Sixty percent of workplace assaults occurred in health care in 2006, and most of the assaults were committed by patients, according to the Bureau of Labor Statistics.
But as the years have gone on, violence in emergency departments and hospitals has only escalated, according to reports.
“Nationally, it’s a very big problem, and we take it very seriously,” said Dr. James Adams, professor of emergency medicine and doctor at Northwestern Memorial Hospital.
Seventy eight percent of physicians reported observing at least one violent act occurring in the emergency room in 2007 to 2008, with 21 percent of responding physicians reporting more than one type of violent act.
This startling statistic was presented at the American College of Emergency Physicians Annual Meeting in Chicago in October 2008, following a national survey of emergency medicine residents and attending physicians.
But the rise in emergency room violence continues today, with emergency department nurses reportedly experiencing the most physical assaults of all nurses.
According to a report in the March/April 2011 “Nursing Economics,” in a study of Minnesota nurses, emergency department nurses were over four times more like to report they had been assaulted compared with nurses in other units.
“It’s absolutely a problem, and it’s an increasing problem,” said Sharon Canariato, deputy executive director of the Illinois Nurses Association. “In general nurses and other health care workers are three times more likely than other works to be a victim of violence. In the U.S., between eight and 13 percent of health care workers are victims of physical violence every week.”
This has always been an issue, but it’s an issue that seems to be worsening in hospitals, according to Canariato.
“Patients and relatives are really the perpetrators,” Canariato said. “The rise is with visitor violence from the families who are being verbally or physically abusive now.”
When looking at violence in emergency departments, it’s considered anything from verbal abuse to spitting, hitting, pushing, etc., Canariato said.
“It is an occupational hazard—hospitals have a responsibility to keep workers safe,” Canariato said. “The reason an emergency department is more likely to experience violence is because they have 24-hour accessibility to the public, and that’s why the rates of violence are harder.”
There’s not a single reason as to why violence is increasing in emergency departments, Canariato said. She listed common factors as patients coming in under the influence of drugs and alcohol, the stress of being in an emergency department, and the fact that emergency departments often see at-risk patients such as gang members, violent offenders or psychiatric patients.
But the economy might also be playing a role in the increasing violence across Illinois hospitals.
Recently many people affected by the economy have been using emergency departments for treatment rather than seeking out general physicians, Canariato said.
“Health organizations have had decreased staffing, which leads to increased wait times, and escalated stress levels,” Canariato said. “ERs are absolutely crowded throughout Illinois—overtaxed and overburdened.”
But there are many things hospitals can do to make workers and patients feel safer, including implementing new safety policies.
“The most important thing is to be proactive,” Canariato said. “Hospitals should have a zero tolerance policy for workplace violence and treat it seriously.”
Adams said over the years Northwestern has built up multiple programs for staff to make sure the hospital is safe for everybody. He said dealing with emergency department violence is part of the emergency medical training at the hospital, and that the hospital has everything from security guards standing by 24 hours a day to medicines to calm patients in dangerous situations.
“Our training has become better over the years,” Adams said. “For example if a person is hostile, we know not to be hostile back and to calm them down with words and behaviors. Human interactions can be powerful.”
It’s only when people can’t control themselves and represent a danger that the hospital then takes control of a violent situation, Adams said.
Many solutions to the problem have been suggested over the years after violent events have occurred in emergency departments, such as the September 2010 Johns Hopkins Hospital shooting, with one possible solution being the installation of metal detectors and other screening procedures in hospitals.
At the American College of Emergency Physicians Annual Meeting in Chicago in October 2008, it was reported that less than half of respondent emergency departments did not screen for weapons and only 38 percent used metal detectors.
Adams said installing metal detectors at Northwestern Memorial Hospital has been considered before, but it’s always been ultimately discarded.
He pointed to a staff having to man the detectors at all times, and the detectors potentially slowing down sick patients entering the emergency department.
“They have been considered, but we found that wasn’t the route that would help us out the most,” Adams said. “We’ve found that there are other techniques that are much more effective. If a person is out of control, we need to get them under control. It’s a strong and caring environment that really does help to minimize the violence.”
Adams also said that the hospital found that metal detectors would not be that hard to circumvent if a person had an intention to carry out violent acts.
Canariato suggested that closed nurses’ stations would help in hospitals, despite the belief in keeping all barriers open and accessible, as it historically puts nurses more at risk.
“Emergency departments should be the most well lit place,” Canariato said. “They should have a visible security system.”
She also suggested a lighting system, such as green for okay and yellow for heightened security as well as panic buttons and silent alarms as ways for hospitals to ramp up security.
“The potential for violence is a daily occurrence,” Adams said. “We’re always attentive and on guard for it. But we have become better and better at handling it over the years. It’s unfortunately a norm. It’s always a risk.”
