“Call Security!” is a phrase that is too often yelled across a busy Emergency Room. It's a disruptive moment for any staff nurse, patient or family member who is involved.
Violence in Emergency Departments is a hot topic due to the rising frequency of occurrences nationally. Everyone knows that you don’t touch a cop or any ‘man in uniform.’ Even mouthing off to a cop will get you in trouble. That should never change. As a new mother, I am a believer in instilling a little fear along with manners. I don’t want to have a “punk” for a child. Some people just missed these lessons growing up and everyone from the McDonalds server to nurses are paying for it.
As an ER nurse for most of my career, I have become almost desensitized to the reality that violence in our workplace is becoming more frequent and just as common in the suburban hospitals as those in major cities. The explicatives mother f****w**** or bitch, or f-this and f-that are common language in an Emergency Room. As the nurse this language is directed at, you learn to walk away and control the patient with methods supported by your hospital.
I can remember working the Christmas Eve over-night shift last year and being assigned to take care of the “psych” patients who had complaints from suicidal attempts to true schizophrenia to the classic belligerent drunks. This particular holiday I felt as if I was babysitting the large population of drunks that filled our beds until they “sobered up” or could call family to come pick them up. Many people don’t realize how often “drunks” are “dumped” in an ER rather than taken to the local jail, fined for public intoxication and released in the morning when they ‘sleep off’ the alcohol. The reality is that jails are full and the local Emergency departments get filled with this population.
No judgement is passed on these patients and their actions, but they can make your night miserable. The cursing, screaming, crying, nudity, crudeness, spitting, and swinging at staff just begins to describe the excitement.
Violence in the Emergency Department commonly starts when a patient arrives agitated, often for issues related to drug addiction, alcoholism and psychiatric care. This clientele is becoming more numerous and more violent. Visits to Emergency Departments for drug- and alcohol-related incidents climbed from 1.6 million in 2005 to 2 million in 2008, and the number of those visits resulting in violence increased from 16,277 to 21,406, according to the federal Substance Abuse and Mental Health Services Administration.
The Los Angeles Times reports that hospital workers, particularly in emergency rooms, say assaults including biting, grabbing, spitting, hitting, kicking and chasing happen so often that they consider it part of the job.
Even with de-escalation training, verbal abuse can quickly become physical abuse. Despite a large media campaign in 2009 and development of a Workplace Violence Surveillance Study led by the Emergency Nurses Association (ENA) to collect quarterly data via an online survey from emergency nurses, the 2010 number was grim. According to latest figures from the ENA, 53.4 percent of nurses in an ER reported experiencing verbal abuse and about 13 percent said they had encountered physical violence at work in the previous week. Being grabbed or pulled was the most common physical assault while yelling and swearing were the most common kind of verbal attack, said 89% of nurses surveyed in 2010, a finding that I agree with based on my clinical experiences.
The ENA’s President AnnMarie Papa, RN, the Clinical Director of Emergency Nursing at the Hospital of the University of Pennsylvania and Penn Presbyterian Medical Center, is proactive in demanding a no tolerance stance to protect nurses. "The only thing good I see coming out of this is that we continue to let people know that this is an issue. Public awareness is important because it's the public who is committing the violence," says Papa.
The phrase “a no tolerance stance” always makes me think of the public service announcements that plays between innings at the Phillies games and publicize a no tolerance attitude for foul language and violence. It concludes by Jimmie Rollins saying “You will be ejected!” I wish we could ‘eject’ the violence patients more commonly in the ER.
Direct care providers have been a target of violent acts for many years. Thankfully, government is being more proactive in installing the ENA’s no tolerance policy. As of February 2011, 39 of the 50 U.S. States, either had effective legislation against assault or pending legislation. However, that means 11 states have no laws protecting nurses.
Our region has adapted laws to protect nurses that you should know about. For example, Pennsylvania law states “aggravated assault ... is a felony of the first degree.”
In New Jersey, the law similarly reads, “a person is guilty of aggravated assault if he commits a simple assault upon any person engaged in emergency first-aid or medical services acting in the performance of his duties while in uniform or otherwise clearly identifiable as being engaged in the performance of emergency first-aid or medical services.”
Yet, violent cases nationwide are common. In May 2011, a woman treated at Sanford Hospital in Fargo, N.D. for being a suicide risk, made her first appearance in court on a felony charge of fourth-degree assault for allegedly kicking an emergency room nurse, causing the woman to fall backwards.
Similarly, an Albany N.Y. news station reported that a nurse said she was violently assaulted inside Tryon Residential Center by an unruly 15-year-old. The nurse suffered stab wounds, cuts to her head and a chipped tooth.
In early September 2011, a nurse suffered a broken jaw when he was punched by a patient at Erie County Medical Center’s emergency psychiatric unit. This attack followed an incident the week before in which a different patient violently kicked another nurse.
In 2010, The Washington Post reported 151 hospitals have resorted to using stun guns to control violent patients.
As always, I want to hear your personal experiences. What is the clientele like at your hospital? Is the clientele the biggest issue affecting the rise in violence or is it something else? Are you receiving training to be prepared to deal with violent and abusive patients? How are you being kept safe? Let’s keep this initiative to end violence a priority. I will dedicate a few blog to this topic and I need to hear from you.