Health workers’ safety in spotlight

By Kim Archer, TulsaWorld.com

An angry patient kicked a nurse in the chest and she suffered a cardiac contusion.

One patient was mad at a hospital employee because she wouldn’t let him smoke. So he left, came back with a can full of gasoline, doused her and set her on fire with his lit cigarette. She died a month later.

Both incidents happened at an Illinois hospital where Laura Preston once worked. Nothing as serious has happened during her 1 1/2-year tenure as emergency department director at St. John Medical Center. But nurses and emergency workers in Tulsa and across the nation are subjected to verbal or physical violence on a daily basis.

“It happens every day,” she said. “People become agitated. They are verbally abusive to nurses. They spit or scratch or kick or hit.”

More than half of 3,465 emergency room nurses surveyed reported experiencing physical violence at work, including being kicked, spat on, pushed, hit, scratched, shoved or bitten, according to a national study published in this month’s Journal of Nursing Administration.

One in five were verbally abused more than 200 times during the same period, the Emergency Nurses Association study reported.

As a whole, the U.S. health care sector leads all other industries in workplace violence, with 45 percent of all assaults against workers resulting in lost work days, according to the Bureau of Labor Statistics.

“We’ll always have somebody upset, particularly with more people laid off,” Preston said. “And sometimes there’s just a crowd. People have to wait longer.”

When a patient is combative, nurses and physicians first assess the patient to determine if there has been a head injury or if alcohol or drugs are a factor, she said.

“Sometimes patients will get agitated because they want drugs, specifically painkillers. When we say no, they get angry,” Preston said.

R. Shawn Rogers, director of the emergency medical services division of the Oklahoma State Department of Health, recalls numerous times as a medic when he found himself in dangerous situations.

“I was certainly assaulted by patients when I was working in the field. I shudder when I remember some of the stupid positions I put myself in as a young medic,” he said. “I don’t know anyone who has run very many calls who has not had to deal with a violent, deranged person in the performance of their duties as an EMT or paramedic.”

Earlier this year, two Tulsa firefighters were assaulted by bystanders as they tried to assist a woman with respiratory problems. In Oklahoma, an assault against a firefighter is a felony punishable by two to 10 years in prison.

As violence against health care workers has become more visible, officials have begun to do more to protect them.

Oklahoma is among 16 states that introduced efforts this year to reduce or prevent violence against health care workers. Fourteen other states already had legislation or programs in place, according to the American Nurses Association.

In May, Gov. Brad Henry signed into law a measure making assault of on-duty nurses, paramedics, doctors, nurse aides, interns and hospital security a felony punishable by up to two years in jail and a $1,000 fine. It took effect immediately.

“It adds a layer of protection for our employees who are sometimes at risk,” said Mary Johnson, executive director of patient services at St. Francis Hospital. “The ER basically parallels what’s happening in the world.”

Rogers agreed that the law was needed to protect the state’s health-care workers.

“I think legislation to make such attacks a felony is very appropriate, and that there will be occasions when people like drug-seekers are deterred. But the real answer to protecting EMS providers is better resource coordination,” Rogers said.

He said a well-coordinated response would bring firefighters and law enforcement to emergency scenes so paramedics and EMTs aren’t the sole responders.

“The times when I felt most threatened were when my partner and I were the only public safety responders on the scene,” Rogers said.

Although much of the violence against health care workers happens on the streets — in the case of emergency medical technicians and paramedics — or in emergency rooms, health care workers at nursing homes and psychiatric units also are vulnerable.

In fact, nursing assistants who work in long-term care facilities have the highest incidence of workplace violence of all American workers. Twenty-seven percent of all workplace violence happens in nursing homes, according to a study by Florida researchers published in the Annals of Long-Term Care in January.

About 90 percent of those who assaulted staff had dementia, such as Alzheimer’s disease, the study reported.

All health care workers need training on protecting themselves and avoid putting themselves at risk, Rogers said.

St. John’s emergency room nurses have all taken Crisis Prevention Institute training to “learn how to de-escalate a situation,” Preston said.

And security officers there are well-trained and on-site around the clock, she said.

St. Francis Hospital ER nurses have had the same training and also have security officers ready all hours, Johnson said.

“We’re a very busy emergency department and we monitor and track this,” she said.

Employees are encouraged to report any incidents to their superiors, Johnson said.

If necessary, the perpetrator will be restrained and police will be called.

“If a patient purposefully injures a nurse or doctor, we encourage them to press charges,” she said.