Last month, in April, 2024:

• two security guards at a Rhode Island hospital were stabbed by a patient.
• an emergency room worker in Willmar, Minnesota, was seriously injured after being stabbed by a patient.
• in three separate incidents, several Memorial Regional Health Emergency Department staff members suffered patient assaults.

When we hear national news stories about workplace violence, we might assume that such things don’t happen here in Craig, but they do.

“It’s not uncommon for our staff to be kicked, pinched, spit on or hit by patients,” said Sarah Moore, a Registered Nurse and Manager of the MRH Emergency Department. “The abuse can also be verbal and comes from both patients and family members. People say terrible things, sometimes threatening us or even threatening our families.”

A recent survey of American emergency physicians and nurses found that nearly 70% have been physically assaulted on the job. Studies show that healthcare workers in general are five times more likely to be injured than workers in other professions. And according to the Colorado Hospital Association, violence against healthcare workers is on the rise.

The problem is exacerbating the current healthcare worker shortage. The National Council of State Boards of Nursing reports that 100,000 registered nurses have left the profession in the last two years due to stress, and another 610,000 intend to stop nursing by 2027.

At MRH, Moore doesn’t believe that workplace violence has yet caused any staff members to quit, but she is aware it could well happen. Staffing is already challenging enough for rural healthcare without this additional threat. “I often hear team members say, ‘I didn’t become a nurse to get hurt by patients,’” Moore said. “We became nurses to help people.”

The Role of Mental Health and Substance Use Problems

Moore said that most incidents of verbal and physical abuse toward MRH staff are the result of mental health crises and/or substance use episodes.

“The ER sees patients who are in crisis,” she said. “Some patients are intoxicated or present with another substance use disorder, and some are suffering from an underlying mental health cause. They’re not oriented, and it’s not safe to let them leave until after they’re assessed and stabilized, but they often don’t want to be here. They can lash out. Later, when they’re sober and calm, they sometimes come back to apologize for how they acted.”

Taking Action Toward Better Protection

The Colorado State Legislature has introduced a bill intended to lessen workplace violence in healthcare settings. It would require healthcare facilities to submit biannual violence incidence reports and offer post-incident services to affected staff, among other measures. The bill is currently under consideration.

At MRH, new protocols are in place to better protect staff. A workplace violence taskforce has been formed. Security staffing is being ramped up. De-escalation and self-defense trainings are teaching staff members to manage aggressive patients and keep themselves from harm as much as possible. In addition, a new Unruly Patient response team can be called for at a moment’s notice, bringing key staff members from across the facility to help control any escalating violence.

In Colorado, it’s a felony to assault a healthcare worker in the ER, while it’s only a misdemeanor in other settings. In the MRH ER, you will now see signs warning patients and visitors that “Attacking a healthcare provider while they are carrying out their duties, including any act of violence involving bodily fluids, constitutes a severe offense that could result in felony charges.”

MRH staff members are now also being encouraged to report all incidents of aggression, both verbal and physical. “Historically, nursing staff nationwide have not reported as we should have,” Moore said. “Verbal and physical abuse were almost considered just part of the job, but that culture has slowly been changing. It’s not OK, and it takes everyone to work toward making that culture change.”

Because privacy is our top priority, the group photo was staged for visual effect but the descriptions about violence in our ED are real.