Massachusetts Nurse :: April 2005

Emergency room violence growing concern for nurses

By Jill Harmacinski
Staff writer

BEVERLY—Charlene Richardson has been bitten, kicked and punched by patients during 13 years as an emergency room nurse.

She knew the job could get rough. But one night in March 2003, Richardson said, the abuse went too far.

A drunken, 50-year-old Salem man was brought to Beverly Hospital for treatment. As Richardson helped him get ready to leave, he lunged at her, grabbed her crotch and tore through her hospital scrubs. He refused to let go.

For 90 seconds "that felt like forever," she said, the two struggled, wrestling into the hall, where another nurse, three security guards, two emergency room patients and a visitor came to help. Once security guards handcuffed the man, Richardson grabbed the phone and called police.

"I was shocked and upset and angry," she said. "But I was OK."

Her story is not unique. Nationally, crimes against nurses and health care workers are as common as assaults on police and correctional officers. One study completed this year indicates hospital assaults often go unreported.

Richardson and Essex County District Attorney Jonathan Blodgett spoke at a recent seminar sponsored by the Massachusetts Nurses Association about emergency room violence. More than 70 people, most of them nurses, attended the event at Angelica's restaurant in Middleton. When asked for a show of hands, almost half of the nurses at the seminar indicated they had been assaulted at some point during their careers.

Blodgett, the son of a retired Salem Hospital nurse, said that's unacceptable.

"Some might say that's just part of the job," Blodgett said. "But no one should ever have to tolerate such horrible behavior."

In 2002, more than 4,000 hospital employees were assaulted while working in emergency settings across the state, according to the Bureau of Labor Statistics. Area hospitals would not provide numbers on how many nurses were assaulted locally in recent years.

Police records show patrolmen were called to Beverly and Salem hospitals on more than 380 occasions in the first eight months of this year, though the calls were for a variety of reasons—from helping to handle drunk and unruly patients, to standing by while a Medflight helicopter landed.

Since 2001, police have been called to Beverly Hospital's emergency room 536 times, again for a variety of reasons.

Part of the job?

Police are accustomed to getting dispatched to Beverly Hospital's emergency room, said Beverly Lt. William Terry. Generally, the calls are about disruptive patients, "someone who is out of control and being disorderly. Most of the time, it's because they are drunk," Terry said.

Salem Lt. Conrad Prosniewski said police officers in that city are often sent up to the hospital to control drunken, unruly people. In most instances, these individuals are taken into police custody and charged with disturbing the peace or disorderly conduct.

"A lot of people who are under the influence of a lot of different things often show up on the hospital's doorstep," Prosniewski said.

Patients have assaulted emergency room workers. "It happens every once in a while," Prosniewski said.

At Salem Hospital, a nurse working in a mental health unit was once pushed down a flight of stairs by a patient, according to Fran O'Connell, president of the 560-member nurses union.

Working a Friday or Saturday night shift in the emergency room can be crazy, O'Connell said, depending on the volume of patients and types of emergencies, which may include stabbing and domestic violence victims or victims of drug overdoses.

"The emergency room is always a concern," she said. "You never know who's coming through those doors and how stable they are."

Other nurses said they've endured slaps, kicks and punches from patients.

"At what point do people have to have consequences for their actions ... consequences for their own unacceptable behavior?" asked Susan Vickory, a registered nurse who lives in Lynn.

In 2000, Vickory was working for a Greater Boston veterans hospital when she witnessed a patient slam a fellow nurse repeatedly against a metal door. An "embarrassed" hospital administrator later tried to ignore the assaults, she said.

"She wanted to pretend nothing ever happened," Vickory said of the administrator. "It was that whole blame-the-victim mentality."

After this assault, Vickory joined a group of nurses who pushed for criminal prosecution of violent patients. Today, Vickory, a nurse for 36 years, works with an MNA task force that studies hospital violence and supports victims.

"I've collected more stories than you can imagine," she said.

Image problems?

Nursing advocates say hospital administrators don't like to talk about workplace violence because it ruins the "hotel-like image" hospitals want to project.

"The mindset is, 'This is a hotel and the client—the patient—is always right,'" said Evelyn Bain, who studies workplace violence for the nurses association.

Last year Beverly Hospital tried to have security officers alter their uniforms, switching from a police-style shirt and pants to professional-looking suit jackets and ties. In response, campus security officers formed a union and successfully fought the change.

"They wanted to turn us into valets and customer-service people, not security officers," said David Arsenault, president of the hospital's security union. "They wanted patients to see someone in a nice suit jacket walking around ready to help them."

In Richardson's case, she said, hospital management refused to talk to her about her assault, even after her attacker was convicted of indecent assault and battery and sentenced to 18 months in jail. She is still a nurse at Beverly Hospital, but Richardson is bitter about the way she says her employer treated her.

Richardson said she spoke publicly about her assault because she wants to improve safety for nurses.

Despite repeated requests, Beverly Hospital officials would not comment on Richardson's assault or on the general issue of workplace violence. Instead, the hospital released a prepared two-sentence statement praising its emergency room staff.

Silence on the subject of hospital violence is common. A study conducted by the U.S. Department of Justice this year showed that many assaults go unreported.

The study showed a "persistent perception within the health care industry that these assaults are part of the job. Under-reporting may reflect a lack of institutional reporting policies, employee beliefs that reporting will not benefit them or employee fears that employers may deem assaults the result of employee negligence or poor job performance," according to the federal study.

Salem Hospital has a workplace violence response plan in place, according to spokesman Arthur Bowes. He said any employee assaulted there would be offered immediate medical attention and followup counseling.

"We'd provide as much support to the employee as possible," Bowes said.

Learning to help

Evelyn Bain, the nurses association occupational health and safety specialist, said support after an assault can be the key to helping nurses cope.

Even if an assault causes no serious physical injury, she said, it can be "psychologically traumatic."

And too many nurses, she said, complain that after a violent episode, the hospital administration turned its back on the victim.

"No one said they were sorry. No one told them they didn't deserve this," she said. "That's a very comforting and very important thing someone can do."

Bain has interviewed nurses who have been sexually assaulted, held hostage, intimidated by patients' family members and even saw fellow hospital workers get shot. Nurses who have been attacked often prefer to talk anonymously. Hospital administrators, in large part, are also very hesitant to address the issue, she said.
Bain traces the problem in part to poor staffing levels for both nurses and security guards at hospitals. At the same time, she said, "society has become more violent. There are more drugs around, and handguns are more available."

But denial is not helping anyone, she said. "Hospitals today are convinced they are hotels," she said. "They have a hotel focus. And no one tells you when someone is assaulted in a hotel."

Charlene Richardson said the assault has made her a more cautious nurse. At the same time, the experience has shaped her future. She now wants to pursue a second career in legal nursing and hopes to become a safety advocate for others in her profession.

"We are on the front lines without guns, bulletproof vests and Mace," she said. "We are out there trying to help. When did it become OK to hit or beat us?"

Reprinted with permission of The Salem News