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Attacks on hospital nurses trigger state laws to protect them

Posted On: Nov. 23, 2014 12:00 AM CST

Recent acts of violence against health care employees are leading more states to take action to protect medical workers' safety.

California Gov. Jerry Brown signed a bill into law in September that requires hospitals to implement plans to protect workers from aggressive and violent behavior. Illinois and New Jersey are among states with similar laws. More than 25 states, including California and New York, already have tougher criminal penalties for people who assault health care workers.

Health care workers nationwide are nearly four times as likely to be injured on the job as the general working population, according to the Bureau of Labor Statistics' latest data. Particularly at risk are people working in emergency rooms, psychiatric units, long-term care facilities and nursing homes, expert say.

Acts of violence against health care workers are “happening with increasing frequency, so health care facilities need to start looking at this more than they used to and ... start being more proactive and preventive,” said Carolyn Reinach Wolf, executive partner at Abrams, Fensterman, Fensterman, Eisman, Formato, Ferrara & Wolf L.L.P. in New York and a former hospital risk manager.

Recent incidents include a patient at St. John's Hospital in Maplewood, Minnesota, who assaulted four nurses with a metal bar from his hospital bed on Nov. 2. Two of the nurses were hospitalized, one with a collapsed lung. The patient, who reportedly was suffering from “episodes of confusion,” died a short time later.

On Feb. 7, a nurse at New York's Brookdale University Hospital and Medical Center suffered brain injuries when a patient reportedly stomped several times on her head.

In August, the Occupational Safety and Health Administration cited Brookdale for failing to adequately protect employees in 40 cases of workplace violence between Feb. 7 and April 12. OSHA also fined Brookdale $78,000 and ordered it to immediately implement a workplace violence prevention program.

The incidents at the Minnesota and New York hospitals are two of the more widely reported examples of violence against health care workers, but are not isolated cases. That is why states are pushing for employer-run workplace violence programs or tougher penalties for assaulting health care workers, experts say.

In addition, nursing groups and a service workers' union in California want the state to set more specific workplace violence and prevention standards, including broadening the scope of what's considered workplace violence to include psychological trauma and counting all hospital employees as health care workers.

Experts say more patients seeking treatment for dementia and mental health issues are contributing to the upswing in violence against medical workers.

Lynn Echols, director of emergency department, respiratory services and prime care at Habersham Medical Center in Demorest, Georgia, said more patients are visiting the emergency room for primary care, and mental health patients sometimes wait days for proper treatment because of a lack of available hospital beds. Patients might get tired of waiting and lash out, or become frustrated if they don't receive narcotics they request, Ms. Echols said.

Last year, she and a clinical support assistant were assaulted in the emergency room by a patient who “became angry with the plan of care,” Ms. Echols said. Neither filed workers compensation claims because their injuries weren't permanent and didn't require time away from work.

Ms. Reinach Wolf said health care workers and their employers are so focused on keeping patients safe that they don't always pay enough attention to their own workers' safety.

In Minnesota at St. John's Hospital where the four nurses were attacked earlier this month, a hospital spokeswoman declined comment on whether the nurses have filed or plan to file workers comp claims.

Through September in Minnesota there have been a record 46 workers comp indemnity claims filed by nurses assaulted or intentionally injured in hospitals, according to the state Department of Labor and Industry. That's more than the 29 claims filed by the state's nurses in all of 2013. Last week, a Minnesota state representative proposed legislation that would increase prison sentences and fines for people who assault nurses, a measure that would offer nurses the same level of protection as public safety employees.

Furthermore, violence nationwide against health care workers likely is underreported because “workers are trained to deal with people who are unstable — whether it's mentally or physically,” Ms. Reinach Wolf said. Health care workers generally feel, “We should be able to handle this.”

Health care workers have long considered physical and verbal assaults by patients and visitors as “part of the job,” said Marilyn Hollier, president of the International Association for Healthcare Security and Safety and director of hospital safety and security for University of Michigan Hospitals and Health Centers in Ann Arbor, Michigan. “They feel bad for these patients because they know they can't help themselves. That's the struggle.”

Ms. Echols, the hospital emergency department director, also serves on Georgia's Joint Study Committee on Violence against Health Care Workers. She said she hopes the committee, established in April as a result of a Georgia Senate resolution, will propose making “any incidents of violence toward a health care worker a serious offense.”

Ric Henry, president of health care risk management consulting firm Pendulum L.L.C. in Albuquerque, New Mexico, said he doesn't discount the importance of legislation when it comes to promoting health care worker safety, but “the primary driver for change in the workplace is training.”

Health care workers should be trained to deal with behavior-related incidents, cognitive impairment issues such as dementia, and learn how to defuse heated situations when they do arise, Mr. Henry said.