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ED nurses seeking protection from violence
OSHA standard needed, nurses say
"Two dead in Tennessee Hospital Shooting" – New York Times, April 19, 2010
"Shooting Inside Danbury Hospital" – Hartford Courant, March 3, 2010
"Gunman Opens Fire Inside North Carolina Hospital" – FoxNews, February 15, 2010
Violence erupts in emergency rooms across the country with a troubling frequency. The worst cases make the headlines, but for emergency room personnel, it is the daily volley of physical and verbal assaults that create a stressful and hazardous work environment. Amid a growing concern about safety in Emergency Departments, emergency room nurses are pressing for a workplace violence standard, rather than the current voluntary guidelines, from the U.S. Occupational Safety and Health Administration.
One in four emergency room nurses experienced 20 or more acts of physical violence at work in the past three years, according to a 2009 survey by the Emergency Nurses Association (ENA). About 20% reported experiencing 200 or more incidents of verbal assault in the past three years.
The emergency department is inherently stressful for patients, who may be feverish or fearful or in pain. "There's a lot of anxiety and frustration that comes with going to an emergency department," says Bill Briggs, RN, MSN, CEN, FAEN, president of ENA in 2009 and trauma program manager at Tufts Medical Center in Boston. "That's compounded by a crowding situation. You add to that a problem with alcohol abuse and drug abuse and a significant mix of mental health patients. You can have quite a volatile situation."
That makes work a hazardous, stressful place for emergency personnel. Two-thirds of the nurses reported that they do not feel safe in the emergency department.
The emergency room events fuel a stream of violent events that make acute-care hospitals the site of more work-related injuries from assaults than any other workplace, according to 2008 data from the U.S. Bureau of Labor Statistics. Combined with psychiatric care and long-term care facilities, health care facilities were the site of more than 10,000 reported assaults that resulted in injury. That represented about 47% of all work-related injuries from assaults in 2008.
Violence in the Emergency Department "is pervasive throughout the country," says Briggs. The ENA survey found high levels of physical and verbal assault in urban, suburban, and rural hospitals, he says, with a slightly higher incidence on the night shift or among male nurses.
Assaults should not be tolerated
Workplace violence is not an issue solely of security. Limited access entries and security guards are ubiquitous in the nation's emergency departments. But beyond those necessary tools, hospitals need to promote a culture in which physical or verbal assaults are not tolerated, says Briggs.
In the survey, nurses who reported fewer barriers to reporting events also reported experiencing fewer incidents.
"There was less reported violence in hospitals that had a culture of reporting," he says. Hospitals need to make it clear that violence against its health care workers is unacceptable, he says. "You would never go into a supermarket, not like the price of an item, punch the cashier and get away with it," he says. "If you went to a bar and got obnoxious, you'd be thrown out."
Briggs has experienced the violence in emergency departments. "I've been kicked and hit and shoved and spit on," he says. One employer implemented a two-day violence prevention training program for the ED that included physicians, nurses, security officers and clerical staff.
They learned how to spot the warning signs and how to diffuse tense situations or agitated patients or visitors. "It truly reduced the violence," he says.
Diane Gurney, RN, MS, CEN, ENA president and a retired manager of an emergency department in Hyannis, MA, was once slapped so hard by a psychiatric patient that she had to wear a neck brace for days. In the Emergency Department, she has been slapped, spit at, and yelled at. But she is gratified by the attention the issue has been receiving.
Fourteen states have passed laws making it a felony to assault health care workers, although those laws are not always consistently enforced, ED nurses say.
"When I go across the country to talk to people, it is stunning to hear what some of them have been subjected to," says Gurney.
Violence erupts in rural hospital
Last February, a bar fight spilled into the emergency department of Scotland Memorial Hospital in Laurinburg, NC. According to news reports, at 3 a.m., a 31-year-old Domario Covington was being treated for a laceration to his neck that he received in the fight when another man came looking for him and his girlfriend. The man identified himself as a family member, so he was allowed to visit the patients. He brandished a gun and began shooting, leaving Covington in critical condition and running out only after the gun jammed.
"When that person with the gun started shooting, [employees and patients] were seeking shelter and were afraid," says marketing coordinator Karen Gainey. "They didn't know if the shooter was going to come after them or if he was just intent on shooting the patient. Thankfully, his gun jammed. If it had not, we don't know what he would have done."
The hospital has since changed its policies. For example, patients in the emergency department now must indicate who will be visiting them, and the visitors must show identification. The hospital also created a special code that would send immediate help to the emergency department.
The 104-bed rural hospital seems an unlikely spot for an eruption of violence. "It was incredibly shocking that this could happen in a small rural area such as ours, a small community hospital such as ours," says Gainey. "It just goes to prove that we're living in a world that is changing.
"It doesn't matter where you live. Terrible things happen and there are people who are intent at hurting others," she says. "We have to improve security matters and we're working to keep our staff, our patients and our visitors safe."