Rick Lucas sees his fair share of violence on the job.
The 41-year-old, who works as a nurse at the Ohio State University Wexner Medical Center in Columbus, recalled one situation when he admitted a patient to the intensive care unit for an overdose.
The patient’s father became aggravated after being told what happened. The man shoved another staff member and drew his fist back to throw a punch before security got involved.
The violence erupted in a split-second.
“I’ve definitely been threatened more times than I can count,” said Lucas, president of the Ohio Nurses Association. “I’ve had patients throw urinals, or spit at (me), or hit and pinch. … That kind of stuff happens pretty frequently.”
His experience is common in the health care industry. The American Medical Association, American Hospital Association, American Association of Medical Colleges and other groups have been warning for years about a rise in violence at health care settings, whether it’s at a doctor’s office, hospital or nursing home.
This year, there have been numerous high-profile incidents, including deadly ones, in Northeast Ohio and nationwide.
In February, a man held staff hostage at UPMC Memorial Hospital in York, Pennsylvania, before killing a police officer and injuring five other people. That same month, a nurse at HCA Florida Palms West Hospital in Royal Palm Beach, Florida, was severely beaten by a patient who broke “essentially every bone” in her face. In March, an Akron Children’s Hospital nurse who was nine months pregnant was attacked by a minor patient. In August, a knife-wielding man was shot and killed by police after he attacked an employee at Charleston Area Medical Center’s General Hospital in Charleston, West Virginia.
And this summer, the Canton-based Aultman health system experienced shootings at its main hospital in Canton and its facility in Orrville. In one case, a patient grabbed a gun from a security guard and shot a patient care tech in the abdomen, seriously injuring her. In the other, a man brought a gun into the emergency room.
Health care workers are five times more likely to experience violence than other occupations, according to the U.S. Bureau of Labor Statistics. The American Hospital Association estimated that 16,990 hospital employees had a violence-related injury or illness that required days away from work in 2022.
Carolyn Smith, an associate professor and associate dean for research at the University of Cincinnati College of Nursing, said workplace violence has always been present in hospital environments, but health care settings have seen an increase in the past decade.
“It is alarming that we are continuing to see increased episodes of workplace violence,” she said. “It has had an uptick, especially with COVID and also a corresponding reduction in health care resources, shortages of nurses, and in my opinion, the more business-focused aspect of providing health care.”
Rick Lucas, president of the Ohio Nurses Association, represents front-line nurses and medical professionals who have experienced violence in their medical centers. Lucas recently talked about the issues at the association offices in Columbus.
Why has there been an increase in violence?
The COVID-19 pandemic may have worsened a decline in patience for those visiting hospitals, Smith said.
“People’s stress levels (were) even more exacerbated within the health care setting,” she said.
An emergency room nurse from Northeast Ohio — who asked that her name not be used because she feared retribution from her employer — said many patients are frustrated by long wait times, which are caused, in part, by staff shortages.
“As health care workers in the ER, we are constantly having meetings with our medical director and talking about how we can improve the patient experience, the wait time (and) things like that, but sometimes it really is just inevitable,” she said. “If there’s chaos in the back of the department and the front of the department is overloaded, … people are just going to have to wait.”
She said while it can be nerve-racking as a patient to have to deal with waiting for care, it can be a good sign.
“If you go back to the waiting room, it doesn’t mean you don’t need to be in the ER; it just means that you don’t need to be seen right this second,” she said. “We see everybody who wants to be seen, and sometimes people come in for a rash that they’ve had for eight months, but today is the day they want to be seen, and then they get mad when they’re not seen immediately.”
What happened at Aultman after the shootings?
Aultman declined to make employees involved in the shootings at its Canton and Orrville facilities available for interviews for this story.
Following the shootings, Aultman said it has taken many measures to enhance security, including reviewing security protocols with experts, restricting access points, and continuing to screen all patients and visitors entering any of their emergency departments for weapons.
The incidents were reviewed by multiple government agencies, including the Occupational Safety and Health Administration, and no findings were levied against Aultman, the hospital system said.
“Workplace violence is an issue affecting hospitals, nursing homes and other medical facilities across the country,” Aultman said in a prepared statement. “We will continue to monitor developing trends and best practices in the health care industry. As we continue our efforts, the safety and security of the staff, volunteers, patients and visitors at Aultman facilities remain of paramount importance.”
John Palmer, spokesman for the Ohio Hospital Association, which represents the state’s 252 hospitals and 15 health systems, said it provides educational opportunities and resources to hospitals to encourage safety and security practices.
“Developing security procedures and safety protocols must be a collaborative process,” he said. “Hospital greeters, environmental service workers, food service workers, and other non-clinical staff have a role to play.”
Nurse: ‘I go into work nervous a lot of times.’
The ER nurse from Northeast Ohio said she’s seen plenty of violence in her career, and it impacts how she approaches her work.
“(There) was an older gentleman. … He had early onset dementia, and he had a urinary tract infection, which can make especially older patients very confused and alter their mental status,” she said. “I could see he was starting to get agitated and worked up. I made a call to security, and nobody showed up for 10 minutes.”
“This man was getting out of bed, I was trying to wrangle him to keep him safe, and he slapped me, open-hand slapped me in the face, and I had a welt on my face for two days,” she added. “That is an instance where it could have been avoided if I had proper support and proper response.”
She said there are some cases in which patients who are violent genuinely can’t help it, and this can make calling attention to the problem difficult.
“In that instance, I would have never pressed charges on that person,” she said, “but I think another issue is that we don’t press charges enough on people who do know what they’re doing.”
Taking measures to ensure safety, she said, like metal detectors and weapon screening, are important in making sure staff feel comfortable and safe coming to work.
“I go into work nervous a lot of times,” she said.
She said there’s a lot of verbal assaults that can occur in health care settings, and this can disincentivize people from working in the emergency department.
“People yell at you, berate you, call you names, and I think over time it can definitely make people jaded,” she said. “I’ve definitely had nurses that I’ve known that have switched areas at the hospital to avoid that much interaction with so many people during the day.”
Assaulting a health care worker is a first-degree misdemeanor in Ohio
In Ohio, those who assault health care professionals, workers or security officers at a hospital can be charged with a first-degree misdemeanor. If there’s a history of offenses in the health care setting, the responsible party can be charged with a felony.
But the increase in violence has sparked new legislation by local, state and federal lawmakers.
Earlier this year, Gov. Mike DeWine signed legislation — House Bill 452 — that added new measures for addressing workplace violence in health care settings, including requiring hospitals to have a workplace violence incident reporting system and establish security plans for preventing workplace violence.
“These events have become so common that I have heard nurses and health care workers say things implying that experiencing violence is ‘just part of the job,'” state Rep. Rachel Baker, D-Cincinnati, said in a prepared statement. She sponsored the legislation. “This is unacceptable and as a state it is critical that we work to support those providing direct care to patients.”
Congress also is considering the Save Healthcare Workers Act to make it a federal crime to assault health care workers in hospitals, with greater penalties if there are serious injuries. A Harborview Injury and Prevention Research Center report has estimated that violence cost hospitals $18.27 billion in 2023, with the costs ranging from treatment for victims to security to training and prevention programs.
“It is an unacceptable reality that those who dedicate their lives to healing should face the threat of violence,” American Hospital Association President and CEO Rick Pollack said in a prepared statement. “We know the enormous human and emotional toll violence takes on our communities and caregivers.”
The Burden of Violence to US Hospitals report by Rick Armon
In Akron, the City Council recently voted to boost the penalty for threatening a health care worker to a first-degree misdemeanor, with a mandatory jail sentence of at least three days.
Tracy Carter, Summa Health’s director of government affairs and health policy, told council’s Public Safety Committee the measure will add needed protections for those who deliver care to patients.
“Your action also serves as a model for other local government leaders to follow, ensuring every individual who answers the call to health care and takes an oath to do no harm is provided with a safer environment for the delivery of care,” she said.
Carolyn Smith said violence in healthcare settings has seen prevalence in recent years.
Workplace violence researcher: ‘Verbal assault is the No. 1 form of workplace violence.’
Smith, the University of Cincinnati researcher, said it’s crucial to teach medical and nursing students to identify forms of workplace violence that may be more preventable to reduce the frequency.
“It’s really important that … we really teach our students how to recognize even those more lower forms of workplace violence and be able to know how to mitigate when maybe stress levels are increasing and be able to deescalate,” she said, “so that hopefully we can avoid things getting to a point where there’s maybe a more aggressive form of violence that might occur from a patient or visitor within the hospital.”
Smith said health care workers, including nurses, are one of the most predominant health care sectors that record experiencing nonfatal work injuries including violence, but the reporting system does not include instances of verbal assault.
“Verbal assault is the No. 1 form of workplace violence, and if you were to ask any nurse, they’ve experienced it at some point in time during their career,” she said.
According to a February study from National Nurses United, eight in 10 nurses reported experiencing at least one type of workplace violence over the course of a year, and 45.5% of nurses reported an observed increase in workplace violence in that timeframe.
Smith said there is research that suggests that nurses who experience physical assault at work are much more likely to leave the profession.
“There’s a nursing shortage as is, and the demand for nurses is just going to continue to grow as our population ages,” she said. “If we are not getting this issue of workplace violence under control, then we might be having nurses that go into the profession leave because they feel unsafe.”
Rick Lucas
Lucas: ‘There has to be an acknowledgement that we’re humans.’
Lucas, the president of the Ohio Nurses Association, which is headquartered in Columbus, said one of the things the association is pushing for is more security screenings for hospital entryways.
However, he said, some organizations are reluctant to add metal detectors and other security measures because they think it could give the perception that it’s risky to visit a hospital.
“If you go to a concert, if you go to Disney, the most magical place on earth, you go through security,” he said. “There are lots of places where going through security is a normal part, and so keeping our hospitals safe … it seems like an easy trade-off that folks I think would welcome.”
Beyond preventative measures, Lucas also said there needs to be support available for staff members who have been victims of workplace violence.
“Being assaulted at work and then being made to return to duty without any time to make sure that you’re physically, mentally and emotionally OK is not good for patients,” he said. “You want somebody that’s at their best, not somebody that’s just been traumatized and victimized that needs time to heal and recover. … There has to be an acknowledgement that we’re humans.”
He said hospitals aren’t always supportive of their workers, noting his personal experience after the patient’s father threatened staff.
“Whenever the manager came in in the morning, they wanted to talk to us about the situation that happened, and (the conversation) was that we didn’t do a very good job of deescalating the situation and managing the situation,” he said. “(But) it erupted from nowhere, and somebody got shoved and hit their head on the wall, and the response was that we didn’t do a good job of managing the tensions in the room.”
Dan Yaross
’20 years and longer ago, hospitals were mostly thought of as safe havens.’
Dan Yaross, president of the International Association for Healthcare Security and Safety based in Chicago, said the culture surrounding hospitals has changed drastically in recent history.
“Twenty years and longer ago, hospitals were mostly thought of as safe havens,” he said. “But unfortunately, our society has degraded to a much more aggressive, violent (and) impatient society, and so hospitals can’t continue to operate like previously. … We’re facing a whole different culture and environment not just here, (but) globally.”
Yaross said the organization thinks a tiered security system would help to reduce workplace violence for health care settings.
“Picture security rings that start at the organization’s property line, so it’s pretty much public space, and then it’s semipublic space on your grounds,” he said. “But then the next ring would actually be the building perimeter, your doorways. So there, it starts becoming more of a semi-private area, so not everyone has the right to come into your building.”
Inside the building, Yaross said, there should be increased security barriers that make it harder for unauthorized people to enter key areas, like the main lobbies and the emergency department.
“Especially at the (emergency department), there should be weapon screening done at that doorway,” he said. “Weapons detection is one of those topics that is still up for debate, which surprises me as a consultant … because the culture there still thinks that we’re giving the wrong perception to our community that we feel it’s unsafe.”
Yaross said a lot of the organization’s efforts focus on proactively identifying patients with histories of violence and informing staff members.
“If (a) person has a tendency of quickly escalating, we want to make sure that staff at either different departments or even a different facility within that organization … that front line staff can see (it) in the medical records system when they pull them up,” he said. “The programs that are very successful and have really reduced the number of violent incidents, especially the severity of those, have been using a more proactive feature like flagging patients that do present violence.”
Yaross said preventative measures are key in mitigating the issue of violence in the workplace and protecting staff members.
“We want to make sure that the medical and nursing staff can provide world class care, no matter what organization they’re in,” Yaross said. “They can’t do that if they’re always worried about watching their back because they’re fearful of violence.”
Includes reporting from The Akron Beacon Journal.
Janson McNair can be reached at 330-580-8347.
This article originally appeared on Akron Beacon Journal: Workplace violence in health care settings increasing, experts say
