In November of 2014, on an otherwise ordinary day at St. John’s hospital in Maplewood, MI, 68-year-old Charles Logan wrested a bar from his hospital bed and attacked several nurses. Surveillance video shows Logan’s rampage through the nurse’s station, as panicked workers flee and try to help one another escape, but Logan manages to strike four of the eight nurses. Two of those nurses fall against his heavy blows, only to be battered repeatedly, before officers arrive and subdue him. Logan dies shortly thereafter in police custody, his actions a mystery to all involved.
According to an article in Scientific American, little is being done to stop these types of assaults. Lisa Wolf, a registered nurse and research director of the Emergency Nurses Association, paints a dreary picture of lethargic acceptance. “There is a top-to-bottom cultural assumption that violence is part of the job. It goes from the bedside to the judicial system.” Studies show this to be the case. Nearly 80% of ER nurses reported being assaulted in 2014, and it doesn’t start and stop in the emergency room. The Scientific American article cites the US Bureau of Labor for this harrowing statistic: “Health-care workers experience the most nonfatal workplace violence compared to other professions by a wide margin, with attacks on them accounting for almost 70 percent of all nonfatal workplace assaults causing days away from work in the U.S.”
Now I’m just hitting the basic points from the Scientific American article—it’s long, illuminating, and interesting read — but the main thrust of the article is that nothing will change violence in the space of healthcare until a cultural shift occurs whereby the public simply acknowledges that not only is not acceptable to assault healthcare workers, but there are serious penalties for doing so. We have seen this shift in other industries, most notably in air travel post 9/11, where you can and will be charged immediately upon threatening or otherwise assaulting airline personnel.
Nothing will change violence in the space of healthcare until a cultural shift occurs whereby the public simply acknowledges that not only is not acceptable to assault healthcare workers, but there are serious penalties for doing so.
So the question is, then, as a doctor, what can you do to protect yourself, your nurses, your administrators, and your patients from violence in the workplace?
Even if you don’t make the rounds in the graveyard shift in the emergency room, patients can become upset and agitated for a number of reasons. They may be drug seekers who are upset that you won’t prescribe the type or quantity of drugs they want. They may be upset at a loved one’s diagnosis and take their anger out on the messenger. They may be frustrated by a claim denied by their insurance. They may be mentally ill. Any number of reasons can make an unhinged person snap, but at the grocery store (for instance) it’s just groceries or customer service or a long line. At the doctor’s office, we are talking about life and death, addictions, money, prolonged illnesses, lifestyle, etc., subjects that matter far more than a long line at the grocery store or getting cut off in traffic.
Linda Girgis, a family physician in New Jersey, writes in a recent article published in Physicians Practice, “A doctor never goes into a patient encounter thinking how to defend themselves, but rather with the mindset of curing and helping. Most doctors are unprepared for when a patient suddenly goes ballistic and are put in harm’s way.”
She continues with a list of 10 tips that you, as a physician, can do to help ensure your own personal safety as well as that of your personnel. Below is a brief summary, but I encourage you to check out the list yourself. She has a very detailed plan-of-action for dealing with agitated patients, and we say in the industry, an ounce of prevention equals a pound of cure.
In short, she recommends that you always keep an exit between you and your patient, never lose your temper, have a signal with your staff to alert them to let them know you are in danger or feeling uncomfortable, and immediately contact the police if the patient becomes aggressive. It’s fairly common sense stuff, but in the heat of the moment, it’s good to have an actionable script that you can fall back on to ensure the safety of your workplace.
As an additive effect, these steps help address the systemic violence that happens to healthcare workers across the board. By adopting a zero-tolerance policy against violent patients and showing them in no uncertain terms that assaults against personnel are unacceptable, we in the healthcare industry can do our small part in shifting the cultural landscape from one in which violence against medical personnel is part of the daily routine to one where it is limited to isolated incidents and punished accordingly.