How Violence Has Become the Status Quo in the Emergency Department

Derick Alison
Derick Alison
16 Min Read

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    Jeremy Faust is editor-in-chief of , an emergency medicine physician at Brigham and Women’s Hospital in Boston, and a public health researcher. He is author of the Substack column Inside Medicine. Follow

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    Emily Hutto is an Associate Video Producer & Editor for MedPage Today. She is based in Manhattan.

In part 1 of this Instagram Live clip, Jeremy Faust, MD, editor-in-chief of MedPage Today, talks violence in healthcare with Steven Haywood, MD, an emergency medicine physician, and Sarah Warren, RN, executive director and co-founder of Don’t Clock Out. Haywood and Warren discuss the abuse they have faced in the workplace and offer suggestions for how healthcare workers can be protected.

The following is a transcript of their remarks:

Faust: Topic today of our live Instagram: responding to violence in healthcare.

I’m Jeremy Faust with MedPage Today, and this is a very important issue. I mean, look, literally 85% of emergency doctors said that violence has increased, and they’re right. Here at MedPage, we have covered this issue a lot. I’m just going to read off a couple of the articles that we’ve published: Violence in Healthcare: Why Are People So Angry?; I Didn’t Sign Up for Violence When I Became a Nurse; Violence in Emergency Departments on the Rise; Confronting the Growing Violence Against Staff; Violence Against Nurses Worse Than Ever, Analysis Finds; The Last Straw; and we just go on and on and on.

It seems like this is a problem that was not even discussed when I was in school, and now every day you think, “Is today the day?”

So, let me just start with Sarah. Sarah, how did you get started with this issue? I mean, I get how important it is, but how did you start with this issue being one that you really wanted to take ownership of?

Warren: Yeah. I mean, I experienced workplace violence within the first 6 months of my nursing career, and I wasn’t adequately prepared for what I was going to face.

I made the mistake of — and trigger warning, workplace violence — I made the mistake of putting my stethoscope around my neck during my shift. I received a report that my patient was alert and oriented times 4 and that they had no prior incidents. There was no reason for me to be really concerned when I walked into my patient’s room. I tried to do my initial assessment and I had my stethoscope around my neck, and my patient actually tried to strangle me with my stethoscope.

And in that moment, I froze. I had no idea what to do. I’d never received any training for how to get myself out of a situation like that. And not only that, but the CNA [certified nursing assistant] actually happened to walk into the room around the same time that this was happening and she’d frozen as well. She had no idea what to do. We locked eyes while I’m holding something that is potentially going to harm me, and I’m trying not to harm my patient in the process of trying to save my own life. That was deeply traumatic.

What drove me to want to talk about this is that after that incident, I didn’t know what to do. I didn’t want to even report that this happened because I felt like it was my fault. I felt like I put myself in that situation and that I shouldn’t have worn my stethoscope around my neck and put myself in that vulnerable position. Instead of trying to figure out the problem, I was blaming myself.

Thankfully, I did report this incident because that helped protect anyone else from the same experience with that patient. But we often don’t report, and that leads to more harm and more incidents.

Faust: Yeah. I want to come back to reporting, because that’s a huge part of this. Thank you for sharing that. It’s going to change your career, a moment like that. So thank you for sharing that with us, and I’m sorry that you had to go through that. That’s just unacceptable and that’s why we’re here.

Steve, tell me about how you got involved in this.

Haywood: As you mentioned, Jeremy, it’s sad. Violence has become the status quo in the emergency department. That’s completely unacceptable.

Very early in my career, I remember I was in the resusc [resuscitation] bay and we had a patient that consented for treatment; then he got angry, kicked a paramedic, punched a nurse, and young naive Steve, early doctor, said, “Hey, this is assault and battery.” [I] called some officers, they came in and told me they were more than happy to take my statement and pass it along to the DA, and nothing happened from it.

The only time I’ve successfully had anyone charged is when an officer was actually standing at the bedside and witnessed my staff member get punched in the face and witnessed the bloody face and charges were pressed.

I was called to testify, so I traded shifts and I sacrificed a day off. I show up to find out that the court date has been changed. I traded shifts, sacrificed another day off, and the court date had been pushed back again. Then before the third court date got there, the charges had been dropped.

Just this year I was calling a family member to update them to let them know, “Hey, there’s a good chance that your family member is not going to survive the night.” And was told verbatim, “I’m on my way there right now with a gun, and if she’s dead when I get there, I’m going to kill you.”

It’s become commonplace. We have hundreds of stories. So I’m very, very pleased to partner with the American College of Emergency Physicians to try to enact change. It’s the status quo right now, and that’s completely unacceptable.

Faust: Yeah. So there are two things that I want to explore a little bit with you both. One is about reporting internally to the hospital and the support network that’s supposed to be there and how that’s going. The second is what you just said, which is that — isn’t this just a crime? Isn’t this just literally battery? Why isn’t there more legal action here?

But let’s start with the hospitals. That’s where we all work. Sarah, why do you think people don’t report? I assume that it’s for a lot of different reasons. One of which is maybe that there’s a sense that nothing will happen; and also I hate emails and meetings and if that’s not going to make my life better, why do it? But it has to be more than that, right?

Warren: Yeah. We have weekly support groups through Don’t Clock Out. Something that comes up very frequently is workplace violence, and a lot of the reasons that people come for support is because of their experiences.

Many times these individuals talk about having severe incidents of workplace violence and feeling like it was preventable, but feeling like their management didn’t want to have them report it. We’ve had people who literally have been retaliated against by their institutions for reporting severe incidents of workplace violence to the point where they’ve lost their jobs. This is documented, this is factual, and it’s heartbreaking. It’s a tragedy.

Not only that, they’ve gotten to the point where they feel like the only way they can get any sense of justice and prevent this from happening again is to report to a news agency. That’s something that a healthcare worker in our support groups has done, and they have felt that this is an immense weight and they feel a personal responsibility to address this problem.

That’s not fair to these healthcare workers. It shouldn’t be on them to make this massive system change when they were failed themselves. And they’re having to navigate potentially a legal system and also potential disability from being injured from workplace violence.

The other part of this is in training. We are told that this is part of the job at times. We’re told by folks who’ve been in the field for a long time that this is what you need to expect if you want to work in healthcare. You need to have grit. You need to be able to deal with the most difficult parts of humanity.

But I don’t think that’s helping us. I don’t think that’s serving us. I think that that’s leading to more omission. I think that’s leading to incidents that should be reported not being reported, and healthcare workers feeling like, “I had something really terrible happen to me, but this doesn’t fit in that category, so I’m just going to brush this off.” But it does compound and it does take a toll.

Faust: Yeah. I think that what happens, as you said, is that people feel like if they escalate it, they’re just going to be blamed. Instead of, what can we do to prevent this? It’s, what could you have done to prevent this? What did you do wrong or what did you not do that was enough?

Steve, how do hospitals handle this? And also dealing with the patients, because the patients are sort of customers at some point and we treat them like that, which may not be a good thing.

Haywood: It’s tough. I’m very fortunate as I work for a very supportive institution where we have constant security in the emergency department. We have certain individuals that have demonstrated a pattern of violence and are flagged. There’s certain services, non-emergency services, that they cannot receive because of their history of violence.

But we’re in the emergency department, we’re directed by federal law to give anyone a medical screening exam that needs it, so I can’t refuse service to anyone. I’m very appreciative of my security staff. You can’t just have random big guys, you need well-trained staff who know not to escalate things but can actually de-escalate things with their presence.

But really this is a bigger issue than just my brain or our brains, we need standards. We need workplace safety standards. We need to make this an OSHA [Occupational Safety and Health Administration] issue. OSHA ensures workplace safety. This is a workplace safety issue, and we need to get OSHA involved.

There’s a bill that is actually pending right now, it’s the Workplace Violence Prevention for Health Care and Social Service Workers Act. This has already been passed by the House. This is a bipartisan bill, it’s been introduced by Republicans and Democrats to set forth standards for workplace safety. In any other workplace, if you had this pattern of safety issues with anything, OSHA would be all over it and OSHA would set out patterns for the standards that you have to meet at your facility.

I’m fortunate that I think my facility does a pretty good job, but we need to have standards across the board because again, this is completely unacceptable.

Faust: Yeah. So just to repeat a little bit of what you said — there is this bill, and I guess my understanding of it just from what the coverage we’ve had in MedPage Today and elsewhere is that because it is designed to have OSHA enforce something, there’s resistance to that on Capitol Hill on one side. Because any time you give more power to a regulatory body at the federal level, that’s like a power grab. And so that philosophical opposition is what’s holding that law back. Is that right, Steve?

Haywood: Yeah. And there’s always the fear of unintended consequences. But when you have something like this, when the status quo is you have training set aside for what to do — not if, but when, you are assaulted in your workplace, that is an unsafe working environment. That’s become the status quo; that’s unacceptable.

We are to the point where we need standards across the board. This has bipartisan support, there are Republicans and Democrats supporting it. Again, we have to change the status quo.

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