Ending the silence on healthcare violence

I began my career at the University of Vermont Medical Center as an emergency department physician over 30 years ago, and I now serve as the President and Chief Operating Officer. Over my three decades here, I have seen the hospital, the practice of medicine, and the world in which we provide care continually evolve. I can say it has never been more challenging or more dangerous for caregivers to do their jobs than it is right now — and this is especially true for my emergency department colleagues. 

In our hospital, we are seeing alarming acts of violence and other inappropriate behaviors committed against our staff by patients and visitors. In 2022, our hospital — small by national standards — recorded 826 security incidents, which resulted in 172 injuries sustained by our employees. Our staff have suffered bites, concussions, dislocated jaws and broken bones. These assaults also cause lasting emotional trauma for medical providers who are simply trying to do their jobs. Most of our staff return to work after an incident. Others won’t, and some can’t, due to a debilitating injury. 

This is not a local phenomenon. It is happening nationwide, and it is as unacceptable here as it is in metropolitan areas like Dallas or Seattle.

At UVM Medical Center we have taken action to prevent this violence against our staff — including additional security, infrastructure, and staff training. We are grateful to the Vermont Legislature and Gov. Phil Scott for passing new legislation aimed at protecting health care workers. We’ve also been working closely with a local coalition on community solutions. In a year, the number of violent incidents dropped by 11% here. This is good progress, but violent acts against staff still number in the hundreds, and a single incident is one too many.

As the person ultimately responsible for the safety of our staff and as an ED doctor, when I go to see our team after one of these incidents, nothing makes me feel more powerless. Our providers show up with heart to provide great care, but they are threatened by the very people they seek to help. 

To move forward, hospitals need greater collaboration from community, state and federal partners. The measures UVM Medical Center has implemented are costly, and many rural medical centers, or providers who care for patients in their homes or in the community, do not have the financial ability or population base to pursue them — especially as budgets become ever tighter for nonprofit healthcare. We need awareness. 

That’s why I am proud that staff from UVMMC bravely shared their voices in a UVM Health Network project that has uniquely shown the world what it is like to work in healthcare today. Nothing I have seen before has captured the reality this effectively. When a version of the project was featured in the New York Times Op-Ed section, it caught fire with millions of views, and we’ve heard from healthcare organizations nationwide that their frontline staff see themselves in it.

The video is difficult to watch, but it is important. I hope that it will spark continued nationwide conversation and collaboration toward creating a safer environment for our medical professionals and their colleagues from coast to coast to continue their life saving work. For policymakers, moving forward federal legislation, like the Safety From Violence for Healthcare Employees (SAVE) Act, is a great start. Passage of that bill would afford our teams similar protections against assault and intimidation as flight crews and airport staff. 

Beyond that, it is going to take additional creativity. A good first step is to listen to our teams and hear their experiences. Because this is not theoretical. It is happening daily. These very real experiences will serve as a road map to the necessary investments and rules that will better protect those who work day and night to protect others.

Stephen Leffler, MD, is president and chief operating officer of the University of Vermont Medical Center in Burlington.

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