'Violence is not part of anybody's job'

Assaults lead to stress and injury

After his cheek was fractured when a patient smashed a fist into his jaw in the emergency department, Jeaux Rinehart, RN, BSN, PHN, figured he'd had enough. He worked for 32 years as an emergency room nurse and loved it, but finally he could no longer tolerate patients hitting, yelling, cursing, or spitting at him.

"The violence is getting worse and worse and worse," he says. "I have to finally put my foot down and remove myself from the environment."

Rinehart's experience reveals the impact that workplace violence has on the everyday lives of hospital employees, especially those who work in high-risk units such as the emergency department or psychiatric unit. An online survey by the Emergency Nurses Association found that 26.6% of ER nurses had considered leaving the emergency department and 9.5% had considered leaving nursing because of workplace violence.

For Rinehart, the beginning of the end came three years ago, when he was working triage and a man approached, seeking methadone. Rinehart told him that he would need to be evaluated for pain medication, but that the emergency department doesn't provide methadone.

As the patient grew angrier, Rinehart's survival instinct kicked in. He figured he needed to get out, so he turned around and headed for the rear door. (The triage room had two doors.) Before he could get there, the patient hit him on the back of the head with a billy club then swung at his face, fracturing his cheek.

Nearby, someone witnessed the incident and called a Code Strong, a signal that means "severe incident, respond immediately." The man ran off and wasn't identified. He had given a false name and information.

After he recovered, Rinehart returned to work, feeling a bit shaky and wary. Then another day, a man who was brought in by the police for a psychiatric evaluation got out of his restraints. He punched Rinehart in the face, then spewed a ball of spit at the nurse. When Rinehart restrained him, the patient said, "When I get out of here I'm going to go home and get a gun and come back and shoot you dead."

Rinehart wanted to press charges, but he faced reluctance. Often, nurses report that police discourage them from pressing charges because of the patient's mental or medical state. In this case, Rinehart persevered and the patient received a four-month jail term. He still frequents the hospital's emergency room.

Yet Rinehart has moved on, into an administrative job that takes him away from the patients he once was devoted to treating. (Rinehart, who is from Seattle, asked HEH not to mention the name of his hospital.)

"Violence is not a part of anybody's job," he says. "You wouldn't take it at home, in the store or on the bus. Why would you take it at work?"

Sometimes Rinehart walks through the emergency department. "I hear patients yelling at each other and the staff. It brings back all the memories of why I did what I did," he says. "It was the right decision."

Nurses seek better reporting

Police officers sometimes bring people to the psych unit of Antelope Valley Hospital in Lancaster, CA, to be evaluated because of aberrant behavior. But when hospital workers call the police because of an assault by a patient in the psych unit, they seem surprised that someone would want to file a report, says charge nurse Colleen Sichley, RN, BSN.

"Where did we ever give anyone the right to assault someone else?" says Sichley. "If a mentally ill person assaults a police office or a fireman, I believe there are penalties."

About a year ago, another nurse in Sichley's unit went into a patient's room to medicate her. The patient suddenly grabbed her by the hair and started smashing her head against the floor. The nurse was out of work with head and neck injuries for more than six months, Sichley says.

Many other incidents occur with threats, kicks, slaps — aggressive behavior that doesn't result in injury. The California Nurses Association sponsored a bill to strengthen the state's current workplace violence law by requiring improved reporting, training and response to incidents. "There would actually be some legal consequences for assaults against health care workers," Sichley says.

Meanwhile, Sichley tries to look out for her co-workers. "My goal as a charge nurse is to make sure my staff members are safe and all my patients are safe," she says. "If I get a feeling that something is wrong, I'm on the phone trying to get medication or security.

"When I see a patient who is very tense, punching their fists, jaws tight, those are the people I think are ready to blow. We try to find a quieter place and give them some attention. Some calming medication often helps to reduce that," says Sichley.

Better staffing would help, as well, both in providing back-up for employees and reducing the frustration patients feel when they have to wait for care, she says."I want to help people get better," says Sichley. "I didn't realize I was going to be hurt along the way."