A qualitative meta-synthesis of emergency department staff experiences of violence and aggression

•ED staff experienced violence and aggression as an inevitable part of the job.•Staff appraisals of violent behaviour influenced their tolerance towards patients.•Occupying role of victim when caring for patients created “wounds”.•Consistent organisational response to violence and aggression is imperative. Patient and visitor violence or aggression against healthcare workers in the Emergency Department (ED) is a significant issue worldwide. This review synthesises existing qualitative studies exploring the first-hand experiences of staff working in the ED to provide insight into preventing this issue. A meta-ethnographic approach was used to review papers. Four concepts were identified: ‘The inevitability of violence and aggression’; ‘Staff judgments about why they face violence and aggression’; ‘Managing in isolation’; and ‘Wounded heroes’. Staff resigned themselves to the inevitability of violence and aggression, doing this due to a perceived lack of support from the organisation. Staff made judgements about the reasons for violent incidents which impacted on how they coped and subsequently tolerated the aggressor. Staff often felt isolated when managing violence and aggression. Key recommendations included: Staff training in understanding violence and aggression and clinical supervision. Violence and aggression in the ED can often be an overwhelming yet inevitable experience for staff. A strong organisational commitment to reducing violence and aggression is imperative.