Right now, in an emergency department somewhere in America, there’s a patient yelling at a nurse, spitting at her, punching her in the face or even wielding a metal Mayo stand, threatening the very care provider who is trying to help.
It’s a scenario that is becoming increasingly more common at my hospital – though sometimes it’s a doctor, social worker or ED tech, not the nurse, who bears the brunt of the patient’s wrath.
Incidents of serious workplace violence like these are four times more common in healthcare settings, according to Occupational Health and Safety Administration (OSHA) figures. And the problem is getting worse, especially in EDs, where it’s a byproduct of the rise of behavioral health issues, substance-use disorders, the dwindling of public and financial resources for high-risk populations, and even a shift in nation’s tenor that’s redefined what’s acceptable.
In October, the American College of Emergency Physicians (ACEP), released the results of its workplace-violence survey, which included responses from 3,500 emergency physicians nationwide: Close to 50 percent of emergency physicians told surveyors that they’d been physically assaulted while at work. Additionally, 60 percent ED docs revealed those assaults occurred within the past year.
To their credit, government agencies and legislators are sounding the alarm. In 2018, CAL/OSHA, California’s Division of Occupational Safety and Health, proposed a rule that would require covered employers to develop a workplace-violence prevention plan.
In November, House Democrats followed suit, and proposed legislation with similar calls to action. And now, Congressman Joe Courtney (D-Conn) has recently introduced a bill that would direct OSHA to “issue a standard requiring health care and social service employers to write and implement a workplace violence prevention plan to prevent and protect employees from violent incidents in the workplace.”
For healthcare organizations like ours, in Oakland, these developments are long overdue. The first step in making our Emergency Departments safer for patients and healthcare workers is to understand the magnitude of the problem. But while the legislation is laudable, it’s insufficient: There’s limited information on how violations would be enforced, or how initiatives aimed to curb violence — such as purchasing metal detectors — would be funded. And we definitely need funding!
Healthcare organizations cannot reasonably foot the bill for every single security expenditure. Think of it this way: If this were the airline industry and the government didn’t help to subsidize the cost of increased security at airports, the price of airline travel would be astronomical, and the industry as we know it would be crippled.
So where does that leave us, while we wait to see how forthcoming laws will be funded or enforced? For me and many of my peers, the answer is taking power into our own hands by employing smarter and more creative solutions to protect our healthcare workers.
For example, we can do a better job of listening to staff on the front lines. If a staff member feels unsafe in the department, we need to give them a voice to express their concerns. For instance, a multidiscipline workplace violence task force can be established to brainstorm solutions centered on patient and staff safety. For the staff, knowing there is a format for creating solutions is a great first step.
A hospital task force like this one can ask itself the tough questions that lead to change: Are we screening for weapons? Should we start needing screening visitors who may have a propensity towards violence? How do we signal the staff about patients who have had a history of violence in the past? Are there other opportunities for improvement? More effort can be made to train providers on how to properly de-escalate hostile situations or communicate with patients in non-triggering ways.
Additionally, we can do more to strengthen collaboration and information sharing. Our ED uses a platform that can collect information among 80 percent of the hospitals in our community inside a shared network and dispatches a concise patient summary to the point of care. This information can be shared instantly when a known patient enters any of the EDs on the shared network. This way, providers are alerted in advance if patient is a high utilizer of hospitals or has a history of hostile or violent behavior. Simply knowing that someone has a propensity to be violent can help clinicians prepare themselves.
This capability came in handy about six months ago, when, in the wake of a stabbing death of a young woman on our public transportation network (BART), someone else was stabbed with a screwdriver on another train. Police apprehended the female perpetrator and put her on a psych 5150 hold. But she wasn’t charged with assault and was instead dropped off at our hospital, without police at the bedside. Having a system that can alert providers that a patient has a history of violence allows the staff to bulk up security and take necessary safety precautions.
But even more important, especially now, is speaking up. We must let our member associations like ACEP, agencies like OSHA, and Congress know that we need help. The more we communicate our concerns, through letters, phone calls, and thoughtful commentary, the more likely we are to have our voices heard by lawmakers, the media and the public.
It is not enough to pass legislation; we also need funding that allows frontline healthcare providers to put tools and staff in place to provide safe healthcare environment. Workplace violence is a national epidemic, and we must do everything we can to make sure our societal safety nets can be a source of treatment of these issues, not a larger part of the problem.