VCU’s emergency hospital entrance in Richmond. (Parker Michels-Boyce / For The Virginia Mercury)
Expressing frustration with what they say are increasing incidents of violence at work, doctors at the Virginia College of Emergency Physicians are urging federal lawmakers to support a U.S. Senate bill that would give greater protections to health care workers.
“I have been assaulted by patients hundreds of times — have been punched, kicked, spit on, and had objects thrown at me and weapons pointed at me. All this from the patients whose lives I’m trying to save,” one doctor who has worked as an emergency physician for three decades wrote in a letter to Sens. Mark Warner and Tim Kaine, Democrats from Virginia.
The emergency physician, who goes unnamed in the letter, isn’t alone. The Bureau of Labor Statistics says that 70 percent of private sector workers who “experienced trauma from nonfatal workplace violence” in 2019 worked in health care or related social assistance roles, making them five times more likely to be injured by violence at work than others.
S.4182, the Workplace Violence Prevention for Health Care and Social Service Workers Act, would direct the Department of Labor to create enforceable standards to ensure health care and social services workplaces implement violence prevention, tracking and response systems. A companion bill in the House was passed in 2021. In 2019, the Virginia General Assembly passed legislation making it a Class 1 misdemeanor to threaten to injure or kill health care workers.
There is no comprehensive statewide dataset on health care workplace violence for Virginia, but the Virginia Hospital and Healthcare Association says violent attacks on health care workers are on the rise. VHHA established a Workplace Safety Task Force in 2020 that is collecting data to find a baseline measurement for statewide injuries, as well as “sharing educational resources and best practices” to reduce such injuries, according to VHHA spokesperson Julian Walker.
State-level trends track national data, according to Toni Ardabell, chief of clinical enterprise operations at Inova, a major health care provider in Northern Virginia with 18,000 employees and more than 2 million patients a year. In 2021, 648 physical workplace violence incidents were reported within their hospital system and Ardabell assumes many minor incidents go unreported. By one NIH estimate, almost 90 percent of incidents are not formally reported.
She said violence has been on the rise during the COVID-19 pandemic, accelerating a longer-term trend. Assault rates against health care workers nationwide have doubled in the last 10 years and around 40 percent of those working in hospitals have been victims of physical violence in the last year. Another survey put that number at 78 percent.
“I think the stress of COVID, the stress of the mental health crisis in our communities, all have contributed to behavior we have seen all over the country,” Ardabell said. “Most of the violence events that are reported are carried out by visitors or mental-health patients— people that are frustrated, they are already coping with a life issue.”
Ardabell cited the breakdown of the state’s mental health system as another possible factor in rising incidents of violence. Understaffing and overcrowding at publicly-funded psychiatric care hospitals have increasingly forced patients to stay in local emergency rooms instead of at state facilities, where they may not receive adequate care. Some private hospitals have dedicated mental health units where patients can receive proper care.
“What we are not equipped to deal with is the extremely physically abusive mental health patients,” Ardabell said. “The state closed beds in mental health institutions where these patients should be, and so there is not a real good solution for these patients right now.”
The workload and stress of the pandemic pushed many nurses out of the field, leading to a nursing shortage in Virginia. Ardabell said that though workplace violence isn’t showing up in exit interviews as a primary cause of leaving the jobs, it could be a contributing factor in worker burnout.
It is also common for family members of patients to take their anger out on workers. The highest concentrations of violence take place within emergency and behavioral health departments, with nurses in the ER being four times more likely to be assaulted than those in other departments, but Ardabell emphasized that there is no typical situation.
“The situations can really be all over the map. It could be a confused patient that hits someone in their confusion, it could be someone who purposely hits someone because of their anger,” Ardabell said.
The daily threat of violence was underscored by two attacks on hospitals earlier this month. First a shooting at a hospital in Tulsa, Oklahoma, that saw four people killed, and then a stabbing at a medical center in Los Angeles, where three medical professionals were injured. In response, the Virginia Hospital and Healthcare Association released a statement expressing concern and highlighting steps that hospitals were taking.
“Unfortunately, hospitals and the people who work in them live with the daily reality that health care professionals face an elevated risk of being victims of workplace violence,” read the statement. “In response to these conditions, hospitals across Virginia have implemented a range of safety and prevention programs for staff including alerting systems, safety protocols, enhanced security personnel presence, and more to protect patients, family, visitors, and staff.”
In the meantime, ER doctors continue push for better working conditions. “The physical and verbal abuse and violence toward all ED staff is out of control. This bill is a decent start, but we need even more,” read another letter.
“We are sitting ducks.”
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