They don't assume that violence doesn't happen at their hospital because it's small or in a nice neighborhood. They use resources, like ones from the ENA, to combat and refuse to tolerate violence. They also teach their nurses to recognize signs of potential trouble; Brecher says high-risk people tend to be "intoxicated, frustrated, and may have waited a long time to be seen."
If nothing else, the fact that nurses consider leaving—and in some cases do leave—a job because of violence should be impetus enough for hospital leadership to take the problem seriously. Brecher says it costs about $65,000 to replace a nurse.
"From the nurse leader's perspective, this is a huge loss," she says. "It's an incredible amount of money going out the door."