V – Violence in Health Care

Greenwich Hospital

It’s a little known fact, that as a group health care workers experience more non-fatal violence in the workplace than any other industry.  Statistics indicate the highest incidence of violence is against nurses, mental health worker and security staff. These non-fatal assaults include hitting, punching, biting and having things thrown at them, but occasionally can be as devastatingly extreme as shootings and rape.  Non-fatal assaults in health care account for 70% of all violent assaults across all industries.

Now, in my mind hospitals should be really safe place, with hushed halls and people who speak in low, soothing tones and the swishing of crisp uniforms going through the halls.  Unfortunately, that is not the case anymore.  I have experienced it.  I have had things thrown at me by patients and their families (and one time by an Obstetrician – that’s another story).  I have been kicked and bitten. I have had families, patients and the friends of patients’ families swear at me, call me every name in the book and this is not uncommon.  A survey was done, the National Crime Victimization Survey (2005-2009) and over 150,000 nurses interviewed recounted some type of assault.  Those are some staggering statistics.  These statistics don’t include the verbal abuse nurses endure routinely.

All of these statistics, and the increasing reports of violence against health care works raises the question as to why the frustration and the anger. Why are people so confrontational and abusive towards health care workers?  What makes it okay to lash out at the people who are there to help?  It is safe to say that people are more stressed today, feeling helpless against economic woes, and frustrated toward corporations that wield their might and treat the consumers that made them what they are as insignificant ants.

Everyone comes into the hospital already carrying their own baggage and stressors, pile onto that worries about a sick family member, child or perhaps themselves.  Add to that long wait times, difficult and sometime delayed access to care, or denial of care because of insurance issues and you have a walking, talking, emotional caldera ready to explode. And who is there to suffer under the fallout, the people nearest them; the nurses, the doctors, the mental health care workers and anyone else with whom they may come into contact. Nurses and doctor provide direct care, they are in close proximity with the patient, and so they are first to come into the contact with the anger, the desperation or frustration.

Nurses don’t seem to have much recourse in dealing with this abuse.  If it is reported, the Hospital Administration in many cases (not all cases) will try to keep the incident quiet.  It is the patient and the family who are appeased.  If the nurse does report the assault, for most, nothing is done.  In one of the articles I read, the nurse who had been assaulted, she was told by the judge he felt like being clobbered was just part of the job and the assault charges against the perpetrator were dropped.  What the heck?  Maybe being clobbered is ‘part of the job’ for a WWF participant, but not for people who work to help others.

Hospitals have made a half-hearted move to offering violence prevention classes.  These are not mandatory for hospitals to institute.   Other hospitals are encouraging nurses and other personnel to report incidents of assault without fear of reprimand (which to me seems rather puzzling – why should someone be reprimanded for reporting a physical assault while trying to do their job).  But again, the literature indicates the commitment to these types of programs is insipid at best.  Where can changes be made to protect the people who help others?

It needs to start at a really basic level.  We are all consumers of health care, and we can start the ball rolling.  We need to understand the health care field is going through some major changes, and it isn’t changes we are all happy about.  Access to care is even more difficult these days, many people are turning to the Urgent Care clinics and the Emergency Rooms, which means longer wait times and bigger bills.  I have tried twice within the last 6 months to see my Primary Care Provider, both times I was quite ill with fevers, and each time I was told the next appointment was in 2 weeks.  Well by then I would either be dead or better.

Despite all of this, it is not the doctors or the nurses we need to flail at, because they too are in the midst of this maelstrom of shortages, not being able to deliver the care they deem necessary because of the constraining vices applied by the insurance companies.  The nurses and the doctors are all dealing with the same issues as the patients and the families, but from a different perspective.  It isn’t easy for them either.   So clobbering them, kicking them, verbally abusing them is not going to help and will only drive them away from the health care industry altogether, which in turn will lead to more shortages, longer wait times and less access to care. Perhaps everyone should just be a little more patient and know that the health care professionals are there to help, they are not thinking up ways to anger or injure the patients. The doctors, the nurses, the mental health care professionals spent many years in school preparing to help their patients.  Why would they do anything other than that? They work to heal, but that is hard to do in fear.

ADDENDUM:  There is a really good article regarding a study done with Emergency Room nurses and their experiences with violence.  Unfortunately all the sites I went to would only allow me access to the abstract, but here is the reference.

Wolf, L.A., Delao, A.M. and Perhats, C.  Nothing Changes, Nobody Cares: Understanding the Experience of Emergency Nurses Physically or Verbally Assaulted While Providing Care (2013). Journal of Emergency Nursing.

Also, I have found a website created by created by three nurses who are victims of assaults while at work.  Please take a look. STOPHealthcareViolence.org

Thanks to commons.wikimedia.com for the use of photo.

39 replies »

  1. Unfortunately I am not surprised to read about the violence and abuse health care workers have to suffer on a daily basis. Here in the UK we have a similar situation for broadly the same reasons. A & E departments are like war zones on a friday and saturday night, ambulance staff are assaulted while trying to help injured but violent drunks and ward staff are subjected to many kinds of abuse bith physical and verbal. My own experience when I’ve been in hospital has only ever been good. All the staff whether doctors, nurses or ancillary staff have been first class. I cannot understand why people behave so badly and never will. It is totally unacceptable in my view

    • I agree completely. Just seems bad behavior is pervasive in all facets of daily life now. And I am always shocked by it, I guess I haven’t become desensitized at all. And waiting just seems to be part of health care today. It’s nobody’s fault. I know I had a Mom just cuss me out in front of her children for making her wait in a room, where she had to entertain her own children for 35 minutes. And there was nothing I could do about it but apologize. I seem to spend a lot of time apologizing these days. Thanks for the comment!!!!

      • Wow…what you guys have to put up with is crazy!

        That reminds me of LM at the doctor last week–he asked the nurse if he was going to have to “wait an hour to see the doctor, like last time.” I could have died (and this was from his own time-keeping, not me). He got an earful after the nurse left.

      • Those clinic room walls can close in on you after a while. It’s not so bad in the Outpatient arena, although I have had my educational status insulted by some really interesting individuals. I try to let it roll off, but after all this time, I am still waiting for that thick skin my colleagues keep talking about.

      • I don’t know, it’s really kind of deflating and demeaning. I had one lady tell me last week ‘why the f*** did I just drive 2 hours to see a Nurse Practitioner’ she sneered when she said Nurse Practitioner like she had a really awful taste in her mouth. Made me feel real insignificant, like I had wasted her time. Thanks for the empathy – most people don’t get it.

      • Jeez, what an ass. Some people are absolutely clueless. My soon to be sister in law is in school to be an NP–also pediatric, she plans–and she is worried about this sort of thing.

        The NP who looked after BG in the hospital was amazing.

    • Hi my friend!!! I agree. Bad behavior is unacceptable, swearing at nurses and doctors is not going to make anything go faster or more smoothly.

  2. A well-written post enlightening me and I am sure, others, on a sad state of affairs. Not acceptable at all as David reiterates. Stress, fatigue, anger and frustration all lead to lashing out but as you say, people are lashing out at the wrong people; those who are trying to support them. I can’t really imagine being treated that way at work. The worst I have dealt with as a teacher are angry emails and still, these feel sickening at the time.

    • I can imagine the parents of students can be quite draining. I have seen how they behave when simply dropping their children off at school. The thing to me that is most exhausting about being in a hospital situation, is you don’t get any support from the administration – the customer is always right (but not really) – So you feel like you are out there, helpless and without any kind of defense. I have just had to stand there and take it (verbal abuse). Nothing I can do about it.

      • For the most part – No. It is usually a ‘He said, she said’ thing and the patient or patient’s family is usually in the right. But now I work Outpatient these things rarely happen, for which I am quite grateful.

  3. That’s so sad. When I’ve observed nurses in the hospital, I often find they come across as distant and impersonal, like they don’t care, which can be a bit upsetting to someone going through a tough time. But no wonder, when they have to shield themselves emotionally from all the abuse that comes their way (as well as being tired and drained)! It’s a vicious circle, really. I’m sorry your environment can be so unsafe, with such a lack of support! I admire the work you do very much.

    • Oh thank-you for your comment. I’m good to go now, work with great patients and families but I have been in dicey situations, where I thought to myself-Wow, I really need Hazardous Duty pay. The literature though on this this subject, recounts some pretty scary situations. Wrote this piece, because I was helping my son do research for an essay he had to do, and until recently I was not aware of how bad it can be out there.
      PS. I have come across some nurses like the ones you mention in my experiences as a patient, I think they are stretched so thin (Work smarter – not harder edict), which really does not work when you are caring for people, sometimes it is really hard to be personable (but I believe of all the things we have to do without that should be the last to go). I have found though, if you say to the nurse, ‘I sense you are having a rough day’ most of the time it helps (I know that is hard to do when you are in a tough situation as a patient).

      • You’re right, empathy always helps. I try my best to put myself in the other person’s shoes before reacting negatively to things. And I am glad your situation is better now – I hope it gets better for others, too!

  4. This is such an eye-opening post, and while I find it pretty shocking ~ I guess it shouldn’t surprise me. An incredible look inside a profession where health care givers already show pieces of their greatness as humans, and then to also have to put up with this part of their work. Great post ~

    • Thank-you. I found the statistics quite staggering too, I honestly did not know how big a problem this was until I started doing some research (especially in the adult ERs).

      • Staggering is a great word. I suppose in the ERs I think I could see how this is an issue (so much emotion and absolute uncertainty with who/what is going on), but still…truly unbelievable.

      • It really is, and I think a great deal more abuse goes unreported because the victims feel like nothing is going to be done anyway. It is really kind of a hopeless situation, until changes are made.

  5. I my ER this one patient threatened to shoot the nurses. Security was put on alert but he still comes and goes. It feels like the hospital is not taking it seriously. I guess they are waiting for the disaster to take place before they stay on it and mean it. In another hospital in the area a nurse was savagely beaten by a patient – blood splattered on the walls. She was in critical condition. I’m not sure if she made it.

    • That is awful. Honestly I had no idea this problem was so prevalent until I really started digging into the literature. I read one article where two nurses were stabbed in Los Angeles on the same morning, while doing their jobs in different hospitals.

  6. Wow, is something like this common? I didn’t realize. I’ve had horrific nightmare experiences with healthcare workers here, but it would never cross my mind to physically or verbally abuse anyone, even though I feared for my life in their care. However, once the crises (plural?) passed, I did call and complain to their superiors. I can’t get over that so many people would actually hurt or harm another person. It’s criminal, and crimes should be prosecuted.

    • Unfortunately most of the charges never make it to court and if they do it is a misdemeanor. The are trying to pass a bill through to bump it to a felony. I am sorry you had trouble with healthcare workers, you should never ever have to go through that when you are in a situation requiring assistance.

    • Thank-you so much. I had no idea it was such an issue. I helped my son do research for a paper he was doing in this subject and was flabbergasted at the statistics. I guess we go through our nursing career thinking we are the only ones that come across this, but it turns out unfortunately we are not alone in our experiences. Thanks for the reblog!!!!!!!

      • Neither did I. I guess I thought I was the only one that had bumped into some very angry, belligerent people. I suspect most nurses have had at least one experience they just stored away, never really spoken about, or care to think about. I posted a link to the website – Stop the Violence – two nurses that had the motivation to bring it out in the open. Interesting site.

      • I’ve had lots of violent encounters, but I work in psych, AND we’re prepared for it as individuals and an institution. Many facilities seem to pretend it doesn’t exist – it saves them money, they think.

      • That’s what the articles said, for the reason hospitals don’t do more for the victims. But I don’t think they look at the big picture – lost work hours, disability claims, psychological trauma. To tell someone that has been a victim of violence in the work place not to press charges is just horrible, reprehensible in my opinion. Makes the victim feel like they are just another cog in the wheel, a dispensable cog and nothing more. Some of the ER nurses in the articles I read refuse to go back. In one of the comments I received, the author said she was a victim and got out of nursing because of it. That is a real shame.

  7. As to the article you cite: I obtained a copy (go go teaching hospital super powers!). If anybody wants a copy, I can mail it to you. I don’t think it’s legal to send it via interent. Let me know – Greg

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