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Violence Against Healthcare Workers: A Rising Epidemic

Wallace Stephens
As National Nurses' week comes to a close, more attention needs to be brought to increasing rates of violence against employees in the field of healthcare.
Studies show violence against healthcare employees is more common that most people realilze, and advocacy groups say it's time for policymakers to act on this growing but underreported problem. While 75% of nearly 25,000 workplace assaults occur annually in healthcare settings, only 30% of nurses and 26% of emergency department physicians have reported incidents of violence.1 Those unfamiliar with daily events in healthcare institutions may be shocked to learn that violent altercations are so common that most employees in the field consider them to be simply part of the job.

“Workplace violence against nurses has been going on for decades,” said Michelle Mahon, RN, nursing practice representative for National Nurses United, in an interview with The American Journal of Managed Care® (AJMC®). “A physician heard a nurse being verbally abused by a patient. She walked up to the nurse, put her hand on her shoulder, and asked her if she was OK. The nurse shrugged it off and said that is happens all the time.”

The World Health Organization (WHO) defines workplace violence as, “Incidents where staff are abused, threatened, or assaulted in circumstances related to their work, including commuting to and from work, involving an explicit or implicit challenge to their safety, well-being, or health.”2 WHO considers both physical and psychological harm, including attacks, verbal abuse, bullying, and both sexual and racial harassment, to be workplace violence.2

According to the American College of Emergency Physicians (ACEP), nearly 7 out of 10 emergency physicians believe that emergency department violence is increasing.3 About 80% of these physicians acknowledged that these events have also taken a toll on patients. Over 50% said that patients have been physically harmed. Also, 47% of physicians have said that they’d personally been physically assaulted at work.

The government has taken initiatives to help protect employees in the healthcare field, but advocacy groups have stressed that more meaningful changes are needed. In March, ACEP sent a letter of support for the Workplace Violence Prevention for Health Care and Social Service Workers Act, which asked Congress to consider how emergency departments (EDs) are staffed to ensure that the main provisions of the legislation could be appropriately implemented.3 Near the beginning of April 2019, the Nevada Assembly’s Committee on Commerce and Labor passed a violence prevention bill that would make employers more accountable for the safety of their employees, according to a statement

In an interview with AJMC®, Leigh Vinocur MD, national spokesperson for ACEP, said more attention has been brought to the issue. “We’re bringing this up again because we want people to take notice. There are some bills in Congress about assaulting emergency medical services or healthcare workers. Maybe there needs to be some of that muscle behind it and people need to understand,” she said. 

Types of Workplace Violence

According to a study in the New England Journal of Medicine, there are 4 types of violence that can occur in the workplace.5 The first type is by perpetrators who have no association with the workplace or employee. In the second type, the assailant is a customer or a patient of the workplace or employee. A third type is when the attacker is a current or former employee of the workplace. The fourth type occurs when the perpetrator has a personal relationship with the employee but not with the workplace.

The second type of violence, usually committed by patient, their families, or their friends, is most prevalent against healthcare workers. However, acts of violence also occur between staff members. “I was previously assaulted by a physician,” Mahon mentioned.

Identifying the Causes

A hospital setting creates extreme levels or stress for patients, their families and friends, and employees of the institution. Fear and illness are major contributors of agitation and aggression from patients. While there are many causes act of violence, dire, emotional circumstances an addition to an overly stressful environmental are main contributors. “It makes sense because the healthcare setting and the ED specifically is a very emotionally volatile experience for people. Patients are at their worst, they’re feeling horrible, they’re ill, they’re frightened and vulnerable. Their family members are also frightened and stressed out, and people lash out. We see psychiatric issues because of lack of behavioral health, gang violence,and gun violence." Mahon said.

“It’s not always a criminal element that’s lashing out. These are frightened and scared sick people, frightened family members that are screaming,” Vinocur mentioned.

Previous measures taken by employers to reduce acts of violence have also been criticized by employees. “Safety interventions that hospitals have taken are failing. Acts of violence that occur are brought up the executive level daily, but that does nothing to prevent workplace violence. It’s a response not a prevention measure,” Mahon stressed.

“The violence that’s occurring is coming from sick people that are not in their right mind the majority of the time. It is not our patients. Many people are taking the approach of criminalizing our patients. It does not prevent violence to charge patients with a felony.” Mahon said. “It could be you. You can get your wisdom teeth pulled and be out of your head from that anesthesia drug and not in a good decision-making capacity. You could be confused, not understand what’s happening, and assault your nurse.”

Major design flaws in the current healthcare system have also been blamed for creating negative care settings. “Healthcare is not focused on wellness. The system creates a situation where there is so much stress, where people can’t get preventive care, where they’re worried about whether or not they’re going to have to file bankruptcy because their wife is sick and in bed, getting a surgery that they need. People suffer with food insecurity. There are no resources to take care of their family member or their loved one or themselves. This type of stress is leading to violence, and it all comes together in that hospital room. The system is broken. Our healthcare system has warped priorities.”

Frequency of Verbal and Physical Attacks

Whether the abuse suffered by healthcare employees may be verbal or physical, every single day employees in the healthcare field are assaulted in the United States.

In an interview with AJMC®, Schipp Ames, vice president of Communications, Education and Member Services for the South Carolina Hospital Association noted the alarming reports of gun violence that occurred in South Carolina hospitals in April 2019. “Within 48 hours we had 2 hospital shootings in South Carolina. Something like that happens once and everybody’s antenna goes up. Something happens like that twice in that quick of a timeframe and people start to get very scared. To see that happen 2 times on back-to-back days like that when we’ve never had a hospital shooting, as far as I’m aware, in our history in 1 of our hospitals, it’s pretty hard to comprehend.”

Ames addressed the frequency of violent acts in healthcare settings. “I’ve been asked the question, ‘how often does this happen?’ and I think I shocked the reporter from South Carolina who asked. I said, 'This happens every day whether its physical or verbal assault. It just so happens that this time the gun was a weapon, but in the past it’s been a towel rack that was ripped off the wall and used to beat a nurse.' These were very deadly and very dangerous incidents that involved guns, so they got more attention, but I think a lot of folks don’t realize how much doctors and nurses jeopardize their own safety every day when they make that vow to go and serve patients,” Ames said.

Addressing the frequency of violent incidents, Vinocur said, “I would say that you can’t go through a shift without being sworn at or spit on. If you consider verbal abuse, it’s probably daily. Eighty percent of emergency room doctors have at some point been involved in workplace violence.

"If you look at labor and statistics after police and things like that, healthcare workers are on top of the list, from years back, being known as a dangerous profession. It isn’t just the ER, it’s all of healthcare. We put up with it but it’s a tragedy that we, as a nation, have to look at and assess," Vinocur said.

“It’s very prevalent, it’s a very big problem, It’s really common. I was also held at gunpoint in my workplace. The inpatient room, then the psychiatric unit, and the emergency department, in that order, is where most instances of violence occur,” Mahon pointed out.



 
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