Two weeks ago The New York Times published an article entitled A Chinese Nurse Resigns, Bidding Farewell to Her Florence Nightingale Dream. The article focused on one nurse’s experience with violence from patients and patients’ families, a major problem for healthcare providers in China. The nurse in this article left nursing because of the ongoing exposure to violence. A week later a story emerged across social media about a nurse assaulted by a patient who used the nurse’s stethoscope in an attempt to strangle her. In her 23 year history as an ED nurse, this was not the first time the nurse had been assaulted by a patient.
Thousands of similar accounts of violent behaviors inflicted on nurses exist here in the United States and around the world. Violence in healthcare, and specifically violence directed toward nurses, has reached epidemic proportion based on numerous accounts of violence and injury reported to healthcare administrators; discussions on social media (#ViolenceAgainstNurses); and numerous journal and print articles such as Susan Trossman’s article, It Can Make Nurses Sick in the May/June issue of the The American Nurse; and calls for legislation beyond misdemeanor charges for assault against healthcare workers despite legislation in several states (see map below). Some estimate violent behaviors directed toward nurses are higher because many nurses do not report violent episodes or injuries suffered at the hands of patients which results in significant underreporting of these violent occurrences.
The threat of assault by patients unnerves nurses, and actual assaults affect nurses beyond physical injury. The psychological quagmire of devoting oneself to helping patients in their most vulnerable state and then suffering an assault at patients’ hands impedes nurses’ ability to function without trepidation and fear because of the psychological toll of an assault-a factor seldom addressed by coworkers, managers, or administrators. The experience of violence against nurses can leave nurses with symptoms that meet the criteria for PTSD.
My first nursing job was in an inner-city trauma center. Threats of violence and assault were always close at hand, but the staff was supportive of each other and worked together to ensure each other’s safety especially the safety of those of us who were new and shell-shocked by such behaviors. Unfortunately, a busy ED and trauma center can leave a nurse vulnerable to angry patients, patients withdrawing from or high on drugs, and patients experiencing psychotic episodes. The patient may not have deliberate intent, but when a patient attempts to bite a nurse’s face or some other violent behavior, the patient’s actions override his or her lack of the intent. This was the case for one nurse during our first year working together as the patient, already restrained by security and nursing staff, attempted to bite her face. She managed to move away before any serious physical injury occurred, leaving her face with only a slight abrasion; however, the emotional toll left this nurse anxious, unsure of herself, and frightened. She could no longer function with the confidence and self-assurance required in this ED, and despite some time off, she eventually transferred out of the department to work in an office where exposure to such violent behaviors were unlikely.
The nurse assaulted with her stethoscope also left her job: lack of concern by colleagues and by administration led her to resign her position-not the assault. I suspect that should she again become the victim of an assault there is the chance this nurse will not only leave her new employer, but may leave the profession.
In June, OSHA announced initiatives to reduce the number of injuries to nurses by increasing hospital surveillance and by invoking fines up to $70,ooo per case in which hospitals are aware of potential for injury yet fail to self-initiate corrections prior to a nurse incurring injury. The primary goal of the initiative is to limit injuries nurses incur while lifting patients, but Assistant Secretary of Labor, David Michaels, indicates that “injury” also includes incidences incurred by violent patient behaviors. Although varied and unclear, healthcare institutions also incur direct and indirect costs associated with violence against nurses.
OSHA’s initiative represents a beginning, but violence against nurses is too urgent an issue to fall under another initiative: Violence against nurses is not a secondary issue and should be addressed as an independent topic. Furthermore, this initiative penalizes hospitals, but fails to include support measures for nurses who suffer injuries-physical or emotional-because of violent behaviors.
Nurses must tell their stories of the brutalities and assaults they’ve suffered, stand together, and rally for administrative, managerial, and in some cases stronger legal actions to ensure physical and emotional health and safety, and become a part of implementing aggressive initiatives for nursing colleagues who are victims of violent behaviors. Nurses cannot work and care for patients effectively under the threat of violence, and attrition from the profession is too costly for patients, for fellow nursing colleagues, and for healthcare.