I started doing some internet research about this topic after hearing a recent story about a nurse friend being punched in the face by a patient that was completely coherent and not delusional. I would love to be able to say that violence against nurses, and physicians alike, doesn’t happen, but that would be a lie. It is an odd phenomenon to know everyday you go to work you risk serious injury from someone you are trying to protect and take care of.
The International Council of Nurses recently released a report that included a discussion on violence against nurses. The Emergency Nurses Association (ENA) last September issued a press release after a year long study (Emergency Department Violence Surveillance Study) stating that between 8-13 percent of ER nurses are victims of physical violence every WEEK in our country. ER nurses are on the front line of violence everyday. While violence can occur at any time and at any point in a patient’s hospitalization; as Theresa Brown, an oncology nurse and writer for the NY Times Well Blog, can attest to. The volume and the population of patients that seek emergency services or are brought to ERs lends itself to being ground zero for violent outbreaks along with psychiatric hospitals. The ENA findings continue:
The Emergency Department Violence Surveillance Study also found that 15 percent of the nurses who reported experiencing physical violence said they sustained a physical injury as a result of the incident and in almost half of the cases (44.9 percent), no action was taken against the perpetrator.
These are shocking numbers when you read them- though I am really not surprised.
We all have stories about patients in altered mental states caused by disease processes (ie dementia and schizophrenia), drugs (legal and illegal), and various other reasons; attacking, spitting, biting, hitting, pinching, or kicking staff in the hospital. I have many, many stories dating back to my days as a nursing assistant in a nursing home. Many patients confused and unaware of whats going on and where they are respond violently out of fear. Fear and delirium compounded make for a dangerous state. Fighting or resisting care is not uncommon and when the “fog” of delirium lifts, patients are back to themselves and don’t remember these instances. As nurses we have great compassion and understanding for people suffering in those mental states. Though recently, I have experienced and heard more and more stories of patients and families retaliating violently who are not inebriated, or in cognitively affected mental states. It’s frightening.
A few months ago, I had a patient going through alcohol withdrawl in the ICU after surgery and was on the ventilator. He needed to have his upper extremities restrained to keep him from getting out of bed and pulling out his IVs or breathing tube. When I came on shift, his wife was sitting at the bedside. The nursing assistant joined me to turn him on his other side and allow me to examined the skin on his back making sure there were no areas of redness or breakdown. He was a big man, solid in muscle mass and weighing about 250 pounds. As we were getting ready to turn him, he sat bolt upright and swung at me. I was able to duck and he missedthe left side of my head. The nursing assistant was able to grab his hand and tie his arm back down. We were able to verbally reassure him and remind him of where he was and he relaxed back into the bed. My immediate asumption is that he was startled and acted out violently out of fear and confusion. I wouldn’t usually make a big deal out of it. Though while sitting in a sleeper chair in the corner of the room and after seeing me duck as her husband almost punched me in the side of the head, the patient’s wife started to laugh. I turned around and with an absolutely bewildered look on my face and with a tone of horror I asked her “What’s so funny?” She replied “It’s just good to see him back to his old self.” WHAT?? His old self?! Would she laugh if he was startled by someone on the street and punched them in the head? I was outraged. I had to try very hard to keep my calm and remind her that this behavior is not funny; violence against nursing staff at this hospital is not tolerated. I also reminded her that if he had hit me I could press charges and call the police. She gave me one reason after another related to “Well, that’s just him and thats how he is… a firecracker.” All I could think was, I would be horrified if my family member did that, whether they knew what they were doing or not and just be very glad no one got hurt.
I have heard and read stories about nurses being hit or kicked and injured seriously enough to have to miss work for months and there being no penalty for the perpetrator of violence. When you do a search on Google there are A LOT of stories that come up in the news and on blogs telling of nurses being injured by patients. What is more compelling to me is: What are states and hospitals doing to take proactive steps to curtail or prevent violence against staff?
In November 2010, New York State legislation was passed to include nurses in the same group as police officers and firefighters making violence against a nurse a Class D felony.
Massachusetts also passed a Violence Against Nurses Law in 2010 extending the current legislation that covered EMTs and ambulance personnel to cover nurses, doctors, dentists and many other health care workers.
The California Nurses Association and representatives testified in March in support of legislation that would hold hospitals accountable for implementing policies to keep nurses and patients safe.
What is more interesting is what health care organizations are doing. At the University of Wisconsin Hospital in Madison, WI a safety program has been initiated that codifies a patient’s risk of violence. The program was recently discussed in the Journal of Emergency Nursing. The most pragmatic part of the program is that being staff designed- it recognizes that violence in the ER may never disappear. We need to continue to train, educate, and alert our coworkers to the potential violent situations that can occur. Being prepared is half the battle!
While violence against nurses continues to rise, I know much of it goes unreported. In the ICU it is uncommon for us to call a code grey (Washington State’s code for a violent person) because most of the time we have enough staff to control the situation. I also know that because I have never been seriously injured I have never reported any of the violence I have experienced. I have always taken the position that it is part of the job. Mine is the exact attitude and perception that needs to change. Between staff and institutions setting practice and behavioral standards we can work towards making stories of violence the exception, not the expectation.