Assault on Healthcare Workers

Our healthcare workers in this country are assaulted on a regular basis. The people who are saving our lives and managing the sick are being hit, kicked, scratched, bitten and spat at, as well as threatened and harassed. Even worse, the violence in our hospital emergency departments is escalating. What is even more disturbing is that assault in this line of work is considered the cultural norm. The violence is thought of as  “part of the job” (https://www.sciencedirect.com/science/article/pii/S009917671300216X).

According to The Journal of Emergency Nursing  (May 2014) 80% of the nursing workforce have been attacked and a recent publication in October 2018’s Emergency Physicians Monthly reported 47% of emergency room doctors have been physically assaulted. Of those assaulted, 70% say that although the hospital administration or hospital security did respond to the incident, only 3 percent of those cases resulted in pressing charges
(https://facilityexecutive.com/2018/10/violence-in-emergency-departments-on-the-rise/).

What are the likely reasons for the increased assaults on our healthcare workers?
(http://epmonthly.com/article/violence-ed-reaches-crisis-point/)

1. Reduction in provisions for mental health care in the U.S., along with the closing of mental institutions
2. Supreme Court ruling (1976) mandates the constitutional right to medical care for prisoners
3. Growing number of gangs committing violent acts
4. Increased access to guns and other weapons (legal and illegal) https://www.templehealth.org/News/Dr.AmyGoldbergAppearsonCNNtoDiscussGunViolenceandThisIsOurLane
5. Hospital security personnel are not necessarily effectively trained and many are unarmed. Hospitals are also focusing on more welcoming approaches for patients by introducing hotel-like services. Although this strategy creates a less stressful environment for consumers, it’s critical that these measures do not compromise security
6. The Occupational Safety and Health Administration (OSHA) issues guidelines for violence-prevention programs, but there is no federal statute requiring hospitals to adopt them (https://www.scientificamerican.com/article/epidemic-of-violence-against-health-care-workers-plagues-hospitals/)
7. Emergency rooms are vulnerable since they have open access to the public 24/7
8. Hospital administrators want to avoid bad publicity (and litigation) when violent acts occur in their hospitals

           
What can we do about reducing this violence?

1. Fix the underreporting of violent acts: With underreporting and a long-time acceptance of assault being the cultural norm, there is simply not enough known about what is effective prevention. Therefore, we need to change the process. Several states have passed laws making it a felony to assault a health-care worker, but only a few have included provisions for violence-prevention training and incident reporting. Hospitals are generally left to monitor themselves. The recent exception is California (2016, State of California Department of Industrial Relations Labor Code, Section 6401.8). Under this legislation hospitals are unable to take on punitive or retaliatory actions against employees who seek assistance and intervention when they are victims of violence. Hospitals must also document and retain incident reports when hospital employees or other healthcare workers experience these violent acts (http://epmonthly.com/article/violence-ed-reaches-crisis-point/).
   
2. Research: The National Institute of Occupational Safety and Health (NIOSH)
   
3. has only recently begun researching violence prevention for healthcare workers.
4. Evaluate preventative measures: Which of the following measures are effective? Security guards, cameras, security for parking lots, metal detectors, and increasing visitor screening inside hospitals, especially in emergency departments. Some hospitals in Baltimore, Philadelphia, Los Angeles and others are experimenting with utilizing former gang members as consultants. The rationale is that gang members will more likely cooperate with their peers, rather than law enforcement (http://epmonthly.com/article/violence-ed-reaches-crisis-point/).
   
5. Our society must recognize the need to change the cultural norm. The assault by a patient is simply “not part of the job” of a healthcare worker. We recognize this with the service of our police officers, and the judicial system seeks severe punitive measures. We should have the same regard for the public service of our healthcare workers. But oddly enough, there is indifference by police, prosecutors, judges and hospital administrations when it comes to healthcare workers being assaulted. As a result, the problem is compounded because healthcare workers tend not to report assaults. Even with underreporting, one-third of the workers compensation cases are linked to patient-inflicted injuries (https://www.scientificamerican.com/article/epidemic-of-violence-against-health-care-workers-plagues-hospitals/).
   

           
The United States is not alone in dealing with this subject. An international coalition was formed to address violence in the healthcare field on a global level; it is called Safeguarding Health in Conflict Coalition (https://www.intrahealth.org/vital/10-global-health-issues-watch-2018).  This violence against healthcare workers is not only at a crisis point in this country, it is considered an epidemic.
           
Reports, presentations, conversations and reviewing incident reports about hospital violence may or may not have the strongest impact on the subject. Perhaps having hospital administrators spend a Saturday night in the Emergency Department will have the most influence in providing invaluable insight to the problem.