Understanding patient violence against health care workers

The following op-ed was published on February 2, 2011 in USA Today.

Last fall, a surgeon at Johns Hopkins Hospital was shot by the distraught son of a patient for whom he was caring. The man later killed his mother, then himself. A week earlier, a patient in a Long Island, N.Y., hospital beat his nurse with a leg from a broken chair, causing serious injuries. The following month, a psychiatric technician at a Napa, Calif., state hospital was fatally attacked on the job.

This snapshot of violence against health care workers reflects a disturbing trend. According to a Bureau of Labor Statistics analysis published last year, almost 60% of assaults in the workplace occurred in a health care setting. Nearly three-quarters of these assaults were by patients or residents of a health facility.

No longer havens

Health care settings have been traditionally thought of as “safe havens,” open to anyone as a place to be protected and cared for. This is a trend worth watching. The Joint Commission, a national accrediting agency, soberly noted last year that “health care institutions today are confronting steadily increasing rates of crime, including violent crimes such as assault, rape and homicide.”Violence is most common in psychiatric facilities and emergency departments, but can also be seen in waiting rooms, long-term care centers and critical care units. Nurses are the most frequent targets. According to a 2010 survey from the Emergency Nurses Association, more than half of ER nurses were victims of physical violence and verbal abuse, including being spit on, shoved, or kicked; one in four reported being assaulted more than 20 times over the past three years. The survey noted that the violence seemed to be increasing at the same time the number of alcohol-, drug- and psychiatric-related patients was rising.

Clearly, we must do better protecting those charged with healing the sick. Most hospitals have focused attention on controlling access with security personnel. They’ve also trained staff how to recognize agitated patients, de-escalate threatening situations and to routinely report such incidents. Some facilities and states have taken stronger steps. Detroit’s Henry Ford Hospital has installed metal detectors, and Massachusetts recently strengthened criminal penalties for assaults on health care providers.

Doctor-patient strains

But I wonder whether the rising tide of violence against doctors and nurses is more emblematic of a dysfunctional health system. Patients are learning that health care is a commodity. I see firsthand the deterioration of the doctor-patient relationship, as physicians are pressured to see more patients in shorter amounts of time. Patients are rightly frustrated, and some are lashing out.

Rita Anderson, a former emergency room nurse, successfully spearheaded New York’s 1996 campaign that made it a felony to assault a nurse. She told CNN, “People are just tired of waiting, or they are just angry that they’re not getting the care they feel is acceptable. Instead of saying something, their response is hitting, screaming, spitting, yelling.”

Sometimes the simplest approaches are the most effective. Rather than adding security or installing metal detectors to prevent hospital violence, doctors and nurses could do a better job of empathizing with patients who are under stress when they are hospitalized or are angry because they’ve waited hours for medical care. At the same time, patients must realize that health care professionals are doing the best they can with an overtaxed health care system and should never resort to violence or abuse.

That shared understanding and cooperation is essential if we hope to restore our health care institutions to the safe havens they were meant to be.

 is an internal medicine physician and on the Board of Contributors at USA Today.  He is founder and editor of KevinMD.com, also on FacebookTwitterGoogle+, and LinkedIn.

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