Workplace Violence

Employee safety at your health care facility

03.15.2006

From the Massachusetts Nurse Newsletter
March 2006 Edition

    MNA and DA
  Norfolk County D.A.William R. Keating met with the MNA at his office during a Jan. 11 workplace violence program. From left, Evelyn Bain, MNA Health and Safety Division Coordinator; Reggie Redfern, retired police chief, Easthampton; Rosemary O’Brien, chairperson of the MNA’s Workplace Violence Task Force; and Keating.
   

In early January, Reggie Redfern, a retired police chief from Easthampton, called the MNA and asked if he could reprint an article from the April 2005 edition of the Massachusetts Nurse about an emergency room nurse who was assaulted at work. Redfern was interested in it because of his involvement as an educator with hospital security and police departments.

Redfern subsequently invited the MNA to attend a two-day conference that was being hosted by Cambridge Health Alliance and Youville Hospital on Feb. 9 and 10. As part of this conference, Redfern and retired Sgt. Louis Savelli brought participants through a world immersed in gang violence. It was a world that some of us had glimpsed before, but it was also one that we could never fully understand the way these two police instructors did.

The work Redfern and Savelli are doing is about showing what kind of impact this type of violence is having on our society at large. Health care workers may be at risk and placed in vulnerable situations when dealing with some of these offenders.

Learning to recognize potential offenders’ cues and when to notify hospital security was a key element of the training, as this is how police and hospital security can most effectively diffuse or prevent a situation from occurring. Keeping with this theme, Redfern and Savelli submitted the following articles to help MNA members better understand the issue.

Workplace violence and awareness

By Chief Reggie Redfern (Ret.),
President, SRR Traffic Safety Consulting

On Feb. 10, 2006, a nurse at Northwestern Memorial Hospital in Chicago was attacked by a male described as being in his 30s who tried to sexually assault her. The attack took place just before dawn in a public rest room within the hospital. The attacker had been hiding in one of the bathroom stalls and grabbed the nurse before she could break free and flee. Chicago police and hospital security personnel are investigating.

Workplace violence in hospitals and health care facilities is a major concern across the nation for those who are “in the trenches.” Nurses, doctors, clerical staff and security personnel face numerous challenges emanating from people from all walks of life, all levels of psychological well-being and at all times of the day and night. There was a time when hospitals, churches and schools were safe places, “hands-off” when it came to violence, but not any longer.

Clearly, any facility that has numerous rooms, storage places, entrances and exits, and ease of movement by staff and non-staff creates a challenge 24 hours a day. Proper handling of patients who become aggressive, threatening or dangerous requires specialized training to calm the disturbance while at the same time applying the proper force necessary to overcome the encounter. Add to this an individual preoccupied with sexually attacking another individual and it may literally become a fight for one’s life.

In any hospital, it is the nurses and security that fill shifts around the clock. They are the first line of defense for any facility when it comes to violence. Unfortunately, they are also the first ones to be viewed as “collateral damage” when someone is determined to disrupt a health care setting.

An area that needs special attention by medical facility personnel so that they do not fall into the category of collateral damage is where, and when, gang members are treated for wounds related to gang violence. With the influx of gangs and gang-related injuries, these individuals are regularly brought to emergency rooms throughout the country. By their very nature, gang members are accustomed to a violent lifestyle and the inside of a hospital. Even though the professionals there are concerned with the individual’s health and well-being, a hospital can become a gang member’s battle ground.

Simple things in an emergency room such as cutting off a shirt, removing beads and taking off a hat may be viewed as a sign of “disrespect” to an individual’s gang colors. Having members of two rival gangs in the same treatment area may bring about additional injuries to anyone present, including those who are trying to save a stranger’s life.

No place that the public has access to is totally safe. Attacks have happened in maternity wards where two rival gang members’ girlfriends had given birth; in cafeterias; and in admissions areas.

Awareness, through education, is the key to preventing incidents such as these from happening. Awareness of your surroundings applies to the incident in Chicago as well as it does to any hospital in the country. Because hospitals are open 24/7, awareness can save your life even if you are in a public rest room.

Gangs and the workplace

By Sgt. Louis Savelli (Ret.), NYPD
President, Homefront Protective Group

A common misconception held by health care workers, security officers and law enforcement officers has led to a false sense of security. The misconception, simply stated, is that hospitals and health care facilities are neutral territory for gangs and other bad guys. We don’t know where anyone came up with that idea. To the contrary, hospitals, doctor’s offices, clinics and other health care facilities are frequent venues for gang activity. After a long night of drinking, drugging, gang banging and fighting, many gang members and their rivals end up in hospital emergency rooms and many become admitted patients for short or long-term care. Often, once at the ER in an agitated or intoxicated state, violence is seconds away.

What we have seen in 25 years of law enforcement and health care work, is that gang members, drug dealers, drug abusers and just the average everyday criminal needs little or no provocation to attack a doctor, nurse or health care staff member. In one such case, for no apparent reason other than a long wait in the emergency room, one gang member smacked a nurse in the face. On another occasion, a prostitute threatened the lives of everyone in a doctor’s waiting room just because she didn’t like the way others were looking at her.

There are many warning signs (indicators) and cautions relating to potential violence from gangs. Some of the things to look for or to be cautious of within your workplace are:

  • Obvious agitation of patients and /or visitors as they arrive to the ER. This may indicate that they just came from a fight or may be looking for a fight.
  • Mad dogging: A staring down or staring contest between visitors or directed at staff can be a clear indicator of impending violence. Many times, rival gang members arrive in the ER and begin a mad-dogging session that will usually erupt into violence.
  • Gang identifiers can be a great indicator of a gang’s presence and, of course, if there is a gang presence, the potential for violence—even to staff—increases exponentially. Gang identifiers can manifest themselves in the form of colors; clothing of the same designer; a specific symbol; tattoos; or a specific sports team. Gang identifiers can be displayed in items on the person of the gang member (i.e., phonebooks, bandannas).
  • Other indicators can be the refusal to give up a bag or clothing that can be hiding weapons or drugs. Several years ago, at a local hospital in Brooklyn’s Sunset Park neighborhood, an ER patient involved in a car accident would not relinquish his clothing to a nurse. He was later observed passing a bag to a friend (fellow drug gang member). When officers responded, it was discovered that the bag possessed several pounds of marijuana ready for sale and that the person who took possession was armed with a gun. Had a nurse or security officer intervened further, the drug dealers were prepared to kill.
  • Perception of disrespect can be deadly for staff since gang members thrive on wanting respect and need to maintain ‘face’ in every situation. Some gangs cannot accept orders from a female doctor or nurse because it is against their code. Removal of a gang member’s colors by staff can be perceived as a disrespectful act and result in an attack.
  • Weapons are a way of life for gang members and they seldom leave home without a gun, knife or razor blade. The wrong comment or action by a staff member or patient can result in a shooting, stabbing or slashing.

As evident in the most recent statistics, gangs are spreading and their resulting violence is proliferating. Cities, towns and workplaces have become all too common arenas for their macho street mentality. No longer can a blind or naïve eye be turned toward gangs and their violent tendencies. Understanding and awareness can help thwart and avoid violent situations while saving the lives of staff, patients and visitors alike. Training, protocols, and procedures can insure safety measures are followed and violence at the hands of gangs can be greatly minimized.