Hospital patients are attacking staff at an alarming rate, and there are no federal regulations providing employees with any form of blanket protection.

It is both shocking and unacceptable to think that the very individuals who are charged with caring for people during their most vulnerable moments are at risk of verbal and physical abuse or at times, even assault. The patients who lash out against nurses are only partly to blame; it is the hospital administrators who can gather data on the incidents, enforce strict zero-tolerance policies against violence and create environments that discourage assaults. But often the hospital is more concerned with protecting itself rather than the nurse who is at the frontline.

The statistics are alarming: over the past decade or so, there has been a marked increase in the rate of violent incidents reported against healthcare workers. In one informal survey, as many as one-in-four nurses suggested that they had been attacked at work between 2013 and 2014. Patients often kick, scratch, and grab them; in rare cases even kill them. In fact, there are near as many violent injuries in the healthcare industry as there are in all other industries combined.

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There are currently no federal rules in place to protect nurses in hospitals, though some states have passed laws of their own. Some states have put in measures which include requirements that hospitals create and implement violence-prevention programs, such as teaching de-escalation techniques and increased penalties for people convicted of assaulting health care workers.

In October, California passed the most stringent guidelines in the country, obligating healthcare employers to develop tailor-made violence-prevention plans for each workplace with the input from their actual employees. But the problem has worsened: so much so that the U.S. Department of Labor is considering putting in place nationwide workplace-safety standards for hospitals to prevent this kind of abuse happening in future.

Many assaults against healthcare staff take place in the emergency units and in psychiatric wards, and because they have the most contact with patients, nurses and nursing aides bear the brunt of this violence. Patients with dementia or Alzheimer’s and patients on drugs are often the ones most likely to hurt nurses, according to a research study published last year in the Journal of Emergency Nursing. The study surveyed more than 700 registered nurses at a private hospital system in Virginia, and 76 percent said they had experienced some manner of physical or verbal abuse from patients and visitors over the past 12 months. About 30 percent said they had been physically assaulted.

It is perhaps to be expected when working directly with patients who are in emotional and physical pain that healthcare workers are at risk of violence. It has been proposed that the increasing abuse has a lot to do with money: during the Great Recession, public and private hospitals began to cut budgets at the same time people were losing jobs—and their health insurance. That meant that fewer nurses and security guards were available to help when patients got out of control, and more people going to state hospitals instead of private practices for their medical care since they couldn’t be turned away due to lack of medical insurance. States also cut billions of dollars in funding for preventative mental-health services, which likely influenced the increased incidence of violence against doctors and nurses. Psychiatric patients often arrive at emergency rooms where staff are largely ill-equipped to deal with their violent outbursts. Bonnie Castillo, a registered nurse, and director of health and safety for National Nurses United which represents more than 160,000 nurses across the country.

According to Castillo, the lack of preparedness is creating volatile, unpredictable situations. Her organization has been pushing for states to pass laws to protect workers in the healthcare industry.

There is also the misconception that violence against healthcare workers is merely ‘a part of the job’ and they must just deal with it.

Castillo speaks of nurses feeling loath to report these incidents for fear of being punished by the employer for escalating the incident She said she had once been punished by a past employer for calling 9-1-1 after a patient attacked her. It’s not surprising then, that only 29 percent of the surveyed nurses who were physically attacked had reported it to their superiors. About 18 percent said they feared retaliation if they reported violence, and 20 percent said they didn’t report it because of the widespread misnomer that violence is a normal part of the job.

A spokeswoman for the Inova Health System hospitals, where the nurses were surveyed, did not respond to a request to comment for this story, though it is hardly a problem unique to one hospital.

Rose Parma, a registered nurse in California’s Central Valley, says nursing school did not prepare her for the brutality she would face in her career. She has endured patients spitting on her and has even been threatened with her life whilst on duty. But when a delirious patient kicked her so hard in the pelvis that she slammed into a glass wall and fell to the ground, she felt compelled to report the incident. She was two months pregnant at the time. Her complaint was met with a nonchalant reaction by her supervisor, with Parma left feeling as if this kind of abuse of nurses was not unusual and ‘no big deal’ Her manager then said she would see her at work the following day. Although her baby survived the attack, Parma was shocked at her senior’s lack of empathy. They did not even offer her any trauma counseling.

Often nurses are loathe to report abuse and physical violence.

As the Department of Labor only considers implementing nationwide safety standards, individual hospitals are putting their own measures in place. One hospital in Massachusetts offers its staff self-defense classes. Another in the state hosted a training exercise that simulated potentially violent hospital scenarios: gang violence in the emergency room, an outburst involving a mental-health patient, and an estranged ex-boyfriend in the maternity unit.

Unfortunately, these types of precautionary measures do not seem to be the norm at hospitals across the United States, It is feared that this kind of danger in the workplace may contribute to a further shortage of nurses in the United States. When there are not enough nurses at hospitals, and those who are there feel stressed and unsafe, patients and staff all end up suffering.

Violence against nurses results in lawsuit

Only last month, news media outlets reported that four nurses are suing an Illinois correction officer after a prison inmate gained control of his gun and used it to escape and then rape a nurse, according to a Medscape article published online on June 8.

Delnor Hospital in Geneva was the location of the altercation where on May 13, 2017, Tywon Salters, a 21-year-old prison inmate was being treated. The Kane County officer, Shawn Loomis unshackled Salters so that he could use the restroom at which point he took the officer’s gun and held two nurses hostage. The article stated that Officer Loomis allegedly ran away and hid in another room.

According to the article, during a May 25 press briefing, Sean Murray, the nurses’ attorney said, “What we’re largely concerned with is this should never have happened. There should never have been that opportunity. …. I’d like to know why the officer went into the other room and closed the door, and didn’t take any further action to subdue the gunman, and I think all of those questions need to be answered before we get to anything else.”

The unlawful act comes amidst a national concern over the safety of healthcare workers and a West Coast push last fall to develop hospital rules against violence.

California has developed protocols for violence against healthcare workers, including the Workplace Violence Prevention in Healthcare standard, which took effect April 1. The rules could become a model for other states, the article suggests.

Although there is not total buy-in, it is a start. Either way, the healthcare workers have a right to be protected in their mission to care for others.

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