence, such as care of psychiatric patients in the ED, crowding, long wait times, misconceptions of staff behavior, perceptions of staff as uncaring, holding/boarding patients, shortage of nurses, and lack of an enforced visitor policy. These are wellknown ED problems, and the solutions are difficult, hence the need for innovation. In addition, there is a need to change hospital administration’s and emergency nurses’ perceptions and attitudes that violence is acceptable and ‘‘comes with the job.’’ Reducing ED violence will require solving many of the larger problems that afflict EDs, some of which originate outside the ED at the hospital or community level. As indicated by the nurses in this study, a strong administrative commitment is imperative to reducing ED violence and eliminating barriers to reporting incidents of violence. Staff and ED managers need to know that senior administrators are aware of the violence issue and support efforts to prevent and mitigate violence. Nurse executives must be proactive in taking steps to make the workplace safe. Establishing a culture of acceptance for reporting violent incidents is a positive step toward creating a safer work environment. Procedures for reporting violent incidents should be clear and consistent, and ED staff should have access to medical care and follow-up counseling if needed. Another essential strategy to addressing ED violence is convening an interdisciplinary task force to identify vulnerabilities in the ED and develop a plan for preventing, mitigating, responding to, and reporting violence. This task force should include the chief operating officer, chief nurse executive, ED medical director, ED manager/director, security personnel, risk management personnel, local police, and most importantly, ED nurses. Findings from the study were inconclusive regarding the effectiveness of education and training on violence prevention; however, many hospitals provide violence prevention education for ED staff.

JONA  Vol. 39, No. 7/8  July/August 2009

347

Copyright @ 2009 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

Education should include practical and relevant skills for managing assaultive behavior in the ED. For example, education for ED managers and staff should include learning how to be aware of one’s surroundings and identify patients and visitors who may be disposed toward violent behavior.

Conclusion
The recommendations outlined here involve facility and department level change for improving workplace safety. This study is one important step toward identifying ways to mitigate and respond to ED violence. Additional research to further this cause should focus on the effectiveness of education in preparing nurses to deescalate a potentially violent situation, the usefulness of various security measures and environmental controls, best practices for reducing ED violence, and longitudinal trending of ED violence incidence and prevalence rates.

More importantly, federal and state laws to protect ED nurses from violence are needed to address this issue. Whereas some states have made assault of a nurse a felony, other states do not have such stringent laws in place to adequately protect nurses. Unfortunately, legislation such as this is often passed only after a tragic incident against a nurse takes place. To make this a legislative priority, leaders of nursing organizations need to use their government affairs departments to heighten legislators’ awareness. Without legislative action at the state and federal level and innovative strategies at the hospital and department level, there can be no realistic hope of significantly decreasing ED violence.

Acknowledgment
The ENA thanks Susan Shott, PhD, for providing statistical and publishing expertise.

References
1. American Association of Occupational Health Nurses. 2005 Key public policy issues. 2005. Available at http://www.aaohn. org/press_room/upload/policy%20platform%202005.pdf. Accessed January 7, 2008. 2. International Council of Nurses. Press release: new research shows workplace violence threatens health services worldwide. 2002. Available at http://www.icn.ch/PR10_02.htm. Accessed January 7, 2008. 3. US Department of Justice, Bureau of Justice Statistics. National crime victimization survey: violence in the workplace, 1993-99. 2001. Available at http://www.ojp.gov/bjs/ pub/pdf/vw99.pdf. Accessed January 7, 2008. 4. US Department of Labor, Bureau of Labor Statistics. Census of fatal occupational injuries charts, 1992-2007 (preliminary): manner in which workplace fatalities occurred, 2007. 2008. Available at http://www.bls.gov/iif/oshcfoi1.htm#charts. Accessed September 11, 2008. 5. McPhaul KM, Lipscomb JA. Workplace violence in health care: recognized but not regulated. Online J Issues Nurs. 2004;9. Available at http://www.nursingworld.org/ojin/. Accessed January 7, 2008. 6. Sofield L, Salmond SW. A focus on verbal abuse and intent to leave the organization. Orthop Nurs. 2003;22(4):274-283. 7. Ferns T. Violence in the accident and emergency department: an international perspective. Accid Emerg Nurs. 2005;13:180-185. 8. May DD, Grubbs LM. The extent, nature, and precipitating factors of nurse assault among three groups of registered nurses in a regional medical center. J Emerg Nurs. 2002; 28(1):11-17. 9. US Department of Labor, Occupational Safety and Health Administration. Guidelines for preventing workplace violence for health care & social service workers. 2004. Available at http://www.osha.gov/Publications/OSHA3148/osha3148. html#text1. Accessed January 7, 2008. 10. Anderson C, Parish M. Report of workplace violence by Hispanic nurses. J Transcult Nurs. 2003;14:237-243. 11. Bradley DB, Moore HL. Preventing workplace violence from negligent hiring in healthcare. J Nurs Adm. 2004;34(3): 157-161. 12. Gilmore-Hall A. Violence in the workplace: are you prepared? Am J Nurs. 2001;101(7):55-56. 13. Kindy D, Petersen S, Parkhurst D. Perilous work: nurses’ experiences in psychiatric units with high risk of assault. Arch Psychiatr Nurs. 2005;19(4):169-175. 14. Lipscomb J, Silverstein B, Slavin T, Cocy E, Jenkins L. Perspectives on legal strategies to prevent workplace violence. J Law Med Ethics. 2003;30(3):166-172. 15. Love CC, Morrison E. American Academy of Nursing expert panel on violence policy recommendations on workplace violence. Issues Ment Health Nurs. 2003;24:599-604. 16. Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health. Violence: occupational hazards in hospitals. 2002. Available at http:// www.cdc.gov/niosh/pdfs/2002-101.pdf. Accessed January 7, 2008. 17. Anderson C. Workplace violence: are some nurses more vulnerable? Issues Ment Health Nurs. 2002;23(4):351-366. 18. DelBel JC. Deescalating workplace aggression. Nurs Manage. 2003;34(9):30-34. 19. US Department of Justice, Federal Bureau of Investigation. Workplace violence: issues in response. 2004. Available at http://www.fbi.gov/publications/violence.pdf. Accessed January 7, 2008. 20. Clements PT, DeRanieri JT, Clark K, Manno MS, Wolick Kuhn D. Workplace violence and corporate policy for health care settings. Nurs Econ. 2005;23(3):119-124. 21. Kowalenko T, Walters BL, Khare RK, Compton S. Workplace violence: a survey of emergency physicians in the state of Michigan. Ann Emerg Med. 2005;46(2): 142-147. 22. Gerberich SG, Church TR, McGovern PM, et al. Risk factors for work-related assaults on nurses. Epidemiology. 2005;16(5):704-709.

348

JONA  Vol. 39, No. 7/8  July/August 2009

Copyright @ 2009 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

23. Presley D, Robinson G. Violence in the emergency department: nurses contend with prevention in the healthcare arena. Nurs Clin North Am. 2002;37(1):161-169. 24. Rosenstein AH. Nurse-physician relationships: impact on nurse satisfaction and retention. Am J Nurs. 2002;102(6):26-34. 25. Anderson C. Past victim, future victim? Nurs Manage. 2002; 33(3):26-31. 26. Catlette M. A descriptive study of the perceptions of workplace violence and safety strategies of nurses working in level I trauma centers. J Emerg Nurs. 2005;31(6): 519-525. 27. US Department of Labor, Bureau of Labor Statistics. Case and demographic characteristics for work-related injuries and illnesses involving days away from work: resource tables, 2004. 2005. Available at http://www.bls.gov/iif/oshcdnew.htm. Accessed January 7, 2008.

28. American Nurses Association. Nurses cite stress, overwork as top health, safety concern. Am Nurse. 2001; 33(5):1. 29. Early MR, Williams RA. Emergency nurses’ experience with violence: does it affect nursing care of battered women? J Emerg Nurs. 2002;28(3):199-204. 30. Arthur T, Bain EI. Workplace violence and chemical exposure: a 73-year-old CVA patient assaults nurses with a fire extinguisher. J Emerg Nurs. 2002;28(6):484-488. 31. Lanza ML, Demaio J, Benedict MA. Patient assault support group: achieving educational objectives. Issues Ment Health Nurs. 2005;26(6):643-660. 32. Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health. Research on occupational violence and homicide. 2008. Available at http://www.cdc.gov/NIOSH/topics/violence/traumaviol_ research.html. Accessed September 12, 2008.

Is your computer doing all it can to help you… improve patient optimize educational outcomes and safety? experiences?
Informatics is rapidly becoming essential knowledge for nurse managers and educators.
• FULL online access to complete articles since 2001 — a comprehensive reference library always at your fingertips • More than 25 years of peer-reviewed research • The latest news from the Alliance for Nursing Informatics CIN is your window to electronic health record implementation, clinical decision making, system design, concept mapping, and much more. BONUS with every subscription – CIN Plus! Discover practical knowledge on using everyday software for unique applications, Internet technologies in the classroom, and building a career as an informatics nurse.

explore data for meanings and trends?

To subscribe, call TOLL FREE 1-800-638-3030 or go to NursingCenter.com or LWW.com/nursing.

© Wolters Kluwer Health/Lippincott Williams & Wilkins

F8NIK140

A8K140ZZ

JONA  Vol. 39, No. 7/8  July/August 2009

349

Copyright @ 2009 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

Similar Documents

Premium Essay

Amba660 Week 8

...Case Analysis of Schindler By University of Maryland University College AMBA 660 Week 8 August 31, 2012 Introduction The paper will discuss the challenges faced by Silvio Napoli, in carrying out Schindler’s expansion into the Indian elevator market at the request of the VRA, the corporate committee of Schindler which included Alfred Schindler (CEO), Luc Bonnard (Vice Chairman), and Alfred Spoerri (CFO). To begin Silvio Napoli, a young MBA from France, a third-country national, was fully responsible for the Indian expansion, and he had to get operations up and running and profitable in for years. His challenges included staffing and implementing a business plan he developed. Napoli’s plan two basic premises 1) to sell standardized elevators in India, and 2) outsource manufacturing and logistics in India. Napoli’s plan had success earlier in his career in 1995 with the Swatch Project that bested industry standard 20- to 30- week cycles by 50% with this same approach. Other challenges faced by Napoli included pressure in family his family life as a result of poor planning and no employee assistance program to get his family acclimated to Indian culture. That poor work-life balance distracted Napoli to the point where he could focus on neither his work, nor personal life. After 8 months he had not installed one unit and had orders that were contrary to the standardization strategy his entire business plan was based on. Government activities that affected......

Words: 1774 - Pages: 8

Premium Essay

Week 8

...Marr, B. (2012). Advanced Performance Institute. Retrieved October 18, 2012, from What is a Balanced Scorecard?: http://www.ap-institute.com/Balanced%20Scorecard.html Samet, K., Rider, H., & Weiss Wilkerson, J. (n.d.). Understanding Healthcare Organizations: External Infleunces. Week 7 Bayat, R. F. (2011). Impact on the Productivity of Human Resources Management, Performance Evaluation. Australian Journal Of Basic & Applied Sciences, 5(12), 1629-1635. Smith, K., Gunzenhauser, J., & Fielding, J. (2010). Reinvigorating Performance Evaluation: First Steps in a Local Health Department. Public Health Nursing, 27(5), 425-432. doi:10.1111/j.1525-1446.2010.00875.x Ver Ploeg, M., & Ralston, K. (2008, March). Food Stamps and Obesity:What do we know? Retrieved September 14, 2012, from United States Department of Agriculture: http://www.ers.usda.gov/publications/eib-economic-information-bulletin/eib34.aspx Riskind, A. G., & Lohr, A. (2012). New Scientific Study Indicates that Eating Quickly is Associated with Overeating. Retrieved September 15, 2012, from Obesity in America.org: http://www.obesityinamerica.org/newsroom/Fasteating.cfm Sikorski, C., Luppa, M., Kaiser, M., Glaesmer, H., Schomerus, G., König, H., & Riedel-Heller, S. (2011). The stigma of obesity in the general public and its implications for public health - a systematic review. BMC Public Health, 11(1), 661-661. doi: 10.1186/1471-2458-11-661 Odgen, C. L., Carroll, M. D., Kit, B....

Words: 572 - Pages: 3

Premium Essay

Discussion Questions Week 8

...HRM 530 Week 8 Discussion Week 8 #1 "Employee Development" Please respond to the following: Propose three ways that a mentor and a new employee orientation can assist employees with their career development. Evaluate the following criteria, in order of importance to you, in regard to the workplace: material wealth, success, career satisfaction, and work-life. Determine whether or not you believe there is a way to balance them. Provide two suggestions on how this could be done. Support your position. There are several ways in which a mentor program and new employee orientation can assist employees with their career development. In my current position, we have a mentor program that last for the first six months of a person’s time on the job. During that period, they are paired with a seasoned peer that is responsible for some on the job training as well as aiding them with navigating the corporate culture. This is important because it aids in helping a new employee feel a part of the organization. Employees who feel a part of the organization often feel more passionate about their work. Another reason a new employee orientation is important is because it introduces employees to corporate policies and procedures. Policies and procedures are basically the rules that an organization abides by. Often times, being able to introduce these at the onset of employment help an employee to understand what role they play in the organization, and also give insight into the......

Words: 658 - Pages: 3

Premium Essay

Discussion Questions Week 8

...HRM 530 Week 8 Discussion Week 8 #1 "Employee Development" Please respond to the following: Propose three ways that a mentor and a new employee orientation can assist employees with their career development. Evaluate the following criteria, in order of importance to you, in regard to the workplace: material wealth, success, career satisfaction, and work-life. Determine whether or not you believe there is a way to balance them. Provide two suggestions on how this could be done. Support your position. There are several ways in which a mentor program and new employee orientation can assist employees with their career development. In my current position, we have a mentor program that last for the first six months of a person’s time on the job. During that period, they are paired with a seasoned peer that is responsible for some on the job training as well as aiding them with navigating the corporate culture. This is important because it aids in helping a new employee feel a part of the organization. Employees who feel a part of the organization often feel more passionate about their work. Another reason a new employee orientation is important is because it introduces employees to corporate policies and procedures. Policies and procedures are basically the rules that an organization abides by. Often times, being able to introduce these at the onset of employment help an employee to understand what role they play in the organization, and also give insight into the......

Words: 658 - Pages: 3

Free Essay

Week 8 Chapter 15

...Felicia bourgeois Week 8 home work Wed class Week 8 chapter 15 1) What is the difference between the permanent link and channel testing? The permanent link includes only that portion of the cabling installation that is "permanent" (think punched down). It includes jack to rack -or- wall outlet to patch panel. One connector is allowed at each end but any patch cables must be accounted for and removed from the test results. This generally means you must use the cables that came with your test equipment so the equipment knows exactly what to subtract the channel link includes two or more patch cables and may include multiple patch panels - possibly in multiple closets. 2) if you have installed a category 6a cable, what is the maximum NEXT that can be supported for a 500mhz channel. 26.1 3) what is the insertion loss budget for 300 meter link intended to operate at 10Gbase-SR using OM3 fiber. ILB = (2 x 0.75db) + (0.3km x 3.5dB/km) = 2.6dB 4) What are the basic recommended steps for troubleshooting a cable problem? 1. Split the system into logical elements.2.Locate the element that is most likely the cause of the problem. 3. Test the...

Words: 250 - Pages: 1

Premium Essay

Week 8

...Week 8 Assignment Rubric Written Assignment Grading Form for Good Business Sense Paper, Due in Week Eight |Content and Development |Points Possible |Points Earned |Comments | |70 Points |70 | | | | | | | | |All key elements of the assignment are covered in a substantive way. |30 | | | |The paper answer Questions 1–4 from the Developing Good Business | | | | |Sense activity on p. 394 of the text. | | | | |The paper is 700 to 1,050 words. | | | | |The content is comprehensive, accurate, and/or persuasive. |10 | | | |The paper develops a central theme or idea directed toward the | | | | |appropriate audience. | ...

Words: 264 - Pages: 2

Premium Essay

Week 8 Homewor

...Lauren Martin MG365 Week 8 Homework Situational leadership provides a simple and logical framework with four basic decision-making styes - authoritative, consultative, facilitative, and delegative. Describe each of these styles and discuss when each of them is appropriate to apply. 1) Authoritative decision making: this applies in situations in which the manager has the experience necessary along with the information needed to reach a conclusion. The followers do not have the ability, willingness, or confidence to complete a task on their own. They are not involved in the decision making process to determine a course of action. This would be applied in a circumstance in which the manager is the only source of information or expertise. 2) Consultative decision making: this is a valuable strategy when the manager recognizes that the followers possess some experience/knowledge of the subject, display willingness, but are not yet able to help. The manager selects followers who can aide in reaching a decision, but the final choice rests on the manager. This would be applied in a circumstance when a follower has experience in the area in question. 3) Facilitative decision making: this is a cooperative effort where the manager and followers work together to reach a shared decision. The manager can enlist their help in situations where followers exhibit moderate to high readiness. This type can be used when a manager and a follower is part of a previous......

Words: 330 - Pages: 2

Premium Essay

Itmg381 Week 8 Assignment

...Assignment Week Eight 1 ASSIGNMENT WEEK EIGHT Assignment Week Eight Gary Best American Military University Assignment Week Eight 2 ASSIGNMENT WEEK 8 Chapter 14   First off the large American multinational corporation would need to rely on a teams of lawyers and interpreters to get to know the laws of the European Union against cybercrimes. Security firm FireEye released the results from a study they conducted and found that one third of the businesses in the UK, France, and Germany are at a loss with the new cyber security legislation.(1) If one third of the businesses that are in the European Union do not understand the upcoming laws your research team is going to be very busy. The establishment of the data protection regulation has created to things to point out that may make trying to follow it a little easier. First it wil1 be designated as a regulation. A regulation is applicable in all European Union states.(2) Secondly, there is now harmonization, only one regulatory authority that manages its state of things in all of the European Union states.(2) Before this change each European Union state had its own directive that you would have to worry about compliance. One thing to consider is if you plan on using a cloud based software for your data. It will need to be secured and protected against hacking. You will need secure the data before it is sent to the cloud using a process called cloud data encryption and tokenization.(3) Tokenization is taking the......

Words: 556 - Pages: 3

Premium Essay

Bus 599 Week 8 Bus599 Week 8

...com/q/bus-599-complete-course-bus599-complete-course/21454 http://workbank247.com/q/bus-599-complete-course-bus599-complete-course/21454 BUS 599 Week 1 Discussion "Company Description" Throughout this course, you will develop a series of written papers / projects that you will later combine into a complete business plan for a Non-Alcoholic Beverage company. For this discussion, you must first review the “NAB Company Portfolio”.  The mentioned portfolio contains the company parameters and details you must follow when developing your company. Provide the following information to set the foundation for your non-alcoholic beverage (NAB) business plan. Please respond to the following: * Create your NAB company name and explain its significance. * Develop your company’s Mission Statement and provide a rationale for its components. BUS 599 Week 2 Discussion "Growing Honest Tea"  Please respond to the following: * Review the following documents: * Honest Tea’s business plan for 1999 (PDF). * A strengths, weaknesses, opportunities, and threats (SWOT) analysis based on Honest Teas’ business plan (PDF). * Suppose Honest Tea has hired you as a consultant to evaluate the completeness of their strategy for future growth. Base your evaluation on the provided SWOT analysis. Provide a rationale for your response. BUS 599 Week 3 Discussion "Don't Miss the Mark"  Please respond to the following: * Watch the following......

Words: 5722 - Pages: 23

Premium Essay

Bus 519 Week 8 Bus519 Week 8

...Link for the Answer: http://workbank247.com/q/bus-519-complete-course-bus519-complete-course/22300 http://workbank247.com/q/bus-519-complete-course-bus519-complete-course/22300 BUS 519 Week 1 Discussion "What is Risk?"  Please respond to the following: * There are three (3) schools of thought regarding risk. The first considers the positive and negative aspects of risk, but sees them as separate. The second group believes that there are benefits from treating threats and opportunities together, while the third school does not label uncertainties, but addresses uncertainty as part of “doing the job.” Argue the value of having a risk strategy despite the cost associated with it. Include an example to support your response. Provide a rationale for your selection and determine how this approach helps a project to be successful. BUS 519 Week 2 Discussion "Need for Risk Management" Please respond to the following: * There are four (4) critical success factors that are important for effective risk management: supportive organization; competent people; appropriate methods, tools and techniques; and simple, scalable process. Determine three (3) obstacles for an organization to manage risk effectively. Suggest strategies from the perspective of a project manager to avoid the obstacles. BUS 519 Week 3 Discussion "Project Initiation" Please respond to the following: * Using the “Stakeholder Analysis Template” (Appendix B2 in the Hillson and Simon text) for a company that you......

Words: 2422 - Pages: 10

Premium Essay

Week 8 Activity 1

...Week 8 Activity 1 1. Best available treatment: a water treatment that is the most current and best available through research even though it may not be the treatment used most frequently. 2. Best conventional treatment: a water treatment that is generally used among industries; not always the best treatment available. 3. Clean Air Act: federal legislations that establishes standards for air pollution levels and prevents further deterioration of air quality. 4. Clean Water Act: federal legislations that regulates water pollution through a control system. 5. Due diligence: process of checking the environmental history and nature of land prior to purchase. 6. Emissions offset policy: controls whether new factories can be built in a non-attainment area. 7. Environmental impact statement (EIS): formal report prepared under NEPA to document findings on the impact of a federal project on the environment. 8. Injunction: order of a court of equity to refrain from doing or to do a specified act. 9. Private nuisance: nuisance that affects only one or a few individuals. 10. Zoning: restrictions imposed by government on the use of designated land to ensure an orderly physical development of the regulate area. 1. Solid waste disposal regulations today deal almost entirely with recycling. False 2. The EPA has the authority of have activities halted through the use of injunction. True 3. Conduct that unreasonably interferes with the enjoyment......

Words: 255 - Pages: 2

Premium Essay

Week 8

...Week 8 Project You are a portfolio manager for the XYZ investment fund. The objective for the fund is to maximize your portfolio returns from the investments on four alternatives. The investments include (1) stocks, (2) real estate, (3) bonds, and (4) certificate of deposit (CD). Your total investment portfolio is $1,000,000. Investment Returns Based on the returns from the past five years, you concluded that the investment annual returns on stocks are 10%, on real estates are 7% on bonds are 4% and on CD is 1%. Risk Constraints However, you also have to analyze the risks associate with each investment category. A wildly used risk measurement parameter is called Value at Risk (VaR). (Note: VaR measures the risk of loss on a specific portfolio of financial assets.) For example, given a million dollar stock investment, if a portfolio of stocks has a one-day 4% VaR, there is a 5% probability that the stock portfolio will fall in value by more than 1,000,000 * 0.04 = $40,000 over a one day period. In the portfolio, the VaR for stock investments is 6%. Similarly, the VaR for real estate investment is 2% and the VaR for bond investment is 1% and the VaR for investment in CD is 0%. To manage the portfolio, you decided that at 5% probability, your VaR for stocks cannot exceed $25,000, VaR for real estate cannot exceed $15,000, VaR for bonds cannot exceed $2,500 and the VaR for CD investment is $0. Diversification and Liquidity Constraints As a diversified......

Words: 392 - Pages: 2

Premium Essay

Week 8

...Axia College Material Appendix E Asian Americans According to the U.S. Census Bureau Part I Organize statistics from the U.S. Census Bureau on Asian American diversity using the matrix below and the Asian/Pacific American Heritage Month: May 2010 document. Use the following directions to locate the document: • Go to the homepage of the U.S. Census Bureau website: http://www.census.gov/. • Scroll down to Newsroom. • Click on Facts for Features. • Under the 2010 heading, select the document: March 2: Facts for Features: Asian/Pacific American Heritage Month: May 2010 | PDF Version - 130K. You may also locate the document under the Week 8 Materials tab on your student website. Statistic 1 of the Cultural Makeup column is provided for your reference. Note: you will find only two statistics to place in the Financial row. | |Statistic 1 |Statistic 2 |Statistic 3 | |Cultural Makeup |15.5 million U.S. residents are |In Hawaii, Asians made up the |In the Us in 2008, Chinese | | |Asian or Asian in combination |highest proportion of the total |Americans were the largest Asian | | |with other races. |population 54% |group | |Income | |11.8% Poverty rate for......

Words: 872 - Pages: 4

Premium Essay

It237 Week 8

...IT 237 Week 8 Checkpoint 4/25/2012 How are <meta> tags used to promote accessibility and search engine optimization? Say you have a couple hundreds of photos and each photo has many different people in them. By using a <meta> tag all you have to do is search the name of the person you are looking for and their pictures will pop up. This tag helps search by not making everything in one location, instead if you know the <meta> tag all you have to do is type it in the search and all the information is there. Another good thing about this tag is that you don’t need to know the file names. I like this tag since it helps searching easier as well as being able to not know all the details about the file you are looking for. Take a look at Google. All we have to do is type a name and it automatically searches for the name we typed in. This is a form of the <meta> tag. What is the importance of professional standards in Web development? The importance of professional standards in Web development allows browsers and designers to interact easier with each other. By doing this it helps the designer by knowing what the browser is asking as far as being professional. By having so many different forms of browsers out there, it is hard to have a site look the same on each one. So by having HTML code behaving in the same manner on all browsers is a step in professional standards. By having these professional standards it decreases the development time......

Words: 361 - Pages: 2

Premium Essay

Week 8

... | | | |Prediction Interval Lower Limit |28.74738 | | | |Prediction Interval Upper Limit |45.98115 | | | 7. The business problem facing the director of broadcasting operations for a television station was the issue of standby hours (i.e., hours in which unionized graphic artists at the station are paid but are not actually involved in any activity) and what factors were related to standby hours. The study included the following variables: Standby hours (Y), Total number of standby hours in a week Total staff present (X1), Weekly total of people –days Remote hours (X2), Total number of hours worked by employees at locations away from the central plant Data was collected for 26 weeks; this is organized and stored in the attached spreadsheet Standby. |  |Coefficients |Standard Error |t Stat |P-value | |Intercept |-330.675 |116.4802 |-2.83889 |0.009299 | |Total Staff |1.764865 |0.379036 |4.656194 |0.00011 | |Remote |-0.13897 |0.058798 |-2.36347 |0.026932 | a. State the multiple regression equation Standby hours =-330.675 +1.76485*Total Staff -0.13897*Remote b. Interpret the meaning of the slopes b1 and b2, in this problem. ...

Words: 4991 - Pages: 20