This is a story from Kaiser Health News.
The emergency department at San Leandro Hospital, where nurse Mawata Kamara works, entered detention recently when a visitor, agitated at being prevented from seeing a patient due to covid-19 restrictions, threatened bring a gun to the California facility.
It was not the first time the ministry faced a gun threat during the pandemic. Earlier in the year, a well-known psychiatric patient in the department became increasingly violent, spitting racial slurs, spitting at staff and throwing punches before threatening to shoot Kamara in the face.
“Violence has always been a problem,” Kamara said. “This pandemic has really only added a magnifying glass. “
In the early days of the pandemic, nightly celebrations praised the bravery of frontline healthcare workers. Eighteen months later, these same workers say they are experiencing an alarming increase in violence in their workplaces.
A nurse testified before a Georgia Senate review committee in September that she was attacked by a patient so badly last spring that she landed in the emergency room of her own hospital.
At the Research Medical Center in Kansas City, Missouri, security was called to the COVID unit, nurse Jenn Caldwell said, when a visitor shouted aggressively at nurses about his wife’s condition, which was a patient.
In Missouri, a tripling of physical assaults on nurses prompted Cox Medical Center Branson to issue panic buttons that can be worn on employee ID badges.
Hospital leaders were already sensitive to workplace violence before the pandemic struck. But the stress of covid has exacerbated the problem, they say, resulting in increased security, de-escalation training and calls for civility. And while many hospitals struggle to fix the problem on their own, nurses and other workers are pushing federal legislation to create nationally enforceable standards.
Paul Sarnese, an executive at Virtua Health in New Jersey and president of the International Association for Safety and Security in Healthcare, said numerous studies show healthcare workers are much more likely to be victimized aggravated assaults than workers in any other sector.
Federal data shows healthcare workers suffered 73% of all non-fatal workplace violence injuries in the United States in 2018. It is too early to have full statistics on the pandemic.
Despite this, Michelle Wallace, chief nurse at Grady Health System in Georgia, said the violence is likely even higher because many victims of patient assaults do not report it.
“We say, ‘It’s part of our job,” said Wallace, who is pushing for more reporting.
Caldwell said she had been a nurse for less than three months the first time she was assaulted at work – a patient spat at her. Over the next four years, she estimated, she spent no more than three months without being verbally or physically assaulted.
“I wouldn’t say it’s planned, but it’s accepted,” Caldwell said. “We have a lot of people with mental health issues coming through our doors. “
Jackie Gatz, vice president of safety and preparedness at the Missouri Hospital Association, said a lack of behavioral health resources can spur violence as patients seek treatment for mental health issues and disorders related to substance use in emergencies. Life can also spill over inside the hospital, with episodes of violence that started outside continuing inside or the presence of law enforcement officers exacerbating tensions.
A February 2021 report from National Nurses United – a union in which Kamara and Caldwell are representatives – offers another possible factor: staffing levels that don’t give workers enough time to recognize and defuse potentially volatile situations.
Nurses in the COVID unit have also taken on additional responsibilities during the pandemic. Tasks such as feeding patients, drawing blood, and cleaning rooms would typically be done by other hospital staff, but nurses got involved in these tasks to minimize the number of workers visiting negative pressure rooms where patients were covid patients are treated. As the workload has increased, the number of patients supervised by each nurse remains unchanged, leaving little time to hear the worries of frightened visitors for the well-being of loved ones – like the man who screamed aggressively on the nurses on Caldwell’s unit.
In September, 31% of hospital nurses surveyed by this union said they had been victims of violence at work, up from 22% in March.
Dr Bryce Gartland, president of the Atlanta-based Emory Healthcare hospital group, said the violence had escalated as the pandemic continued, especially during the latest wave of infections, hospitalizations and deaths.
“Frontline healthcare workers and first responders have been on the battlefield for 18 months,” Garland said. “They are exhausted.
Like the increase in violence on airplanes, in sports arenas and at school board meetings, growing tensions inside hospitals may reflect growing tensions outside.
William Mahoney, president of Cox Medical Center Branson, said national political anger is playing out locally, especially when staff members ask people entering the hospital to put on masks.
“People have different political views – they’re either CNN or Fox News – and they start yelling at you, yelling at you,” Mahoney said.
Caldwell, the Kansas City nurse, said the physical nature of covid infections may contribute to an increase in violence. Patients in the covid unit often have dangerously low oxygen levels.
“When that happens, they get confused and also extremely combative,” Caldwell said.
Sarnese said the pandemic has given hospitals an opportunity to review their safety protocols. For example, limiting entry points to allow covid screening allows hospitals to channel visitors past security cameras.
Research Medical Center recently hired additional security guards and provided de-escalation training to supplement its video surveillance, spokeswoman Christine Hamele said.
In Branson, Mahoney Hospital has beefed up its security staff, installed cameras around the facility, brought in dogs (“people don’t really want to swing you when there’s a German Shepherd sitting there”) and organized de-escalation training – in addition to panic buttons.
Some of these efforts predate the pandemic, but the covid crisis has added urgency to an industry that is already struggling to recruit employees and maintain adequate staffing levels. “The number one question that started to be asked is, ‘Are you going to protect me?’” Said Mahoney.
While several states, including California, have rules to tackle violence in hospitals, National Nurses United calls on the US Senate to pass Workplace Violence Prevention Act for healthcare and human service workers , which would force hospitals to adopt plans to prevent violence.
“With any standard, at the end of the day you need it to be enforced,” said union industrial hygienist Rocelyn de Leon-Minch.
Nurses in states with existing laws still face violence, but they have an enforceable standard they can refer to when requesting that this violence be addressed. De Leon-Minch said the federal bill, which passed the House in April, seeks to extend that protection to healthcare workers nationwide.
Destiny, the nurse who testified in Georgia using only her first name, files a complaint against the patient who assaulted her. The state Senate committee is now considering legislation for next year.
Kamara said the recent violence had helped her hospital provide de-escalation training, although she was not happy with it. San Leandro Hospital spokeswoman Victoria Balladares said the hospital had not seen an increase in workplace violence during the pandemic.
For healthcare workers like Kamara, all of this antagonism towards them is a far cry from the early days of the pandemic, when hospital workers were widely hailed as heroes.
“I don’t want to be a hero,” Kamara said. “I want to be a mom and a nurse. I want to be seen as a person who has chosen a career that she loves, and she deserves to go to work and do it in peace. And not to feel like they’re going to be hurt.
Kaiser Health News is a non-profit news service covering health issues. This is an independent editorial program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.