Hospital Worker Safety

March 22, 2018


By Erin Sherer, PA-C, RD

Hospital workers across the country were shaken recently upon hearing the news of a violent attack that took place in the New York City-based Bronx-Lebanon Hospital.  After a disgruntled, fired doctor walked into a hospital and began shooting former co-workers, the story spread like wildfire and struck fear in healthcare workers across the country (Maslin, 2017).  It is unsurprising that this hit healthcare providers especially hard. Not only did it reflect just the delicate balance of mental health providers deal with day-in and day-out, it happened in a place where people go to be healed, a place designated as safe-haven. There are few safe spaces in the modern world, and unfortunately in this instance, the hospital became the site of danger rather than healing.

All was not lost, of course, and tragedies such as these often give rise to exceptional individual efforts and stories of heroism.  The hospital workers at Bronx-Lebanon were, indeed, heroic in their actions: following protocols, prioritizing patient safety, and limiting the damage done.  According to the hospital's surgery department chairman, Dr. Brian Gilchrist, the hospital staff's "complete disregard for their own safety was exceptional," and it is a "testimony to the teamwork and family atmosphere and sanctity of this hospital" (Ferre-Sadurni, 2017).  It was also noted that many hospital workers, "rushed to bring supplies to surgeons as they treated their colleagues—even as the facility remained in a lockdown" (Ferre-Sadurni, 2017).

But while the incident at Bronx-Lebanon stands out because of its media market, it really shouldn't be surprising.  One recent report indicates that a remarkable 24,000 workplace assaults—or over 16 per day—occurred in healthcare settings between 2010 and 2013 (Wyatt, Anderson-Drevs, and Van Male, 2016).  And while workplace violence is decreasing in the United States in general, it is increasing in healthcare settings (Wax, Pinette, and Cartin, 2016).  It is with good reason that the Occupational Safety and Health Administration (OSHA), now recognizes workplace violence as a hazard in the healthcare industry (U.S. Department of Labor, 2016).  Attempts to improve safety in healthcare settings have been implemented in recent years, with many institutions mandating protocols and practices to follow if and when violent situations arise. However, a recent review of literature indicates that part of what hinders improvements in institutional policies is a lack of data of reported incidents (Campbell, Burg, Gammonley, 2015).

Incidents such as these are horribly stressful, dangerous, and damaging in the moment.  Potentially more damaging, the consequences linger long after the incident's aftermath, even if an employee is physically unharmed.  Many survivors of such incidents face long-term psychological, emotional, and social consequences; disruptions in their abilities to function while working; and potential financial consequences (Lanctot and Guay, 2014).  Additionally, those exposed to workplace violence may have more missed days of work, and may feel more job burnout and job dissatisfaction (Philips, 2016). This, in an environment that already presents stressed customers (read: patients) and a now-heightened level of potential incidents.

To prevent workplace violence, more than half of all medical centers in the U.S. have security personnel who carry handguns (Vellani, 2014).  However, a number of practitioners and healthcare administrators do not believe this is the best solution to this problem, and because of this, there is a push to keep hospitals weapon free.  The math is simple: more firearms lead to their use, and the use of firearms in hospitals can lead to more violence as was seen in a 2016 New York Times article highlighting an incident in which a psychiatric patient was tasered, shot, and killed by an armed hospital security officer (Rosenthal, 2016).

The rising tide of healthcare incidents indicates that more research is needed as to how to address issues related to workplace violence in hospitals, clinics, and related locations filled with sick, stressed, and sometimes compromised individuals.  Patients need to feel safe and secure, but healthcare workers need the same; an aggressive issue like workplace violence may need an aggressive approach to fix it. Current recommendations focus on improving documentation of incidents by employees when they occur, and training employees to follow protocols that have been developed for the prevention of violence and management of violence when it does occur.  Perhaps clearer guidelines and understanding of the limits on patient care for a violent patient would be helpful for healthcare professionals who need to react and respond with all patients (and co-workers) in mind?  This author is reminded of the airline admonition to make sure that one's own oxygen mask is in place before assisting others. In instances such as these, healthcare practitioner protocols should focus first on the safety of the other patients and the staff; once those priorities are addressed, the practitioners may return—if able—to the still-important responsibility of helping the individual presenting the threat.

References:

Campbell, C. L., Burg, M. A., & Gammonley, D. (2015). Measures for incident reporting of patient violence and aggression towards healthcare providers: A systematic review. Aggression and violent behavior, 25, 314-322.

Ferre-Sadurni, L. (2017). For Bronx Hospital Workers a sense of duty amid shooting's chaos.  New York Times.  Retrieved from https://www.nytimes.com/2017/07/03/nyregion/bronx-hospital-shooting-workers.html

Lanctôt, N., & Guay, S. (2014). The aftermath of workplace violence among healthcare workers: A systematic literature review of the consequences. Aggression and violent behavior, 19(5), 492-501.

Maslin, S. (2017).   Doctor Opens Fire at Bronx Hospital, Killing a Doctor and Wounding 6.  New York Times.  Retrieved from https://www.nytimes.com/2017/06/30/nyregion/bronx-hospital-shooting.html

Phillips, J. P. (2016). Workplace violence against health care workers in the United States. New England Journal of Medicine, 374(17), 1661-1669.

Rosenthal, E. (2016).  When the hospital fires the bullet.  Retrieved from https://www.nytimes.com/2016/02/14/us/hospital-guns-mental-health.html?mtrref=www.google.com&gwh=79C357BE22298B3A2FE5D8F6D886907E&gwt=pay

U.S. Department of Labor (2016).  Occupational Safety and Health Administration (OSHA). Guidelines for preventing workplace violence for healthcare and social service workers

Vellani, K. H. (2013). The 2014 IHSSF crime survey. Journal of Healthcare Protection Management: Publication of the International Association for Hospital Security, 30(2), 28-35.

Wax, J. R., Pinette, M. G., & Cartin, A. (2016). Workplace Violence in Health Care—It's Not "Part of the Job". Obstetrical & Gynecological Survey, 71(7), 427-434.

Wyatt, R., Anderson-Drevs, K., & Van Male, L. M. (2016). Workplace violence in health care: A critical issue with a promising solution. Jama, 316(10), 1037-1038.