DALLAS — Hospitals are supposed to exist as places of healing.
But on Oct. 22, Methodist Dallas Medical Center became a scene of terror and chaos when a gunman fatally shot two health care workers before barricading himself in a hospital room with the mother of his child and their newborn.
The tragic deaths of nurse Katie Annette Flowers and social worker Jacqueline Ama Pokuaa shocked the North Texas medical community, and local leaders quickly looked for explanations as to what systemic failures allowed such a devastating event to take place. Less than three weeks later, Dallas County medical examiner Beth Frost was shot and killed at work.
Health care employees and advocates say the shootings represent the latest in an increasing wave of workplace violence acts in recent years, which range from verbal abuse to fatal physical attacks.
Organizations representing medical workers are calling on both hospitals and the federal government to better protect the employees charged with keeping people healthy and safe before such violence does irreparable harm to hospitals across Texas and the U.S.
“We can’t afford, right now especially, for any more health care providers – whether it’s nurses, doctors, social workers, whomever – we can’t afford to have anyone leave the bedside,” said Serena Bumpus, CEO of the Texas Nurses Association. “Health care is hanging by a thread right now.”
In 2019, there were 7,300 reported injuries from workplace violence that resulted in days of missed work for health care practitioners and technicians, according to a workplace violence report from the Bureau of Labor Statistics released in July. That’s up from less than 4,700 reported in 2015.
It’s a trend that threatens not only employee safety, but the quality of patient care and worker retention in an already short-staffed industry.
“It’s definitely a huge contributing factor to why nurses are leaving the bedside. Workplace violence, it’s psychological trauma,” Bumpus said.
The unique challenges of health care
Hospitals are unlike other workplace settings.
Family members of patients are often worried about the well-being of their loved ones. Sick patients might be scared, overwhelmed or in pain. The conditions of whatever brought a patient to a hospital in the first place make for a naturally higher-stress environment.
“It’s emotional work. People aren’t doing well. They may be very sick, they may be dying. In the case of social workers, there may be families that are getting disrupted or pulled apart,” said Cammie Chaumont Menéndez, an epidemiologist in the National Institute for Occupational Safety & Health’s Division of Safety Research.
Violent outbursts from patients and family members are not uncommon, and most health care employees expect to experience tense interactions at some point in their career.
Bumpus, who spent 20 years working in a hospital, said she’s been spit at, cursed at and threatened while at work, and she’s witnessed her colleagues experience the same.
Worries of physical safety have only been compounded by staffing shortages and the increased pressure for nurses and doctors to take on more patients. Reports of nurse and doctor burnout, already high before the pandemic, skyrocketed as hospitals filled with COVID-19 patients.
The negative impact of staffing challenges on hospital violence rates is twofold: Patients may become agitated with long wait times or especially busy health care workers, while those same workers have less capacity to monitor and preemptively intervene in situations that have the potential to turn violent.
When interacting with patients and their families, “we look at them, we touch them, we talk to them. We can tell what’s going on with them,” said Jean Ross, president of National Nurses United, the largest union of registered nurses in the U.S.
“It isn’t just to prevent violence, it’s to prevent them from being more ill, from some kind of traumatic situation occurring with their health. But if we’re not there, if there aren’t enough of us, we can’t do that,” she said.
Violent outbursts can cause lasting damage to workers, including serious physical injuries, psychological trauma and even death.
That trauma “can lead to staff shortages and discourage qualified health care workers from wanting to work in a hospital setting where they might be vulnerable to attacks like this,” said Priscilla Ross, Senior Associate Director of Federal Relations at the American Hospital Association.
After more than two years of working in pandemic conditions, hospital employees are increasingly speaking out against poor workplace conditions, including the previously unspoken reality of patient violence.
“I think one reason why it is finally starting to surface is because we’re tired of it, as a profession,” Bumpus said. “We’re tired of giving ourselves to people every single day and not being treated with courtesy and respect.”
A push for change
Occupational safety researchers say there are effective ways to prevent attacks against health care employees.
The Occupational Safety and Health Administration developed violence prevention guidelines tailored to employers and workers in health care and social services, and NIOSH offers courses for nurses in how to identify and deescalate certain types of violence. These resources also detail the importance of properly responding after a traumatic workplace event.
National violence prevention programs first arose in the ‘90s as homicide and violence rates against retail employees increased. Researchers found that those programs could be adapted to any environment, and were particularly well suited for health care settings, Menéndez said.
Effectiveness of these programs, though, hinges on buy-in from management and employees.
“Everyone has to have a seat at this table and everyone should have the psychological safety in their work environment to speak up and identify past experiences where things weren’t safe,” Menéndez said.
Preventing violence in hospitals doesn’t end at the implementation of a workplace violence plan. “These things need updating or revisiting on an annual basis,” Menéndez said.
While many large health care companies have implemented OSHA’s guidelines, several professional medical organizations want to make violence prevention plans required by law.
The U.S. House of Representatives passed the Workplace Violence Prevention for Health Care and Social Service Workers Act in April 2021, which would mandate OSHA to create a federal standard requiring health care employers to develop workplace-specific violence prevention plans. The Senate version of the bill was introduced in May of this year.
Another piece of federal legislation takes a different approach to preventing workplace violence. The Safety from Violence for Healthcare Employees Act, or SAVE Act, would establish federal criminal penalties for people who knowingly assault hospital workers. The bill, introduced in the House in June, is modeled after the federal statute that protects aircraft and airport employees.
The SAVE Act includes protections for individuals who are mentally incapacitated because of illness of substance use. It would also authorize $25 million in grant funding over 10 years to improve violence prevention efforts in hospitals through training and technology.
Jean Ross said she’s hopeful that, as people become more aware of the risks health care employees face, the more likely it is that something will change.
“I think everybody in the public understands what our lives are like inside these facilities, and if you didn’t before, you certainly do after this pandemic,” Jean Ross said. “We’re not often listened to. We need to push, we need to pester, we need to demand and insist and we will keep doing that until we get what we need. Nurses don’t give up.”
Steps experts say hospitals can take to minimize violence
— Implement security tools like panic buttons at work stations or personal alarm devices worn by employees
— Record any violent events that happen at the hospital and refer to records data when evaluating the hospital’s workplace violence prevention program
— Establish a system to keep track of clients with a history of violence so that employees are better prepared for future encounters
— Establish a program of medical and psychological counseling for employees who have experienced or witnessed assaults
— Involve employees in the creation, implementation and evaluation of workplace violence programs
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