How America Can Curb the Epidemic of Violence Against Health Care Workers

Yves here. I had no idea that health care staffers often face physical violence, outside psych wards, rehab centers, and prisons. Admittedly the opening anecdote is in one of those settings but the examples go way beyond that.

What a disheartening revelation. And of course, another example of how workplace safety protections, in terms of both employer vigilance and government oversight, are missing in action.

By Tom Conway, the international president of the United Steelworkers Union (USW). Produced by the Independent Media Institute

The patient intended to commit suicide and knew the worker making his bed at Essentia Health-St. Mary’s Medical Center in Duluth, Minnesota, stood in the way.

So he crept up behind the caregiver, grabbed the cord to the call bell and began choking her with it.

Only chance saved her, recalled Tuan Vu, a longtime hospital worker who was on duty in another part of the facility that day, noting the woman’s colleagues rushed to the rescue after the struggle inadvertently activated the call bell.

The U.S. House just passed a bipartisan bill, the Workplace Violence Prevention for Health Care and Social Service Workers Act, to curtail the rising epidemic of assaults on doctors, nurses, certified nursing assistants, case managers and others on the front lines of care.

The legislation, now before the Senate, requires hospitals, clinics, medical office buildings and other facilities to develop violence prevention plans that cover the unique needs of each workplace.

For example, Vu said, a plan requiring that only specially trained behavioral health workers care for suicidal patients would have been one possible way to avert the near-strangulation of his coworker a few years ago. She was assigned to the patient’s room that day even though she wasn’t a mental health specialist.

The Occupational Safety and Health Administration (OSHA) would enforce this violence prevention act and intervene if workers experience retaliation for reporting safety lapses.

“Having this type of legislation would put our safety at the forefront,” explained Vu, a behavioral health technician at Essentia and unit president of United Steelworkers (USW) Local 9460, which represents thousands of workers at more than a dozen northern Minnesota medical facilities. “It’s not something people should be desensitized to.”

“I’m a big guy. I’m not so worried about myself,” said Vu, who’s had racial epithets hurled at him and endured bites, kicks, punches and inappropriate touches over the years. “But I worry about some of my coworkers.”

Health care professionals are five times more likely to encounter violence on the job than other Americans. The crisis has festered for years. Workers face assaults from patients with substance abuse, dementia or cognitive issues, and they’re attacked by patients’ stressed-out family members.

The COVID-19 pandemic made a horrific situation worse. Even as they grappled with staffing shortages and infection-control protocols, workers experienced a spike in assaults from patients and others upset with mask requirements, restrictions on visitors and financial pressures stemming from the coronavirus.

No one is safe. When a patient attacks a health care worker, the struggle can spill into hallways, nearby treatment rooms or parking lots, putting other patients and visitors at risk.

At the urging of the USW and other unions representing caregivers, the House initially passed the violence prevention bill in 2019. USW members and retirees alone collected 80,000 signatures demanding enactment of the legislation.

But the Republicans then in control of the Senate refused to consider the measure. Now, as injuries continue to mount, it’s more critical than ever to get the bill through the Senate.

Right now, OSHA recommends health care facilities adopt violence prevention plans. But the agency doesn’t require them to do so. Many medical facilities pinch pennies on security and look the other way when workers experience violence on the job.

“Something needs to change,” insisted Jessica Johns, a senior technician at Cleveland Clinic Akron General in Ohio who estimated she’s been assaulted 100 times in the past 10 years.

“I’ve been hit. I’ve been scratched. I’ve been spit on. I’ve been bitten. I’ve got dents in my legs from people kicking me,” said Johns, whose role as a “floater” requires her to work in whatever part of the hospital needs her that day. “I just can’t believe the violence happens as often as it does.”

A few weeks ago, Johns faced one of her biggest scares yet. A patient grabbed her by the hair and pulled her down onto the bed. She thrashed furiously to get away and injured a knee while kicking against the bed frame.

But she felt even worse when a patient recently scratched a colleague and left a permanent injury. “Now, she has a scar on her face,” said Johns, who represents hospital workers as a member of the USW Local 1014L executive board.

Instead of going the extra mile for safety, employers often expect health care workers to accept violence as a part of the job. They trivialize incidents or try to portray them as the staff members’ fault.

That’s reprehensible, especially when so many attacks can be predicted and avoided. The violence prevention bill requires medical facilities and social service agencies to identify safety weaknesses and take a proactive approach.

For example, enclosing nurses’ stations, installing panic buttons and using heavy, hard-to-move furniture are all commonsense measures affording greater protection. Johns, lightly stabbed with a butter knife on one occasion, wonders why any facility still serves meals with metal silverware.

Assigning behavioral health specialists to care for suicidal or aggressive patients is one idea for reducing assaults. Providing a basic level of mental health training to all of a facility’s workers, Johns said, is another safeguard.

Workers also would like to see facilities install more metal detectors, hire sufficient numbers of security guards and maintain staff ratios that ensure all patients receive proper attention. And employers need to show they have workers’ backs when assaults occur.

Vu said he and his colleagues have run out of patience with employers willing to let them return home bruised and bloodied at the end of their shifts.

Facilities need to implement violence prevention plans with all due speed, he said, and front-line workers have earned a role in formulating them.

“We’re the ones that are out here,” Vu said.

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  1. Juneau

    Thank you for posting this. Some in healthcare would like to be able to press charges against these patients while hospitals strongly discourage it. The issue is subject to debate with mentally ill patients but otherwise it seems reasonable. I know people who have been assaulted on the job and none took legal action. Most of them nurses and nursing aides. Better protections, support from admins, training, metal detectors and adequate security staff could make a big difference.

  2. DitchDoctah

    Yep, I have had to “retreat” to or stage a block away in our Amberlamps many times, because some lunatic had a gun on scene. Then, we’d wait until or scene was “secure” and we were given the nod by the city.

    Funny thing is as my veteran colleague and mentor always said, ” ‘scene secured’ just means there are more guys with guns on scene”. Never been truer. Five person stab scene, triaging victims, the perpetrator was pretending to have an asthma attack and she could have easily “shanked” me as they say in the colloquial.

    Have a whole ‘nother bag of stories on the hospital side of things the most notable including withdrawing opiate addicts, meth-addled super humans, and paranoid junkies. See a theme? def live in a failed state in a failed union of states. America’s penis, specifically.

    All because I wanted to “help” people and a morbid curiosity. Boy, was I dumb. I am about to hang up my hat. I am tired of all my colleagues being dead in the eyes, because they have to work an ungodly amount of hours because BLS darkly represents not only the level of care EMT-Bs can provide, but the amount of bread they bring home to their families.My medic pay ain’t much better-just shy of 40k. I am tired of being bitter and it spilling over to the innocent. I can’t turn it off around my family, either. Oh, and there is the helplessness knowing that if you fix this human now, you do not have the power to fix the socioeconomic conditions that led to this pathology–they will just get sicker.

    Better get out now as if I stay around too long there is a statistically huge chance of developing a crippling drug addiction or suck-starting a pistol.

    I think I will try a new career as an electrician.

  3. jackiebass63

    Visit an emergency ward after dark and you may be surprised what you see.It doesn’t even have to be on a weekend.It amazed me at the number of weird looking and acting people I saw when accompanying my wife to the emergency room. You have homeless, mentally ill, and people on drugs. Often they aren’t accompanied by a law enforcement officer. It doesn’t surprise me. that often violence happens against workers.

  4. David in Santa Cruz

    I’ve seen the inside of both American hospitals and American jails. Not much difference between the two. I’ve made it a goal to avoid either…

  5. Mason

    I’m about two weeks out from finishing EMT-B and one of the classes I wanted to take at the same time was Krav Maga. Since folks were huffing in each other’s face sparring, I opted to wait for a vaccine.

    At the end of my first Intern shift, I went into the emergency ward with my two Paramedic proctors. We are waiting in the hallway with a stretcher when this pretty tall black guy started to talk to a nurse in an angry and upset manor. His voice pretty serious.

    “If you don’t let me out of here, I’ma gonna kill you.” Everyone’s attention gathered pretty quickly.

    The nurse and my paramedic buddy trying to de-escalate, saying “No one is keeping you here”, but he keeps threatening the nurse and anyone trying to talk to him. I’m standing like six feet away. Paramedic buddy tries to get ahead and cover the nurse, he’s wearing his stab/bullet plates. Were all lowering our hands trying to get this guy to calm down.

    It took a couple minutes for security to show up and direct him away. He has a skull deformity, disabled at birth. The guy made threats before but are always empty. So yeah, a good preview of things to see on the job. I’m thinking part time and I have the money for some extra training including Krav Maga.

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