Caring for those Who Care for Us

NEPTUNE- So much of the time when you write about something like healthcare worker assaults you rely on a research study abstract which robs us of the sense of outrage we should feel when someone becomes the victim of violence because they were just trying to help someone who needs help.

It’s a unique kind of moral injury when its endured week in and week out, year after year. It can, and has driven talented healthcare professionals out of a profession that grows increasingly shorthanded. If we don’t collectively standup for them who will? 

During a recent four day stay at my neighborhood hospital, the Jersey Shore University Medical Center [Hackensack Meridian Health],  I benefited greatly from the outstanding care I received from my physicians, nurses and support personnel. This was all the more remarkable considering some of what I overheard when the patient I shared my room with would on occasion physically act out on the staff trying to help him. 

The skilled techs and nurses repeatedly defused the situation by patiently reminding the ailing patient that he shouldn’t hit them. These interactions were around the clock and the patient, who never left his bed the entire time of my stay, required complete care.

No doubt, for these accomplished professionals this, while perhaps a difficult case, was not a unremarkable one involving an elderly patient with complex medical issues that required very labor intensive care. 

 

FESTERING IN THE OPEN

As it turns out, this has been brewing for years, with an uptick in workplace violence that targeted healthcare workers resulting in serious injury and lower morale for a profession we entrust with our lives.  

“Even before the pandemic, health care was seriously plagued by violence,” reported the Philadelphia Inquirer last year. “Almost three-quarters of the nation’s  workplace injuries due to violence occur in healthcare settings, according to the Bureau of Labor Statistics. Jennifer Comerford, a risk management analyst with ECRI, a Plymouth Meeting-based nonprofit that advises hospitals on safety and quality, described the situation as ‘mind-boggling.’”

Now, years into the pandemic, violence against healthcare workers  has now reached “epidemic proportions” with that workforce accounting for half of all the victims of workplace violence, according to the Emergency Nurses Association.  

The Joint Commission, a non-profit, and the nation’s oldest accrediting body for hospitals, reported that workers in healthcare are at least four times more likely to be targeted for violence than other workers. “Alarmingly, the actual number of violent incidents involving health care workers is likely much higher because reporting is voluntary,” the Joint Commission concluded. 

“The statistics are staggering,” according to surveys by the American College of Emergency Physicians (ACEP) and the Emergency Nurses Association (ENA), with “almost half of emergency physicians report being physically assaulted at work, while about 70 percent of emergency nurses report being hit and kicked while on the job.”

“The frequency of violent attacks on nurses, physicians and patients in our nation’s emergency departments is unconscionable and unacceptable,” editorialized the American College of Emergency Physicians on their website. “For medical professionals, being assaulted in the emergency department must no longer be tolerated as ‘part of the job.’”

DEATH ON THE JOB

“Nurses often take the brunt since they’re on the front lines, the ones who interact most with patients and their families,” according to the New Jersey State Nurses Association, a non-profit advocacy group. “While many assaults don’t cause serious injuries, some nurses have gotten broken bones, black eyes and other harms. In rare cases, nurses have been killed. In April 2019, Lynne Truxillo, a 56-year-old nurse at a hospital in Baton Rouge, LA, saved another nurse by pulling away a patient who was attacking her. The man turned on Truxillo, grabbed her by the neck, and struck her head on a desk. She died several days later from complications related to the assault.”

It’s not always patients acting out on healthcare workers. Consider the case of the 54-year old hospital technician who was attacked in February in a breakroom at the Hackensack University Medical Center with a wrench and was sprayed with chemicals that caused serious burns to her face and other parts of her body.

The alleged assailant was a traveling nurse, who police say died of a self-inflicted gunshot wound. 

Last month, in a letter to Congress, the American Hospital Association, which represents 5,000 hospitals wrote with the “onset of the pandemic…..violence against hospital employees has increased — and there is no sign it is receding. Day after day, the media reports about patients or family members physically or verbally abusing hospital staff. Data supports these news reports.”

The AHA correspondence continued. “Recent studies indicate, for example, that 44 percent of nurses reported experiencing physical violence and 68 percent reported experiencing verbal abuse during the COVID-19 pandemic. The escalation of violence in health care settings is of great concern to our member hospitals and health systems. Attacks on health care staff, whether by patients or visitors, result in serious harm and jeopardize our workforce’s ability to provide care.” 

According to the American Journal of Managed Care, the majority of attacks “come from patients or family members who have problems with substance abuse, a mental illness, or drug-seeking habits”.

“Furthermore, the generalized fear, helplessness, and stress felt by individuals seeking medical attention and by their loved ones, especially when the patient is critically ill and there is frustration with the health care system, lead to increased risk of WPV [work place violence] in hospitals,” AJMC found. “These strong emotions and anger that individuals may harbor can emerge and be inappropriately directed toward health care workers. Additionally, a history of violence increases the risk that an individual will commit an act of WPV.”

 

ON THE BOOKS BUT NOT ENFORCED

Currently, according to AJMC, only 26 of 50 US states have any law to protect health care workers from assault. One of them is New Jersey. 

Barbara Rosen, RN, vice-president of Health Professional and Allied Employees, the state’s largest healthcare union,  maintains that the “law to curb violence in the workplace exists but is currently not being enforced.”

“Compassion, empathy and professionalism are some of the hallmarks of our work in caring for patients,” wrote Rosen in  a statement to InsiderNJ. “While caregivers have always had to contend with violence in the workplace, including often from the people they are caring for, the coronavirus pandemic has exacerbated the issue in many ways.”

Rosen said her union wanted  “to focus on mitigating violence before it happens—a root-cause analysis of why violence is taking place ” which needs to include addressing the state’s staffing crisis that can “cause long delays in a patient receiving attention, which may push some patients over the edge. And, some patients come in with mental health issues or are in emotional distress.”

It’s a common sense prescription.

“Safety measures, including a safe work environment, a staff that’s well trained and adequate staffing level could go a long way toward mitigating violence before it happens,” concludes Rosen.

Do our healthcare workers deserve anything less?

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