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Elaine Thompson / AP
Jeaux Rinehart, president of the Washington State Emergency Nurses Association, said he's not surprised by a new survey that shows violence in the ER remains high, with more than half of nurses reporting verbal assaults and more than 1 in 10 experiencing physical attacks.
Rinehart was beaten in the head by a patient in 2007.
Tammy Mathews was working a late-night Sunday shift in an Alabama emergency department when a patient, drunk and high on drugs, grabbed her around the neck, choked her until she couldn’t breathe -- and then spat in her face.
Jeaux Rinehart was staffing a Seattle emergency room when a patient in a triage room, upset that he couldn’t get methadone, pulled a billy club out of a backpack and beat Rinehart in the back of the head and across the face, breaking his cheekbone.
So neither Mathews nor Rinehart was surprised to learn that an ongoing poll of nearly 7,200 emergency nurses finds that violence in the ER remains high, despite increased attention to a problem that leaves some health workers worried about danger every day.
“It’s so global,” said Rinehart, 51, president of the Washington State Emergency Nurses Association. “It’s actually getting worse.”
According to latest figures from the national Emergency Nurses Association, between January 2010 and January 2011, more than half of nurses in the ER -- 53.4 percent -- reported experiencing verbal abuse and about 13 percent said they had encountered physical violence at work in the previous week.
Being grabbed or pulled was the most common physical assault, while yelling and swearing were the most common kinds of verbal attack.
That’s about the same rate previously detected by the ongoing survey conducted by the ENA starting in May 2009. The Des Plaines, Ill., association surveys nurses at three-month intervals, partly to determine if the problem is getting any better, said AnnMarie Papa, the group’s president.
Frustrated, she admitted that it isn't.
“It’s upsetting to me that we can’t change the culture,” Papa said. “What is this with society that says it’s OK to do this to people who are trying to help them?”
Nurses on the front lines, like Mathews, 49, of Auburn, Ala., say that long waits, crowded conditions and growing numbers of mentally disturbed patients all exacerbate the stress of emergency department visits.
“Tempers kind of flare up and it just happens,” said Mathews, who was assaulted in 2005.
Both Mathews and Rinehart have worked in emergency departments for decades and they say they’ve come to expect vile treatment by patients and their families.
“I’ve been called things that, honestly, I have never even thought about putting those words together,” said Rinehart, who was attacked with the club in 2007.
The problem has received serious attention in recent years. At least 25 states have strengthened penalties for attacking health care workers and a growing number of hospitals have bolstered both physical security measures and staff training, according to the American Hospital Association.
At Virginia Mason Medical Center in Seattle, the hospital where Rinehart works, a new emergency department opened just last week with greatly enhanced security features, among other amenities, according to spokesman John Gillespie.
But that progress hasn’t curbed the crisis, said Papa, who advocates a zero-tolerance policy to stop ER violence. Only about a third of nurses actually submit formal reports about physical violence and less than 15 percent report verbal assaults, the survey found. That might be because in almost half of cases of physical violence -- 46.7 percent -- no action was taken against the perpetrators. In nearly three-quarters of cases -- 71.8 percent -- nurses received no response from hospital officials about the assaults.
In Mathews’ case, she said the hospital wanted her to drop assault charges against her attacker, and that officials fired her when she refused. She works in the emergency department of a different hospital now and she says she's still wary of erratic patients. Rinehart said he has transferred out of the emergency department to focus instead on patient safety.
“I miss it, but I don’t miss being called every name in the book," said Rinehart, who worked in ERs for 32 years. "I miss it, but I’m not going back.”
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I have empathy for ER nurses, but it happens on the floor too when patients don't get what they want ASAP even tho you might be in an emergency. RN Managers are not much better, they scream at you for no reason and say F**** you, when you are requesting better staffing for the oncoming shift. The manager stated "what are you worried about, you will be in bed by then." It says everything about their character when they act in an unprofessional manner. How do some managers get their jobs if they have no empathy, they certainly are no longer competent at the bedside. They are surprised when told it is now a felony for Managers to intimidate or harass bedside nurses in Virginia. The laws protect Airline staff and DMV staff, but not RN's. Over my career I have worked in a large teaching hosp in DC and a smaller hosp in Arlington Va, they are all the same. I wonder if patients ever think that one day they or their family member will be in the hosp for open heart or cancer surgery and look up into the face of their bedside nurse and think, Is this nurse going to treat me the way I have treated nurses. Good question!
This is a stupid article, the ambulance and first responders put up with far more crap than these ER nurses.
This is just an attempt to make their job more sacrificial. ER Nurses have a snobby attitude and think they are God's gift to the world, they flirt with the ER docs and try to be an expert in everything that they dont know.
Go ride in the ambulance and then re-read this article, you will then discover this article is a bunch of crap.
30 years of EMS and 20 in the hospital most of it ER. You are way off base rookie. I've been assaulted in both realms. I have and do still ride the ambulance. You need to do some more inside clinical time.
Hold that thought!, are you high??
OH BOO HOO, ER nurses hold themselves in higher esteem and as bigger martyrs. Go ride with the ambulance responders and first responders. Ambulance personnel put up with more crap and usually difuse the situation BEFORE the person reaches the hospital. ER Nurses think that everyone wants them, they think they are better, they're work is far more glamourous than that of the ambulance personnel.
I know I worked an ambulance as a paramedic and NREMTA for 4 1/2 years, have several saves and a couple of life saving awards. I got broken ribs, a knife in the back, wrestled a .25 caliber gun from a drunk, got in several fights, all to secure the person before the ER nurse had to deal with them.. I got puked on and puked in my mouth during CPR the ER nurse had her ambu-bag, I did mouth to mouth.
Ohh boo hoo, you are a puss looking for publicity.
Maybe you need another job, like myself had enough and went elsewhere, instead of taking it out on a paramedic. Unlike some ER nurses that I have seen treat paramendics , I have been nothing but cooperative and hold you guys and girls in high esteem for the job you do. So please dont take your negative sarcasim out on every ER nurse. I feel this blog is just for stress release and to notify the public there are problems in the Er. Start on blog on paramedic abuse and I am sure you will hear alot of stories there also.
30 years of EMS and 20 in the hospital most of it ER. You are way off base rookie. I've been assaulted in both realms. I have and do still ride the ambulance. You need to do some more inside clinical time.
While that is really terrible what you have been through, do we really need to play the "I'm the bigger martyr" game? It sounds like the situation has been really ___y for first responders, ER personnel, ICU nurses, and many others. I even know a PT who had to do CPR on a drowning victim who puked in her mouth and wound up dying while she was doing the CPR. She was so traumatized she spent hours telling me about it over and over again.
i am SO happy i don't work in this industry! it sux!
Happens all the time. Has become 'part of the job'.
Our Emergency dept is the drunk tank, psych holding unit, and babysitter to all the meth/drug users as they come down from too much. The medics and police bring them in, and yes they get the abuse also, but we keep them hours and days sometimes, every person who has to enter the room is at risk. Unbelievable vulgarity, spitting (which instantly gets them a spit mask), punched (if we haven't restrained them already). Thank Goodness for our Security Team, but it still happens way too often.
There are good, bad, efficient and ineffecient in every field but it seems to me people in the same field of public service should be more supportive of each other, have a better understanding of their safety issues and be sensitive to them. It must "suck" to go through this regardless of where, in or out of the hospital you work, and the hospital admin should come out from under their desks and be the first to demonstrate that support. I realize they have an image and political correctness to consider but they should do the right thing by their own anyway. I'm not saying "beat" the patient but at least take a legal course.
I have spent enough time employed by a major facility to know how it works.
I am now working at an urgent care, I rather be in an Emergency room, I use to do Level 1 trauma's and never was burned out. But as of 2010, I will never work in an ER again, Not only is the abuse from the patients and family members, The overcrowding and wait for patients to be seen is so long, the anger arises before the patient even gets to the triage room. Also the prescription drug abuse is causing a high rate of violence due to the patients that are drug seeking. When the Emergency room physicians are prescribing narcotics and giving out prescriptions for them left and right, the patients who are drug seeking are coming back for them abusing ER visits and causing problems when they return.
It dosn't help either when there are patients around the nruses desk on beds and practically hanging from the ceilings, and not enough staff , the state wont let you go on diversion because to many of those cause the hospital fines, the patients get upset because the care is less, the RN's are stressed , the techs are stressed , the ER is in crisis, and can they expect anything but violence. I believe it is the new society to be abusive and not care about others, but also the hospitals need to take some responsiblilty and standards, and the goverment for allowing the abuse in the Emergency rooms . There are many patients that should have cllinics to go to and urgent care like the one I work at to take care of minor illnesses and injuries and take some stress off the ER's.
Mardi,
Like you, I think some of the violence in the ED would be decreased if the people who use the ED as if it were their regular dr's office were not allowed to use it that way.
One small problem, some people refuse to use the other resources when they are available.
My hospital has a low/no cost clinic across the street from the hospital. The clinic deliberately leaves open plenty of appointments for walk-ins, but some of the ED abusers still insist on using the ED instead of the clinic.
The part of this that makes no sense is that if they went to the clinic they would be in and out faster AND get more personalized care than they get in the ED.
It's as if they feel the need to be in the ED for the social factor and to see if they recognize who's being brought in and for what. Like they feel a need to be a part of the drama or if there isn't enough drama then they stir some up.
Does this make any sense to you folks?
I was attacked by a nurse in the ER when she mistook me for a street junkie. I was on Methadone for Chronic Pain for 4 1/2 years. My family physician put me on it but the side effects were horrendous. I was always constipated and incontinent not to mention falling asleep and being completely useless to my family. Anyway, I begged my doctor to put me on something else and he refused. I went off the Methadone cold turkey not realizing I could die. When I told my doctor I had gone off of it several days before, he never warned me of the withdrawal. He just ask me how I was feeling. At that time I was just a little antsy and that's what I told him. Not 48 hours later I was wired out so bad I couldn't sleep. I didn't sleep for almost a week and ended up in the ER. When the ER doctor realized what was happening to me he immediately sent me to a drug rehab unit. Unfortunately, my insurance does not cover drug rehab so I had to go to a free treatment program. They were not experience to handle my situation. It was run by mostly recoving addicts that had been clean for 18 months and needed the job. Did I mention not one of them was over the age of 20???!!! To make a long story short I ended up with hallucinations, my pulse rate was 116 and I thought I had been kidnapped at one point. They called an ambulance and I ended up at the Altoona Regional Hospital ER in Pennsylvania. My behavior was bizarre, to say the least! I knew I was hallucinating and there are gaps in my memory but what I do remember is the nurse lost her patience with me when I wanted to wash my white pants out because I had urinated in them. She tried to grab them away from me. When I wouldn't give them up she yanked my head back by my hair injuring a disc replacement. A scuffle ensued and a male nurse, who hadn't seen her attack me first, came up behind me and bent my thumb back on the hand I had just had operated on for carpel tunnel. He then preceded to align my right arm in line with my spine. I screamed in agony. I was charged with several counts, some felony and some misdemeanor charges. I was facing 10 years in prison because this nurse lied and said I hit her with my fist. I couldn't even make a fist two weeks after carpel tunnel surgery!!!! I had to plead to misdemeanor charges and pay a $3000 fine along with with my attorney that charged me another $2000 because we had to travel several hours to court. The alternative would have been fighting these charges and paying more than $10,000 in attorney fees. I was put on probation for 6 months and still have 2 months to go. I am filing a complaint with the state hoping they can access the cameras in the ER to see what she did to me. I realize these hospital ER employees are pushed to their limits sometimes but what happened to me is so uncalled for. She mistook me for a street junkie and took all her frustrations out on me. I hope there is justice yet for me.
grow up and take responsibilty and blame for your sorry life.
oh please..........do you have any more excuses for your reprehensible abusive behavior....
i worked in an la county ER for 26 years. I agree with my fellow nurses that assaultive patients need to be prosecuted. But I would like to remind non nurses who read this that it is also incredibly rewarding when a patient you have busted your butt for simply says thankyou.
As a Psych Nurse I feel for the ER Nurses, the patients I get who are violent have already abused the ER staff. Part of my job is dealing with violent patients, when I have been assaulted, they were just crazy. I still have to deal with the injury and hope I don't get fired for getting hurt and bringing up the cost of worker's comp costs. If a patient is charged, it is a minor offense and they get a fine that they are'nt going to pay anyway, as they usually leave and go to another city.
I am a retired nurse from the 60's. There was not near the violence in hositals that their is today, It is a indicative of a much more violent society. There is a basic code of behavior for all public places and that should include hositals. Anyone who can't abide good behavior should be escorted to the door. I don't care how sick they are. Nor do I care how much their families or friends want that care. No nurse should have their health and safety put at risk because of the criminal behavior of a patient, friend or family member.
I have been and ED RN for about 30 years...I have to say that the acceptance of violent patients has increased over the years. There was a time when we could call the police and have these offenders removed. Now it is all about customer satisfaction. Ahhhh the Press Ganey.....the Hospital Emergency Room is not Disney World. It isn't expected to be a pleasant experience, and at Disney World the unruly would be removed from the property and instructed never to come back. Have you ever tried to get a trespass warrant issued and then upheld in a hospital emergency room....it's a joke. Hospital administrators, and the public (patients and their family members and visitors) all believe that abuse be it verbal or physical are part of the job (you want to work ED, expect to be assaulted on a regular basis). I have been punched, bit, cussed out, called every name under the sun, had knives pulled on me, my arms twisted and been pushed by both the patients and their families. I have been reprimanded, written up and spoke to sternly for standing up for myself. If you are not an Emergency Room nurse, you have no idea the trials and tribulations encountered. Police and Medics have laws to protect them, nurses.....they don't even have their employers behind them. Why they worry about offending and abusive patient or family is beyond me....they might not return, they might go to a competitor's ED. So what, no great loss....but we must bow to the power of the Press Ganey.
As a current ER Nurse, I can tell that those percentages are probably low as far as occurances. I work the weekend shift and hardly a weekend goes by that I'm not threatened or verbally assaulted.
This is not an ER issue alone (though I agree that abuse toward ER nurses is tripled compared to other nurse), patients feel that because we are doing a service we are their servants, since hospitals ratings and pay depends on them they can treat a hospital as a hotel not a hospital... and some associations and politicians think that is ok and encourage that attitude. How sad. Not being able to deny services to some people that abuse the system is ridiculous and those who arent' in the front line think that abuse is bad but yet we have to treat the patient like a customer...and the"customer is always right" well no, not in healthcare... nurses are patients advocates sometimes a family member is not. Leaving the hospital because you can't smoke in your room is ridiculous and then you come back like nothing happen and demand dinner while refusing your meds. Sometimes nurses are abused physically and can't respond except with the stuff we are taught in orientation which limits harm to the patient, can't call security on them because the patient may turn around and sue... what the heck??? sorry had to vent.