The attack came out of nowhere on a routine summer evening shift at Albert Einstein Medical Center.
A patient on the behavioral health floor had gotten into a nursing station, where only medical staff are permitted. As a medical technician tried to coax the woman back to her room, the patient lunged at her — and bit off a chunk of her left ring finger.
The patient spat the finger on the floor, according to complaints filed with the Occupational Safety and Health Administration.
“The finger could not be reattached,” police officers who responded to the North Philadelphia hospital wrote in a sparse report of the event, which took place last July.
Working at hospitals such as Einstein has gotten more dangerous since the pandemic. Nurses at Einstein have been spat at, threatened with rape, and punched in the face so hard they needed reconstructive surgery, according to OSHA reports, police records, and interviews with nurses.
In fact, hospital jobs in Pennsylvania have become almost as risky as working in a coal mine or metal manufacturing plant, according to the 2021 Pennsylvania Workers’ Compensation and Workplace Safety Report. In manufacturing fields, workers are most often injured through accidents or by overextending themselves. In health care, acts of violence are driving the most common type of injury: being struck.
Nurses say staff shortages, inadequate security, and lax training and protocols for emergencies make their environment dangerous. The pandemic also exacerbated people’s mental health challenges and in some cases limited their access to routine mental health care, adding strain to the hospital units charged with caring for them in crisis.
Violence and threats have become so commonplace in certain settings that some health care workers interviewed by The Inquirer shrug it off as part of the job.
Jyll Kurczewski, a registered nurse in Einstein’s psychiatric ward, called police when a patient punched her in the face. But she decided against pressing charges because she didn’t have time to go down to Police Headquarters to file a report.
Danielle Wright, a nurse who frequently works with patients experiencing psychiatric emergencies at the hospital’s crisis response center, didn’t even bother reporting to her supervisors a few years ago when a patient groped her breast while she was treating him.
“I just kind of swatted his hand off and walked away,” she said. “Sometimes it feels like, oh, it’s just another day.”
The union that represents Einstein’s 900 nurses is demanding that hospital executives address what they call unsafe working conditions. Now in negotiations for a new contract, the Pennsylvania Association of Staff Nurses and Allied Professionals wants more nurses on each floor and more security guards trained to respond to violent patients. Nurses at Temple University Hospital, represented by the same union, made similar workplace violence concerns a central issue in their contract negotiations last year.
At a rally outside Einstein’s North Philadelphia hospital May 11, about 100 nurses carried signs reading “Safe Staffing Saves Lives.”
“What is happening in our hospitals is unconscionable,” said Maureen May, PASNAP’s president, who also works in a maternity unit at Temple University Hospital.
Damien Woods, a spokesperson for Einstein’s owner, Jefferson Health, said in a statement that safety is “of paramount importance.”
“Jefferson is committed to supporting our employees and has instituted numerous improvements, and will continue to do so, that enhance the safety of all our facilities,” he said in an email. Woods declined to elaborate on those improvements or address specific questions about safety.
Nurses detail violence in their workplace
Hospitals across Pennsylvania are worried about violence against workers.
About 36,250 people employed in the state’s hospitals, nursing facilities, ambulatory health care, and social services were injured on the job in 2021, according to the state’s 2021 workplace safety report. This accounted for 22% of all workplace injuries in Pennsylvania that year.
That’s likely an undercount because hospital culture often discourages reporting offenses that fall short of serious crimes, said Chris Chamberlain, vice president of emergency management for the Hospital and Healthsystem Association of Pennsylvania, which represents most hospitals.
“There’s sometimes a sense that being injured on the job as a health care worker is part of the job,” said Chamberlain, formerly an ER nurse for 20 years. “Patients are going to assault you, and that’s just the way it is.”
At Temple, local PASNAP president Mary Adamson, who works in the hospital’s ICUs, said nurses advocated for more protections in their new contract after concerning incidents over the last year.
In one especially alarming episode, a patient who had arrived from the city jail tried to leave the hospital through the ceiling tiles in his room and began throwing items and swinging at nurses in the ICU.
Nurses were incensed when higher-ups at the hospital held a meeting about it and didn’t include staff members who’d intervened or witnessed it, Adamson said.
In another incident, a nurse on her floor was groped by a patient who then threatened to “f— the hell out of her,” she recalled. Adamson said the woman reported the episode to a security guard, who allegedly told her he couldn’t do anything because he hadn’t witnessed it.
“I found her crying alone outside the room,” Adamson said.
Temple did not respond to a request for comment.
Staffing shortages cited as union negotiates new contract
Nurses say staff shortages are a key part of the problem. Having too few nurses on a unit may result in lapses in patient care.
Einstein Medical Center, a 548-bed hospital in North Philadelphia, is among the many hospitals struggling with vacancies after medical staff retired or quit during the pandemic. At Einstein, this affects one of the busiest emergency departments in the city, with a Level 1 trauma center and among the largest inpatient behavioral health units among general hospitals in the Philadelphia area.
Staffing shortages have been especially challenging in Einstein’s emergency room and behavioral health unit, where patients often require a higher level of care and observation, nurses told The Inquirer. In the behavioral health unit, many patients’ treatment plans call for one-on-one monitoring around the clock.
“If people are feeling like the nurses are ignoring them, people could become violent,” said Wright, the crisis response center nurse. “If the nurse isn’t responding when patients need them, that’s very upsetting to people.”
Einstein leadership added an additional security guard in the behavioral health unit and an additional nurse and medical technician on the floor after nurses complained. Wright says the security guards already working at the hospital are well-trained in de-escalation tactics and make staff feel safer when patients act aggressively. But the union wants more on hand.
Amid bargaining, nurses say they want support dealing with trauma and burnout, including counseling after a staffer is assaulted. Wright said staff would benefit from a system that would flag patients who have been involved in previous violent episodes in the hospital so that nurses are aware they may need more staff to care for them safely. Kurczewski said nurses would also like Einstein to establish clear protocol on when and how to remove a patient from the unit and when to call police.
The union is further asking Einstein for more transparency on workplace injuries, contending that the hospital has refused to show them results of an internal safety audit conducted after a fatal shooting at Jefferson University Hospital in 2021.
Einstein nurses are also seeking higher wages, which they say would help fill vacancies and retain workers. At last week’s rally, nurses said that Einstein has about 300 open nursing positions mostly filled with traveling nurses who are paid higher rates than permanent nurses and aren’t as familiar with the hospital and its longtime staff. About 280 nurses have left the health system entirely in the last year, the union says.
While the Einstein negotiations are ongoing, Temple’s nurses won significant reforms in their contract negotiations last fall. For the first time, Temple’s nurses are allowed to take up to a week off with pay when they’re assaulted on the job. Their new contract also requires witnesses and affected staff to be present when higher-ups are debriefed on workplace violence.
Though violent incidents still happen, Adamson said, nurses at Temple feel more protected.
Recently, a man came into the hospital swinging a five-foot metal pole. He chased two nurses with it and trashed an information desk, Adamson said. The nurses weren’t injured, but they were shaken enough that they couldn’t return to work, she said. The new contract allowed them to take several days off.
“It’s a situation that is rampant across the country. All nurses talk about it. But I don’t know what would happen if we weren’t union and fighting for these things,” she said.
Nurses look to lawmakers to help with solutions
The issues have prompted federal and state-level lawmakers to propose legislation that would make it a federal crime to assault a health care worker and provide funding for training and safety.
A bill in Pennsylvania’s legislature would require hospitals to establish violence-prevention committees to assess risks to hospital staff and train them to mitigate dangers. It would also make reporting acts of violence mandatory.
But until such measures are enacted, Einstein nurses said, they worry that the hitting, scratching, and name-calling they experience on a near daily basis may keep escalating. And the worst acts continue to haunt, nurses told The Inquirer, explaining how the stories get retold again and again.
“Did you hear,” they whisper in hallways and elevators, “about the woman whose finger was bitten off?”
