Violence Against Healthcare Providers
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As violence increases across the country, so too have acts of violence against healthcare providers. Unfortunately, this is not a new trend; polls conducted in 2014 and 2020 revealed that 71% of physicians and 82% of nurses reported having been targets of violence at some point in their careers, and the U.S. Bureau of Labor Statistics estimated that healthcare and social service workers are 5 times as likely to suffer a workplace violence injury than workers overall.
Since the beginning of the COVID pandemic, this epidemic of violence has continued to worsen. An August 2022 poll conducted by the American College of Emergency Physicians (ACEP) revealed significantly increased rates of violence in the ED, with 55% of physicians having been assaulted and 79% having witnessed an assault (both were increased by 8% compared with 2018). The vast majority (98%) of assaults were committed by patients, but assaults by family members/friends, and other visitors were also reported.
Recently, there have been incidents in which patients have attacked their physicians, staff members, and/or other patients in healthcare settings, sometimes with deadly outcomes. On January 27, 2022, a nurse was attacked and knocked unconscious by a family member who was distraught over a patient’s death. On June 1, 2022, a patient shot and killed two physicians, including his surgeon, a staff member, and another patient after reportedly becoming frustrated with his postoperative pain following back surgery.
Violence against healthcare providers has become so pervasive, that it is almost expected; a survey in 2000 revealed that 73% of nurses believed that being assaulted by patients is part of their job.
However, the healthcare industry is beginning to fight back. Two bills introduced in recent months will seek to bolster protections for healthcare providers against violence.
The Workplace Violence Prevention for Health Care and Social Service Workers Act (HR 1195) would require OSHA to create a federal standard mandating healthcare and social service employers to create and implement a workforce violence prevention plan. This bill was passed by the House of Representatives in April 2021, and it is currently awaiting a vote in the Senate.
The Safety from Violence for Healthcare Employees (SAVE) Act (HR 7961) was introduced in the House of Representatives on June 7, 2022. This bill would criminalize acts or threats of violence against hospital employees, and it was modeled after legal protections for airline flight crews. The bill was endorsed by both the American Hospital Association (AHA) and the ACEP.
Additionally, in 2022 the Joint Commission issued updated Workplace Violence Prevention Standards to assist hospitals in improving their prevention efforts.
Recommendations:
Strategies for preventing violence in the healthcare setting focus on staff development, enhanced security measures, and even the physical design of hospitals and clinics. Specific recommendations include:
- Develop flags to alert staff of patients who have a history of violent or aggressive behavior.
- Restrict where visitors can go without authorization or secure badging.
- Expand security technology, such as cameras and alarms, while striving to keep security minimally visible to maintain a welcoming environment.
- For ambulatory clinics, design multiple exits from the office and incorporate a secure back office area for staff.
- Enhance staff’s ability to prepare for and respond to aggression through training, such as empathic communication and de-escalation techniques.
- Develop an interdisciplinary team to respond to incidents involving patients and visitors, and to de-escalate if possible.
In its Patient Violence resource, ECRI recommends these additional recommendations:
- Obtain leadership commitment to workplace safety, and establish a culture that does not tolerate violent behavior.
- Incorporate OSHA’s “building blocks” for effective workplace violence prevention into the organization’s approach to curbing patient violence.
- Develop a comprehensive violence prevention program and policy that includes specific provisions for preventing patient violence.
- Define patient violence to include verbal and physical threats and assaults.
- Address the behavioral health needs of patients hospitalized with a medical condition by providing access to behavioral health professionals.
- Enlist pharmacy department support to appropriately manage behavioral health patients’ medications.
- Ensure an adequate supply of psychiatric medications is available on medical units.
- Minimize anxiety-producing stimuli in the emergency department (ED) environment, where the risk for patient violence is high.
- Develop a process for staff to activate a code to mobilize the response team to help with a difficult patient.
- Use debriefings after every event so that those involved in the event can reflect upon the experience, discuss what went well, and identify opportunities for improvement.
Additionally, ECRI has the following two resources available for the prevention of violence:
Violence in Healthcare Facilities
Self-Assessment: Violence Prevention in the Healthcare Workplace
Sometimes, preventing violence begins with holding patients and family members accountable for their behavior, and appropriately withdrawing from care before an inappropriate patient turns threatening or violent. For information on withdrawing from care, see MIEC’s article How to Discharge a Patient from Your Medical Practice.
For assistance with situations involving specific patients, MIEC members should contact us at (800) 227-4527 or claims@miec.com.