News & Events

Warning: Nurses experience violence in this emergency department

From the Massachusetts Nurse Newsletter
October 2010 Edition

By Chris Pontus, MS, RN, COHN-S
Associate Director, Health & Safety

It was toward the end of her shift when Brenda Tate’s patient in Room 19 rang his call button. She remembers pulling back the patient’s curtain. “I could just hear ‘Ugh,’” Tate said. Her patient lunged at her and stabbed her three times with a knife. “I’m still having nightmares,” said Tate. She was working in the intensive care unit of Sky Ridge Medical Center in February when she was stabbed by a patient who also happened to be a well-known doctor in the Denver area.

Grady Michael Holder, 53, was charged with attempted firstdegree murder and second-degree assault with a deadly weapon in the attack. He had been admitted to Sky Ridge and transferred to the intensive care unit to be treated for alcohol addiction.

Why were patients allowed to have knives and clubs in the ED? We don’t know. We do know that dangerous people have been regularly admitted to our EDs since the first specialized trauma care center in the world was opened in 1911 at the University of Louisville Hospital in Kentucky. Tragically, 99 years later many hospitals have still not recognized the significant value of their nursing staffs and have not proactively implemented procedures that adequately protect them from grave injury.

Prevent the Violence: An Act Requiring Health Care Employers to Develop and Implement Programs to Prevent Workplace Violence (S.988) has been filed by Rep. Michael Costello (D-Amesbury) and Sen. James Timilty (D-Walpole). This bill would require health care employers to perform an annual risk assessment and, based on those findings, develop and implement programs to prevent the violence in the first place.

Not providing nurses with a safe and secure ED is unforgivable. After witnessing violent behavior between patients and nurses—and between nursing and medical personnel— in hospitals for close to a century, hospital administrators certainly cannot say that they are unaware that violent situations regularly unfold in their EDs.

The Occupational Safety and Health Administration suggests that hospitals provide adequate protection against violence in the workplace. OSHA states that, “Workplace violence is an issue in emergency departments because of the crowded and emotional situations that can occur with emergencies. In addition, ED patients could be involved with crimes, weapons and violent behaviors that could put the ED employee at an increased risk of workplace violence.”

To manage these risks, OSHA offers guidance in the form of possible solutions, including good work practices such as:

  1. Training staff to recognize and diffuse violent situations and patients.
  2. Being on the lookout for potential violence and suspicious behavior and reporting it.
  3. Providing adequate staffing levels, with experienced clinicians on each shift.
  4. Making counseling and treatment programs available to employees who have experienced workplace violence.
  5. Using appropriate engineering controls.

The Joint Commission on Accreditation of Hospitals’ “Environment of Care Standards” requires health care facilities to address and maintain a written plan describing how an institution provides for the security of patients, staff and visitors. Institutions are also required to conduct risk assessments to determine the potential for violence, provide strategies for preventing instances of violence, and to establish a response plan that is enacted when an incident occurs.

How hospitals can provide a secure work environment

The JCOAH suggests hospitals take the following actions to prevent assault, rape and homicide in the health care setting:

  1. Work with the security department to audit your facility’s risk of violence.
  2. Make improvements to the facility’s violence-prevention program.
  3. Take extra security precautions in the ED, especially if the facility is in an area with a high crime rate or gang activity.
  4. Work with HR to make sure it thoroughly prescreens job applicants and establishes/follows procedures for conducting background checks of prospective employees and staff.
  5. Confirm that HR has procedures in place for disciplining and firing employees as a way of avoiding violent reactions.
  6. Require key staff to undergo training in responding to patients’ family members who are agitated and potentially violent.
  7. Encourage employees to report incidents of violent activity.
  8. Educate supervisors that all reports of suspicious behavior or threats by another employee must be treated seriously.
  9. Ensure that counseling programs for employees who become victims of workplace crime or violence are in place.

Now is the time for hospital administrators to embrace these essential safety practices, as it takes time to find the human and financial resources required to design and implement improved safety measures in hospitals.

Administrators should be working on the issue of violence in the ED because it represents an opportunity for significant cost savings. With budgets shrinking and management looking for ways to lower business costs, here is a good opportunity to improve workforce morale and foster a less stressful working environment while saving dollars. After all, lowering the frequency of smashed faces and attacks with deadly weapons would be a real win-win situation.

Hospitals are employers that have a legal responsibility to provide employees with a workplace free from hazards that are likely to cause death or serious physical harm6. They also have an ethical responsibility to provide a safe, non-violent workplace that fosters a climate of trust and respect.

The continuing lack of strong violence prevention programs and policies in hospitals must be addressed. In addition, the institutional cultures that refuse to acknowledge the true cost of workplace violence must be changed.

E-mail for a list of supporting references.