Stronger measures needed to prevent hospital violence

You’ve been waiting in your hospital bed for pain medicine or some ice water, and are starting to get cranky about the nurse’s delay. Then you find out that it happened because another patient tried to strangle her with her stethoscope.

Or you hear “Code Silver” on the overhead speakers, and a nursing assistant comes in, wedges the door shut, and helps you get out of your bed and hide behind it. “Just a precaution,” he whispers apologetically. “We have these drills.” Hours later you find out that “Code Silver” means “active shooter on hospital property,” and that an intensive-care patient’s relative pulled a gun on the staff.

And not long after that, you read about a surgeon in Boston who was shot and killed by a patient’s family member.

These were real events, and they are all too common. Hospital and emergency care involves issues that lead to anger or hysteria in some patients and family members.

Health care facilities deal regularly with drug users demanding narcotics and with criminals who need little reason to become violent. But are they doing all they can to prevent doctors, nurses and other health care workers from becoming victims?

While we doctors are only rarely targeted — even the dumbest drugseeker realizes that you don’t get what you want by taking out the person who can order it — we and our patients depend heavily on the people who keep health care running: nurses, therapists, X-ray techs and the little-noticed people who keep the place clean. According to a 2014 study in the Journal of Emergency Nursing, though, 76 percent of nurses experience violence in the workplace; 30 percent experience a physical assault.

Most states now have laws making assault on a health care worker a felony. This allows emergency rooms, clinics and hospital lobbies to carry signs warning that slugging a nurse or shoving an X-ray tech will mean doing hard time instead of just paying a fine or sitting in jail for a few weeks.

But a warning sign does not take the place of more effective security staffing — barriers that make it harder to smuggle a weapon into a clinic or hospital, and whistleblower protection for employees who report criminal behavior and ask for help.

Most— but not all — hospitals have some sort of security presence, and even the larger ones have just one or two police officers. But when an ER patient becomes violent, too many nurses report that they get little help and less sympathy.

“You lost control of the situation.” “The patient isn’t responsible.” “If you’d been communicating the situation more clearly...” — those are all common responses. And as one experienced ER nurse put it, “We have to be bleeding for the police to even bother filing a report, and the hospital’s paperwork goes on for days.” Hospitals in highcrime neighborhoods hesitate to put up more than a warning sign for fear of scaring off other patients, and many are unwilling to pay for security staff.

Most attacks on health care workers, like the one by a gun-wielding relative in Tomball this year, take place in the most critical areas of a hospital: intensive-care units and emergency centers. Nurses who are busy with critical things like breathing tubes and heart monitors are often the target of confused or drug-addicted patients or of family members who blame the caregivers for any and all bad news.

We already have agencies that monitor hospital safety and quality, like the Joint Commission for Accreditation of Healthcare Organizations and the Occupational Safety and Health Administration.

These have the power to sanction hospitals with inadequate safety protections, but they have mostly limited their concerns to infection controls. They rarely react to assaults until after the event, even though their help in enforcing prevention could save not only lives but some very expensive lawsuits.

Americans have no problem with safety precautions like keycards in hotels, metal detectors in airports and courthouses, and bar-code ID bracelets in amusement parks. We have whistleblower laws for state employees who report corruption, but do little to protect a nurse who reports an assault that could have been prevented.

Isn’t it time we expected hospitals and clinics to protect the safety of the people who care for us when we’re sick or hurt?