‘The Last Straw’ Driving Workers Out of Healthcare

Harry Severance, MD
Harry Severance, MD
10 Min Read

Severance is a professor of medicine and an advisor on the healthcare workplace.

Over the past several years, I have received an increasing number of requests for advice about career change options from doctors, nurses, and other healthcare workers citing feeling increasingly unsafe within healthcare workplaces.

Many report being struck with closed fists or blunt objects, and all report knowing other workers who have been assaulted, some even being shot or stabbed. Many report now feeling unsafe just showing up to their healthcare workplaces. While most confirm that there are a host of other significant disruptive workplace issues, feeling unsafe has become a “last straw” now motivating them to consider other options.

A few health professionals have given me permission to share generalities about their experiences.

Case One

One case concerns “MN” and “BN,” a husband-and-wife healthcare couple. He is an emergency physician working at a large-volume trauma center referral hospital, and she is an RN working in an outpatient clinic at the same facility.

He reports being pushed, shoved, and struck several times while at work over the past year. He cannot even begin to quantify the number of times he has suffered verbal abuses. He knows several doctor colleagues and multiple ED nurses who have been physically assaulted, with at least one doctor and one nurse injured enough to have to be admitted. There have been several cases of patients or patient’s families brandishing knives, and one case of a violent patient with a firearm who was subdued prior to the gun being discharged. The gun was loaded.

Similarly, she reports multiple episodes of being pushed, shoved, and struck at work. She says that almost all the nurses she works with have had similar experiences.

MN and BN have two small children and just learned they have a third on the way. They both report that they now fear going to work — and fear for each other. They are profoundly concerned about one or both being severely injured or killed. For the sake of their growing family, they are seriously exploring safer work options, especially those outside of clinical healthcare.

I asked them what might change their minds about leaving healthcare. They answered that although they know there are no absolute guarantees in life and that “stuff happens,” why should they be at profoundly increased risk of being shot, stabbed, attacked, or dying just because they show up for work at a healthcare worksite versus some other type of job? And why isn’t someone doing something to make healthcare workplaces safer?

Case Two

“LV” is a nurse practitioner who reports that she was walking down the hallway of her hospital workplace when, upon rounding a corner, she was struck multiple times by a patient assailant. (The “after action” report confirmed there were no previous interactions between the patient and LV — she was just in the “wrong place at the right time” — though this was her normal workplace and pathway.)

She was injured severely enough to have to undergo trauma evaluation and overnight admission. She has now recovered from her physical injuries but suffers profound anxiety each day going to and being at work. She is receiving counseling for her anxiety, and her medical and counseling costs are being covered by the hospital. But she has been asked by administration several times to not discuss or further report this event as it is “bad for business.” She has received multiple emails, texts, and messages of condolence from peers, noting that they too have been assaulted on-the-job.

I asked if there was anything that might change her mind about leaving healthcare. Her answer was for someone to guarantee that she would not be assaulted again at work.

However, she has not seen any changes at her hospital to improve worker safety, and she was most discouraged by the administration directing their energies into trying to cover up the event. This assault has “changed [her] life,” and she reports that she may never work in healthcare again.

Case Three

“JB” is a medical student working through his initial clinical rotations. He and his colleagues have already witnessed episodes of worker assaults and have suffered verbal abuse.

However, what led him to reach out to me was when he learned that a close family friend — a physician at another facility who has become his role model — was recently assaulted and injured by a patient’s family when he went in to deliver some bad news to the patient.

JB reports that healthcare workplace violence is becoming an emerging hot topic among his medical student and pre-med groups. There is increasing discussion about alternative careers.

He wants to know what options he might have to change career paths at this late date.

He emphasized that discussions among his peers revolve around their impression that, though violence is escalating, no one is doing anything about it. He says that he chose medical practice as a career path in order to help people, but he feels that the very people he planned on dedicating his life to helping are the ones increasingly harming healthcare workers. This has caused him much anguish!

I also asked him if workplace violence issues are causing pre-meds to seek other careers. He said he believes the number of undergraduates enrolled in pre-med courses at his site has declined compared to past years.

The Bigger Picture

Assaults against healthcare workers remain grossly underreported. Yet, the available numbers are staggering and document a picture of steadily mounting violence.

Approximately 75% of all reported U.S. workplace assaults (~396,000/year) occur in healthcare and social service settings. Healthcare workers are five times more likely to experience workplace violence than employees in all other industries.

Congress remains deadlocked on healthcare violence bills. A few states have increased penalties for those who have assaulted healthcare workers. But this is after the damage has been done. There are few if any requirements for hospitals to implement workplace violence prevention plans.

The Bottom Line

For how many of the 4 to 5 million healthcare workers (20% of our entire U.S. healthcare workforce) who have left healthcare in the last few years — including over 117,000 physicians (over 10% of our nation’s doctors) who left healthcare in 2021 alone — have the conditions of an unsafe healthcare workplace become a definitive factor or “final straw” in their decisions to leave?

We currently have little quantitative data for that question, (I have provided a small worker sampling here), though data is beginning to emerge connecting healthcare workplace violence and/or incivility with workers’ “intent to leave.” That healthcare has been ranked as the most dangerous profession suggests that unaddressed workplace violence may be a factor in many departures.

This continued exodus of healthcare workers threatens many of our already unstable hospitals and worsens the lack of patient access to timely and vital healthcare.

Hospitals, clinics, and other healthcare workplaces should be a “safe haven” for all — patients, families, and workers — not the most unsafe of all U.S. workplaces.

Could unaddressed workplace violence be a “domino” that critically disrupts our already fractured healthcare system?

Harry Severance, MD, is a physician practitioner and educator. He is a published author and national speaker on issues related to healthcare, including pandemic preparedness and workplace/workforce disruptors. He provides advice and mentoring to those facing issues within their healthcare workplaces. Opinions expressed are the author’s alone, and do not necessarily represent views or opinions of the author’s employers or affiliates.

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