Harm to healthcare workers: The impact of violence in the workplace

You’ve likely seen at least one story. Nurse held hostage at gunpoint and raped by violent patient, doctor murdered by disgruntled patient or family member, nurse stabbed by patient. The news fills with these stories every day, and yet despite all the efforts over the last few decades to curb these events, they continue to happen.

But what has really been done about this? What protections are in place for healthcare workers, and where are we failing that we could do more? Over the last decade plus, 34 states have enacted some form of protection for healthcare workers, including Connecticut.

Most involve education about how to maneuver a crisis situation, a few have protections for healthcare workers who report threats or acts of violence. The problems lie in the extreme variation of who is protected by these laws and what they actually cover. Some laws only protect emergency department employees, some only cover mental health workers. But the reality is that not all patients who become violent have a history of mental health problems or are in the emergency room. These acts of violence happen in offices, in hospital units, and in parking lots.

In Connecticut, people with disabilities who are deemed to have acted out in violence because of their disability are protected from persecution. This creates a precedent. If someone is experiencing mental health issues and injures a healthcare worker during an acute episode, does that mean they can claim their disorder precipitated this and are therefore protected from consequence? The law isn’t clear on this, but this is the underlying issue in Massachusetts regarding “Elsie’s Law.” Elsie Wilson was a rural emergency department nurse who was stabbed and nearly died from a patient for whom she was caring.

I myself, over my nine-year career as a nurse, have been punched in the face, kicked, spit on, verbally threatened with violence or sexual harm, and I am NOT unique, which is the sad reality for everyone I know in healthcare. Just last month a friend of mine, also a nurse, called the police on a patient who intentionally slammed her wrist on a table because he was angry about his discharge. If you ask any healthcare worker you know what they’ve seen or experienced personally, not one will be able to deny they’ve experienced workplace violence.

Then ask them how many of them have reported this violence to either a supervisor or the police. Statistics show that 50% of all assaults are on healthcare workers, and only 30% are reported. Many times this is because nurses and other healthcare workers are afraid of losing their jobs or worse, their license if they refuse to care for a patient, seen as patient abandonment, or because many of us were trained and licensed before these laws were in place and still don’t realize that we have since gained respect as “people with rights” in the workplace worth protecting, even sometimes over our patient’s needs.

The number of high-profile and serious events that have occurred have gotten the attention of the CDC, the WHO, and the Joint Commission, an organization who accredits hospitals and other healthcare facilities, but the majority of assaults are non-fatal. This by no means invalidates the level of violence that occurs, but despite these organizations recognizing an ongoing issue in healthcare, there is still no federal law that protects healthcare workers. There was legislation introduced in 2018, and re-introduced in January 2019, to Congress to place federal protections for healthcare workers, but as with most legislation, it is taking a long time to gain a foothold for real progress.

Workplace safety is a fundamental right for every working citizen. OSHA oversights include extensive content on how to address violence against healthcare workers with how to report incidents, how to prevent them, and adequate training across disciplines within a healthcare organization. It also requires a commitment that any and all incidents, regardless of level of injury, be taken seriously and addressed promptly with an intervention or action plan to prevent future incidents. Without federal protections for all workers or requirements for prevention training for any and all staff at healthcare sites across the nation, regardless of size or number of employees, this is likely to be an ongoing issue.

Maureen Burns, a registered nurse, lives in Meriden.