Who has the most dangerous job in America? YOU DO!
Workplace violence against healthcare workers is rampant. Almost 75% of the workplace assaults between 2011 and 2013 happened in healthcare settings. Workplace violence for healthcare workers is a much bigger problem that the general public or healthcare providers know. It is the most violent industry outside law enforcement in the US.
The American College of Emergency Physicians’ survey reported that more than 75% of ED physicians experienced at least one incident of workplace violence per year. Emergency nurses reported almost the same for physical or verbal assault. Not surprisingly, ED residents reported feeling safe at work “occasionally”, “seldom” or “never”. (Schnapp, et al.)
The emergency room is predisposed to violence because it is the entry place for many patients. In addition the contribution of increasing general violence in the public sector seems to have spilled over to the healthcare setting. Other factors such as gangs, long wait times, drugs and alcohol, mental illness, overcrowding, and family dysfunction are major contributors.
There are other emotionally charged areas of the hospital which also are grounds for violence against caregivers. Women’s healthcare, including labor and delivery, ICU, neonatal or pediatric ICU and other areas exterior such as parking lots. The emotional issues surrounding pregnancy, new babies, parenting and estranged parents lend themselves to disruption, disagreement, and violence. Home care carries its own type of workplace violence and unsafe conditions. Home conditions and neighborhoods can expose the caregiver to many safety issues. Nothing upsets me more than to send a caregiver into a home where one or more residents are drinking alcohol or using drugs.
There has been an increase in hospital security and the number of hospital guards and now, more and more hospital guards are carrying weapons. And there are good reasons to incorporate weapons into the environment. I was fascinated a year ago when a patient, a college student, was admitted to a local hospital for treatment of a possible bipolar disorder. He arrived driving an increased speed and wrecked several cars while trying to park in the lot. That was early in the morning and several hours later he was laying on the floor in his room, shot by the hospital security. The New York Times reported it under the title When the Hospital Fires the Bullet. It is a legendary story https://www.nytimes.com/2016/02/14/us/hospital-guns-mental-health.html?mcubz=0
I am familiar with many of the famous stories of hospital violence and have experienced having violent incidents within the facility I worked but I was not prepared for the number of events that have been recorded. Data released in 2015 by the U.S. bureau of Labor and Statistics revealed 19 homicides in 2015, 16 committed intentionally by gun violence. This is a 46% increase over 2014. Brown University reported in a study there were 241 incidents of hospital shootings from 2000 to 2015.
The potential impact of violence is significant both for the victim and the witness to the event. There is the direct psychological trauma of shock, injury and in some cases death, but it also triggers and sets in motion emotions which can be long lasting. These emotional factors affect patient care. Initial emotions include rage, shock, frustration, humiliation, and depression. But other affects may be increased absenteeism, burnout, decreased productivity and fear for safety. It may even prompt a new crop of concealed weapons and credentialed carriers. There are hidden costs as well. Counseling, medical treatment of the victims, worker’s compensation claims, workforce turnover, and low morale can be greatly increased. It also damages the facility reputation and can involve the facility in litigation, especially if no policies or precautions are in place.
One of the keys to preparation for the unlikely but foreseeable event is training. New workshops for de-escalating tensions with patients and families and providing escape for co-workers is best provided when preparation has been done. Our response time and the correct response depend upon identifying risk factors, recognizing the potential, and preparing the methods to combat the hazards. After all, we never expect the shooter on our doorsteps or the driver that purposefully enters the crowd.
