Increasingly, nurses facing violence on the job

Amber Knierim, 20, wanted to be a nurse when she grew up, her MySpace profile says.

Instead, she's in jail for beating one up - a Temple University Hospital emergency-room nurse who was attacked when she tried to keep Knierim from grabbing needles from an empty examination room on June 21.

"She picked the wrong person to mess with," said Joan Meissler, 53, of Northeast Philadelphia, now working on light duty until she heals from the beating that wrecked her finances and left her in permanent pain, angry, and disheartened.

On Wednesday, 180 nurses and other health-care workers will convene in a ballroom at the Philadelphia Airport Hilton for a booked-to-capacity session on workplace violence for health-care workers, sponsored by the Pennsylvania Association of Staff Nurses and Allied Professionals, a union.

"It's a national problem," said union president Patricia Eakin, adding that she did not want to single out Temple. Eakin, a nurse, an emergency room colleague of Meissler's, was on duty the day Meissler was attacked.

Meissler wants Temple to erect a billboard in the neighborhood with two pictures on it - hers and Knierim's. "Temple needs to send a message to the community," said Meissler: " 'Lay a hand on one of our staff members and you'll spend the next five years in jail.' "

The U.S. Department of Labor Tuesday released 2009 statistics that ranked paramedics and nursing aides as being the workers most likely to miss work because of injuries. While most of the injuries come from overexertion caused by lifting, there are 38 incidents of violent assaults per 10,000 nurses aides.

The only occupations that face a greater likelihood for assault on the job are police and correctional officers.

Between 8 percent and 13 percent of emergency-room nurses are victims of physical violence every week, according to a survey released in September by the Emergency Nurses Association, a professional group in Illinois.

Why is the work so dangerous? Nurses and experts point to a number of factors.

First is proximity. "We as nurses are hands on - to touch and be touched," said nurse Christine Pontus, occupational health and safety director for the Massachusetts Nurses Association and one of the national leaders addressing the issue. "The boundaries are not as clear."

Pressed to reduce expenses, hospitals have been cutting back on nursing and security staff at a time when the number of uninsured using emergency rooms is growing. Those same budget constraints are limiting options for treatment and care of the mentally ill and addicted.

Unemployment and the economy has exacerbated stress among the general population, with that tension manifesting itself in hospitals, where frustrated patients and their families waiting longer for treatment tend to lash out at staff members.

Most of the violence is by patients or their families against nurses and other staff, according to the Emergency Nurses' survey.

Many hospitals don't have complete safety plans that include adequate staffing, consistent and frequent use of security wands and metal detectors, training in violence de-escalation, safety committees with worker representation, emergency-drill sessions, and analysis of unsafe conditions.

Meanwhile, there is some sense that nurses and others should accept violence as part of the job, Pontus said. She is the lead speaker at Wednesday's event. District attorneys from Philadelphia and Delaware County are scheduled to attend.

"A lot of times the victims are traumatized and afraid to speak," especially if the organizational culture doesn't support them, Pontus said.

"There is a stigma of victimization, embarrassment, fear of being blamed for provoking the assault, fear of job loss," she said. "The patients abuse us and we abuse each other. We're all post-traumatic out there."

Two weeks ago, a California nurse working in the intake area of the Contra Costa County jail died when a new inmate faked a seizure. When the nurse bent over him to help, he grabbed a lamp and smashed her over the head. She died on Oct. 28, three days later.

A psychiatric technician at Napa State Hospital in California was strangled on Oct. 23 by a patient, one of a majority committed there for crimes related to their mental illnesses. Local news reports described a chaotic facility where security had become lax.

Those are the headline cases, but the reality is more like what emergency room nurse Sean Poole, 33, experienced at Crozer-Chester Medical Center on Friday night.

Poole and a fellow nurse were trying to get blood work from an intoxicated and delusional patient when the patient bit his coworker, drawing blood. "It was pretty bad," said Poole, who lives in the tiny borough of Parkside in Delaware County.

Poole has been punched and bitten, but has never pressed charges. "It's hard to get anything to stick," he said. "If they are intoxicated, it won't hold up because they were intoxicated. If they are mentally ill, it won't hold up because they aren't in their right mind."

In the spring of 2009, Crozer-Chester nurse Aimuel Elder walked into a patient's room to find family members fighting and using pepper spray. He got sprayed as well.

"I tried to settle things down," he said. "The police were called and so were our own security. The police arrived before our security."

Another staffer said that panic buttons on their badges don't work.

"Violence in health care is a national trend and is on the rise," a Crozer-Chester spokeswoman wrote in an e-mail. Kathy Scullin said the hospital, located in Upland, just outside the city of Chester, has revamped safety procedures. Many employees attended an on-site safety seminar on Oct. 14, with additional training on strategies for de-escalating emotionally charged events available to key staff.

Nurse Elder says society is partly to blame for problems in the hospital. "Some of it is the big picture, the deterioration of the level of civility in our society in general," Elder said.

It's particularly tough on the male nurses, he said, who, like many men in civilian life, would tend to fight back if attacked. "You can't defend yourself like you would on the street," he said. "If anyone is going to take the hit, it's going to be you."

It's the same, day in and day out, at Temple, nurses said, where hospital administrators promised a safety committee after Meissler was assaulted. But the committee never met, they said.

Responding by e-mail, a Temple spokeswoman said the hospital addresses safety issues through its "Environment of Care" committee. "While safety in the workplace can never be guaranteed, Temple University Hospital takes all reasonable measures to provide a safe working environment for its staff," Rebecca Harmon wrote.

Last month, Collicia "CC" Solomon, 33, of Trevose, was in the middle of her emergency-room shift at Temple when a patient who was admitted for a dog bite threatened suicide. He pulled out a knife and then threw it at her.

"I never knew he had a knife," she said. "I was shocked."

ER nurse Kitan Ellerson, 28, of Northeast Philadelphia, said she was punched in the face in March 2009. "The supervisors didn't do anything," she said. Ellerson pressed charges.

"It makes you frightened," she said. "I just had a baby and the whole time I was pregnant, I was afraid of being hit."

On June 21, Meissler's day in the Temple emergency room began calmly enough, at 8:25 a.m., usually a slow time. That's probably why there were fewer people around who could come to her aid.

Knierim came in with a problem requiring her to be transferred to another hospital - a plan she didn't like, Meissler said. That's when Knierim rushed into an isolated examining room and began to grab needles, threatening to hurt herself with them.

Meissler followed her to stop her, she said. Knierim grabbed Meissler by her ponytail, slammed her against the wall, threw her across the room, punched her and then pushed her over and began kneeing her. Another psychiatric patient heard the commotion and joined in beating Meissler.

A member of the housekeeping staff heard the noise and intervened. On Oct. 15, after pleading guilty to aggravated assault, Knierim was sentenced to six months to 23 months in prison, according to court documents.

On Tuesday, Meissler went to yet another physical-therapy session.

"It's been a nightmare," she said.