Originally published in our book “Unready: To err is human – the other neglected side of Hospital Safety and Security†July, 2010 and as relevant four years later as it was on day one.

Two stabbings in separate UCLA hospitals occurred this week in California, leaving one Nurse in critical condition, which brought our attention back to this issue. There is an update at the end of the post.

Myth: Hospital Stakeholders are Safe and Secure in their Hospitals.
Reality: Hospitals are very dangerous places for all employees, in general, and women in particular. The risk of being in an unhealthy environment does not stop with exposure to a whole range of diseases. Female healthcare employees are counted among the most physically assaulted workers in the American workforce.

Violence in hospitals is viewed as a multidimensional problem and the level of it in the nation’s emergency departments has risen unabated over the last decade. Hospital’s emergency departments are the hospital’s “window to the world†and the door through which some of the most anxious and fearful populations enter.

The triage process makes a lot of sense to those engaged in the activity, but often it is not commonly understood nor appreciated by patient populations. Increased overcrowding and long waits for treatment elicit strong emotional responses from patients and their families. Even with adequately staffed, skilled security personnel and sufficient numbers of experienced caregivers, treatment sites get overwhelmed.
The lack of available beds for timely admissions for seriously ill patients leads to frustration, and families may lash out at caregivers or become behavioral problems themselves. Many walk-in patients have chronic mental health problems and are often disruptive, loud, and aggressive. Gang-related shootings may bring in both the shooters and the victims. Add the ever-present “forensic patient,†who may be a danger to himself or others, with a police escort and who also may be a flight risk. Escort officers may or may not be experienced and are often inattentive.
Under the category of “no good deed goes unpunished,†anecdotal reports are starting to surface from healthcare organizations that uninsured patients are showing up at physicians’ offices and emergency rooms demanding care, now that the healthcare reform bill has been signed into law.

Weapons of every type and description find their way into these treatment sites. Design and construction of facilities do much to mitigate problems associated with space and segregation of unruly patients. Metal detectors are in use by many hospitals across the nation. Hospital authorities are reluctant to employ these proven tools in the fight against violence out of concern for symbolic appearances of an unsafe environment for customers. Security officials find it a hard sell.

One hospital security official tells of a situation where he convinced his executive suite to try a temporary metal detector only at the emergency room entrance. The first month’s yield of weapons was more than 500. They included firearms, knives, razors, pepper spray, and an assorted number of items that were designed to inflict harm. Needless to say, metal detectors were to be a permanent fixture in several places on this campus.

When interviewing caregivers about “violence in hospitals,†the emergency department is generally the first to be mentioned. Incident reports tell a broader story. Verbal abuse is recorded from all locations in the hospital; however, physical abuse is always under-reported. One-on-one encounters without witnesses are difficult to judge. Violence between and among coworkers is on the rise. One narrow point in the funnel is Human Resources and a comprehensive criminal background check policy. A recent statewide study of background checks for healthcare workers revealed that one-third of the state’s caregivers did not have a criminal background check at the time of employment. The unsettling aspect of this population is that they were caregivers with close person-to-person patient contact relationships: 75% of all psychiatric technicians, 50% of all family therapists, social workers, and dentists, and 12% of all physicians.

We now turn to patients as victims of violence from caregivers. One startling report covering 1970 to 2006 identified 54 caregivers responsible for over 2,100 deaths. Caregivers who are serial killers have been able to move from hospital to hospital with relative ease. The importance of identifying and reporting these offenders should be an organizational priority. One well-intended step taken by the healthcare industry has been to inform the federal government when they take action against dangerous caregivers. The value of having a central registry to protect vulnerable patients across the nation speaks for itself.

The Department of Health and Human Services revealed that its two-decade-old national database listing the names of those reported as offenders (nurses, pharmacists, psychologists, other healthcare professionals) across the nation “is missing.†It provides little comfort to know that they will reconstitute the list as soon as possible. To err is human, but what are the consequences?

April 2014 Update

A recent study shows that little progress has been made over the last few years and if anything, we are sliding backwards.
“Assaults on emergency nurses have lasting impacts on the nurses and the ability of emergency care facilities to provide quality care,” said 2014 ENA President Deena Brecher, MSN, RN, APN, ACNS-BC, CEN, CPEN. According to the Bureau of Labor Statistics, assault on a healthcare worker is the most common reason for non-fatal injuries or illness requiring days off.

“More than 70% of emergency nurses reported physical or verbal assaults by patients or visitors while providing care. As a result, we lose experienced and dedicated nurses to physical or psychological trauma for days or sometimes permanently. Healthcare organizations are responsible to nurses and the public to provide a safe and secure environment.”

The study places the onus on healthcare organizations to improve training and education, make environmental modifications, and take a stronger approach to law enforcement. There are many direct quotes from first-hand victims  here,

A video interview can be seen here