One night, in our emergency department, a 38 year-old male was brought in by the police after a domestic altercation with his wife. He'd been drinking but he seemed cooperative. A full evaluation was needed, and as part of it, the nurse calmly approached him to start an intravenous (IV) line. "Sure, go ahead and try", he said. But when the needle entered his skin, he jerked his arm away. "That hurt!", he exclaimed. The nurse tried again and succeeded, and she drew blood tubes and set up the intravenous fluids. But then he abruptly slapped her across the face and shouted, "That was for the first one. Now we're even." An assault like this should not be tolerated in any setting, but they unfortunately happen in hospitals all too frequently.
The coronavirus pandemic has brought widespread public attention to the dangers of working in healthcare, especially in hospital Emergency Rooms (ERs) and Intensive Care Units (ICUs). There have been countless news stories of doctors, nurses, and other staff working long stressful hours, often without adequate Personal Protective Equipment (PPE), putting themselves in harm’s way to provide care to their patients. These individuals are rightly praised for their bravery, but there is another risk they are – and have been - facing as well. This danger existed for healthcare providers before the current pandemic and was less visible but no less serious. This other threat healthcare workers constantly face is workplace violence.
We are hospital-based emergency medicine physicians. We can both attest that violence, and the threat of violence, both physical and verbal, is an ever present concern while working. We have each been threatened by patients. They are not necessarily angry at us but more frequently at the healthcare system, or they are bringing their unresolved personal issues into the healthcare setting. Regardless, it’s still unsettling to be threatened with physical harm by someone you are trying to help. Yet, we count ourselves lucky. No patient has physically harmed either of us. Sadly, too many of our colleagues and friends have not been as fortunate. This applies especially to our colleagues who are often victims because they are women, along with nurses, physician assistants, and other staff who spend time close to patients. We know staff who have been punched, kicked, and even bitten by patients they were trying to help.
The violence isn’t confined to the emergency department. Healthcare is a surprisingly dangerous field. According to the Occupational Safety and Health Administration (OSHA), health care providers experience workplace violence at a rate that is four times higher than other employees in private industry. You may be surprised to learn that the number of workplace violence incidents in the healthcare industry exceeds almost every other industry combined.
Despite the ubiquity of violence in our field, there are surprisingly few protections for us. In fact, in our home state of Maryland, it is not even a felony to assault a healthcare worker. It is a misdemeanor, often not prosecuted. Additionally, hospitals are not required to engage in any proactive violence prevention planning. OHSA does offer guidelines to help hospitals counter violence, but these are purely advisory. Hospitals are not under obligation to follow them, and they are certainly not enforceable.
At the federal level, there is legislation in Congress that seeks to provide some legal protections for healthcare workers against workplace violence. The Workplace Violence Prevention for Healthcare Workers and Social Services Workers Act (HR1309) would require hospitals to “develop and implement a comprehensive plan for protecting healthcare workers...from workplace violence”. This law places the onus on hospital leadership to develop proactive strategies designed to keep their employees safe. Equally important, it prohibits retaliatory action against employees who report incidents of workplace violence. And it would approach this problem on a national level.
This bill passed the House of Representatives in November 2019. The House vote was 251-158. The Democrats voted in favor 219-0, and the Republicans voted 32 in favor and 158 against. Senator McConnell and the Republican leadership in the Senate, however, have given no indication that they will allow the bill to be considered for discussion or vote and have not offered any reason for this. This legislation, like so many others, seems destined to fall victim to partisan politics for reasons that we cannot fathom.
This is unacceptable. Federal legislators from across the political spectrum have been effusive in their praise of healthcare workers during this pandemic, calling ER and ICU staff “heroes”. We appreciate the accolades, but we are looking for action. Shielding healthcare workers from violence should never be a partisan issue and should have been addressed years ago, but there is a new sense of urgency during this pandemic. We have enough to worry about when we go to work. We should at least be afforded basic safety protections that will help keep us safe so we can focus on job #1: taking care of patients.
We call on healthcare workers, their families, and everyone who supports what we do to contact their federal legislators now demanding action.
Dr. Gregory Jasani, M.D. and Dr. Dan Morhaim, M.D. are emergency medicine physicians in Baltimore, MD. Dr. Morhaim was a member of the Maryland House of Delegates from 1995-2019.