The Martyr at Your Bedside

The abuse of healthcare workers.

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“Kane County jail inmate Salters, 21, from Chicago, was at the Geneva hospital May 13, 2017, recovering from surgery after he ate part of a jail-issued sandal.

He was in a patient room when Loomis unshackled Salters so he could use the toilet, according to an Illinois State Police summary report. Salters overpowered Loomis and stole his .45-caliber semi-automatic pistol with about 12 to 16 rounds inside.

One of the nurses was sitting in her office when Salters, wearing only a white cloth bandage across his torso, locked the door and demanded the nurse take off her clothes, officials said. He pointed a gun at her, took her pink hospital scrubs and demanded her phone and car keys.

‘We may both be leaving in body bags’: State police report details fatal Delnor Hospital standoff »

Salters told another nurse to get in the elevator and bring him to the first floor. Salters and the nurse were going to leave from an ambulance bay, but they then saw officers arriving on scene.

Salters turned around and went into a decontamination room with the nurse, holding her hostage for several hours with a gun to her head, officials said. Salters hit her with a gun, threatened to kill her and raped her, according to the lawsuit.

Salters fired a shot into the room, and within seconds police officers came through the door. The standoff ended when a North Aurora SWAT officer shot and killed Salters. The bullet killed Salters and also struck the nurse in her arm, according to the lawsuit.” Chicago Tribune.

This is one case. There are many. As per the Emergency Nurse Association, “workplace violence against health care workers, including emergency nurses, has become a national crisis.”

A study on 3465 Registered Nurses, members of the Emergency Nurses Association, concludes that approximately 25% of respondents reported experiencing physical violence more than 20 times in the past 3 years, and almost 20% reported experiencing verbal abuse more than 200 times during the same period. Respondents who experienced frequent physical violence and/or frequent verbal abuse indicated fear of retaliation and lack of support from hospital administration and ED management as barriers to reporting workplace violence.

As an ER doc, I can vouch for that. I’ve been called names you don’t want your children to hear. I’ve been threatened, kicked and slapped by patients. And as a doctor, I’m the farthest away from direct patient care. The nurses, the CAs, the environmental workers, all the other staff are closer to the fray.

I asked my Facebook friends for their stories. I got hundreds. I also got a mandate.

“We need a sit-down, tape recorder and a big bottle of wine. Then it might get serious. I forgot more than I can remember. It’s sad.”

“Girl I can’t even begin to text that much!! One request, focus on DAs not actually charging patients with assault if they are mentally ill or intoxicated. To add to this, focus on hospitals that drop the charges “on behalf of the nurse/EMT/whatever” because they don’t want patients to feel unwelcome.”

These are some of their stories.

“Demented patient grabbed my hair and started punching me. I stepped back and she fell forward. I caught her and fell flat on the floor breaking my fall on a tray table. I had to take 5 months off work… I had to have surgery… my workman’s comp stopped all coverage saying I had a preexisting condition… I was a single mom with 3 kids so I had to go back to work. My back has never been right since.”

“Nearly every week someone threatens to kill me. Verbal assault happens about 2-3 times a shift.” 

“I had my face broken in 4 places by a psychiatric patient.”

A male patient: “BITCH HEY BITCH BITCH I’M TALKING TO YOU HEY CUNT WHEN YOU GONNA GET ME THAT ICE!!! You fucking bitch I’m gonna kill you!!”

“Hey, you single? I’m gonna take you out to olive garden and then I’m gonna take you back to my ranch and give you some dessert. You’d like that wouldn’t you?”

“A dementia patient with a broken hip… bit me, latched onto my shoulder and practically locked his jaw. Nurse had to pry his jaw open with a pen…”

“86-year woman became combative, I got her tele-pack… but I missed the telephone in her other hand. I missed a week of work due to the concussion.”

“Patient claims to the physician that I put my penis in their mouth and then was adamant that I somehow also put my penis in their rectum at the same time.” 

“Autistic young man going thru psychosis. Bit me thru 3 layers of clothes. Needed tetanus and stitches. Mom was highly pissed I reported it… Next day he bites dad’s finger straight off…”

“A gang member was getting Dilaudid every 3 hours. He miscounted… when I told him it wasn’t time, he took out the gun hidden under the mattress of the hospital bed.”

“I had my contact knocked out of my eye by a wet brief. Same resident gouged a bleeding wound in my forearm and then spit in it. Dementia is a bitch.”

“Yesterday I had a psych patient grab my wrist, pull me up to and put his genitals in my face while telling me to s**k his d**k b***h.”

 “The patient’s girlfriend snuck in an insulin pen that he used to bring down his blood sugar… he tried to stab us with it, then pushed his bed against the door to barricade himself in.”

 “I was slapped in the face by a drunk woman who was brought in for peeing in the bowling alley… now I’ve been off work for 8 months after suffering a rotator tear trying to help a patient that was combative postictal.”

“I went in to get vital signs on a patient and he had about 6 male visitors. All six of them were sexually harassing me. ‘Hey there shortie, when you gonna give me a bath’ ‘Hey brother she’s trying to get your sugar? When you gonna get my sugar I got alllll the sugar you need right here.'”

“Patient dug her nails into my arm… She called me over saying she wanted to hold my hand… My arm is scarred­­­­––not that I’m a model or anything––it’s just annoying to see the scars every day!” 

“Verbal abuse is essentially every day… Usually over narcs or another non-emergent process.”

“Dementia patient trying to leave. High fall risk. I was trying to escort her to her bed… she ended up slapping, scratching, and biting me. But hey, she never hit the floor 🤷🏼‍♀

 “I was punched in my belly while pregnant with twins… I didn’t do anything about it…. looking back that was not a good choice, but I blew it off… the babies were fine.”

“I currently have an orbital blow-out fracture, a concussion, and a black eye from taking a fist to the face a week ago.”

“I had a patient stab me with a used needle, she was hep-c positive, thankfully my follow up tests were clear.”

“Punched in the eye by a patient less than a month before my wedding… I was PISSED when my eye was black.”

“I worked in a pediatric psych unit. A patient held a set of scissors to my neck saying he was going to slit my throat (9 years old); another ripped my hair out (7 years old). My favorite, however, was when I was called a ‘motherfucking cunt’ by an 8-year-old.”

“Demented patient locked herself in the bathroom, writing poo-poo hieroglyphics on the wall and herself… she came at me like a crazed Jumanji character… I grabbed her arm to steady her and BAM! she stabbed me in the eye. Had a nice semi-circle red mark for two weeks, follow-up with occupational health to make sure I didn’t get conjunctivitis from her poop smearing… her family was shocked that grandma did what she did… ‘she’s so sweet’.. fuck that shit.”

Some of the stories are funny. In our line of business, you can’t survive without a sense of humor. I’ve never seen an ER or a psych nurse without a sense of humor. They must all be dead.

“Got punched in the balls by a dementia patient. Was trying to help clean him up. ‘Get the fuck out of here you fucking Jew.’ Shit I’m not even Jewish, I just have a big nose 😂

 “I got mule-kicked by a 36 yo g3p2 at 38w trying to deliver ‘naturally’ …”

 “I had a hospice patient throw water all over her room; I was trying to block her from kicking/hitting and beating staff with a stuffed panda bear…”

 “I had a Muslim patient scheduled for a TURP. He kept calling me an infidel in pre-op and in the OR before he went to sleep. How insulting…”

 “Drug addict tried to stab me with a dirty needle because I didn’t fetch her AMA paperwork fast enough. Shit (literal) thrown at me because altered mental status and she thought I was the woman who screwed her husband. 🤣And I’m just now in nursing school so I must be a sucker for punishment.”

 “Dementia patient accused me of urinating in the brief she was wearing, which was funny until she grabbed the used washcloths I was using to clean her to hit me with.” 

 “I had a dementia patient try to rip out my hair. Grabbed my hair by the roots and yanked. Lucky for me, I was wearing a wig 😂 she looked terrified and dropped my wig.”

 “Does getting breast milk squirted at me on two separate occasions by two different people count?”

“I was hit with the IV pole by a patient who couldn’t find his healing crystal…”

“Grabbed by the hair and yanked down over the bed when I was removing his EKG leads. Began punching me in the back of the head and bit me. Meanwhile, I was pressing my Vocera saying “security.” It paged the chaplain instead.”

 “Tonight someone threatened to shove a crowbar up my ass and then throw ninja stars at me. Does that count?”

“This little lady snuck up behind me like a ninja and hit me across my lower back with a wet floor sign… she had dementia… She thought I was an intruder in her house…but still… that hurt… if we ever have an active violent person on the floor… I have a plan… I’m sneaking up on that bastard and smacking the shit out of them with a wet floor sign.”

 “Spiritually pre-occupied patient kicked the devil out of me while chanting a prayer. Good thing it worked otherwise the devil would’ve kicked the hell back and more 👿

 “I was trying to convince a tiny old lady with one tooth to take her pills for me… she slapped me across the face… I get hit by patients so often that I didn’t even realize it… 🤣 I kept trying to convince her that pills in apple sauce taste good.”

Some stories are heartbreaking. People’s health, people’s jobs, people’s families are at stake just for being there and doing their job.

“I am unable to work as an RN because a drunk girl assaulted me and ruptured 2 discs in my back”

“A patient told me, ‘I’ll hunt you down and rape your daughter.’”

 “A male tried to kick me in my 9-month pregnant stomach… luckily my female nurse jumped on top of him with an elbow to the face! 💪

“Does the constant soul-sucking drain from needy patients who come in with agendas, not emergencies, count as abuse?”

 “Pt slammed me face first into the door. Outcome: two teeth knocked out, left arm displaced humoral fracture, in 6 pieces. He had just been released on bond for assault. My arm fracture became a non-union fracture and had surgery and a bone stimulator. Nerve damage and CRPS. He was not prosecuted for the assault.  It took almost a year for the humerus to heal. I couldn’t work in the ED any longer.”

 “Our local hospital was put on lockdown after a nurse walked to her car and a man said ‘all nurses should die.’ Then threw kerosene on her and tried to light her on fire.”

 “My first pregnancy ended in miscarriage after punched in the stomach by psych patient who liked attacking women. Second pregnancy had little old lady who was sundowning kick me in the stomach. My son was born OK a few months later.”

“I’m a student nurse and so far I’ve been hit with various walking aids, had a patient try to break my arm whilst sort of holding me hostage, been hit in the stomach by patients, and I’ve had a full urine bottle thrown at me… Why am I doing this again?”

Some stories are downright weird, even for those of us who think they’ve seen it all.

“The patient’s support dog was even more aggressive than they were. They both bit a few workers, WTF!”

 “I have been assaulted a few times… you’d think it was while I worked in correctional nursing but it wasn’t. It was in the ER. I actually felt safer in the prison than in the ER.”

 “Had a guy yell at me to let him out of his restraints so that he could make me his little bitch and squeal like a little piggy while he spread my pretty pink hole. Probably one of my more uncomfortable moments I’ve felt in the workplace. 🐷

“I had a confused patient get a skin tear and just calm as can be looked at me then his bloody hand then back at me while wiping his hand on my scrub top.”

“I had my jaw dislocated by a patient who wanted to sit in his own poop. It was burning his skin so 6 of us went in to hold him while cleaning. Another nurse let go and boom.”

There seems to be a consensus that the administration, the police, and the system, in general, don’t care about the healthcare workers. Instead of being supported, they get blamed for getting assaulted, they are discouraged from pressing charges, they watch as the people who assaulted them are set free. They have to take personal time off for recovering after being assaulted. They are hurt and angered by the unfairness of the system.

“I’m missing teeth from a patient kicking me in the face. The hospital blamed me for getting near her feet.”

“A near 100-year-old woman tried to choke me with my lanyard. I was trying to give her Ativan applesauce for agitation. LTC got so obsessed with making sure granny doesn’t get abused they took away all the things that keep staff from being assaulted. Granny getting abused never happened because of mean ole careless nurses, it happens because LTC/SNF is so woefully understaffed it’s downright dangerous…”

“Torn ACL, MCL, Meniscus, and IT band…three operations later I still walk with a limp and the person that attacked me got 1-year probation… The justice system failed, and until people are held accountable it will keep happening.”

“Patient picked up a heavy chair, threw it at me, hit me square in the knee cap and cracked it. Security was called. They left saying they weren’t going to get involved with a crazy patient. Even though I was on the floor and he was beating on me.”

 “The worst was a rich person on drugs and alcohol that threatened to kill me. Found me online and stalked me. The administration took the patients side and suggested it was my fault.”

“Why is it big news when someone gets attacked by an animal but this is allowed to go on? If a person in our society commits these offenses they are arrested. If they are in a confined area, an entire SWAT team is dispatched. So why is it OKAY if it happens inside the walls of a hospital? And if your spouse does these things to you, they will be arrested. Doesn’t matter if they are mentally ill.”

“Unfortunately, in the world we live in now, we are the ones who get blamed for our own assaults. 🙄 Then we lose our jobs.”

“I have been threatened by a patient to wait outside for me with a gun, punched square in my nose, kicked, pinched, bit, chairs thrown at, spit… recently we were just told we have been restraining to often and we need to work on our verbal de-escalation more. Sometimes that JUST DOESN’T WORK.”

 “Having an asshole point his dick at me and piss on me from top to bottom and in my shoe when I went to help him with the urinal. Called security and nothing happened. Had to go back in and make sure his ice water was topped off. The biggest abuse of health care workers is ADMINISTRATION!”

“It’s easy for a patient to get out of charges while they are admitted, especially with a mental health diagnosis… It’s basically a get out of jail free card because they can claim that they didn’t intend to do what they did and they are sick. Laws are weird.”

“Every attack on a healthcare worker should result in jail time for the perpetrating asshole, and financial restitution to the attacked healthcare worker. Healthcare workers must be allowed to defend themselves by any means necessary. If institutions don’t like that perhaps they should step up and provide a safe working environment.”

“I got kicked in the chest by a drug overdose patient. Cops said I couldn’t press charges because he was “altered.”With that same logic, a drunk driver shouldn’t be held accountable cause they were altered when they crashed/killed/hurt others?”

“A group of drunk rowdy patients waiting to have their simple lacerations sutured threatened to wait for me by my car and rape me. I told them I would call the police… It turned out they were the local on-duty cops.”

 “it is more work to fill out all the forms…You end up defending yourself and trying to cover your own ass. System sucks, healthcare worker abuse is one of the most visceral things that the system seems to ignore. I’ve just come to accept that you never ever truly trust any patient when it comes to your personal safety.”

At some point, people give up. They give up caring. They change jobs. They quit.

“A patient…went to attack a palliative patient in her room so I closed her door and held onto the handle to stop him going in. He rained down with punches telling me to let him the f*** in… he lost balance and fell… I was reported for not doing my job as he got injured. I was off for three days recovering… I stopped caring about that after a while.”

“It makes the nurses, their assistants, and the doctors, jaded since you feel like a glutton for punishment when you’re just trying to do your job helping people.”

“I have lost a lot of drive for bedside nursing… I wanted to be a nurse since I was 13… For every patient who shows you gratitude or a shred of human decency, the other 9 out of 10 tend do the exact opposite.“

“An elderly woman bit and tore my hand open, dislocated my shoulder. She poked me with those crazy hairpins, beat me with a snow shovel, an umbrella, and a baggage cart. All because I wouldn’t let her go out in negative degree weather with snow falling rapidly. Our building was on a cliffside. I got told to let her go next time. Like wtf?!”

“Being abused by patients has burnt me out and has me considering a new career.”

 “At a certain point it’s not even money, it’s a loss of hope…”

The November 2011 Emergency Department Violence Surveillance Study, a cross-sectional study of 7,169 nurses, states: “The overall frequency of abuse during a seven-day period… was 54.5%. Participants reported experiencing physical violence (12.1%) and verbal abuse (42.5%) …”

Most of them did not report the incident, because of a perception that assaults are part of the job, believing that reporting won’t do any good and that assaults will be viewed as poor job performance.

This is the problem. The solution? Nobody knows.

Bill Schueler, MSN, RN, CEN, CPPS, WVTS, a coauthor in the upcoming edition of Emergency Department Management, says: “When you dig in the… literature, it is surprising how much of what is recommended…is not necessarily “best practice.” It is more of an industry standard…the science doesn’t pan out for metal detectors, violence prevention programs, Tasers, reporting of violence, violence prevention policies, or which violence assessment tool is best. There’s research that could be done… what if we put our efforts on the recovery/mitigation? What if we put in robust support systems for caregivers after they are assaulted: placing them on paid leave instead of them having to use time off and workmen’s compensation; visible executive and management support with a message that “violence is not acceptable here, but if/when it happens, we will support you to the fullest”; a hospital culture that clearly states and shows that violence will not be the norm here, both to patients and caregivers AND a culture that lives up to that expectation (many talk the talk, but don’t even crawl the walk”

According to the Bureau of Labor Statistics’ Census of Fatal Occupational Injuries, at least 58 hospital workers died as a result of workplace violence between 2011 and 2016. The Government Accountability Office found that “health care workers at inpatient facilities were at least five times more likely to encounter nonfatal workplace violence compared to workers overall… the full extent of the problem and its associated costs are unknown. The number of nonfatal workplace violence cases in health care facilities ranged from an estimated 22,250 to 80,710 cases for 2011…”

The recently introduced Health Care Workplace Violence Prevention Act, would direct OSHA to require health care facilities to develop workplace violence prevention plans. It follows regulation enacted in 2014 in California, directing CA/OSHA to craft a workplace violence prevention standard. Their definition of workplace violence includes physical acts of violence and threats of violence, and it emphasizes the importance of staffing.

In the meantime, more incidents will happen. More healthcare professionals will get hurt, depressed and discouraged. More of them will quit. Patient care will suffer. Costs will soar.

Bill Schueler says: “It was estimated to have cost US hospitals and health systems a total of $2.7 billion in 2016 and that includes costs for preparedness and prevention; unreimbursed medical care for victims; security and training; and medical care, staffing, and indemnity. It would be estimated that an average hospital paid $481,596 for violence-related costs in 2016. Annual costs from violence can range from $97,000/year for injured nurses to $270,000 for injured caregivers, in conformity with the linked studies on American Hospital Association and Journal of Emergency Nursing.

Since I can’t say it any better, I will close with the words of one of the assaulted nurses.

“I was assaulted by a patient while at work. A patient that I had cared for and dedicated myself to for 12.5 hours a day for three straight days prior to this. Let me tell you, having… hands around your neck, the inability to breathe, let alone call for help, to the point where you can’t see a thing… is one of the absolutely gut-wrenching, most terrifying feelings anyone could ever imagine… officers came to my ER room to get my statement and inform me that they are unable to take this patient into custody. Instead, said patient gets to stay at the hospital, where my coworkers are forced to care for someone who just tried to murder their friend. Do you know what it feels like to know that someone who just tried to kill you isn’t even being arrested?… when did my life become so INVALUABLE that someone can try to take it away, and not be taken into custody??? If this happened in front of you on the street, would you expect that person to get a slap on the wrist and get to continue walking down the sidewalk? How safe would you feel then? What if it was a teacher, a cashier, a police officer who was assaulted? Do you think their assailant would get to go upon their day like nothing happened, and not be arrested and taken into custody? Or should we wait and have a psychiatrist come do a mental evaluation first to decide if they should be held accountable? Should we have someone evaluated before getting arrested each time we have a domestic violence call? What if they aren’t mentally stable?

I’m putting this out there to bring awareness of what is happening in hospitals. Just because you are in the hospital does NOT MEAN THERE ARE NO LAWS AND NO MORAL RESPONSIBILITY. You cannot strangle people. You cannot sexually harass people. You cannot hit, kick, bite, scratch, spit, or call people names. And by people I mean those folks who sacrifice time with their families, their bladders, and their SANITY to care for you.”

Thanks to all those who bared their souls to help with this piece. I’m sorry I couldn’t include everybody.  Thanks to Bill Schueler for sharing his expertise. I hope we’ll bring awareness to this painful subject and help change happen.

Here’s to a society in which the safety of healthcare workers is at least as important as the patient’s comfort, and even more important than money.

Rada Jones MD MBA is an Emergency Doc in Upstate NY, where winters are long, people are sturdy and geese speak mostly French. Her thriller, OVERDOSE, is now on Amazon.