Workplace violence has always been a part of healthcare. A few years ago, when I was working as a clerk in the ER, I noticed a patient in the ER doing karate moves. He jumped over the counter, punched through our clock, and pushed toward the emergency room. A Highway Patrol officer pointed his weapon at the patient, and I subdued him with one of the doctors, who then sedated him. In another instance, when I was a hospital security guard, I was attacked by a patient who broke a piece of medical equipment and stabbed me in the arm with it as I tried to restrain her.
Violence is getting worse
While workplace violence in healthcare Nothing new, but it has now reached epidemic proportions.
Nationwide, approximately 70% of people who experience workplace violence resulting in injury work in health care or related fields, according to the U.S. Bureau of Labor Statistics. More than 40% of nurses reported being physically assaulted, and 68% reported being verbally abused. A recent survey by the American College of Emergency Physicians reported that 55 percent of emergency physicians were physically assaulted on the job.
Workplace violence at Scripps Health, where I am President and CEO, increased from 1,314 in FY 2020 to 1,808 in FY 22 (annualized).
An example that bothers me is Mary, a Scripps operations executive who was bitten viciously on her chest and pulled out her hair by a . Mary was traumatized physically and mentally by that incident. She returned to work in another capacity, but ultimately decided to leave the healthcare sector because of the incident. Countless people also left the arena because of the violence.
Why is this happening?
The COVID-19 pandemic has caused significant and widespread emotional distress for a number of reasons, including compliance with lockdown rules, financial hardship, parenting issues, and being unable to see to relatives and other difficulties. To make matters worse, what was supposed to be a public health problem has turned into a political one, and anger has grown in the country. Stress levels build up to the point where it’s easier to trigger the brute force switch. It didn’t stop.
Patients with more sensitive triggers—those with behavioral health challenges, chemical dependence, and homelessness—have always been part of the equation, but their numbers are increasing . Hospitals bear the brunt.
what can we do?
At Scripps, we are taking a number of approaches to try and improve this situation. Depending on the type of healthcare facility you work in and the level of violence, some or all of these approaches may be worthwhile.
We support team members who have been injured in hospital and are struggling. We have done a lot of organizational development work with our staff to try to normalize what they are going through and equip them with the tools they need to successfully deal with an angry public. Part of that is our new de-escalation training, through which we’ve reached thousands of employees. Online video training and tip sheets are also available for employees, and by offering CME credits, we encourage greater participation.
In addition to training, we are focusing on providing the resources needed and enacting procedural changes to make employees feel safer, and ideally, safer.
Across the system, patients with a history of violence are identified with a peace sign on their door, their identification bracelet is purple, and staff are provided with dos and don’ts for working with this patient opportunity to prepare.
We have been focusing on competitive recruitment and retention practices to ensure we have the best security team. I’m not in favor of arming security with guns because the chances of someone else getting a gun are too great and could result in serious injury or death. Instead, we provided our security team with Tasers, which have proven to be a very effective deterrent and de-escalation tool.
At our hospital with the highest number of workplace violence, we are implementing a 24/7 enhanced technology metal detection station at the entrance to the emergency department. We will be closing the lobby entrance overnight; the intercom system allows for a security response and access to the few people who are present at the front door when it is closed. We are improving the safety of elevators entering patient care units.
Many of these improvements are the result of comments we have received from staff, and we continue to solicit comments through our regular town hall meetings and other venues.
But we cannot make all the necessary changes alone.
As a result, we are working with law enforcement to improve treatment procedures for our inmate patients, and we have developed some law enforcement guidelines for handling inmates in medical settings. We have asked patients to take some responsibility, both through messages pleading with them to be kind to healthcare workers, and through facility signage letting them know that we will not tolerate abuse of our staff. At the legislative level, we have been advocating for increased penalties for violence against healthcare workers.
As difficult and frustrating as it may be, we must keep going. We must take steps to improve the safety of those working within our health system. We must continually seek help from governments and others to address the social problems that lie on our doorsteps, making our jobs more dangerous.
A danger to healthcare workers is a danger to all. If we are hurt ourselves, we cannot continue to help the hurt.
Chris Van Gorder, EMT, MPA, is the President and CEO of Scripps Health and a Fellow of the American Academy of Healthcare Administration.