How Can We Address Increasing Violence Against Healthcare Personnel?

Violence is no stranger to healthcare settings, which I know from personal experience. A female patient attacked a colleague and tore off his shirt, broke his glasses, and threw him down a metal staircase when I worked with him. I never learned what caused the attack, but it was horrendous. The patient was placed in the quiet room, and that was it. Nothing else except for a bit more of a major tranquilizer.

A nurse was killed when she refused to give a patient a cigarette. Of course, the patient had already committed murder, so what did he have to lose? By using a ballpoint pen, a patient stabbed another nurse in the neck.

A psychiatrist on a ward where I worked was also attacked. After I left the office and building, the patient repeatedly hit the small woman psychiatrist with her handbag, which contained a heavy book. The psychiatrist had injuries to her shoulder and neck and went on sick leave for two months. The patient was immediately transferred to another hospital in the state, one for violent patients who had attacked, primarily, physicians.

None of this happened recently, and the violence at the two hospitals where I worked was always treated the same: transfer when an MD was attacked, quiet room for every other attack. The staff felt demeaned and resentful.

“The risk of workplace violence is not distributed evenly across specialty. Data shows that those who work in the emergency department, in geriatrics, or in psychiatry are substantially more likely to experience violence.”

Today, however, the level of violence, primarily at hospitals, is causing a sudden decision for nursing staff to seek other employment or leave the field entirely because of burnout or a lack of safety. Some estimates place the number of nurses leaving by 2027 at around 600,000. The result is that we have inadequate levels of staffing now, and it will get worse. In fact, hospitals are upping their recruitment abroad to supplement the paltry stream from US sources.

The rise in violence against medical professionals has had a substantial influence on the medical community, causing serious difficulties for both patient care and healthcare workers. Stressed and overworked healthcare professionals may degrade the standard of patient care. Also, the fear of violence can make it difficult for healthcare professionals to carry out their jobs properly, which can reduce productivity and increase the risk of patient care errors. In such a situation, what can be done?

How It Is Being Addressed

The media has been providing information on the issue, and both public awareness and education about it are needed. But is that enough? Obviously, an informed public is needed, but what steps are hospitals taking to protect and train their personnel?

According to research, healthcare is the profession where more violence occurs than in any other workplace, and about 654,000 personnel are injured each year. Yes, this is shocking, and I’m willing to play devil’s advocate here after reading what hospitals are proposing by way of decreasing violence in healthcare settings. No, I am not an expert on the matter, but some of the propositions appear to be circling the wagons without addressing some very real issues.

A perusal of the information that is being provided to healthcare personnel boils down to learning to de-escalate potentially violent incidents, educating the public and patients, planning for escape, where to hide, and how to call for help or security personnel. The one factor that is missing is the most distressing of all. The reasons for violence? Patient dissatisfaction, scarcity of mental health facilities, the opioid crisis, the pandemic—the list goes on.

Using a phrase that has become familiar to many of us, “You don’t bring a knife to a gunfight.” How does that apply here? I believe it is apparent that we are not more forcefully addressing the issue of gun availability, but not simply the ready supply of guns in stores.

The type of gun that is being used in almost all of these violent incidents is one meant for war. To more graphically present what these guns do, I have read in the research that the exit wound is the size of an orange, and survival is all but hopeless.

The issues are broader than employee and patient education, where to hide, or hospital protocols. To say that we are handling the question of gun violence in the US would seem to me to be somewhat naive or evasive. It’s a head-in-the-sand gesture when over 200 mass shootings occurred in the first half of 2023. Anyone wishing for more detailed information on gun violence can search the Gun Violence Archive.

Personnel shortages are only one result of the violence we are seeing. The future history books will carry a good deal of bold-faced type to underscore the recklessness we’ve encountered with regard to loss of life and our responses. The question remains: when will it stop?