Violence in the workplace has always been part of healthcare. When I worked as a clerk in the emergency room years ago, I noticed a patient in the ED making karate moves. He jumped over the counter, put his fist through our time clock, then pushed his way farther into the ED. A highway patrolman drew his weapon on the patient, one of the doctors and I restrained him, and then the doctor gave him a shot to sedate him. In another instance, when I was a hospital security officer, I was attacked by a patient who broke a piece of medical equipment and stabbed me in the arm with it while I was trying to restrain her.
The Violence Is Getting Worse
Although workplace violence in healthcare is nothing new, it’s now reaching epidemic proportions.
Nationwide, approximately 70% of those who experienced workplace violence leading to injury were in healthcare or related fields, according to the Bureau of Labor Statistics. More than 40% of nurses reported being physically assaulted, and 68% reported verbal abuse. A recent survey by the American College of Emergency Physicians reports that 55% of emergency physicians have been physically assaulted at work.
Workplace incidents of violence at Scripps Health, where I serve as president and CEO, went from 1,314 in FY20 to 1,808 (annualized) in FY22.
One example that haunts me is that of Mary, a Scripps operations supervisor who was attacked by a patient who threw a chair at her, viciously bit her on the chest, and pulled out her hair. Mary was physically and mentally traumatized by that event. She came back to work in another capacity, but she ultimately decided to leave healthcare because of the incident. Countless others have also left the field because of violent incidents.
Why Is This Happening?
The COVID-19 pandemic caused significant and widespread emotional distress for many reasons, including complying with the lockdown regulations, financial difficulties, issues with childcare, and other hardships such not being able to see loved ones. To make matters worse, what should have been a public health issue became a political issue and the amount of anger in this country increased. The level of stress built to the point where the violence switch was more easily triggered. And it hasn’t let up.
Patients with even more sensitive triggers — those suffering from behavioral health challenges, chemical dependency, and homelessness — have always been part of the equation, but their numbers are increasing. And hospitals are bearing the brunt of it.
What Can We Do?
At Scripps, we’re taking several approaches to try to improve the situation. Depending on the type of health facility you work in and the level of violence, some or all of these approaches may be worth instituting.
We have support for team members who have been hurt on the job and are struggling. We conduct a lot of organizational development work with our people to try to normalize what they are going through, and equip them with the tools they need to be successful in dealing with an angrier public. Part of this is our new de-escalation training, through which we’ve reached thousands of employees. There is also a video training and tip sheet available online to employees, and by offering CME credits, we encourage even more participation.
Beyond training, we are focused on providing needed resources and making procedural changes to make staff feel safer and — ideally — be safer.
Throughout the system, patients with a history of violence are identified on their door with a peace sign, and their identification bracelets are purple, providing staff an opportunity to prepare for their work with that patient.
We’ve been focused on competitive hiring and retention practices to ensure we have the best security team possible. I don’t support arming security with guns because there is too great a chance someone else can get hold of the gun and serious injuries or death could result. Instead, we’ve provided our security team with tasers, which have proven to be an extremely effective deterrent and de-escalation tool.
At our hospital with the highest number of workplace violence incidents, we are implementing a round-the-clock enhanced technology metal detection station at the emergency department entrance. We are closing the lobby entrances overnight; an intercom system allows security to respond and enable access to those few people who present to the front entrance when it is closed. And we are increasing the security of elevator access to patient care units.
Many of these improvements are results of the input we’ve received from staff, which we continue to solicit through regular town hall meetings and other venues.
But we can’t make all the needed changes alone.
Accordingly, we are working with law enforcement to improve our procedures for treating a patient who is a prisoner, and we have also developed some proposed guidelines for law enforcement on handling a prisoner in a medical setting. We have asked patients to take some responsibility, both through messaging imploring them to be kind to healthcare workers and through facility signage letting them know abuse of our employees will not be tolerated. On the legislative level, we’ve been advocating for increased penalties for violence against healthcare workers.
As hard and frustrating as some of this is, we must keep trying. We must put in place measures to improve the safety of those who work within our health systems. And we must keep asking for the help we need from the government and others to address societal issues that are being laid at our doorsteps, making our jobs so much more dangerous.
Danger to healthcare workers is a danger to all. We can’t continue to help the hurting if we are being hurt ourselves.
Chris Van Gorder, EMT, MPA, is president and CEO of Scripps Health and a fellow of the American College of Healthcare Executives.