Nurses face an epidemic of violence in hospitals

An Alabama ER nurse, Tammy Mathews, was working a late-night shift when an intoxicated and medicated patient grabbed her around the neck, choked her until she couldn’t breathe and spit in her face.  She survived, MSNBC reported, but found that her employer wanted her to drop assault charges against her attacker. Then when she refused, she said officials fired her.  

Accounts like these compel me to keep talking about violence directed at nurses. 

Nurse Erin Riley poses for a photo in Lakewood, Ohio. A victim of on-the-job violence, Riley is not alone, according to an examination by The Associated Press. Violence against nurses and other health professionals is rising as an influx of drug addicts, alcohol abusers and psychiatric patients are forced into hospital emergency departments by cuts to state treatment programs.

While violent fatalities in the workplace are on the decline, healthcare workers remain at high risk of violent injuries.  The Emergency Nurses Association (ENA) reports that “workplace violence (not exclusive to nursing) accounts for approximately 900 deaths and 1.7 million non-fatal assaults each year in the United States.”  In 2004, half of non-fatal injuries to workers from assaults and violent acts occurred in healthcare settings, the Bureau of Labor Statistics (BLS) reported.

Among health care practitioners in 2009, 46% of all nonfatal assaults and violent acts requiring days away from work were committed against registered nurses. The patient's room is the most dangerous place for a nurse, with 82% of physical assaults occurring there.  WOW !

The numbers convey urgency, but what is being done? In February 2011, the ENA launched the ENA Workplace Violence Toolkit to assist hospitals in managing violent patients in the emergency department.  Similarly, the Occupational Safety and Health Administration (OSHA) recently issued a directive to provide policies for workplaces where violence is identified as a hazard.  Inspections are done to bring attention to violent trends, based on previous reported incidents, and an institution’s response to violence is evaluated, and citations are issued accordingly.  The goal is to have facilities establish workplace violence prevention programs that are enforced.

In healthcare facilities, OSHA also suggests enclosing nurses’ stations, installing deep service counters or bullet-resistant, shatter-proof glass, providing employee “safe rooms” for use during emergencies, and ensuring that all patient rooms have two exits.  OSHA names many other preventative suggestions but each facility, based on its location, demographic and history of incidents, is responsible for creating its own plan for safety. 

At my hospital, we have a seclusion room for patients who are violent on their arrival in the ER. We also have locks on all doors to limit access, and a 24-hour security presence in the department. But more aggressive safety measures have often been discussed at our staff meetings. 

For example, our patient care rooms are currently separated by curtains, and lack a physical barrier if a patient encounter escalates.  I have seen patients, jump through the curtains and swing from the curtains in a rage of fury and attempted elopement (an unannounced exit from the ER before being officially discharged).  Our local police will respond for immediate backup if we call.

Other measures, such as strict visitor policies, comfortable waiting rooms that minimize stress, security escorts to employee cars, and teaching workers not to carry keys, pens or other items that can be used as weapons, cannot be overlooked.

But despite all the violence prevention programs, nurses are hesitant to report assault, the ENA’s report found. Sixty-six percent of nurses indicated they did not formally report physical violence and 86 percent did not file a formal report when verbally assaulted, although they often informally told another staff member.  

Surprisingly, eight percent of those who experienced physical violence and 16.9 percent of those who were verballly abused did not notify anyone.  Worse yet, the ENA reports, “in almost half (46.7 percent) of the cases of physical violence, no action was taken against the perpetrator.  In nearly three-quarters (71.8 percent) of cases, nurses received no response from the hospital about the assault.”

Is safe patient care a thing of the past?  Are nurses taught to accept or ignore some forms of violence as an occupational hazard?  Do we honestly report every time a patient spits on us or make a derogatory comment?  

Should a previously violent patient be free to walk into the ER on another date as a patient or visitor?  How is your nursing unit secured? 

With new laws governing many hospitals in many states, who is responsible to keep nurses safe?  Does it continue to fall on the hospitals or employer or do local police need to be more involved in handling complaints?  Should our first and last names be on our ID badges? Are security cameras used to help hold the perpetrator accountable?  Keep the discussion going by posting your thoughts.