“How often has your partner physically hurt, insulted, threatened with harm or screamed at you?" This four-item inventory, called "HITS" for short, is used to screen patients for domestic violence in primary care and hospital settings all over the world. In reflecting on my work as a bedside nurse at a community hospital, I often wonder how many times my patients have hurt, insulted, threatened with harm or screamed at me.The answer is once a week at best and multiple times per day at worst. And I can say that my threshold for this pain is much higher than when I first started, so more minor affronts probably slip through the cracks of my overworked and exhausted brain at the end of days of being on my feet for 13 hours.
According to the Bureau of Labor Statistics (BLS), 69 percent of all workplace violence injuries occurred in health care settings in 2017. (Workplace violence against nurses in particular is not a statistic tracked by BLS or the Occupational Safety and Health Administration.) My guess is that this is grossly underestimated; nurses are often hesitant to report violent incidents because they don’t want to be perceived as weak, don’t have time to, or simply don’t want to think about whatever awful thing happened.When I was faced with reporting an incident involving a colleague, the person in human resources tasked with my case shook my hand at the end of our conversation and then asked me “Oh, was that appropriate touch?" It is no wonder we are having difficulty retaining nurses if this is the response we receive when reporting concerns about our safety.
I vividly remember a time I reported violence I experienced from a known verbally abusive patient on my unit. My colleagues’ response was to ask if she had come at me physically. Well, no, she did not physically attack me, but she did scream at me and use some choice profanity to show her displeasure with me as a person and professional shortly after walking into her room. This, apparently, should not have been enough to make me feel unsafe.
Unfortunately, in a setting where I have also had the dubious privilege of having been slapped, grabbed and sexually harassed by various patients, I can’t say I’m surprised at the lack of response to my feeling unsafe because somebody raised their voice at me. If I were in any other work setting, the things people say and do to me on a regular basis would be unacceptable. But I am a nurse, and I am here to serve. And so, I am also sometimes a punching bag (literal or figurative) when something doesn’t go the way somebody (doctor, nurse or patient) would have liked.
Let me be clear: I love being a nurse. I love holding hands in difficult times and empowering people with knowledge about their health so they can take care of themselves. I love lending a compassionate ear to the people who feel unheard. These are the reasons I became a nurse. I was warned about the violence when I was in nursing school, but I couldn’t understand how it could be true if my job is to just partner with my patient in the pursuit of health. And yet, here we are.
Solutions have been proposed, though there is little to no oversight of preventive or reactive measures at the federal or state level. Evidence-based strategies promoted by the World Health Organization include:
- Improved security systems at hospitals, including visitor check-in and metal detectors;
- Designing staffing patterns so that patients are seen and treated quickly and, therefore, have less time to escalate;
- Providing security escorts to parking garages at night;
- And training staff on crisis de-escalation (though I think it is very important to note that de-escalation training is not enough as a standalone intervention).
Legislative efforts like H.R. 1309 — Workplace Violence Prevention for Health Care and Social Service Workers Act — makes enforceable the “Guidelines for Preventing Workplace Violence for Healthcare and Social Workers" published by OSHA in 2015. But advocacy and lobbying are needed to move this legislation forward.
Nurses are so often taken for granted as "just" the people assisting the real doctors in their work. But nursing is actually an incredibly difficult and taxi
We also need more people studying this area to determine root causes and successful interventions. Some of the most recent reports I found were from 2010 and 2013; we need to be monitoring workplace violence against nurses more closely if there is any hope of making a strong case for broad change.
This Nurses’ Week, I call on all the nurses, family and friends of nurses, patients and their friends and family, and anybody who believes in the right to be free from fear of violence in the workplace — we need to expect and demand better. I believe in a world where I can go in to work and expect to be treated with respect, or be supported by my management in the event I am mistreated. It is possible, but we need some help in making it a reality.
Jenna Mermer (email@example.com) is a bedside nurse, researcher, clinical faculty and advocacy leader for the Graduate Nursing Student Association.