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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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It would be cool if every nurse, doctor, nurse's aid, etc learned some form of defense. Next time someone starts something, just make 'em mind...make it a rule or law that says all personnel have a right to defend themselves.
A few years ago I was sick and had nurses helping me each time I went for treatment. So good to me, I can't imagine how it must be to have someone treat them like some do.
Thanks for all you do, ladies and gentlemen...I couldn't have handled my illness w/o your kindness.
bluepanther20, A couple years ago I was required to go through training for a response to just this sort of patient behavior. Unfortunately (or fortunately), I almost didn't pass the course because I had taken a self-defense course taught by a homicide detective provided by my school of nursing back in the 70s.The detective taught dirty tricks and then some (including use of a fish fillet knife).
The most recent "response training" tried to convince those who didn't know better that a violent person can be "peacefully" subdued without hurting anyone. Yeah, right. The maneuver that almost kept me from passing (and would've cost my job) was my now-instinctive response of taking the aggressor's knee out with a kick from the side (or on the knee cap).
I'm not an ER nurse. I work maternity and labor and delivery! I've been assaulted by gang members on my unit and had to change where I parked because of them. And this at a supposedly middle-class "family" hospital.
I've left bedside nursing. I salute those who stay.
I like the idea of an old fashion beat-down first and then charge them with a felony for abusing emergency room personnel and if we cant do that just refuse them service and give emergency room personnel immunity for anything they have to do to protect themselves.
I have two kids that are ER nurses. It won't get better until criminal penalties are increased for assault, stricter search procedures during admitting, armed security on staff in facilities that are high risk, increasing staffing (lower patient load ratios), nursing unions taking on hospital administration - through litigation as needed, and several lawsuits by nurses against hospitals.
Unfortunately, folks are starting to go this route, but if they settle with (which they often do, because no nurse has the kind of money for a long legal battle with a hospital group) the hospital the hospital usually gets a pass on it since they aren't necessarily admitting guilt. The staff then are usually barred from further talking about the incident or the hospital in any negative manner.
It's a system set up to protect big business and corprate investors rather than doing what's right for the patients or the staff.
@fumando-Agree with everything you said. Been a paramedic as long as there have been paramedics in California. During my career have had my jaw broken by a "grateful" patient, stabbed in the hand by a kitchen knife, had a watermelon thrown through my windshield (yes, I hear you laughing), etc. The worst was at a high rise ghetto where we had to wear hardhats because the residents would throw beer bottles from the upper floors at us as well as urinating on us. The residents would disengage the elevators so we would be forced to use the stairs carrying all our equipment, and we were there to help! We do see people at their worst and their best. IMO part of the problem is public perception of what is going on. I was being physically assaulted by a highly aggressive patient, this only after trying to talk him into being transported. Several civilians who had been watching this from coffee shops immediately came over and accused me of attacking "that poor man." It is part of the job and all the ER personnel I know expect and prepare for this type of behavior. Most of these patients are altered for one reason or another. I don't know what kind of law can hold someone responsible for their acts when they are altered. Sure, some are just jerks, but in my experience most are altered. The best approach is to assume your patient may be abusive, treat as such, and be pleasantly surprised when they aren't. Otherwise, find another place to work.
I've been a paramedic almost twenty years and faced the same abuse in the field. I've been spit on, punched, shot at, had a patient try to stab me and been attacked more times than I can count. Sure, it's frustrating, disappointing and downright disgusting, but it also comes with the job. Unfortunately we see people at their worst moments and they take it out on the people in the immediate area. There has been a major push to enact laws that hand out increased punishment to individuals that abuse healthcare workers and I think it's a great start. The unfortunate part is that it doesn't prevent it from happening. The most important skill I have found is awareness of my surroundings and approaching each situation as a potentially dangerous one. Even after all these years, I'm still amazed at the way people treat one another, including those trying to help them. Does it mean we'll stop taking care of them? Nope. That's what we do and we will continue to do so. As an industry, we have to start looking out for one another and encourage the higher ups to support us as well.
A start would be meaningful consequences. We should not be contractually obligated to provide care for people that are physically assaultive. End of story. Can't keep your hands to yourself? Well then I'll show you how and keep mine to myself. Good luck going to the bathroom after a fresh amputation.
Looking out for one another? I'm not a soldier or prison guard. I am a professional that helps individuals attend to their needs during a time of crisis. Putting it on "one another' to keep ourselves safe is common decency, but gives administration a pass on their duty to provide safe working condidtions and hazard pay.
If I punched a banker in the face while making a deposit I would still get arrested (after they take my money of course), go to jail and very likely be banned from that branch. Why is health any different? Being ill doesn't give you a free pass to be an as**ole.
The ER nurses are saints. In some settings the attitude to protecting them is actually improving at the admin level. It must get better and what they do should be appreciated. I fully understand those who come in (not drunk or drugged) that are simply so afraid they curse. The nurses I know are smart enough to know who these are and find forgiveness for them. The others we need tools to deal with and not worry about lawsuits and "rights".
Thank an RN today.
Cursing isn't the problem for me. I've had everything from my gender, my mother, and my race (I'm white) attacked. I've been called bad names in various languages. Those are words.
What I had a problem with were the physical assaults. I've had numerous pairs of glasses broken after being slugged in the face/head. My husband never knew where the bruises would be when I came home from work.
Yes, thank a nurse, an EMT, a paramedic, a firefighter, the police, and a doctor today.
This doesn't happen just to ER nurses....it happens to nurses in ALL areas. Nurses are raped by patients, murdered by patients. I've been a RN for 17 years and it's ridiculous how some patients treat nurses. I once had a patient attempt to kick me in the belly during my pregnancy and wished that my baby would DIE.
Hospital administrators turn a blind eye to what happens to healthcare workers who are verbally assaulted, physically abused, and worse.
Even worse are the patients who come in shooting guns at Doctors and Nurses for whatever their reason may be. Maybe they think it'll get them access to the pharmacy? I don't know. But violence against healthcare workers has got to stop. Hospitals, it's time to protect the people you employ. We are not 'out to get' patients, but it would appear that they are indeed out to get us. It's sad to say, but we need protection in the workplace. My gloves may protect me from a patient's blood, but they do nothing to stop a punch.
Patients who are actively psychotic are given a free pass, because we know they are actively psychotic and thus precautions are taken. They are not in their right mind. For all they know, you really are a giant dragon. I swear though, if you swing a punch at me as a guy with a broken leg, stabbed from a barfight, woman in labor, drugseeker, etc. I am going to be one unhappy camper. Sure, the most I can do is be slow about getting you that extra pillow, but you bet your ass I'm gonna be slow about it. I won't ever, under any circumstances, do anything to endanger a patient or withhold medical care, but that doesn't mean I have to kiss your ass while doing it.
One of my nursing classmates from the university where I graduated was killed before he ever took his nursing boards (so less than a month after graduation) by a patient's brother who was pissed that he (comabative from the first second) wasn't allowed in during the efforts to revive his brother. So he went home, got his gun, and came back and opened up into the ER--which only had curtains between the beds. The ones hurt? All hospital staff.
Part of the problem is that nursing's history is rooted in religion. It was nuns and monks that started nursing and there was this religious glamour to being a martyr to your patients (like catching TB or or leprosy from them). Dying while caing for the sick and infirm was like your insta-ticket to heaven and it's very clearly carried on to this day.
I know a lot of nurses have spoken up on this board today, but when you talk among collegues about institutional violence the common refrain is, "yeah, but they wouldn't do it if they weren't sick". The enabling BS! Being sick only lowers a person's inhibitions enough to make them comfortable doing it. Meaning it's still a part of who they are and how they operate.
Now it's getting worse because of the corpratization healthcare. It's bad for BUSINESS to have staff pressing charges against paitents, but it's much too expensive to hire and maintain a 24/7 security team to protect the staff. Don't even get me started on the "delivery high quality, compassionate care... while being accountable to investors" BS one hospital group is pushing.
I work in mental health and if I had known in nursing school that I was going to be more punching bag-prison guard than a nurse I would have never gone into the field. After borrowing $15K to get my RN I can't quit if I want to. Good, safe faciities don't want inexperienced nurses and it doesn't really matter, because they are few and far between and terribley hard to get into anyway.
I recently was taken to the Emergency room for care after I started shaking uncontrollably. Turns out I was in shock from a nasty UTI - temp. 105, heart rate and blood pressure all elevated.
There was one particular ER nurse that took care of my every need with true concern and friendly attitude.
She was a genuine sweetheart who made this traumatic event easily tolerable.
I wonder what percentage of ER nurses are as outstanding as she.
Many--no, most!--nurses are outstanding! Thanks for recognizing how special this one was.
The element of the people who use the ER as a doctor's office is part of the problem. They are savages and have no concern for anyone but themselves. I'm sure that most of the people who come in with injuries or illness who are not what you call "mentally ill" are polite. My husband and I have been to the ER a few times for injury or illness and never treated anyone poorly. There is a certain elementthat goes to our ER (all from the same bad neighborhood!) who are common thugs and can't behave to save their lives (literally). Maybe they'd settle down a little if the nurses and doctors had a billy club or taser. ER staff deserves to work ina violence free workplace. That's what we call it where I work... where I am not allowed to carry my weapon to protect myself. And I can't close the office when I'm the only one here. Once again, the criminals have more rights than the (potential) victims.
Amen to that Lizzie, amen to that. It is an emergency department. I wish people could respect that.
I am sorry to say I have a problem with nurses in and out of the hospital and
Big Nurse of One Flew Over the Cuckoo Nest resonates with me but I am
appalled by this article and a nurse should not feel threaten and indeed
hospitals should protect her except for the Big Nurse and her kind,whatever
her size. What goes around comes around!
Hello Nurses! Thanks for the heads up as I probably wont want to be a nurse in the ER. i will stick to Sub Acute Nursing!! Actually, the laws in the State of Washington in regards to assault are the same for Nurses and Police officers. The same penalties apply also with Physicians, lawyers... if a person is convicted in a court room of assault be it physical or verbal with intent and the ability to fullfill the threat, its automatic 5 years jail time and a stiff fine to boot. See Washington State Laws online. I would think if the Admin of a Hospital allows this sort of thing they may be putting themselves in a bad way as well as they are responsible for your safety while on shift in their facility. It is up to us how we handle it though, we draw the line. We are Professionals and can determine what would be a necessary response per incident. I dont think that everyone who comes in the ER for help would be there just to attack a Nurse.
Mmm. They do.
Google "ER shooting" (not the Tv show.) People really do come into the ER with the intent to cause harm
Good luck getting hired by any facility after pressing charges against a pt. Violence is rampant in ALL areas of nursing and sub-acute nursing isn't any different. It just hurts a little less sometimes because, more often than not, the pts. are old and weak. Also congregating in the "safe" nursing specialties does nothing but side-step what has become a growing problem in the field.
Because one is a "healthcare worker" does not "entitle" them to be subject to abuse.Period. I am married to an RN, We have many "healthcare" worker friends and they do not deserve to be abused while treating people that chose to be mean.
If people knew that this was an option for the E.R. staff perhaps they would be a little more receptive to the care people are trying to give them.
Sorry, if people chose to be an a$$ then they should be one all by themselves...
Wow....Just wow. The (thank goodness) few times we've had to go to the local ER, I was so glad to getting good care for either myself or the family member I was with, that assaulting a nurse or doctor would have never, ever crossed my mind. Yes, we had to wait one night for HOURS, between the waiting and treatment rooms. I spent nine hours sitting with my father while they were working to get him admitted.
A big 'thank you!' to the competent, kind, caring professionals in the ERs and may you never have to deal with another out-of-control, violent patient.
Thorozine...the universal answer to aggressive patients.
Amen, brother! But personally, I prefer a B-52: 50mg Benadryl + 5mg Haldol + 2mg Ativan = one docile patient.
If only we weren't bound by those pesky restraint laws.
I loved B-52's. Drug em till silent. Maybe social service can talk to you when your not such a ass. And Im off shift. Sir you look anxious! How bout some more Vit A
Wow, awful that the people who are there to help you are treated worse than garbage. I have respect for those knowledgeable enough to treat me and willing to take the time to do so, with high levels of patience and compassion. I can't imagine why someone would want to be abusive towards such caring people. It takes a very special person to do this type of work in the first place, and I am sure they don't get compensated enough.
I can vouch for this. I was punched by a pt in the ER that resulted in a fractured nose. This is among the countless time I can recall myself or another staff being assaulted in my 13 yrs of Emergency work. The problem is people believe that just because your in pain or under stress you have the right to abuse those around you. I had to restraint the individual for my own safety after he sucker punched me. Was I allowed to hit back. NO!. Then I would have been the bad nurse. These people need to have charges brought on them and to serve time little all criminals. I joined this profession to help, not be everyone punching bag. How bad is it that I now work in a jail and feel 10 times safer. Let alone the inmates repeatedly thank you for your help, as opposed to being called every profanity because you didnt get what you wanted for your so called Emergency. And damn right I pressed charges. FYI, TOO stupid to live should be a approved Diagnosis!
“What is this with society that says it’s OK to do this to people who are trying to help them?”
This is what comes from an entitlement society. There is no tolerance when people are given things most of their lives. When they don't get what they want and feel entitled to they get angry and lash out. What ticks me off most is how hospitals don't follow up on complaints or charges. Like big companies they shrug it off a because they figure it costs more to go after an offender than it is worth (monetarily) and THAT is another huge problem.
If you get away with acting a certain way and there are no repercussions the lesson you learn is it is okay to continue acting that way. Each of these people should have spent some time in jail and had some money taken out of whatever they have.
The one time I had to go to the ER I was in incredible pain but never even considered lashing out at the folks helping me. Instead I wrote the hospital administration a long letter afterward telling them how professional and polite their ER staff was.
It's not just the "entitlement" society as you say. A lot more of the problem is that criminal charges, institutional violence and litigation are bad for business and healthcare is very much a BIG BUSINESS. Private pay for a personal punching bag? We can help you with that. 'Cadillac' insurance? We'll give you the punching bags AND fire the staff if the make any noise about it. It all comes down to how the patient is PAYING the facility.
The people that hit the most are the ones that know theren't won't be any consequnces. Kids are hands down the most violent and many institutions that process adolescent patients will fire staff if there is even the remotest inkling the staff did follow the book verbatim.
JJMurray, It's not just the "entitlement" society. I've been hit, punched, slapped, kicked, and shoved by fur-wearing, diamond-dripping society types who drove cars that cost more than my house. And these SOBs then call the administrators (at home!) and complain about their care.
Give me a druggy anytime.
As an ER nurse with fifteen years of experience, I will say that I remain aware of my surroundings at all times. I have been assaulted and have witnessed multiple peers being assaulted. The difficulty for me is knowing that I can face criminal charges and lose my licesne if I defend myself physically. There are many people like ttmadison that believe that compasion will prevent violence. It is rarely the case that mental illness, or psychological affects of physical injury are the root cause of the violence. Regardless, I would invite ttmadison to complete four years of advanced study and obtain advanced certifications, and go to work 12 hours at a time with the risk of assault possible with almost every patient.
Though I thoroughly enjoy working oin the ER, I have reached a point in my life and career where I am ready to move to a different venue. If I were allowed to use my skills and training in self-defense the same way I am expected to use my nursing skills and training, I would be willing to stay active in ED nursing. I am currently completing graduate school to obtain licensure as a nurse practitioner. I will continue to show compassion for my patients, while remaining acutely aware of the possibility that any patient may attempt to assault me.
Don't the hospitals have to provide a safe workplace under OSHA rules or whatever the acronym for that is? Everybody else has to abide by federal workplace standards, why don't the doctors and nurses get to have a violence free environment? If you get fired for pressing assault charges, you should be able to press charges for wrongful termination. I am not for frivolous lawsuits, but this is wrong. I don't think the victims should get millions, but the hospitals should be made to stop firing people and hire security to protect the caregivers. The problems with this situation is that the government provides free care to indigents and illegal aliens and makes the hospitals pass the cost over to people who can pay instead of reimbursing the hospitals for the costs. If the government had to pay, they would do more about the health care problems.
I was a street paramedic for twenty years, and during that time I was punched, kicked, bitten and spit on countless times, shot at a couple of times, and stabbed once. In every instance it was by someone just raging out of control over nothing...the adult equivelant of a two year old having a tantrum, with drugs and/or alcohol adding fuel to the fire. In the state where I worked (Florida) assaulting us was a third degree felony, a slap on the wrist, and I can't rememeber a single instance where a patient was ever charged...and I worked for a large agency with over 200 medics, so were talking dozens of assaults per month. The people responsible aren't stupid...they know the score. They know they could vent on us and get away with it, while scoring points with the other street corner losers that they hung with. Law enforcement, the fire department administration, and the courts all looked the other way, and continue to do so to this day.
It's all Reinhart's fault. His face just looks punchable.
..
Occupy the outposts of the medical industrial complex. Take a crap on the Triage nurse's desk.
Keep Reinhart outta the emerg rm. His face is antogonizing and provoking violence.
Years ago doctors and nurses had technicians and orderlies to stand betweem them and the violent, and they took the brunt of it for the better trained. I know, I was one of them. I started in mental health and more than once had to fight for my life. But the same things happened in general medicine, especially in Emergency Rooms, too. Now clinics and hospitals are staffed with CNAs (assistants) and registered nurses, and they take the brunt of the violence.
moreover, the "big guys" that do work in healthcare know thet hold a lot of the cards and are able to lobby for the better schedules. A lot will still stay on night shift and the other 'undesireable' hours out of consideration for their coworkers, but they're only human and it gets tough working off hours year after year.
Our night staff has been gutted of male staff threatening to quit if they didn't get a schedule change to waking hours. I don't begrudge them, but with only 12 mostly middle aged women working on nights we don't set a lot of limits on patient behavior because we have no way too enforce them.