I am an Emergency Department Registered Nurse and NC certified Paramedic. In October of 2018, while at work in the ED, I was violently and viciously attacked and physically assaulted by an Emergency Department patient who repeatedly tried to punch me in the face. You may say to yourself “that’s terrible but it doesn’t really affect me.” You may think that being attacked by patients is “just part of the job.” Or you probably think this “doesn’t happen often enough to be of any significant consequence.” You would be gravely mistaken on all three counts!
Physical as well as verbal attacks on Nurses, providers, and hospital staff are ubiquitous even despite being largely underreported, and assaults on ER Nurses are second only in frequency to psychiatric Nurses in the hospital setting. Even in the case of assaults by psychiatric patients, the Emergency Nurses Association (ENA), the nation’s primary professional organization for Emergency Department Nurses, states “Criminal cases should not simply be dismissed by the criminal justice authorities due to an assailant’s illness or disabilities.” The assault on me was in fact not by an aged and fearful demented Alzheimer’s patient who was disoriented and scared but instead by a middle-aged adult who was angry, hostile, and aggressive.
According to the National Institute for Occupational Safety and Health, workplace violence (WPV) in the healthcare industry is 3.8 times more prevalent than all private industry. WPV has become the most pressing occupational hazard facing healthcare workers. According to Gates, D1, violence in the healthcare setting affects the employee, employer, and patients. In addition to physical injury, disability, chronic pain and muscle tension, employees who experience workplace violence suffer psychological problems such as PTSD, loss of sleep, nightmares, and flashbacks. They may also suffer from fear, anger, sadness, frustration, anxiety, irritability, apathy, and self- blame. All of these physical and emotional consequences can lead to decreased job satisfaction, burnout, and reduced job performance. I am sure you know of someone who has, or have been hospitalized yourself at some time. Violence against hospital staff can directly affect the care you are given. There is a good chance that the Nurse caring for you has been assaulted or knows a coworker who has been.
According to another study by Hester, S. et al2, in a survey of 5,000 Nurses, 76% reported experiencing WPV within the past year, and according to the Centers for Disease Control and Prevention, approximately 9,200 non-fatal workplace violence injuries occurred among healthcare workers in 2013. Also in 2013, there were 27 fatal injuries suffered by healthcare and social service workers. Nurses were the largest percentage of those deaths and injuries. And, although we may feel somewhat insulated from this violence here in Watauga County and Boone, we are not. We are, however, fortunate to have a community hospital that recognizes this nationwide epidemic of violence against healthcare workers and has taken positive and proactive steps to address the problem, but that alone is not enough.
According to the ENA, a three tiered approach must be implemented to begin to address and mitigate WPV against hospital personnel. Our local hospital has taken the first steps by requiring classes in Crisis Intervention which includes recognizing, de-escalating, and evading hostile behavior of patients, families, and visitors. There is also a sworn hospital police department providing round the clock police protection. It is important to note that a Nurse who actually fights back at an assaulter is at risk of losing his or her license by the Board of Nursing.
The second tier of protection for hospital Nurses and staff must come from state legislation. We in North Carolina are lucky in that respect. The NC General Assembly in December of 2015, enacted the bi-partisan H.B. 560 making it a “Class I felony to assault or affray causing physical injury to hospital personnel or licensed healthcare providers who are providing or attempting to provide healthcare services to a patient in a hospital.” Though crisis intervention training from the hospital teaches recognition and avoidance, assaults still do happen and the NCGA has now enacted law to make it a felony. The hospital and lawmakers recognize and take seriously the epidemic of WPV and assaults on hospital staff but does the local Judicial system?
The third tier of protection against WPV lies with the local judicial system and District Attorney. Will the District Attorney’s Office step up to protect the citizens against workplace violence upon healthcare workers? Will the DA prosecute suspected felons to the full extent of the law? Or, will the DA’s office minimalize and marginalize assaults on Nurses because of the historically low conviction rate? These are possibilities brought to my attention by a county official and local law enforcement officers as well as a practicing attorney. It is my sincere hope that the local Judicial system will adopt a zero tolerance policy against workplace violence and assaults on hospital personnel. Local Nurses and hospital staff members are following this case closely.
September 17, 2019- Follow-up. Since my assault, I predicted the person who assaulted me would do it again and I was correct. Instead of being arrested for assault, the defendant was place under an Involuntary Commitment order and while being held the the Emergency Department awaiting placement in a psychiatric facility, the defendant assaulted a police police officer and another Nurse. The Officer attempted to bring charges but apparently met with resistance from the DA’s office. In May 2019, the Officer was finally able to file charges and merge the three assault cases. As of today, Sept. 17, I have been to court seven times: Nov. 20, Jan. 22, Feb. 12, April 9, May 21, Aug. 6, and Sept. 17. I have had to take days off work and be present for each one of these court days, and the person who assaulted me has only been present for the first court date on Nov. 20.
The person who assaulted me, other nurses, and a police officer goes free. All three assault charges were summarily dropped by the District Attorney after nearly one year. So, it would seem that in NC District 24, under Seth Banks, one can easily commit violent assaults against hospital personnel and police officers with complete impunity and disregard for H.B. 560. In failing to recognize and act against workplace violence in the healthcare system, I feel that my coworkers and I have also been additionally victimized by the District Attorney. We are not safe at work.
1 Gates, Donna Marie et al. “Violence against nurses and its impact on stress and its impact on stress and productivity.” Nursing economic$ 29 2 (2011): 59-66, quiz 67
2 Hester, Susan & Harrelson, Christina & Mongo, Tameki. (2016). Workplace Violence Against Nurses: Making It Safe to Care. Creative Nursing. 22. 204-209. 10.1891/1078-45126.96.36.199.