Violence in the ER: 8 ways unresolved healthcare issues harm hospital staff

Rising healthcare bills, painkiller use and untreated mental illness are fueling violence in U.S. emergency departments, leaving physicians and nurses with troubling stories of patient aggression toward staff, Politico reports.

Eight insights on rising violence in the ER:

1. Most U.S. physicians and nurses have been harassed by patients, according to a recent report. When asked whether they had been harassed by a patient, significantly more nurses — 71 percent — than physicians — 47 percent — said yes.

This harassment may be especially severe in the ED, where patients often face serious health problems.

"I got a black eye in a psych room when a patient pushed me against the wall and punched me repeatedly," emergency medicine physician Anne Zink, MD, told Politico, recounting events that happened over several weeks at Palmer, Alaska-based Mat-Su Regional Medical Center's ED. "We had a nurse almost strangled with IV tubing. Another nurse got bitten."

2. Growing violence in emergency rooms speaks to unresolved healthcare issues in the U.S., Politico reports, including patients who are experiencing opioid addiction, trying dangerous new substances like synthetic marijuana or facing heavy financial burdens for medical care. 

3. Without tools to solve these bigger issues, lawmakers and ED staff have urged hospitals to strengthen security to lower safety risks for staff. New Hyde Park, N.Y.-based Northwell Health plans to have retired police officers serve as armed guards at its 23 hospitals within a year.

In 2016, hospitals spent $1.1 billion on increased security, adding to $439 million in medical care, staffing, insurance and other costs as a result of violence against staff, according to an American Hospital Association study cited by Politico.

4. Although the federal government does not gather specific data on violence in EDs, Bureau of Labor Statistics data shows the rate of attacks on hospital nurses more than doubled from 2008 to 2016. Those numbers could be extrapolated to nurses working in the ED, Lisa Wolf, director of the Institute for Emergency Nursing Research, told Politico.

5. In interviews Politico conducted with providers from across the U.S., about two dozen ER physicians and nurses and hospital officials said they felt violence in EDs is rising.

"It has escalated significantly for a number of reasons," said critical care physician Stephen Anderson, MD. "The opioid crisis and drugs in general have gotten stronger and a bigger grip on society. Mental health problems have gotten worse, and the answer is, 'Send them to the ED.'"

6. Northwell Health staff reported more aggression after opioid prescribing was tightened. People who bounced between hospitals to get painkillers became frustrated when they were told "no," said Adrienne Drohomirecky, director of employee safety and prevention at Northwell.

"We've seen the number of verbal threats go up. We saw the number of physical threats against staff go up," said Jon Sendach, deputy executive director at Manhasset, N.Y.-based North Shore University Hospital, part of Northwell. "There seems to be a change in people's willingness to make threats. Either people are dissatisfied with the treatment plan, or, in some cases, people are delusional."

7. It's currently a felony to assault an emergency nurse in 31 states, according to the Emergency Nursing Association, which aims to make it a felony is all 50 states. The American College of Emergency Physicians passed a resolution in 2017 demanding hospitals deal with workplace violence.

8. In March, Rep. Ro Khanna, D-Calif., and Mike Coffman, R-Colo., introduced a bill that would require U.S. hospitals to report all incidents against staff to state occupational safety regulators. The bill also includes a violence prevention plan for hospitals.

"Healthcare workers, doctors and nurses are continuously at risk of workplace violence incidents — strangling, punching, kicking and other physical attacks — that can cause severe injury or death," Mr. Khanna said when he introduced the bill. "This is simply unacceptable."

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