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Description In 2002, the World Health Organization declared workplace violence to be a global epidemic with a negative impact on the retention of health personnel and delivery of health care.1 The violence also results in significant economic, personal, and professional costs.1-3 In the United States, the prevalence of workplace violence in the health care industry is 4 times higher than in other private industries.4 Ease of public access, crowding, long wait times, presence of weapons, and other factors make the emergency department a highly vulnerable area,5-9 especially where triage occurs.10,11 Emergency nurses and other ED staff are at serious occupational risk of experiencing workplace violence, including verbal and physical assaults.5-7 For these reasons, workplace violence has been recognized in many states as a violent crime.12 Yet, at the time of this publication, only about 30 states have adopted laws that make it a felony to assault a registered nurse.13 Other ongoing legislative initiatives include the introduction of the “HR 1309: 1 Both definitions demonstrate that workplace violence manifests in myriad ways as emotional or verbal abuse, coercive or threatening behavior, or physical and sexual assault,4 and can involve consumers, providers, and organizations.15 The patient population (eg, active substance use), along with work schedule (ie, night shift) experience level, and younger age of the health care provider, are consistent risk factors for WPV.8-10,16-18 Acts of workplace violence can cause physical and/or psychological harm to emergency nurses leading to job dissatisfaction, emotional exhaustion, burnout, secondary trauma stress, posttraumatic stress disorder, absenteeism, and intention to leave the job or the nursing profession,4,9,16-25 all of which have potential impacts on patient care due to nurses' decreased productivity, organizational commitment, and engagement.9,18,25-27 Workplace violence is seen as a contributing driver of poor nurse retention and recruitment, further exacerbating the nursing shortage and its costly consequences for health care organizations and their patients.4,18,20,25,27-29 Despite continued education, legislation, and research to increase awareness and understanding of the issue, emergency nurses are reluctant to report incidents of WPV because they believe it is not violence if they did not sustain an injury, reporting can be laborious and futile, patients are not seen as responsible because of their age or illness, and WPV is an expected part of the job.23,28 Different types of violence exist independently, overlap, and enable each other. Background To increase program effectiveness, it is recommended that a workplace violence prevention program include training; formal incident reporting procedures; administrative, environmental, and consumer risk assessment; physical design; and security components to address all types of violence.3,4,6,28,31-38 When establishing a WPV prevention program, WPV experts recommend health care organizations adopt a multi-faceted, collaborative, interdisciplinary approach that includes a variety of stakeholders, such as health care administrators, ED managers, clinicians and staff, law enforcement and security personnel, and specialty providers such as mental health practitioners.28-30,32,33,35,38 Given the crucial focus on prevention of workplace violence by patients, visitors, coworkers, and intimate partners, coordination and advocacy among employees, health care employers, managers, and nursing leadership is considered necessary for effective implementation of educational, administrative, behavioral, legislative, and engineering approaches necessary for mitigating workplace violence.3,4,33-35,37,38 Emergency nurses, with their high risk for experiencing WPV, can serve an integral role in all aspects of violence prevention, planning, monitoring, and reporting.

APRNs have existed for more than 50 years and are established members of emergency care teams throughout the United States (US) and in many countries worldwide.2-6 Nearly a decade ago, the Institute of Medicine identified APRNs as necessary for the future of health care delivery in the US.7,8 Since then emergency departments (EDs) in the US and abroad have become increasingly overcrowded, in part due to their status as a health care safety net for those who cannot access a primary care provider.9,10 It is estimated that EDs provide more than 47% of all hospital-associated health care in the US.9 As a result, there is currently a substantial mismatch between the need for emergency services and the available resources to provide that care.10 APRNs have been identified as particularly important for bridging this gap in both urban and rural settings.11-14 The regulatory landscape for APRNs in the US continues to evolve, and APRNs who work in the emergency care setting face a few unique licensing and certification challenges. The Consensus Model’s licensing paradigm could create barriers to APRN practice in the emergency care setting because it would require APRNs who treat the full population of the emergency care setting to complete three courses of graduate study and to obtain and maintain three certifications (eg, Family Nurse Practitioner, Adult-Gerontological Acute Care Nurse Practitioner, and Pediatric Acute Care Nurse Practitioner).1,17 CNSs, for whom there are fewer courses of study than for NPs, would be required to have and maintain 2 licenses (Adult-Gerontology CNS and Pediatric CNS), but they would be restricted to either primary or acute care.18ENA Position The following are the positions of the Emergency Nurses Association (ENA): APRNs are established members of the emergency care team and are critical to the future of quality health care across the US and worldwide. Background The emergency care setting is unique when compared to most other practice settings in that its patient population consists of all ages and all combinations of medical history and chief complaint, rather than a narrow subset of them, as is the case with most other specialties (eg, pediatric oncology, adult cardiology, etc).19 Although some APRNs only treat a subset of the patients in the emergency care setting, for example, only pediatric patients or only adults with urgent or chronic needs, other APRNs are called upon to treat all patients and conditions, from nonemergent, episodic chronic care to acute, complex, life-threatening traumatic and medical conditions.2,20-23 APRNs are licensed and regulated by state law, and reciprocity across state lines is determined by each state. The Consensus Model’s proposal that US states license APRNs as “primary care” or “acute care” APRNs, along with its stipulation that an APRN only be allowed to expand his or her scope of practice by completing another graduate program of study, stands in contrast to how APRNs are currently licensed and regulated today.24-29 In nearly all states, APRNs are licensed at the role level, and the scope of practice is determined not only by formal education and national certification but by clinical experience as well.30 Degree-granting programs are designed to prepare APRNs for entry-level competency, and postgraduate training after one’s formal course of education confers clinical expertise.6,29,31-34 It is, therefore, no surprise that APRNs who are currently providing safe and effective primary and acute care across the country are certified as family nurse practitioners (FNPs), acute care nurse practitioners (ACNPs), Adult NPs, Pediatric NPs, Adult-Gerontological NPs, Adult-Gerontological CNSs, and Pediatric CNSs, among others.15,21,35,36 The Consensus Model has been a powerful force for raising the quality of APRN education and training in the US and has successfully championed full practice authority for APRNs in all states.15 Regardless of the outcome of these and future discussions over whether and how to implement the Consensus Model’s definitions of primary care, acute care, and scope of practice, APRNs will continue their long tradition of providing safe, effective care in the emergency care setting, and ENA will remain committed to interprofessional collaboration and advocacy on their behalf.Resources Advanced Practice Registered Nursing Consensus Work Group, The National Council of State Boards of Nursing APRN Advisory Committee.