Hospitals combat violence in the ER
Kim Mulford, @CP_KimMulford 3:45 p.m. EDT June 23, 2016
With support from the New Jersey chapter of the American College of Emergency Medicine Physicians, two doctors recently conducted a survey of their colleagues to ask how often they experience verbal or physical abuse in the workplace. Kim Mulford
(Photo: Jose F. Moreno/Staff Photographer)
In New Jersey's busy emergency departments, hospital employees are regularly threatened, cursed, screamed at and insulted. Sometimes, staff are sexually harassed, punched, kicked, bitten, shoved against walls or attacked with weapons.
It's so common, many workers believe such abuse is part of the job. Some believe it's getting worse.
When Dr. Jenice Forde-Baker and Dr. Steven Hochman surveyed 223 of their colleagues at New Jersey hospital emergency departments last year, nearly 80 percent of respondents said they experienced verbal or physical assaults at least weekly.
"We shouldn’t just let it happen and accept it as a culture," said Forde-Baker, an emergency medicine physician at Our Lady of Lourdes Medical Center in Camden. Though she has never been harmed physically, she often is forced to remind patients and visitors they are yelling and need to calm down.
"We want to treat everyone with dignity and respect," Forde-Baker said. "I think it should go both ways."
With backing from the New Jersey chapter of the American College of Emergency Physicians, the two doctors are waging a statewide campaign to raise awareness about violence in emergency departments and ways to increase security.
Abusive behavior not only creates a hostile work environment, but also affects patient care and safety, explained Hochman, an emergency physician at St. Joseph’s Regional Medical Center in Paterson.
"This is already a highly stressful job," Hochman said. "The burnout rate is pretty high in our industry. We feel that emergency doctors and emergency staff should be provided a work environment in which we’re secure."
It's not a simple task.
Beth Manganaro has worked as an emergency nurse for 28 years, the last 17 at Inspira Medical Center Vineland. Years ago, an angry patient under suicide watch charged at her and nearly slammed her face with a heavy door as she tried to escape the room. In another workplace incident, Manganaro heard banging and a brief cry for help, and found a man trying to choke a woman in her hospital bed.
Verbal assaults are routine, she said. Patients might be intoxicated or high, delusional or suffering from a brain injury, or family members might be stressed out and emotional. But the threat of physical harm is scariest.
"We’ve all said it," Manganaro noted. "We just wait for that day for someone to walk in (with a weapon). It’s a continual fear that all ER nurses have, and that will be your day."
Two years ago, a rash of violent incidents in South Jersey hospitals led to policy reviews, active-shooter drills and additional training for staff. But only a handful of surveyed employees said they felt "extremely prepared" for dealing with assaults, a result that surprised Hochman.
"Hospitals need to take more aggressive steps than they are," Hochman said. "People don't feel safe and people feel this issue needs to be addressed."
In 2013, the federal Bureau of Labor Statistics reported more than 23,000 significant injuries due to an assault at work. More than 70 percent were in healthcare and social service settings. Last year, the Occupational Safety and Health Administration updated its guidelines for preventing workplace violence in healthcare settings.
"That got everybody's attention," said Paul Sarnese, Virtua's assistant vice president for safety, security and emergency preparedness.
New Jersey now requires hospitals to organize violence prevention committees and offer at least two hours of training on the topic each year.
Even so, there are no equal standards across the system, said Bridget DeVane, public policy director for Health Professionals and Allied Employees, the state's largest healthcare union. The Neptune-based organization has raised concerns with individual hospitals and the state Department of Health, which is responsible for enforcing the law.
"We see some hospitals where they have protocols in place … and then there are hospitals where we're seeing problems when there's an incident," DeVane said. "There's no proper protocol for how to call in security or police. They don't have panic buttons they can easily get to from the nurses station, or even from the patient rooms."
Indeed, about one third of emergency department employees surveyed said they didn't know what to do or hadn't learned how to respond to assaults, Forde-Baker said.
"But 80 percent of us are going to experience this," she noted.
Kennedy Health installed panic alarms and organized a code response team trained to calm combative patients. It also runs active shooter drills every year with help from local law enforcement, said Kimberly Cavallaro, corporate director of safety and security for Kennedy Health.
Using best practices suggested by the Department of Homeland Security, staff are taught to remove their identification badges; silence their phones; and run, hide or fight when faced with a threat. Local police help run the drill, which simulates the sound of real gunfire, and the local fire department assists with evacuations.
"We’ve seen incidents in other parts of the country," Cavallaro said. "This is what we need to do to prepare."
Often, assaults are committed by patients who can't control their reactions, said Dr. Anthony Mazzarelli, chief physician executive for Cooper University Health Care and an emergency medicine doctor. In those cases, staff can use their medical training in response.
"Not all violence in the ED is the act of a bad person," Mazzarelli said. "Some of it could be for medical reasons," including head injuries, brain infections, changes in mental status, or intoxication.
Sometimes, healthcare workers press criminal charges against an attacker. In 2011, New Jersey adopted legislation elevating an attack on healthcare workers from a simple assault to aggravated assault. But Forde-Baker and Hochman were unable to find anyone who had their cases successfully prosecuted under the new law. More than half of the employees they surveyed didn't know about it.
Hospitals are prohibited from retaliating against employees for reporting assaults in the workplace. But research has shown assaults on healthcare workers are underreported.
That could be due to subtle pressure not to report assaults by patients and visitors. Only 20 percent of surveyed employees said their workplace required them to report assaults. The majority said they were too busy to report assaults, or believed nothing would change as a result. But some hospital officials interviewed by the Courier-Post said they encourage their employees to come forward.
"We need things to be reported in order to take action," said Virtua's Sarnese. "Our employees do a great job with this … anytime they feel uncomfortable and anytime where there's a situation where they don't feel safe."
After a man shot himself to death at Inspira Medical Center Woodbury two years ago, the health system called in an independent security company to review its policies, procedures and security technology. The hospital bumped up video surveillance, added lighting and increased staff training.
Some healthcare workers believe there will never be enough safety measures in place. At Inspira Vineland, Manganaro said she wants to see more security stationed in emergency departments, and increased staffing to handle impatient patients.
Asked if people are more violent than when she first started her career nearly 30 years ago, Manganaro was emphatic.
"Oh my, God, yes. Without a shadow of a doubt," Manganaro said. "We're in a society where, I guess, people have been trained, 'I want it, I want it now, and I want it my way.' ...
"That's not medicine. It doesn't work that way."
Kim Mulford: (856) 486-2448; kmulford@gannettnj.com