Monitors in hospitals beep all the time. Especially in the post-op recovery room. You would never think an anesthesiologist would be silencing them on purpose. You would never think that same anesthesiologist would come charging at you, stick his thumbs into your trachea, lift you off the ground, and strangle you.
This is Beth Duche’s story. She was the acting charge nurse in a busy PACU in Denver, Colorado when she reprimanded an anesthesiologist for shutting off patients’ alarms. He was putting patients’ lives in danger. As the doctor approached her, she never thought her life would be in danger, too.
Nurses are the most exposed to occupational violence
The occupational safety and health administration (OSHA) states that there are 25,000 workplace assaults reported annually, and 75% occur in healthcare and social service settings. From 2006 to 2015 there were 186 workplace homicides in the healthcare and social assistance industry within the private sector. Workers in healthcare settings are four times more likely to be victimized than are workers in the private industry.
Another study found that physical violence, threats of violence, and verbal abuse occurred most frequently in ICUs, whereas sexual harassment and bullying were highest in operating rooms. Physical violence was most common in emergency departments, geriatric, and psychiatric facilities. The main perpetrators were patients, followed by physicians and patients’ families. Nurses perceiving greater work demands and less trust and justice were more likely to have been exposed to violence.
Arrested and placed in handcuffs for doing your job
Alex Wubbels went viral on YouTube when a video was released that showed how she was placed in handcuffs by a police officer and forced into an unmarked car. Wubbels was under forceful arrest for doing her job and following hospital policy as she worked as the charge nurse in a busy Salt Lake City ER. Unfortunately, the perpetrating officer snapped and did not refrain from his actions even though Wubbels screamed, “You’re assaulting me this is crazy!”
Wubbels had her supervisor speak to the police officer prior to being shackled in handcuffs. That did not stop her from being assaulted. Not one person stopped this event from happening in the emergency room.
Hospital violence turned deadly
When a patient becomes violent and charges at your co-worker, pins them down, and starts striking their head, your automatic reaction would be to stop the assault. For Lynne Truxillo, a psychiatric nurse in Baton Rouge, that act of courage ended up costing Lynne her life. The violent patient ended up attacking Lynne. Her coworkers were successful in stopping the attack and Lynne sustained a torn ACL and needed surgery. Initially, she survived her attack but succumbed to her injuries 5 days later. Lynne Truxillo died of a blood clot in her lungs.
The National Institute for Occupational Safety Classifies violence into four basic types:
- Criminal Intent: The perpetrator has no relationship with the victim, and the violence is carried out in conjunction with a crime.
- Customer/client: The most common health care environment-based assault, the perpetrator is a member of the public with whom the nurse is interacting during the course of their regular duties.
- Worker-on-worker: Commonly perceived as bullying, in these instances the perpetrator and victim work together—though not necessarily in the same role or at the same level.
- Personal relationship: In these incidents, the victim has been targeted as a result of an existing exterior relationship with the perpetrator, with the violence taking place in the workplace.
The cost of violence in the healthcare workplace
If an employee requires medical treatment or misses work because of a workplace injury, workers’ compensation insurance will typically have to pay the cost. For example, one hospital system had 30 nurses who required treatment for violent injuries in a particular year, at a total cost of $94,156 ($78,924 for treatment and $15,232 for lost wages). If your organization self-insures (as some large healthcare organizations do), it will bear the full cost. If your organization does not, its claim experience can still affect insurance premiums.
Violence can also lead to other less obvious costs. For example:
- Caregiver fatigue, injury, and stress are tied to a higher risk of medication errors and patient infections.
- Studies have found higher patient satisfaction levels in hospitals where fewer nurses are dissatisfied or burned out.
- Injuries and stress are common factors that drive some caregivers to leave the profession. The estimated cost of replacing a nurse is $27,000 to $103,000. This cost includes separation, recruiting, hiring, orientation, and training. Some estimates also account for lost productivity while a replacement is hired and trained.
Both Beth Duche and Alex Wubbles survived their attacks. Both perpetrators were reprimanded and incarcerated. Although Lynne Truxillo’s perpetrator is serving prison time for manslaughter, Lynn did lose her life.
Violence in the healthcare workplace has reached epidemic proportions. Healthcare managers must commit and participate in workplace safety. They must be able to identify hazards in the workplace, conduct worksite analysis, provide training and ensure the safety and health of all employees while on the job. Nurses and healthcare professionals must be trained to identify, disarm, and de-escalate potential violent attacks in order to ensure their own personal safety.
Editor’s note: This post was originally published on January 11, 2021 and updated on June 9, 2021.