Nursing Notes

April 25, 2011

Nurses fear even more ER assaults as programs cut

Here is an article that is a bit old, but still imparts useful information. The violence against nurses is escalating.   When you go to your work prepared to do whatever it takes to help people survive and improve, the last thing you expect is to be attacked or killed.  It seems that violence against nurses is becoming  the norm not the exception.  What really bothers me is that we seem to have become used to hearing about this violence and no longer react with appropriate dismay.

One of the factors that contribute to this violence may be the actual staffing ratios that hospitals use to staff.  When a very few staff are expected to do all, you set the stage for frustration and violence.  We see evidence of this everywhere today.  Simple frustration regularly erupts into full blown violence.

Please read this article and tell me your thoughts on the topic, won’t you?  This article is from the San Diego Union-Tribune.   You can visit the site to read comments and leave your own.

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By JULIE CARR SMYTH, Associated Press Writer

Tuesday, August 10, 2010 at 11 a.m.

In this July 28, 2010 photo, nurse Erin Riley poses for a photograph in Lakewood, Ohio.  A victim of on-the-job violence herself, Riley is not alone, according to an examination by The Associated Press.  Violence against nurses and other health professionals is rising as an influx of drug addicts, alcohol abusers and psychiatric patients are forced into hospital emergency departments by cuts to state treatment programs. (AP Photo/Amy Sancetta)

// / AP//

In this July 28, 2010 photo, nurse Erin Riley poses for a photograph in Lakewood, Ohio. A victim of on-the-job violence herself, Riley is not alone, according to an examination by The Associated Press. Violence against nurses and other health professionals is rising as an influx of drug addicts, alcohol abusers and psychiatric patients are forced into hospital emergency departments by cuts to state treatment programs. (AP Photo/Amy Sancetta)

In this July 28, 2010 photo, nurse Erin Riley poses for a photograph in Lakewood, Ohio.  A victim of on-the-job violence herself, Riley is not alone, according to an examination by The Associated Press.  Violence against nurses and other health professionals is rising as an influx of drug addicts, alcohol abusers and psychiatric patients are forced into hospital emergency departments by cuts to state treatment programs. (AP Photo/Amy Sancetta)

– AP

U.S. map and chart show expected state mental health budget cuts;

In this July 28, 2010 photo, nurse Erin Riley poses for a photograph in Lakewood, Ohio.  A victim of on-the-job violence herself, Riley is not alone, according to an examination by The Associated Press.  Violence against nurses and other health professionals is rising as an influx of drug addicts, alcohol abusers and psychiatric patients are forced into hospital emergency departments by cuts to state treatment programs. (AP Photo/Amy Sancetta)

– AP

In this July 29, 2010 photo, emergency room nurse Jeaux Rinehart sits in a treatment room at Virginia Mason Hospital in Seattle. Rinehart was accustomed to fielding kicks, spits, scratches and flying punches from his patients there, but one day in 2007 he didn’t move quickly enough. An erratic intravenous drug user who had entered the ER in search of a fix, grabbed a club, came up from behind and, as Rinehart turned, smashed it into his face. Bones broken, Rinehart sucked meals from a straw for weeks. (AP Photo/Elaine Thompson)

In this July 28, 2010 photo, nurse Erin Riley poses for a photograph in Lakewood, Ohio.  A victim of on-the-job violence herself, Riley is not alone, according to an examination by The Associated Press.  Violence against nurses and other health professionals is rising as an influx of drug addicts, alcohol abusers and psychiatric patients are forced into hospital emergency departments by cuts to state treatment programs. (AP Photo/Amy Sancetta)

COLUMBUS, Ohio — Emergency room nurse Erin Riley suffered bruises, scratches and a chipped tooth last year from trying to pull the clamped jaws of a psychotic patient off the hand of a doctor at a suburban Cleveland hospital.

A second assault just months later was even more upsetting: She had just finished cutting the shirt off a drunken patient and was helping him into his hospital gown when he groped her.

“The patients always come first – and I don’t think anybody has a question about that – but I don’t think it has to be an either-or situation,” said Riley, a registered nurse for five years.

Violence against nurses and other medical professionals appears to be increasing around the country as the number of drug addicts, alcoholics and psychiatric patients showing up at emergency rooms climbs.

Nurses have responded, in part, by seeking tougher criminal penalties for assaults against health care workers.

“It’s come to the point where nurses are saying, `Enough is enough. The slapping, screaming and groping are not part of the job,'” said Joseph Bellino, president of the International Association for Healthcare Security and Safety, which represents professionals who manage security at hospitals.

Visits to ERs for drug- and alcohol-related incidents climbed from about 1.6 million in 2005 to nearly 2 million in 2008, according to the federal Substance Abuse and Mental Health Services Administration. From 2006 to 2008, the number of those visits resulting in violence jumped from 16,277 to 21,406, the agency said.

Nurses and experts in mental health and addiction say the problem has only been getting worse since then because of the downturn in the economy, as cash-strapped states close state hospitals, cut mental health jobs, eliminate addiction programs and curtail other services.

After her second attack in a year, Riley began pushing her hospital to put uniformed police on duty.

The American College of Emergency Physicians has recommended other safety measures, including 24-hour security guards, coded ID badges, bulletproof glass and “panic buttons” for medical staff to push. Detroit’s Henry Ford Hospital is among hospitals that have had success with metal detectors, confiscating 33 handguns, 1,324 knives, and 97 Mace sprays in the first six months of the program.

But there are practical and philosophical obstacles to locking down an ER. Bellino and others say safety begins with training health care workers to recognize signs of impending violence and defuse volatile situations with their tone of voice, their body language, even the time-outs parents use with children.

He said nurses, doctors, administrators and security guards should have a plan for working together when violence erupts. “In my opinion, every place we’ve put teamwork in, we’ve been able to de-escalate the violence and keep the staff safer,” he said.

Also, he and others said it is important to combat the notion among police, prosecutors, courts – and, at times, nurses themselves, who are often reluctant to press charges – that violence is just part of the job.

“There’s a real acceptance of violence. We’re still dealing with that really intensely,” said Donna Graves, a University of Cincinnati professor who is helping the federal government study solutions.

Robert Glover, executive director of the National Association of State Mental Health Program Directors, said economic hard times are the worst time for cuts to mental health programs because anxieties about job loss and lack of insurance increase drug and alcohol use and family fights.

“Most of them, if it’s a crisis, will end up in emergency rooms,” he said.

Vermont nurse David DeRosia, who has been attacked at work, said patients want McDonald’s-like fast service even when they visit busy emergency rooms. When they don’t get it, some lash out.

“They want to be able to pop in and get what they need immediately, when the emergency department has to see the sickest patients first,” he said. “There are many people who have unrealistic expectations they can get whatever they want immediately, and it isn’t a reality.”

What has heightened fears among nurses and other health professionals is that attacks have become more violent, Graves said. “What’s bringing attention to it now is the type of violence: the increase in guns, in weapons coming in, in drugs, the many psychiatric patients, the alcohol, the people with dementia,” she said.

Twenty-six states apply tougher penalties for assaults against on-the-job health care workers. A renewed push to stiffen punishment began the Emergency Nurses Association reported last year that more than half of 3,465 emergency nurses who participated in an anonymous, online survey had been assaulted at work.

“It came as news to me that they are one of the most assaulted professions out there,” said state Rep. Denise Driehaus, who is pushing tougher nurse-assault penalties in Ohio.

Yet bills making an assault on a nurse a felony instead of a misdemeanor failed in North Carolina and Vermont during sessions that just ended, and Virginia shunted its proposal to a state crime commission.

Rita Anderson, a former emergency nurse who pioneered efforts in New York in 1996 to make it a felony to assault a nurse, said resistance is often strong – among both nurses and law enforcement officials.

In 1999, after her jaw was dislocated by a 250-pound teenager, Anderson pursued charges under the state law she had worked hard to pass. She said police were surprised a nurse would press charges against a patient, and prosecutors were skeptical of the case.

“It doesn’t matter if you’re drunk or you’re on drugs or you’re in pain,” she said. “That doesn’t give you the right to hit another person.”

Seattle ER nurse Jeaux Rinehart had learned to get outside fast to avoid kicks, spit, scratches and punches on the job at Virginia Mason Hospital. Then one day in 2007 Rinehart didn’t move quickly enough and a junkie who had entered the ER in search of a fix smashed him in the face with a billy club. Bones broken, Rinehart sucked meals from a straw for weeks.

“A thing like that sticks in your mind to the point where it’s always there, it’s always present,” Rinehart said. “I’m on heightened alert a hundred percent of the time.”

Rinehart was attacked again in July. An intoxicated patient punched and spit on him, then threatened to come back with a gun and kill him. He is pursuing felony charges.

Please go to the original site to read this and others like it:

Online:

Emergency Nurses Association: http://www.ena.org

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April 15, 2011

Nurse Dies After Assault At Cape Mental Health Center

As a mental health nurse, of course, this article held some significance for me.  But the problem discussed here–death and physical damage done to nurses during normal work hours–really belongs to all of nursing.  I don’t think about the potential for being hurt when I get up each morning, but the truth of the matter is that I deal with a very volatile population and that staffing for this type of patient is never adequate.  99% of the people I care for would never, ever hurt me or any other person; dispite having a mental illness.  It is that 1% that I have to worry about.  My difficulty is in identifying them in time to protect myself.

My heart goes out to this nurse’s family.  My heart goes out to this nurse’s workmates.  There is nothing quite a scary to a mental health team as the death of one of their own while at work.  I hope that hospital provides the staff with some type of counseling to deal with this event.

Here is the article.  Please read the entire article and feel free to visit the original site to leave a comment there.  Please leave me a comment if you have any thoughts about this article.

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April 14, 2011 11:13 AM

Cape Cod & the Islands Community Mental Health Center in Pocasset. (photo courtesy: David G. Curran/SatelliteNewsService.com)

Cape Cod & the Islands Community Mental Health Center in Pocasset. (photo courtesy: David G. Curran/SatelliteNewsService.com)

POCASSET (CBS) – The death of a nurse at a Cape Cod mental health center may mean new charges for the patient suspected in the crime.

Back in late March, 60-year old Jason Lew, a nurse at the Cape Cod and islands Community Mental Health Center, was assaulted by a patient. Lew’s injuries were so serious he was brought to several different hospitals before he died last Friday.

“There was some kind of an altercation. The nurse who subsequently died was assaulted during the course of the altercation,” said Cape and Islands District Attorney Michael O’Keefe.

O’Keefe said the suspect was immediately arraigned on assault charges, but depending on what the medical examiner finds, more charges could follow.

“It was a couple days later that the individual was deceased. So, it’s that full sequence of events that is the subject of an investigation to see what, if any, other charges might be appropriate,” said O’Keefe.

If the assault is found to have played a role in Lew’s death, it would make it the third worker in a local mental health center to have been killed by residents in the past four months.

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November 18, 2010

Increasingly, nurses facing violence on the job

Here is another article that lies out the problem with violence that nurses and nursing staff are dealing with.  This is a good, but long, article and I hope you will click over to read the entire thing.  Nurses should not have to wonder if going to work will mean a loss of livelihood or worse, a loss of life.

This article is from The Philadelphia Inquirer.  Please do go to the site and read the next page.

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By Jane M. Von Bergen

Inquirer Staff Writer

 

Amber Knierim, 20, wanted to be a nurse when she grew up, her MySpace profile says.

Instead, she’s in jail for beating one up – a Temple University Hospital emergency-room nurse who was attacked when she tried to keep Knierim from grabbing needles from an empty examination room on June 21.

“She picked the wrong person to mess with,” said Joan Meissler, 53, of Northeast Philadelphia, now working on light duty until she heals from the beating that wrecked her finances and left her in permanent pain, angry, and disheartened.

On Wednesday, 180 nurses and other health-care workers will convene in a ballroom at the Philadelphia Airport Hilton for a booked-to-capacity session on workplace violence for health-care workers, sponsored by the Pennsylvania Association of Staff Nurses and Allied Professionals, a union.

“It’s a national problem,” said union president Patricia Eakin, adding that she did not want to single out Temple. Eakin, a nurse, an emergency room colleague of Meissler’s, was on duty the day Meissler was attacked.

Meissler wants Temple to erect a billboard in the neighborhood with two pictures on it – hers and Knierim’s. “Temple needs to send a message to the community,” said Meissler: ” ‘Lay a hand on one of our staff members and you’ll spend the next five years in jail.’ ”

The U.S. Department of Labor Tuesday released 2009 statistics that ranked paramedics and nursing aides as being the workers most likely to miss work because of injuries. While most of the injuries come from overexertion caused by lifting, there are 38 incidents of violent assaults per 10,000 nurses aides.

The only occupations that face a greater likelihood for assault on the job are police and correctional officers.

Between 8 percent and 13 percent of emergency-room nurses are victims of physical violence every week, according to a survey released in September by the Emergency Nurses Association, a professional group in Illinois.

Why is the work so dangerous? Nurses and experts point to a number of factors.

First is proximity. “We as nurses are hands on – to touch and be touched,” said nurse Christine Pontus, occupational health and safety director for the Massachusetts Nurses Association and one of the national leaders addressing the issue. “The boundaries are not as clear.”

Pressed to reduce expenses, hospitals have been cutting back on nursing and security staff at a time when the number of uninsured using emergency rooms is growing. Those same budget constraints are limiting options for treatment and care of the mentally ill and addicted.

Unemployment and the economy has exacerbated stress among the general population, with that tension manifesting itself in hospitals, where frustrated patients and their families waiting longer for treatment tend to lash out at staff members.

Most of the violence is by patients or their families against nurses and other staff, according to the Emergency Nurses’ survey.

Many hospitals don’t have complete safety plans that include adequate staffing, consistent and frequent use of security wands and metal detectors, training in violence de-escalation, safety committees with worker representation, emergency-drill sessions, and analysis of unsafe conditions.

Meanwhile, there is some sense that nurses and others should accept violence as part of the job, Pontus said. She is the lead speaker at Wednesday’s event. District attorneys from Philadelphia and Delaware County are scheduled to attend.

“A lot of times the victims are traumatized and afraid to speak,” especially if the organizational culture doesn’t support them, Pontus said.

“There is a stigma of victimization, embarrassment, fear of being blamed for provoking the assault, fear of job loss,” she said. “The patients abuse us and we abuse each other. We’re all post-traumatic out there.”

Two weeks ago, a California nurse working in the intake area of the Contra Costa County jail died when a new inmate faked a seizure. When the nurse bent over him to help, he grabbed a lamp and smashed her over the head. She died on Oct. 28, three days later.

A psychiatric technician at Napa State Hospital in California was strangled on Oct. 23 by a patient, one of a majority committed there for crimes related to their mental illnesses. Local news reports described a chaotic facility where security had become lax.

Those are the headline cases, but the reality is more like what emergency room nurse Sean Poole, 33, experienced at Crozer-Chester Medical Center on Friday night.

Poole and a fellow nurse were trying to get blood work from an intoxicated and delusional patient when the patient bit his coworker, drawing blood. “It was pretty bad,” said Poole, who lives in the tiny borough of Parkside in Delaware County.

Poole has been punched and bitten, but has never pressed charges. “It’s hard to get anything to stick,” he said. “If they are intoxicated, it won’t hold up because they were intoxicated. If they are mentally ill, it won’t hold up because they aren’t in their right mind.”

In the spring of 2009, Crozer-Chester nurse Aimuel Elder walked into a patient’s room to find family members fighting and using pepper spray. He got sprayed as well.

“I tried to settle things down,” he said. “The police were called and so were our own security. The police arrived before our security.”  …[Read more]

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April 2, 2010

Uptick in violence spurs effort to protect health care workers

Here is another article that talks about the daily violence that occurs in our hospitals and ER’s.  As a psych nurse, I have seen my fair share of violence–both directed at others and directed at me.
In 20 years, I have had my teeth kicked out, my back injured, my rotator cuff torn during a violent restraint;  I’ve had family come to the hospital with a gun, I’ve seen my fellow nurses stalked in the parking lot after work,  and I have even had my coworker killed on the job.  None of that should be considered part of the job.  Not now; not ever.  It is about time that nurses receive some protection under the law.
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By Kyle Cheney/Statehouse News Service
GateHouse News Service
Posted Mar 30, 2010 @ 06:05 PM
BOSTON —

Nurses have been punched and kicked over the years but their attackers have faced little in the way of repercussions, advocates for nurses say, on the eve of an expected House vote on a bill to toughen penalties for anyone who assaults on-duty health care workers.

The bill (H 1696), which has languished for years in the Legislature, would punish individuals who assault nurses, nurse psychologists, occupational therapists and physical therapists with jail sentences between 90 days and 2.5 years or fines up to $5,000.

Current law punishes assaults on emergency responders, ambulance operators and ambulance attendants.

The Massachusetts Nurses Association, citing a worsening situation, hopes recent high-profile attacks on health care workers will tip the scales in their favor.

“There’s been a number of highly publicized cases in Massachusetts of this issue coming to the forefront. The Legislature’s becoming more aware of it,” said David Schildmeier, spokesman for the MNA. “We have an epidemic of violence. Nurses are getting punched, kicked, attacked on a too-frequent basis.”

Schildmeier pointed to increasingly crowded emergency rooms, where patients and family members, frustrated with long waits, are “striking out at the first person they see.”

“We have a much more violent society,” he said.

The association cites a decade-old Occupational Safety and Health Administration report that found that health care workers are assaulted 12 times as often as workers in other private sector industries. In that report, OSHA officials say health care-related assaults are likely underreported because of a perception that they are part of the job.

The MNA also points to a 2004 survey showing half of Massachusetts nurses reported they had been punched within the last two years, and more than 25 percent reported being regularly pinched, scratched, spit on or having their wrist twisted. More than 1,000 calls to 911 were made from inside Brockton Hospital between May 2006 and May 2007, according to the group.

The Massachusetts Hospital Association supports added protection for nurses, but a spokeswoman said the organization would prefer the legislation be expanded to protect “the entire care team.”

“We just thought it was somewhat limited,” said the spokeswoman, Christine Baratta, who said MHA has urged lawmakers to “broaden the umbrella.” Baratta said she was unsure if the organization would support an amendment to that effect during the House’s Wednesday debate.

Rep. Michael Rodrigues, the bill’s sponsor, was not available for comment. The Massachusetts Medical Society did not respond to a request for comment.

Here’s the link to the original article

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March 20, 2010

Violence on the Oncology Ward

I love the New York Times Well Blog.  I can’t help it; I truly enjoy reading it.  I hope you will enjoy reading this article from that blog that describes in detail how you can be simply doing your job one minute and the next you can be in a violent encounter with a patient or a family member.  This is real and continues to be an issue for nurses on the floors.

I don’t believe we should go to our workplace afraid, these encounters are not frequent, but we do need to know that they happen and we need to plan to deal with them when that happens.  As a psych nurse, we are required to train yearly in aggression management, yet even with this training, we still get sideswiped and sometimes get injured.

Please read this article and then let me know your thoughts.  If you have had any similar incidents, feel free to share them here with us.

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March 17, 2010, 11:27 am

<!– — Updated: 10:36 am –>

By THERESA BROWN, R.N.

I’ve read about hospital nurses dealing with violence at work, but I always told myself that was something that happened in the emergency room or the psych ward. In oncology, I reasoned, we have relationships with our patients, and I have always felt safe with them.

But recently that changed, all in the course of one very strange day.It began when one of my patients, a 22-year-old woman who had undergone abdominal surgery the previous day to reduce a large tumor, was given a morphine pump for pain. Her father, for no discernible reason, said he knew the pump was a fake and wanted his daughter to “get the good stuff.”

Then he recounted a conversation he’d had with a neighbor, saying he would have to “reload my gun and bring it to the hospital” if the nurses didn’t give his daughter her pills on time.

While I worked he kept talking, about how he had served in Vietnam and that President Obama was going to “take our guns away.” His manner was genial, even nonthreatening. But I left the room in a daze.

I told Mary, the charge nurse, and she called security, who took the father aside and talked to him. It might have been his idea of a joke, but I was stunned.

That should have been enough for one day — worrying about a man with a gun. But a couple hours later Mary and I were standing at the nurse’s station when we heard shouting from another patient’s room. The voices got louder as we hurried over.

The patient was lying on one of the cots we let family members use to stay the night, rather than on  his hospital bed, and was shouting, “Get her away from me!”

His wife was leaning over him, shouting, “He hit me! He hit me!” A welt was forming under her right eye, while he was getting closer and closer to falling on the floor.

Mary and I looked at each other. “Condition M?” she asked, meaning “mental.”

“Yes,” I said.

She called the condition, and the two of us tried to get him back into his bed. We lifted him up, and his legs collapsed beneath him. By this time others had been alerted, and more nurses came into the room. Four of us together held him upright and safely got him back to bed.

Then a lot of things happened at once. The patient became unresponsive, appeared to have lost consciousness and made a worrisome gurgling sound in his throat. This time we called a “Condition C” — a medical emergency, because it looked like he’d had a seizure.

One nurse hooked him up to the portable defibrillator, and his own nurse, who had left him and his wife talking calmly in the room just 10 minutes before, took his blood pressure. I yelled for a “pulse ox” to check his oxygen level, and an aide came in to get his blood sugar.

This is when the details get hazy for me, because at some point the patient’s wife lunged for him. I was standing behind him and instinctively grabbed for her, hoping to keep him safe.

She wasn’t physically any bigger than I am, but she was angry and, I found out later, drunk. Those two things made her strong. She wrenched herself around, trying to get away from me and back to attack her husband. I caught her again, wrapping my right arm around her chest from behind, fighting to turn her away from the patient and toward the door.

It was one of those spooky moments when I seemed to watch my own body from far away. Dissociation, I know it’s called, but the technical term doesn’t really capture how it feels to find oneself suddenly wrestling a violent, yelling and drunk person, step-by-slow-sliding-step, out of a small room where other people are trying to make a patient stable.

“I didn’t sign on for this,” I thought to myself during the struggle. Beyond sheer grit, I had no skills at self-defense or crowd control to draw on to help me. A male I.C.U. nurse showed up and joined me until security could get there. “Get – her – out – of – here!” I said through clenched teeth, pushing her toward the door. Security eventually stepped in and moved her out of the room.

According to the most recent statistics available from the Occupational Safety and Health Administration, nurses and health care workers are the most common victims of nonfatal workplace violence in the private sector. In a 2004 article about workplace violence in health care, the researchers, Kathleen McPhaul and Jane Lipscomb, assert that workplace violence is one of the “most complex and dangerous occupational hazards” that nurses face. There’s even a YouTube video that features pictures of bruised nurses who were assaulted on the job and ends with a call for action to stop violence against nurses.

Later that day, the patient who had been attacked by his wife was doing better.  And the father who liked to talk about guns had calmed down as well, hinting now in a friendly way about the clandestine work he had done in Vietnam.

The next day I was home and my right arm, which I’d used to grip the violent wife, ached from my shoulder all the way down to my hand. The muscles in my arm would heal in a couple of days, but regaining my peace of mind will take much longer.

Here’s the link to the original article

Here’s the YouTube video this article talks about:

March 5, 2010

Violence in Nursing

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Here’s just a quick follow-up on yesterdays post.  Violence is very commonplace in my line of work, but it seems it is becoming more common in all aspects of nursing.  How will we ever convince people that there is satisfaction in becoming a nurse when we cannot protect them?

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March 4, 2010

Workplace violence against hospital nurses is so common, many healthcare practitioners don’t bother to file reports. But that attitude is changing. HR leaders of healthcare facilities should increase training for nurses — to equip them to deal with potentially volatile situation — as well as enhance reporting and response mechanisms, experts say.

By Marlene A. Prost

When we think of a hazardous occupation, jobs like construction and fire fighting are at the top of the list. But when it comes to daily assaults, few professions can rival nursing.

For years, nurses have been punched and threatened by patients — from intoxicated ER patients to geriatric patients with dementia. They’ve accepted the abuse as part of the job and rationalized that, as long as they didn’t take time off, management wouldn’t care.

But that is changing. Today, nursing and hospital associations are fighting workplace violence by improving security, encouraging incident reports and fighting to strengthen state laws to prevent violence and punish offenders.

The numbers alone are staggering. Last month, a survey in Western Australia reported that slightly more than half (52 percent) of 113 registered nurses in one Australian hospital were physically assaulted in the past year by patients or patients’ families or friends. About seven in 10 (69 percent) were threatened and nearly all (92 percent) were verbally abused.

Workplace violence is a growing problem for U.S. nurses as well, says Nancy Hughes, a registered nurse and director of the Center for Occupational and Environmental Health at the American Nurses Association in Silver Spring, Md.

Healthcare workers accounted for 45 percent of all reported non-fatal assaults resulting in lost work, according to a 2005 report by the U.S. Bureau of Labor Statistics. And in 2006, the Massachusetts Nurses Association reported that half of 172 nurses surveyed had been punched at least once in the past two years, while 44 percent reported frequent verbal threats and abuse.

Not surprisingly, the biggest risks occur in emergency rooms and psychiatric units, although healthcare workers in nursing homes are often subject to abuse by geriatric residents with dementia.

“We’ve become a more violent society,” says Christine Pontus, a registered nurse and associate director for Health and Safety at the Massachusetts Nurses Association. “We’re the front line. … Nurses are operating in facilities where the doors are open 24/7. Police are bringing in a spectrum of human behavior that’s not experienced in other jobs.”

Kathleen McPhaul, a registered nurse at the University of Maryland School of Nursing in Baltimore, says “there is also evidence that the long wait for service, the frustration, hearing bad [medical] news, can set somebody off.”

With mental-health facilities cutting beds and releasing patients to the community, some patients who come to the hospital are “sicker, more violent and decompensating,” she says.

However, nurses today are less willing to tolerate abuse, says Karen Nelson, a registered nurse and senior vice president for clinical affairs at the Massachusetts Hospital Association.

Years ago, when she was a staff nurse, “nurses just had to accept … the slapping and spitting,” she says. “The culture has changed to acknowledge that staff has rights, too. … Hospitals no longer accept that assault and battery by a patient is acceptable.”

Improving the Environment

There is no federal standard requiring workplaces to protect nurses against violence, according to the American Nursing Association, but The Joint Commission — which accredits hospitals — does require that hospitals have a code of conduct to define disruptive behavior and implement a process to manage disruptive behavior.

Hospitals across the country are assessing risk areas and improving security, using guidelines from The Joint Commission, the Occupational Safety and Health Administration and the National Institute for Occupational Safety and Health, experts say.

Basic measures include installing metal detectors and panic buttons, setting up monitors, adding cameras and lighting in hallways, controlling access to interior areas, enclosing nurses’ stations, designing the triage area to minimize risk of assault, improving security response time and offering security escorts.

Training Nurses to Manage Behavior

Like police negotiators, nurses are being trained to defuse volatile situations verbally. That’s important in the era of patients’ rights, when staff no longer routinely use physical or chemical restraints to control patients.

“One thing we find in this country [is that] new, untrained nurses are often the victims. They don’t know how to recognize escalation. They don’t know how to defuse it,” says Hughes.

Five years ago, administrators at Signature Healthcare Brockton Hospital, an urban hospital south of Boston, noticed an increase in patients with substance-abuse and mental-health issues, “who were out of control and required restraints,” says Kim Walsh, a registered nurse and vice president of patient services.

The hospital, which has a locked psychiatric unit, hired a nurse with prior experience with the prison system specifically to train staff to control high-risk situations. They also created response teams to manage volatile patients, she says.

Encouraging Reporting

Nurses may confide in researchers, but they are more reluctant to tell their supervisors if they’ve been attacked by patients, experts say.

Only half of the Australian nurses who had been assaulted mentioned the incidents to senior staff or co-workers. Only 16 percent filed an official report. Thirty percent said they didn’t make a report because such occurrences are not unexpected.

“A lot of nurses feel being assaulted verbally and physically is part of the job, which is unfortunate. They don’t see it as a reportable incident. It’s more paperwork. They’re there to deal with the patient,” says Elise Geig, director of health policy for the Ohio Nurses Association.

Geig says some nurses speculate that an “informal” incident report “sometimes disappears because, to be honest, it affects liability.”

At worst, nurses fear they may be blamed.

“Some hospitals hold the nurse responsible. … Through their tone, they hold them responsible for the action. ‘[What did you] do to provoke it?'” says Pontus of the Massachusetts group.

Facilities need a mechanism for reporting agitated patients before they act out, Pontus says. “That’s where the gap is. We’re not recognizing the small stuff before the real stuff happens.”

OSHA requires that every needle prick be reported, but when it comes to abuse, nurses are forced to make a judgment call.

“HR should encourage nurses to report any incidents, as long as they are going to do something about it,” MacPhaul says. “The policies have to be created to define the incident, be specific about the reported behavior, and what the facility will do.”

Hughes of the American Nurses Association says her organization encourages nurses to report all incidents. “You can always go and report, even to HR. The employer has the responsibility to provide [a safe workplace].”

“Certainly hospitals all have reporting for incidents and accidents,” says Nelson of the Massachusetts Hospital Association.

She advises HR to use orientation sessions to inform nurses of their rights and reporting avenues. “If a manager learns of an incident where a staff member was harmed, you take lessons learned and make sure policies and practices are working.”

Supporting Legislation

Nursing associations are lobbying for state laws aimed at strengthening criminal penalties and requiring hospitals to take more precautions.

For example, H.B. 450 was introduced in Ohio in February to make workplace assault against a nurse equivalent to assault on school employees, police, fire and emergency medical workers — a felony with a mandatory 12-month sentence. Eight other states have enacted such laws.

In Massachusetts, the nursing association is rallying around several bills, including S.B. 988, which would require hospitals to develop a comprehensive workplace-violence-prevention program. Such bills have been signed into law in eight states.

However, the hospital association maintains that the bill duplicates practices that already exist under OSHA and The Joint Commission.

Here’s the link to the original article

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February 10, 2010

Senate OKs nurse protection bill

At first, I read this article eagerly.  I thought, “Great, finally we get protection under the law!”  Then upon further reading, you can imagine my dismay to see that this has been before the Senate numerous times in the past and was killed in committee.  The reason is to deliberate more on who this law is for and what should be covered.

Okay, I’m all for being sure about any new law, however, where do these people live?  Do they not read the papers or listen to news?  At a time when the nursing shortage is fast approaching critical mass with no solution in sight, do we really want to say, “ummm, do nurses really need protection under the law?”  If someone hits me when I am off work, I can file charges and be taken seriously.  If someone hits me while I am working, I don’t have that same privilege.  Yes, I can file but the police will not pursue, nor will my hospital.  Things like this really make me wonder who will want to become a nurse or who will want to remain a nurse–exactly what is fueling the current shortage.

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February 08, 2010
A bill that would require harsher penalties for individuals who injure or attempt to injure nurses was passed in the Senate Jan. 25.

Current penal law calls for harsher penalties for those who assault emergency medical professionals, firemen, and police officers. The bill (S.4018/A.3103) would amend the law by expanding the definition of assault on emergency medical professionals to include registered nurses and licensed practical nurses, while also changing the term “fireman” to “firefighter” and including “she” in the definition of those who may cause injury to another person.

Punishment for assault on registered nurses and licensed practical nurses would, under the legislation, be strengthened to a Class C or D felony depending on the offense. According to the bill’s justification, nurses suffer the highest proportions of injuries among health care workers.

“Nurses and other emergency medical professionals are often among the first to treat persons in need of medical assistance,” said Sen. Ruth Hassell-Thompson, D-Mount Vernon, who, along with Assemblyman David Koon, D-Perinton, is sponsoring the legislation. “Unfortunately, countless acts of violence are inflicted upon nurses while in the line of duty, and currently, the law does not offer them the same protections as it offers other emergency medical professionals.”

According to the bill’s justification, nurses are often subject to numerous forms of emotional, verbal and physical abuse by patients, including choking, stabbing and threatening. A large percentage of the violence goes unreported, thus leading to unpunished behavior, lower job satisfaction and staff shortages, according to the justification.

“Nurses do not discriminate to whom they give medical treatment, often placing themselves in harm’s way,” said Sen. Antoine Thomson, D-Buffalo. “It is our duty to protect them so they can perform their professional duties without fear of injury.”

The bill has passed in the Senate for the past three years but has died in the Assembly Codes Committee every time, according to Shaun Flynn, executive director of governmental affairs for New York State Nurses Association.

Flynn said there has been a historic hesitancy in the Assembly to pass the bill because of concerns about creating a separate category for nurses under penal law. Flynn said that although the bill hasn’t been passed, there is no organized opposition to its contents.

“The Assembly takes more time to take a look at bills like this because of historic concerns about creating separate categories,” said Flynn. “They’re taking their time with it.”

According to Cathy Peake, chief of staff for Assembly Codes Committee Chairman Joseph Lentol, D-Brooklyn, the committee has not passed the legislation because the members want more information about the causes of the violent incidents.

“What nurses are being assaulted?” asked Peake. “Are they emergency room nurses? What are the details of the problem?”

Peake said that opposition was not to the bill itself, but to the prospect of amending a law before knowing the full extent of the problem. She said the committee would pass the bill if it received New York-specific information about the incidents.

“Maybe it would be possible to improve hospital procedure and security before bumping up the penalties,” said Peake.

Flynn said that because the bill has now been around for several years, he thinks that there is a much better chance of it passing in 2010.

Senators in support of the bill said the legislation is necessary especially because of the fact that many hospitals across New York are understaffed, leading many nurses isolated while working with patients who are mentally ill or under the influence of alcohol or drugs — making violent activity more likely.

“By making these acts of violence against nurses a felony,” Hassell-Thompson said, “an important standard will be set that violence against these medical professionals is not accepted and will not be tolerated.”

The bill was referred to the Codes Committee Jan. 25.

Here’s the link to the original article.

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February 5, 2010

RN’s: Victims or Bad Asses

As a psychiatric nurse, I have always dealt with aggressive and/or assaultive patients.  People seem to think that is “just part of the package” but I disagree.  Nurses, no matter where they work, should not be targets for abuse.  These are people who do what they do because they only want to be helpful to others.  Nurses usually describe their choice as a “calling”, much as a nun will describe the need to give her life to God as a “calling”.  Nurses, by and large, want to help others to heal, to restore to health, to learn to live with chronic conditions, to be able to laugh and enjoy life.  Nurses work with the patient, but they also work with the families of that patient in a way that gives them relief and support.

There have been times when working at a psychiatric emergency room that police brought in handcuffed and pepper-sprayed individuals who were actively psychotic and aggressive.  These 3 or 4 policemen would uncuff the person and leave.  I worked the night shift and we routinely had a nurse and two techs available at any given time.  Do you think we were better equipped to deal with this person than those police?  We frequently were assaulted and injured.

There needs to be some protection in the law for the nursing staff of any hospital–that they should not have to fear injury or death because they show up for work.

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By Sheryl McCollum

The ER is open 24/7.  It provides unrestricted access to the public.  Nurses and doctors are trained to help all in need of medical attention.   However, the staff  is exposed constantly to an un-screened and potentially high-risk population for violent behavior.
I have two sisters that are emergency room nurses.  They have both dealt with violent patients.  Both have been hit, kicked and threatened.  One of my sisters was even seriously injured by an inmate that was receiving care.  Unfortunately, most people are not aware of the dangers for nurses in the ER.

ER nurses can deal with individuals that are suicidal, schizophrenic, drug addictive, and/or violent criminals all in a shift.

When dealing with a violent offender, the police can call for back-up.  They have a variety of weapons to defend themselves with such as: OC Spray, ASP batons, and a gun.  Additionally, a police officer also has the authority to place the offender  in a holding cell.  Once the fight is over, the criminal is transported to the hospital for care.  The criminal arrives at the hospital.  The ER reality — nurses deal with the same violent criminals without the back-up, weapons, or authority to place in a cell.

I have had people tell me that the nurse can strap the violent patient to the bed and call security.  Yes, they can; however,  how will they get straps on a strung out, violent criminal who attempted to harm the police?   Nurses are not trained in self defense or take down procedures.

If a person potentially overdosing PCP is transported to the ER, the ER nurses are dealing with the same violent, strong, crazed individual that the police would.  If a criminal is injured, the police take them to the hospital.  These criminals may have raped, burned or killed innocent people.  Again, nurses do not have the same defense training as a police officer.

What about the mental ill patient that has not committed a crime but is in need of medical treatment?  These patients also pose a tremendous risk for the people that give them care.  These patients often do not come into the hospital with the police.  The nurses may never see any security with these individuals, but this situation can still be very dangerous for all who care for this patient.

According to the Bureau of Labor Statistics (BLS), in 2000, the injury rate for nurses is among the highest, and 25 of every 10,000 full-time nurses were injured in workplace assaults. This rate is much higher than private-sector industries, which is 2 per 10,000.

The reality is cops, correctional officers and nurses all deal with the same people.  Nurses are the only ones that have had no training on how to deal with hand-to-hand combat, have no radio, no weapons, and no real lifeline to call for back-up.

I admire the work that they do and the heroic conditions that they perform under each and every shift!

Victim or Bad Ass??? – I say both!

Sheryl McCollum, MS
Director
Cold Case Investigative Research Institute

Here’s the link to the blog, Time’s UP and this post

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