In Baton Rouge Louisiana last week a nurse was trying to assist another nurse who was being attacked by a patient on a behavioral health floor. Last year a nurse was attacked and held hostage in Ohio. Nurses and other medical staff are frequently the source of patient violence and sometimes coworker violence. Does anything really happen to the assailant or does the healthcare facility have a policy for violence?

Even though many healthcare organizations treat a hospital stay like a hotel stay, admission to the hospital should not be one of the high points of your week. Like I said in the blog last week I feel like that we interfere with recovery of the patient by, “pampering them” like they’re in a four-star hotel. Some of my first 10 years of nursing were spent working in Catholic hospitals. What that means is that we had nuns running around. Most of these nuns had been trained as nurses back in the day and now are just providing pastoral care. One night on a nursing unit I was commenting about not bothering the patient because they were asleep. Sr. Joy who was on the floor seeing another patient that was having a rough time said, “you don’t come to the hospital to sleep you come to the hospital to be treated for the condition.” I think about that every time we over pamper a patient. That’s not to say that some patients don’t need high-quality care that’s fairly extensive, but that’s not every patient.

So we’re treating the patient and patients have many issues going on besides whatever they’re being hospitalized for. Just because you’re in the hospital doesn’t mean that life is not going on around you or that all your other illnesses are on hold while we deal with the current situation. Patients can develop delirium, or they’re just plain ass holes. No matter what we owe them compassion; however, they have to participate in their care. In personal experience, I’ve seen healthcare organizations tend to be very poor in staff protection or staff training. We don’t teach our frontline staff how to de-escalate a situation. Oh sure we give them a behavioral health class, but there’s no discussion of hey these are some communication techniques that are valuable with the person that may be aggravated or agitated. The Veterans Administration uses a 30-year-old system called the prevention and management of disruptive behavior. This program emphasizes prevention and only uses management techniques when the prevention fails. In full disclosure, I teach this program to trainers and find it to be beneficial in not only de-escalating but redirecting even patients with delirium. That’s just one healthcare organization most others teach fundamental and aggressive management of violence techniques and nothing else. We owe it to our frontline staff to be able to de-escalate potential violence as opposed to managing it.

The other thing that needs to happen is that healthcare organizations need to take a hard look at frontline staff safety. Nurses and other frontline staff are frequently exposed to violence and are often told not to report it. Approximately 80% of all patient on staff violence is not reported. You know why? Most of the time it’s played off as “oh Mr. Jones just has dementia; it doesn’t mean anything.” Yes, Mr. Jones may have dementia, but it doesn’t give him an ultimate pass on violence. In those situations where a patient is known to be violent, there need to be control measures in place to help protect the staff. Essentially what hospital management is saying by not providing this is what they regularly say, “nurses don’t matter.” I will tell you in one situation where violence was committed against me in a home health setting I was told I would lose my job if I reported that violence to law enforcement. Lose my job? What kind of fucking bullshit is that? It’s basically like saying fuck your safety pal we need to make our money. That is unacceptable, and yes I was looking for a new job. I also threatened the Department of Labor complaint against that organization until I found a new job.

So what do we do? First off we need to get professional organizations to get off their ass and put a foot in the asses of some of these healthcare organizations. They need to spend more time educating and demanding higher levels of staff protection. These organizations also need to lobby legislatures to demand changes in rules and laws that support our frontline healthcare workers. We need to be able to report incidents through management and have appropriate action taken whether this is flagging the patient is a violence risk and requiring the recommending increased vigilance with that particular patient or in extreme cases we may need not to allow that patient to be seen except to stabilize them long enough to be transported out. I know it’s drastic but let’s face it a nurse got killed this week because of poor policy. When do we ultimately say stop?

Frontline staff also need to support each other, which is what this nurse was doing, but also by observing for potential violence in patients, and reporting it. We are a team; we need to act like one and protect each other. We need to stop excusing bad behavior in our patients and tracking it. We need to hold patients accountable. Lastly, we need to have safety mechanisms in place for patients who may have delirium or dementia. Just because I go to work in your damn hospital doesn’t mean your patients get to use me as a punching bag.

Okay, a lot said here that was very unfiltered. I gave up trying not to swear a long time ago. I know that some folks may not like my unfiltered language. For that, I truly apologize but, some of these things that we talk about especially things that affect nurses and frontline staff make me angry. Like violence, that’s why I teach violence prevention and why I teach safe management techniques. I don’t want staff hurt but, I also don’t want patients hurt either. We are healers first, and we need to facilitate a healing process.

What you can do as a frontline staff is a demand these conditions be in place. Demand that professional organizations get off their ass and push for protections in both the hospitals and clinics. Demand these professional organizations lobby the legislature. Lastly, if you’re lucky enough to have a union, that union had better focus, laser focus on your protection.

Also, don’t write off behavior make sure the next staff member that takes care of that patient, the doctor, or the ancillary staff are aware that that patient has, “issues.”

As the sergeant on Hill Street Blues used to say, “let’s be careful out there.”