The week between Christmas and New Year’s might be a lull in most workplaces, but not in hospitals. Overcrowding and understaffing are common, and that can have dangerous results. The very people charged with protecting the health of the public at large face an unsafe environment themselves.
Health care workers experienced five times more violence on the job in 2018 compared to the general population, federal statistics show. Covid-19 has only seemed to increase the amount of violence in health care settings, with regular reports of assaults and verbal abuse toward medical staff.
Health care workers experienced five times more violence on the job in 2018 compared to the general population.
In Branson, Missouri, for instance, the assaults on nurses have become so frequent and severe — incidents of violence tripling in the last year — that a local medical center installed panic buttons to alert security personnel when a patient becomes unruly.
In 2019, the Bureau of Labor Statistics reported nearly 21,000 workers in private industry reported some form of violence while on the job; 70 percent were in health care and social assistance positions. Data going back to 1993 shows steady increases in the health sector over time.
In January, the nation's oldest accrediting body in health care, the Joint Commission, will begin mandating that hospitals institute workplace violence programs and reporting systems to maintain their highest standard of approval, which can be crucial to an institution obtaining sponsors and donors.
While the Occupational Safety and Health Administration, or OSHA, provides guidelines for training and policies on de-escalation, the federal government needs to do much more to protect our nation’s health care workers.
Health care staff face patients in pain, patients who use drugs and alcohol, and patients who have untreated mental health conditions, each of which can escalate anger into aggression. Upset family members who feel their sick or injured loved ones are being ignored or treated poorly and the gang members who are frequently found in hospitals in high-crime neighborhoods can pose additional risks.
Thomas A. Smith, president of Healthcare Security Consultants, which works with health care facilities to assess risks and take precautions, noted that issues ranging from people in crisis to appointment wait times can all contribute to patients feeling agitated or hostile.
“In most of the country, ERs have become treatment centers for the mentally ill. They don’t have other options,” he said. “Many states don’t have enough beds, and funding is reduced. It becomes a risky environment for workers who are not trained to deal with those situations.”
The actual amount of violence is likely even worse than the Department of Labor findings suggest. Judy Arnetz, who researches workplace violence in health care settings for Michigan State University, conducted a large-scale study of several hospitals that revealed incidents of violence went grossly underreported, finding that 88 percent were not documented.
She said that health care employees might not report when an elderly person with cognitive issues gets agitated and punches a nurse, or when a person coming out of anesthesia kicks someone, because the assaults were unintentional. “But a staff member was still hurt,” she pointed out.
Further, she noted that many employees said they didn’t report incidents because they didn’t expect anything to change, as supervisors have their hands full and consequences are rare for patient misbehavior.
High turnover of staff, particularly nurses and medical assistants, also affects safety. Hospitals and clinics can’t serve patients well or efficiently if they are constantly replacing mentally checked-out workers who feel their well-being doesn’t matter.
Arnetz’s study provided an action plan for violence reduction with input from employees and supervisors. De-escalation training, increased staffing and physical space were all considered, and Arnetz saw an immediate decline in the frequency of hostile situations after the plans were implemented.
“We found the units that had an intervention plan in place saw a lower rate of violence in just six months,” she reported. “Even years later, everyone had a significantly lower rate of violence-related injuries.”
Like Arnetz, Smith has found that health care staff grossly underreport the amount of aggression they face. Both have heard that workers don’t want to stop to document a situation, even though it keeps administrators from having vital data to address weak spots in staffing needs and other risks.
Smith recommended that staff be allowed to mark on charts when patients have a history of hostility or impatience, even though managers and administrators can object to the so-called labeling. With these patients, having an extra staff member on standby could make a big difference. He also suggested that patients sign an agreement stating they will abide by the rules of the facility or will be referred elsewhere.
“More armed guards are not a solution,” Smith stressed. “We need long-term planning and active monitoring to keep incidents down. A firm policy should be in place that encourages all staff to report incidents as they happen.”
But ultimately, lawmakers need to provide assistance.
In April, the House of Representatives passed the Workplace Violence Prevention for Health Care and Social Service Workers Act. It requires health care and social service sector employers to do some form of workplace violence prevention via policies, training or education. Currently, the bill is stuck in the Senate, but health care workers can’t afford to wait. Congress must pass this measure immediately.
As we search for ways to help health care workers suffering under the load of Covid, safety must be the priority for all staff — from surgeons and nurses to orderlies and receptionists. That will improve their well-being, and ours.