Workplace Violence: Medical Workers Increasingly Contend with Threats, Assaults

An increase in violence in health care settings is taking place, ranging from rude or belligerent comments to assaults.

Source: TRIB Live | Published on January 17, 2023

workplace violence

When Mike Huss gets an alert from a panic button or call within Allegheny Health Network, he and his team are prepared to jump into action.

“If you look at it, some of it is just verbal abuse. Some of it is physical abuse, where someone strikes, punches, kicks, bites a health care worker,” Huss said. “Probably the most arrests we make are on aggravated assaults on health care workers.”

Huss is head of corporate security and employee safety at Highmark Health. He is responsible for the safety of employees, patients and members across Highmark and AHN.

As one of more than 500 members of the system’s security team, he has witnessed an increase in violence in health care settings, ranging from rude or belligerent comments to assaults.

He is not the only one who has noticed: The Western Pennsylvania Regional Chief Medical Officer Consortium, a group of health system leaders who first assembled to work together before the pandemic, issued a letter last month to the public condemning the pattern of aggressiveness.

“I think we are seeing violence increase in our communities, and I think that spills into our hospital settings,” Huss said. “Sometimes your visit to a hospital can be dramatic. People might be having the worst day of their lives. But patients and families need to understand that these health care workers are here to assist them.”

Signed by 15 chief medical officers from around the region, the consortium’s letter cites “more reports of threats, physical interactions, brandishing of weapons, and harm to providers or others.” It advises patients and their families to “never choose, use, or condone extreme language, threats, uninvited bodily contact, weapons in any form, or other intimidation when in a health care setting.”

The letter marks the second time the consortium has asked the public to consider the impact of violence in health care. In April 2022, the group expressed a similar message, asking patients and their families to keep frustrations in check.

“Things haven’t improved,” said Dr. Don Whiting, chief medical officer at AHN.

“When people are in the hospital, they are at their most vulnerable and most in discomfort, and they tend to lash out,” Whiting said. “But it ends up making it harder to care for people because the people taking care of them are fearful.”

A growing trend

A recent wellness survey at AHN found that 89% of the system’s emergency room resident doctors have been threatened by patients or patient families in the past year, Whiting said. The pattern of behavior has gotten worse since the beginning of the pandemic, he said.

“In 2018, there was sort of a baseline amount of negative interactions among patients and health care providers, but it’s really probably doubled since the pre-covid years,” he said. “Thirty-six percent overall of our resident doctors have been threatened over the last year at least once by family or patients. Nursing-wise, 48% of nurses have been assaulted by a patient or patient family in the last year.”

UPMC’s chief medical officer, Dr. Donald Yealy, said the frequency of negative events is increasing, based on internal reports.

“Many of our observations locally are informal. We have reports verbally by people who work in health care, written reports they follow as part of their daily duties and also by their official actions,” he said. “It’s not something that is isolated to UPMC or Western Pa. Around the country, these reports of threats of violence or actual violence against health care workers are increasing.”

The trend, in some cases, dates to before covid. The rate of nonfatal workplace violence against health care workers more than doubled from 2010 to 2020, according to data compiled by the Hospital and Health System Association of Pennsylvania.

At Excela Health, chief medical officer Dr. Carol Fox cited “a lot of stress and anxiety” in the health care world.

The system has experienced some notable incidents of aggressive behavior in the past year. At Excela Westmoreland Hospital in May, a patient who had been involved in several burglaries in the Greensburg area lunged at a security officer and attempted to take his gun.

In December, a Hempfield man was arrested on a charge of terroristic threats, accused of making threatening remarks concerning the Excela Health Latrobe Hospital and its staff while at the emergency room.

“We’ve seen increasingly, over the past several years, increased levels of individuals who are using extreme language, being more aggressive, being intimidating, those kinds of things,” she said. “People become upset and irate, and sometimes they strike out either with their words and sometimes with their bodies.

“It’s very hard on our staff.”

Incidents have occurred across the region. In December, a patient was charged with aggravated assault of a nurse at AHN Allegheny Valley Hospital in Natrona Heights after he was brought there to be checked out. In November 2021, a patient at UPMC Mercy hospital was arrested after allegedly threatening a hospital police officer with a gun.

Causes and impacts

Staffing shortages across the health care industry may be one component feeding the increase in aggressive behavior, Fox said.

“Hospitals are under the same kind of stresses and strains. It’s not a secret that there’s workforce issues, and there’s no hospital in our region that’s immune to workforce issues” she said. “That often leads to increased wait times for people who are already frustrated.”

ER wait times vary by location and time of day. Wednesday afternoon at Allegheny Health Network, emergency room times varied between close to three minutes and just over an hour across different locations. At UPMC Children’s Hospital on Wednesday, wait times were listed at about two hours. Excela Health did not respond to a request for information on wait times.

The general stressors of the pandemic also may have contributed to the rise in violence, Fox said.

“It’s always been there, but with the pandemic and all of the anxieties associated with that, I think we noticed escalation at that point,” she said. “I just think that given everything that was happening or has been happening, economically and otherwise, in our communities since that time, I think we’ve definitely noticed a perceptible increase in these types of things.”

During the beginning of the pandemic, Yealy said, much of the public was “thanking health care workers and showing gratitude.”

“That well of gratitude seemingly has evaporated, or it’s not as prominent. That background of (frustration) is what we’re seeing now,” Yealy said. “I think that (violence in health care) was becoming more common over years before the pandemic, but after the beginning of the pandemic, it seems to be accelerating even more now.”

Chris Chamberlain, vice president of emergency management at The Hospital and Healthsystem Association of Pennsylvania, cited a lack of behavioral health services in the outpatient community as contributing to the trend.

“More and more folks that need outpatient behavioral health services are forced to come to the local emergency department, and in some cases that has been a causative factor,” Chamberlain said. “It’s hard to say if it is really one thing, but I think we are seeing a confluence and a variety of issues that are resulting in these things occurring.”

Upping security

At AHN, clinical staff participate in crisis prevention training, Huss said.

“We do mock scenarios and try to educate everyone to each other’s role and how we can de-escalate situations when they arise. I think that has gone a long way to train us all,” he said. “A lot of it is communication and how to deal with someone who might be in crisis. Whatever way we can work to build a rapport with that person, to provide them comfort if needed, to reduce their anxiety level, the best pull we have is to be able to communicate with people.”

Managers in each department get “extensive” training, though everyone is taught strategies for dealing with potential incidents, Whiting said.

“There’s a real concerted effort to make sure that our employees feel safe to and from the parking lot, to and from work and things like that. Threats and things like that are also taken very seriously because we want our employees to feel as safe as possible working here,” Whiting said. “We have a very, very good security force, and we have a wellness program for the entire organization.”

Excela and UPMC have de-escalation training, too, and also have placed an increasing emphasis on security, according to their chief medical officers. UPMC declined to comment on specifics for the safety of “patients, visitors and employees.”

“We make sure that entry and exit points are staffed, that they’re monitored, that we have appropriate safety protocols in place,” Yealy said. “Fifteen years ago, that didn’t really happen. Hospitals were wide open. You could pretty much walk in and out as you please.”

Yealy added that security procedures aren’t about impeding access to the hospital for patients.

“It’s about making sure that people feel safe when they absolutely need access,” he said. “We ask, ‘What’s the best way to not only provide safety and make sure that people know that they are safe?’ ”

According to Chamberlain, hospitals across the state have increased their focus on training and crisis preparation.

“Depending on the environment you work in, and anywhere in the health care environment, there’s always the potential for conflict,” Chamberlain said. “But I think with the increase in the occurrences of these situations, hospitals are taking the opportunity to train additional individuals on conflict resolution, even folks beyond the traditional officials like security officers and ER staff.”

Looking ahead

Some health care leaders are hoping that legislative action will help ease the tide of aggressive incidents.

A federal bill, the Safety from Violence for Healthcare Employees (SAVE) Act, introduced in 2022, would add stricter penalties for those who are belligerent toward health care workers and improve training through grants for hospitals. The bill was referred to the Subcommittee on Crime, Terrorism, and Homeland Security in November.

“It would deter violence against health care workers by making it a federal crime, similar to what they did for airline employees,” Chamberlain said.

Attacking a health care worker is already a state crime.

Beyond legislative action, Chamberlain expects many factors will have to come together to lessen violence in health care.

“I think No. 1 is hospitals increasing efforts on safety in the environment, doing risk assessments, developing safety plans, doing de-escalation training, enhancing security where they can and those types of proactive, preemptive procedures,” he said. “Increasing the number of folks entering the workforce will help overall for a variety of reasons.”

Whiting said he hopes patients will be more understanding of struggles that hospitals deal with.

“I would just say to patients: Assume positive intent when (you) come to the hospital,” Whiting said. “We are here to help them, and we are doing everything that we can to do that. Having a feeling of trust is the fastest way to help get better.”