Imagine going to work every day knowing that there is a strong possibility that you will be assaulted—verbally, sexually or physically—and your only form of defense is a thin layer of polyester. Imagine further that despite sustaining harm, you are legally able to call the police for assistance only after you have “adequately” finished your work. Now imagine that you spent thousands of dollars to receive accreditation and training to work in this specialized field—a field you were certain was your calling.
For over 7,000 Alaskan nurses, this is the reality they are now facing.
According to a recent American Federation of Teachers report, 69 percent of reported workplace violence injuries occur in the healthcare and social services sectors, nationwide. Additionally, these workers are nearly five times more likely to be assaulted at work than the rest of the labor force.
“In the nursing and the health care community we’re very much aware of [violence in the workplace] but the culture over the years has been to accept it as part of the job,” explains Alaska Nurses Association Health and Safety Chair Stacey Sever. “When a construction worker goes in to work, they are expected to return home each night because there are a lot of safety precautions in place. I think health care is behind the curve when it comes to keeping people safe.”
Although Sever has been the victim of violence in the workplace, she laughs as she recounts an instance when a patient hurled a cell phone at her head. It’s a shocking response to witness, but not surprising given the mentality nurses like Sever have had instilled in them.
“As nurses, we always think of the patient first,” says Sever. “That’s probably part of the reason that many assaults are never reported.”
A recent survey distributed by the Alaska Nurses Association revealed that 27-percent of respondents have not reported violent incidents they witnessed or experienced. The reasons vary from nurses not knowing the reporting protocol to fearing retribution. It’s a cycle that yielded a deadly result in Louisiana just a month ago. Lynne Truxillo, a Baton Rouge-based nurse died from blood clots caused by a vicious attack from a patient who reportedly slammed her head onto a desk. Rather than reporting the incident, Truxillo waited until the end of her shift to seek medical attention. Her attacker, who was being treated for mental illness, is now being charged with manslaughter.
One 1997 study of staff working in psychiatric hospitals in Washington found that 85 percent of workplace incidents of violence were never reported. While that report is over 20 years old, it is a stark reminder of how long nurses have been facing poor regulatory support surrounding workplace violence.
In her 30-year career as a healthcare professional, Sever admits that the number of incidents have been increasing noticeably. It’s a fact she attributes to the rapid loss of civility amongst Americans.
“Violence has always been there, but it’s increasing,” Sever said. “When I first started working in the emergency room 20-plus years ago it was kind of uncommon for someone to come in under the influence or having psychiatric issues. Everybody would run in and we would give medications and put them in restraints, but it only happened once a month or once every few weeks. It really wasn’t a usual occurrence. Now, you get reports of it happening three or four times a day!”
But why are nurses being targeted? Well, the answer is both simple and infuriatingly complex.
“Nurses are the ones that spend 24/7 with the patient with their shifts the way they are,” says Sever. “They’re the ones that are there during the crisis that’s going on. They’re there during the night. They’re there during the weekends when staffing is a lot less than it is during the daytime which puts them in a vulnerable state.”
Another problem is how contentious the running of the Alaska Psychiatric Institute [API] has been. Without access to API, those in need of psychiatric care are being diverted to Alaska’s emergency rooms where staff are not adequately trained to protect themselves against potentially violent patients. Up until last May, nurses also had limited legal recourse on their side.
Before House Bill 312 was passed, police were often unable to arrest a perpetrator in a hospital setting because the assaults are categorized as a misdemeanor and require police to leave a facility and secure a warrant before returning to remove a violent perpetrator.
Under the bill, police are now able to arrest suspects who are accused of committing misdemeanor assault without a warrant. Unfortunately, the law still requires health professionals to stabilize a patient before they can be released into police custody.
“Nurses and emergency room physicians face a rising tide of violence in the workplace due to increasing numbers of drug addicts, alcoholics, and persons with severe behavioral health disorders showing up at emergency rooms. Enough is enough,” said Representative Chuck Kopp in a 2018 press release. “This legislation recognizes that treating patients and protecting healthcare workers is not an either/or proposition. Both are a priority.”
Sever says that prior to HB 312 there was very little that could be done with a violent patient, and that while the bill is a step in the right direction more legislation is needed.
“Many of the violent episodes our members experience could be prevented with the right policies, training, and security provisions, but these need to be enforced,” she said. “When our members are at risk, we know that patients are at risk, too. It’s past time for a national, enforceable standard.”
The hope is that if the Health Care Workplace Violence Prevention Act (House Resolution 1309) passes, it will force healthcare centers to have health and safety requirements to protect staff from violence. Ideally, a Workplace Violence Prevention Plan could be tailored to fit the needs of each facility but would at least set a legal standard of practice to be enforced by OSHA.
A well-rounded plan will include de-escalation training as well as self-defense, says Sever.
“There are some facilities that do have training in place. They range from like four to eight-hour classes where they talk about de-escalation techniques and how to recognize when someone is escalating no matter the situation—it’s not always going to be someone with psychiatric issues,” explains Sever. “It could be someone who’s going through profound grief over the unexpected death of a loved one, too. So, they teach you those methods and also go into some basic techniques of how to get yourself out of a hold if someone grabs your wrist or your hair.”
If the bill passes, healthcare employers will have 6 months to produce functional plans that address everything from training to physical security measures such as alarms and guards. It will also require clear reporting practices for violent actions.