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When patients turn violent, front-line workers become targets | COMMENTARY

Charles Hartelius, shown on April 4, 2012, was working as a medical tech at the Virginia Beach General Hospital emergency department in 2009 when a man head-butted him and fell against him, causing Hartelius to break his ankle. Emergency department personnel are at increased risk of assault, and some organizations and hospitals are trying to take measures to reduce that risk.
Charles Hartelius, shown on April 4, 2012, was working as a medical tech at the Virginia Beach General Hospital emergency department in 2009 when a man head-butted him and fell against him, causing Hartelius to break his ankle. Emergency department personnel are at increased risk of assault, and some organizations and hospitals are trying to take measures to reduce that risk. (L. Todd Spencer)

He had my ponytail tightly curled around his hands and my neck yanked back as he yelled and spit profanities inches from my face. What started as an argument over a urine sample turned into the scariest shift of my career.

A medical technician hit the silent panic button at the end of the hall, but before the security guards arrived, the emergency department (ED) charge nurse ran from the nurses’ station to diffuse the situation and put the 6-foot, 280-pound patient in a headlock. I was able to slip from his grip and, eventually, security ran in and restrained the drunken, opioid-seeking patient.

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It was 2015, five years into my nursing career, and it was certainly not the first time I had been verbally attacked or threatened by a patient, but it was the first time it had gotten physical. In tears and on my knees, I could only think of how lucky I was. I knew too many ED colleagues who experienced worse. Most had required X-rays, stitches, surgery or physical and mental therapy.

According to the 2015 Permanente Journal’s study of workplace violence, ED patients often become violent due to “pain, stress, lack of privacy, and long wait times.” With fear, worry, alcohol and drug abuse, or mental disorders also present, the ED easily becomes a turbulent and unpredictable environment. Violence against health care workers is not new, but a 2020 report by The Lancet shows that the uncertainty and anxiety of COVID-19 has increased the cruelty of attacks toward front-line workers.

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A nurse in Oklahoma was physically attacked on her way to work, accused of exposing the community to COVID-19. In a Nebraska hospital, a COVID-19 positive patient spat on and punched a nurse in the face when she asked him to put on a mask. Extended wait times due to COVID-19 influx drove an agitated patient in a Kansas City ED to hit a nurse, suffering a concussion; it took three staff members to stop the attack. A patient in a Chicago ED, upset that his girlfriend could not visit him due to COVID-19 restrictions, walked out and returned the next day wielding a handgun and seeking revenge on “people who had wronged him.”

The U.S. Bureau of Labor Statistics 2018 data shows, “health care workers are five times more likely to be injured by workplace violence than any other private-sector industry.” And since 2011, labor department data shows a 60% increase in the rate of attacks on health care workers. These statistics are shocking and unacceptable.

Hospital executives, stakeholders and policymakers must take action to protect front-line workers. Prevention is key. Local law enforcement personnel should be mandated in hospital EDs, especially in high-risk EDs and on night shifts and weekends.

As an ED travel nurse, I have worked in hospitals in South Carolina, Florida, Maryland and Virginia, but only one had a dedicated on-duty police officer stationed around the clock. That officer would make rounds, accompany nurses into rooms of unruly patients, and also act as crowd control when tensions were high in the packed waiting room. I felt safe there; I could focus on my patients there.

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A three-year internal research study by Intermountain Health Care comparing two Utah EDs found a direct correlation between a decrease in dangerous incidents and a law enforcement presence. In the Chicago ED where the patient returned with a gun, that hospital was fortunate enough to have dedicated police officers who were alerted and able to wrestle the gun from the enraged man. As this kind of violence becomes commonplace, forcing health care workers to do an already overwhelming job without trained, professional protection shows a disregard for the well-being of the workers and their patients.

I absolutely loved the adrenaline, critical thinking, patient centeredness, and pride that came with being an ED nurse, but as the abuses continued, I knew I had to prioritize and protect myself and my family. I eventually left bedside nursing and began doing utilization management for an insurance company. Hospitals, already dealing with nursing shortages, cannot afford to lose more bedside nurses.

From the local hospital up to the regulatory level, we must prioritize working relationships with law enforcement personnel to protect and serve the selfless people who have devoted their lives to saving lives.

Seychelles Zack (sczack82@gmail.com) is registered nurse of 11 years who is currently obtaining a master’s degree in health care quality improvement and patient safety through the Johns Hopkins Bloomberg School of Public Health.

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