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Violence Against Health Care Workers: Legislative Responses

By Stephen Wood

COVID-19 and other diseases aren’t the only threat to health care workers. Violence in the workplace is a common occurrence and on the rise.

Despite these troubling trends, the policy response at both federal and state levels has, so far, been lacking.

In a recent survey of nurses, 59% reported that they had been the victims of workplace violence. More than half of those respondents went on to report that they were not satisfied with how the incidents were handled.

According to the U.S. Department of Labor, 12% of the injuries sustained by registered nurses are from violent acts. These injuries can be deadly. Lynne Truxillo, a nurse from Baton Rouge, died from complications from injuries she sustained after an attack on the job. Evelyn Lynch, a nurse in Brooklyn, NY, was beaten into a coma and died several years later, just months from retirement. Dr. Michael Davidson was shot and killed in his clinic by the son of one of his patients. Many more incidents of violence against health care workers go unreported, and very few cases result in criminal charges.

The federal response to address workplace violence in health care settings is H.R.1309 – Workplace Violence Prevention for Health Care and Social Service Workers Act. This act, introduced in February of 2019, requires employers to offer training, investigate acts of violence, and keep records about violent acts against employees. While this is a start, it lacks the teeth that many feel it needs to put safety measures in place and facilitate prosecution and punishment.

Many states have enacted their own legislation, but again, the focus is mainly on reporting and record-keeping, not on measures to protect people from harm. Similarly, few of these laws push for prosecution. In many states, it is a felony to assault a police officer, paramedic, or EMT. Physicians, nurses, and other health care workers are not afforded these protections in most states.

Elise Wilson is a registered nurse who can attest to the experience of violence in the workplace. While working in the emergency department (ED) in the rural town of Southbridge, Massachusetts, she was attacked by a patient wielding a knife. She was alone in a triage room, taking the patient’s information when, without warning, he stabbed her multiple times to the neck and arms. She collapsed and had to be resuscitated by her own colleagues before being flown to a trauma center.

Elise survived, although she has been left with both the physical and mental scars of the attack. She has since been an advocate for providing protections for health care workers, including legislation that makes assaulting a health care worker a felony.

SW: After you were assaulted, what kinds of local changes occurred at your own institution?

EW: Because it is a small community hospital, my institution took it very seriously. They ordered, installed, and manned metal directors in 3 weeks’ time. I was still in rehabilitation when this happened.

Other institutions have not reacted so efficiently. For example, one ED nurse I spoke to after my assault had been pushing for institutional changes for 2 years. To make matters worse, this institution had a metal detector donated to them and it just sat in storage.

It’s spotty how institutions have responded to this. I have spoken to nurses from around the country. I spoke to a nurse from Washington State who stated she had been discouraged from reporting her own personal incident. She was told by the patient that they “were going to kill her” but was told not to report the incident.

SW: What kind of support did you receive from law enforcement and prosecutors?

EW: Again, I was from a small community hospital, so I got a ton of support. The assistant district attorney [ADA] and local detectives visited me often, and the ADA invited me to testify at the Grand Jury. Criminal charges were filed; attempted murder, assault with a deadly weapon, and assault on a security guard. However, the attacker has behavioral health issues, so he was placed in a state hospital.

It took over 6 months to get to the point where it was deemed that he could be forced to take his medications, and then another 6 months before he could stand a competency trial. I’ve been told it won’t likely be until the Spring of 2021 that this will go to trial, a full four years after my attack.

I don’t think my case, which was very high profile, resembles how most of the day-to-day violence is handled.  Many people I’ve talked to are discouraged or patronized. Often times it doesn’t go anywhere. My own daughter, an ER nurse, tried to report an incident in New York City and was told she could “if she really wanted to.” For many, it’s like these incidents just “part of the job.” It can’t be that way.

SW: Elise, you have been a vocal advocate around legislation for increasing safety in the health care setting. How have these efforts been received by organizations like the Massachusetts Nursing Association?

EW: The MNA initially had interest in this. They filed legislation, but it included so many issues unrelated to safety that it was rejected. I spoke at a meeting of the Massachusetts Hospital Association. I said to all of them, “You are a room full of CEOs, you have the opportunity to fix this. Find one person that people can confide in, survey the staff, and find out what happens when it does. Then fix it!” They were going to draft their own bill, make it a felony to assault a health care worker, and increase reporting. I haven’t heard anything since and that was over a year ago.

SW: What do you feel we need to do, from a policy perspective to ensure our health care workers are safe?

EW: Number one, make it a felony to assault any health care worker. Nurses, doctors, aides, whoever.

Second, there need to be policies that actually mitigate violence. Putting up “zero tolerance” signs doesn’t do anything. Every day in EDs across the country there are people verbally and physically abusing staff. Where is the zero tolerance there?

We need to be able to cooperate with law enforcement, so that if there is a violent patient and we need them removed, there is a mechanism for that. We need to have legislation that protects the hospital and protects law enforcement when patients are acting violent or out of control.

I’ve been talking about this across the country for four years. I don’t see much being done. This needs to be a priority to protect our health care team.

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Stephen Wood

Stephen P. Wood, MS, ACNP is an acute care nurse practitioner practicing emergency medicine in Boston, Massachusetts, and a fellow in bioethics at the Center for Bioethics at Harvard Medical School in Boston.

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