With workplace violence in medicine truly an epidemic, who is to blame? Is it the public in general? How about the police? Can it be administration? How about the Media? What about staff themselves?
Let’s take a look at some numbers to prove the existence of the ELEPHANT in the room so many wish to ignore.
OSHA what say you?
OSHA says “Although workplace homicides may attract more attention, the vast majority of workplace violence consists of non-fatal assaults. BLS data shows that in 2000, 48 percent of all non-fatal injuries from occupational assaults and violent acts occurred in health care and social services. Most of these occurred in hospitals, nursing and personal care facilities, and residential care services. Nurses, aides, orderlies and attendants suffered the most non-fatal assaults resulting in injury.” (1)
The CDC weighs in with:
What is workplace violence?
“Workplace violence ranges from offensive or threatening language to homicide. NIOSH defines workplace violence as violent acts (including physical assaults and threats of assaults) directed toward persons at work or on duty.”
Examples of violence include the following:
Threats: Expressions of intent to cause harm, including verbal threats, threatening body language, and written threats.
Physical assaults: Attacks ranging from slapping and beating to rape, homicide, and the use of weapons such as firearms, bombs, or knives.” (2)
Let’s hear what the ENA has to say about it:
The Emergency Nurses Association (ENA) published an article that stated “According to Bureau of Labor statistics, an assault on a healthcare worker is the most common source of nonfatal injury or illness requiring days off from work in the healthcare and social assistance industry.” (3)
Any words from you NAEMT?
“Four in five EMS workers have experienced some kind of injury or medical condition as a result of their work, according to the NAEMT “Experiences with Emergency Medical Services Survey,” conducted by Harris Interactive. Note the leading cause of INJURY was violence with 52% reporting being assaulted on the job. (4)
Trying to solve the riddle in order to recognize the need for a change in emergency medicine one must first understand the root of the problem. I mean, you have to find someone to blame right? Contrary to the belief of some, fixing the problem that is violence will take much more than learning a few physical “techniques” to simply escape violence once it (violent encounter) occurs. The problem must be addressed in various locations, covering multiple topics with cross-training (inter-agency) if possible.
It is amazing what you find when you actually “look”. This was sent to me by an RN who was given permission to research the subject at her hospital.
We keep a record of both pre-hospital and in-hospital assaults that make the news. I have no reports making the news from this particular hospital.
“2013 had 388 calls to security for ‘disruptive or aggressive patients. 84 employees injured by patients severely enough to report to employee health. 19 injured enough to file Workman’s Comp and require care beyond what employee health could provide. And that is only scratching the surface as ED never reports. Only 3 fully reported ED assaults, and multiple calls to same ED bed are logged as one occurrence.”
Let’s look at a few folks we may be able to point the blame finger at:
The Public– When wearing my DT4EMS logo, someone will ask “What is it you do?” I will explain to them I teach EMTs, Paramedics and Nurses self-defense. Immediately the person will give me a bizarre look and ask “Who would want to beat up a nurse-paramedic-EMT?” The average person in any community has no idea how frequently medical staff are faced with use-of-force decisions regarding both self-defense and/or patient restraints. They are shocked when I tell them according to the National Association of EMT’s 52% of providers have been assaulted on the job and according to the Emergency Nurses Association 50% of ED nurses report being assaulted on the job. So since the public is unaware, it must be their fault…right?
The Media- Prior to 2009, it was RARE to see any news coverage of medical staff assaulted on the job. While more reports are surfacing, violence in medicine is still way under-reported. When interviewed reporters always ask me why I believe there is an increase in violence toward staff. I respond with there IS NOT AN INCREASE, there is simply more acknowledgement that staff are attacked. Every chance I get, I email a reporter when they post a story about an EMT, Paramedic, Nurse or firefighter assaulted on the job. I ask them to research the topic deeper and they will be shocked to see how frequent it occurs. Rarely does it ever happen that they follow up. Apparently it’s just not news. Yet let a provider do something criminal… and that to them IS news. If the media kept hearing about the criminal assaults on staff, they would see the need to report it, the public would recognize how big the issue is and change would have to occur. So since the media doesn’t hear enough stories or reports of violence it must be their fault…right?
Staff– Staff are brow-beaten regarding duty to act, duty to respond and patient abandonment but get little in understanding of the use-of-force and that fleeing a violent encounter is NOT patient abandonment. Because there was no formal training offered, staff started doing what they observed police officers doing to “control” a person. This led to more “unofficial training” where they would just pass around advice to one another on how they would handle a particular situation. Couple that with staff acting like cops…that makes the public treat us like cops on scene. The internet is ripe with comments proving the pendulum has swung far to the side of excessive force with regards to the use of force in patient restraint or self-defense on the job. This has had dire consequences where staff are actually committing criminal assaults themselves against true medical patients. Staff in many places are so fearful of violence they are asking to carry guns on duty. Just like any other subject, a lack of knowledge leads to anxiety. Once staff are trained on what is “reasonable” and what is a patient and what is NOT a patient. I hope none of the people get caught on camera doing what they claim they do… Now because staff were faced with responding to violence or using force without training on how to deal with it “reasonably” it must be their fault…right?
The Police- Fit for Confinement is when a person is high or drunk, many agencies require a “fit for confinement” release. Law Enforcement training has officers fearing legal repercussions for a person dying in their custody. This has led to many who are drunk or drugged (but have no other medical complaint) to be passed off to the medical community. Understandably for “liability” reasons on the PD side, but this has led to dangerous incidents of violence on the medical side. Mainly because medical staff have little to no training on how to handle violence. Then because of the verbal and physical actions of many providers, officers sometimes have a mistaken belief of the level of training medical staff possess in the use-of-force. The average medical provider receives less than 4 hours in any type of “restraint” training. Officers on the other hand essentially spend their entire police academy on “restraints” when you think about it. Everything is about when they should, when they should not, how to and how not to- as well as what to do if a person doesn’t want them to- take custody and place a person in temporary restraints (handcuffs). All the while understanding the legal ramifications of doing or not doing so. We have to find a way to work together. Cops are always the ones to blame, right or wrong, so it must be their fault…right?
Administration– There are always patient satisfaction and safety reviews. Where are those same reviews for staff? There is a reluctance to train staff for dealing with violence due to fears of liability. There is a liability in failing to train staff for what they truly face. No matter how many studies have been conducted proving violence is at an epidemic level for EMS/Fire and ED staff… some still hold out, refusing to train staff. Some administrators have the “this is the way we have always done it” attitude. Notice CPR and ACLS changed because evidence proved otherwise. I realize some agencies have been burned by hiring either a police officer (who teaches pain compliance control techniques) or a martial artist (who teaches finishing-destroy your opponent fighting techniques) and refuse to research the subject further due to those past experiences. So I pose the question- Why do so many front line staff want to be armed with firearms yet many administrators don’t feel training for violence is needed? Now add the fact that hospitals don’t want the public realizing how dangerous the ED is (because who would visit a dangerous place on purpose– see, we get it). So since administration is doing what they get paid to do… it must certainly be their fault…right?
So you see, it is much more than a few techniques, no matter how good they are, needed to fix this mess, this monster, we have all created. We are all to blame for letting violence in medicine grow to this epidemic level.
All is not lost.
Here is how training, particularly cross-training, will help:
First, medical staff must be educated as to what is and what is not a patient, when they can and can’t use force, the “reasonable” use of force, and how to document the violent encounter with the medical solution in mind. Police officers who have attended our EVE courses are quick to help correct misconceptions medical staff have regarding the use of force.
Our research has shown since there is a fundamental lack of patient vs attacker recognition, this has led to staff failing to report criminal assaults and believing violence is “just part of the job”. With the belief it is part of the job, staff are reluctant to pursue criminal charges. For those who do wish to pursue criminal charges, fellow or senior staff ridicule them for wishing to do so.
If staff reported more of the criminal assaults to the police, the media would hear about it and so would the public. The police would possibly take a more pro-active role in assisting staff with “custody” of people who are drunk or drugged (who don’t really require medical attention) and reduce EMS transport and ED visits. Penalty is not protection but it proves there is a problem. Many states have enacted laws that penalize specifically those who assault medical staff. Through education we may be able to modify existing laws to keep healthcare providers away from those who should actually be in police custody.
When officers attend EVE, they get a better idea of what medical staff face regarding violence and the lack of training on the subject. This has officers becoming champions for change not only within the medical community but within their department as well.
It is a cyclic process…one builds on the other, yet requires the other for true change to be obtained. We can fix this mess…with your help.
A little motivation to train:
RELATED: Violence in medicine is real. Watch these!
Sources:
(1) OSHA Guidelines for Preventing Workplace Violence for
Health Care & Social Service Workers
(2) CDC Violence Occupational Hazards in Hospitals
(3) Study: Change of Culture, Increased Training Needed to Reduce Violence Against Emergency Nurses