Why does workplace violence prevention legislation matter?

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Yesterday, I asked two questions in #SilentNoMore:

  1. Why do we need #HR1309 to become a law?
  2. Why do YOU need #HR1309 to become a law?

I can’t fathom paraphrasing any of the responses received on this post. Instead, I will share them word for word. This post is a little bit long, but please read every single word. We had so many responses that I had to decide to stop taking them for this post and decide to do a second post in the near future. Remember: we have 10,000 members and every single one of them has a reason for joining. That reason is never good, and it makes us passionate about implementing effective measures to reduce violence at work.

If you feel moved to support this legislation after reading these responses, I urge you to contact congress today. If you would like to be part of the conversation by joining Silent No More, please visit our group. (Be sure to answer the screening questions when you get there. This is how we prevent spammers and bots from joining.)

Trigger warning: this post includes photographs of injuries received as a result of violence at work. Some may be shocking or traumatic. Also, photos were submitted either alone or with text. Most of these photos are not paired with text submitted intentionally. Anonymity is a priority in this field of work and research.

#FromTheGroup:

“I have worked at two hospitals now where shots were fired. One, the perpetrator was handcuffed and accompanied by an officer and tried to grab his gun. Tasing him did nothing. He ended up being shot multiple times by the officer. 

“The second just happened a few months ago. The perpetrator brought a gun into the hospital. I haven’t looked it up yet. But he was evidently high when he did it. 

“I’ve been hit and kicked multiple times, cussed at more times than I can count. Almost sexually assaulted a couple times but was able to get away. A co worker was slapped by a woman who claimed she thought the girl was going to steal her stuff. It was witnessed. Another was punched in the face by someone withdrawing. It took 8 men to hold that perpetrator down. The adrenaline was running so high it took two hours with sedatives every 10-15 minutes to get him sedated enough to move him with just 4 men holding him down. The policy there is that restraints cannot be used unless the patient is in ICU. So we couldn’t even put them on him until we got him to ICU! Things have to change! We need protection.

“We need safe staffing. We need to know that employers and police and prosecutors have our backs when we get assaulted. Right now we don’t have that. And it is scary.”

“We need it passed so nothing happens again like it did to me and many others. It focuses on key points of preventing violence before it happens and keeps workplaces accountable. If everything has to be reported and investigated like it should be to begin with then the government and states can see which hospitals and other workplaces are at risk and unsafe repeatedly. They can come in and make the necessary changes if the workplace doesn’t.

“I need this because even after what happened to me, my workplace is still a dangerous place to work in and to be a patient. People are still bringing in loaded gun, employees are still being attacked physically and verbally. If my workplace doesn’t want to make the necessary changes, I feel like someone should hold them accountable and make them make the necessary changes especially since they are mostly grant funded by the state. If they knew everything that went on there as far as violence and threats of violence they would be shocked. It comes down to someone holding these places accountable to ensure employee safety as they are just trying to do their jobs.”

“People should be safe to do their work. You wouldn’t expect an accountant to not press charges if someone were to hit or bite them while at work, so why do you expect it of health care professionals? Actually you wouldn’t expect them to just take it, you would expect them to fight back. Health care workers cannot, because that would be abuse. Work needs to be violence free or there needs to be avenues to make it as “right” as possible. How do you handle a hostile work environment? 
I need this law to pass because I have been; beaten with a broom, punched in the head, verbally assaulted, jumped on from behind, scratched in the face, neck and chest, bit, had a “snake bite” done to my arm, had parents try to break my fingers by bending them backwards, kicked in the face, kicked in the legs and knee- trying to force it backwards, etc… this is not what I signed up for. I signed up and took an oath to help people, not get beat on while at work. Don’t get me started on the abuse and harassment of the family members and threats.”

Have you ever worn your own blood home from work before?

“Keeping healthcare workers safe from violence on the job will also protect patients.”

“Workplace violence prevention is so important! Employees’ safety and well-being should be the number one priority in any organization. There are so many great nurses, aids, medics, etc. that leave the field, meant to heal and protect, because they’re not being protected themselves. As much as I love caring for people and making a difference in their lives, I cannot do that when I’m being damaged (or afraid of being damaged) in the process. That damage could be mental or physical. We advocate for our patients daily, it’s time for laws and policies that advocate for us. These laws and policies should be put into place without us having to jump through hoops.”

“Accountability is a must in any workplace and to exclude healthcare workplaces from standards that place employers accountable for the health and safety of workers is unacceptable. 

“Healthcare workers deserve an amount of protection that is equal to the threats they face every day.”

“The level of violence we experience in healthcare would never have been tolerated in any other industry. The healthcare industry is largely not in compliance with the recommended guidelines to prevent WPV. A standard would “level the playing field” so that all facilities would invest in prevention efforts, and a HCW in any part of the country would have a basic level of safety. The standard would mandate proper recording of WPV events.”

“A Healthcare provider should not have to go about performing your chosen profession; a helping profession and have to worry every day that you could be hurt, battered or killed and your very own management has the right to let that “incident” go un-investigated because there is no governmental oversight in that facility. Healthcare providers are severely injured and almost lose their lives on the job and it is reported to NO ONE or the NURSE is blamed for the assault, again with no investigation.

“This Bill also would provide for increased safety measures like panic buttons – in case you are alone in a room with a patient and cornered, it mandates increased violence protection training- even in those healthcare environments where it is “not typically” seen as a WPV problem. In this social environment today, there is a 16 times more likely POTENTIAL for a healthcare provider who interacts with patients, families or coworkers to possibly experience exposure to Workplace Violence.
That number was quoted at the Hearing on Feb. 27, 2019(In case that link does not begin at the right time, please begin the video at 01:28:50.)

“I’m a medical assistant in an outpatient clinic. I have not experienced the violence to the degree some of you have but I have placed myself between an irate patient and a very pregnant coworker and have had verbal abuse and very close calls with physical abuse. You shouldn’t have to worry about being attacked while you’re at work no matter what you do. My heart breaks for everyone who has experienced this to such a severe degree. This has actually been a large deciding factor into why I haven’t gone to nursing school yet.”

“With any pt and or family member, we should be able to “kick them out” of the hospital if they begin to be verbal or physical abusive. We, as a healthcare provider, did not go to college to become someone’s punching bag. Now I’m not talking about a pt who cannot help themselves as a Dementia pt or someone who is really mentally ill. If the provider deems them not having a life and death situation then we should be able to call security/police to escort them off hospital property. Even pt’s that are especially verbal abusive. Need to nip it in the bud when it first starts then they know we will not put up with their crap. As a veteran and having PTSD/depression/anxiety, this really haunts me in ways others can’t imagine.”

“If you cannot do or say it in a court room, you shouldn’t be allowed to do or say it in a healthcare setting. That should put it in perspective. What about the droves of people leaving or planning on leaving the bedside/patient care areas due to safety concerns? I was one, left the ED after working patient care areas since 1985.”

“I’ve been a nurse for 23 years, I’ve missed countless holidays with my family…I’ve been harassed by patients, visitors & coworkers…I’ve been vomited, urinated & spit on…I’ve been physically assaulted by confused elderly patients, psych patients, drug addicts and drunks, as well as physicians….I’ve been there for baby’s first breaths, and for their last…I’ve carried amputated extremities to the helipad, and cleaned brain matter off of my patients faces to make them presentable to their loved ones…I’ve loaded critically ill children into helicopters and kissed their foreheads told them their mommy & daddy loved them, knowing that child wouldn’t live…I’ve held the hand of dying patients vowing they wouldn’t die alone…I’ve comforted countless families when they’ve received bad news… I am a nurse in a rural Emergency Department, and there has been such an increase in violence in ER’s and hospitals throughout my career. Last month I was attacked by a “repeat offender” because he wanted a plate of biscuits not the biscuit, bacon & eggs. This man punched me several times in the face and choked me. No one came to rescue me. Although we’re not allowed to fight back, I used my “SAFE” training and was able to free his hands from my neck. I placed him in a “SALT” arm hold. I sustained a dislocated jaw, several loose teeth and whiplash type neck injury. Although a majority of these patients are psychologically or chemically impaired, we do not deserve this treatment. It is not part of the job!”

“I don’t often talk about my personal history outside of how it relates to work, however I raise a 13 year old sibling after losing our mother to suicide several years ago. And I am his sole guardian, by myself.
When I came home from work tonight, I went through my usual routine. I secured my duty weapon and taser in the lock box in my closet, hung my duty belt up, uniform shirt, etc.

“As I was removing my protective vest and going to hang it up, I caught my younger brother staring at me from the doorway to my room. He asked me if I would consider getting a new job and I was stunned at how random it was, I asked him why.

“My brother simply said because “I won’t know what to do if you leave me and never come home one day. I know that hospitals aren’t safe and who would take care of me?”

“I was stunned. We live in an age where even our children know that a place of healing, a place that should be safe is anything but.
All I could do was assure him that I would be fine and no matter what he would be taken care of. But the sad reality in the back of my head is that I know how dangerous this work gets. I further explained that there has to be people willing to stick up for others, that’s why I do what I do.

“It’s more important now than ever that we continue fighting against the normalization of Healthcare violence. It impacts much more than even ourselves.”

“Workplace violence prevention is so important! Employees’ safety and well-being should be the number one priority in any organization. There are so many great nurses, aids, medics, etc. that leave the field, meant to heal and protect, because they’re not being protected themselves. As much as I love caring for people and making a difference in their lives, I cannot do that when I’m being damaged (or afraid of being damaged) in the process. That damage could be mental or physical. We advocate for our patients daily, its time for laws and policies that advocate for us. These laws and policies should be put into place without us having to jump through hoops.”

The story of this image below:

A story that should be reason enough: “Jessica went to work, like any other day. It was Thanksgiving of 2016. She worked as a psych tech in triage at a walk-in clinic connected to both inpatient and outpatient services. It was a special time for her family. She just found out two days prior that her 6-year old was about to have a baby brother. She was nineteen weeks pregnant. 

“No other techs were scheduled to work with her that day, probably due to it being a holiday. Jessica received only one patient in the morning: a male who had been previously assessed and sent home the day before. His discharge had included instructions to come back if anything got worse. He decided to come back, and he brought his father. They waited for paperwork to be completed and for him to be admitted inpatient. During this wait, the crisis worker assigned to the patient stepped out of the office to get something to drink, leaving Jessica alone. 

“This is when the patient began to stab Jessica 105 times. 

“When he began the attack, Jessica attempted to reach a phone to call for help. He grabbed her and threw her to the ground instead. At one point, he stepped back to look her over, as if in surprise – how had she not died yet? Jessica was taken over by a mothers’ instinct and her military training, which told her to curl into the fetal position. She knew to protect her baby and her vital organs. Jessica screamed for someone to call 911. The patient’s father called, and the stabbing continued.

“Police arrived, and they ordered the patient to drop the knife. The patient resisted all commands. When it became apparent he was not going to stop for anything, they shot him. His lifeless body fell to the floor next to Jessica. The assault ended.EMS transported Jessica to the ED, where she was stabilized and transferred to a trauma center’s ICU for eight days. She then spent two weeks closer to home for rehab. Her injuries were extensive. In addition to scars that cover her back, neck, head, and face, she is blind in her right eye. Her spinal cord had been severed, leaving her with inability to feel one side of her body and inability to feel temperature on the other. Other motor and sensory deficits remain.

“When she describes the injuries that still affect her, she says they are too numerous to list. Her physical and mental health have prevented returning to work. She remains in intense physical therapy. She hopes to see things get easier, but understands the injuries that still remain are permanent.

“One incredible miracle, besides Jessica herself, is her son. He was born full-term, months after the attack, and turned two last month. She has relished in this time they have had together. Of course, that isn’t always easy. The road to recovery has been long and arduous. There is still far more to come.”

Jessica’s discharge diagnoses

A few final thoughts.

In a perfect world, we in healthcare and social services would all be supported by management and other senior leadership. We hope they feel we should be protected and empowered to use self-defense (with the minimum force necessary to be effective, obviously), and to freely use the right guaranteed to all other people to call the police. We want to hold a person accountable when they are fully alert, oriented, and capable of choosing non-violent methods of communication, but they instead inflict violent injuries upon us, sometimes ending our careers, or worse, our lives.

Quite often it is said to us in this advocacy work that it’s not okay to punish patients for their behaviors because they have severe mental illness, or are somehow unable to understand the situation. They are vulnerable. Truthfully, healthcare and social services workers understand fully the difference between a person whose intent is to purely harm knowingly and a person who is unable to process a situation due to medical or psychological injury. We understand and we value that difference deeply. It is not our hope to imprison vulnerable people, not in the least.

This is a partial reason why this legislation is so perfect for improving our safety. This legislation is not as focused on the assailants. It is focused on the victims and prevention. States have guidelines on what level of punishment assaulting a healthcare or social services worker receives. This is not decided by federal legislation, though some do hope for that in the future in states where it is rare to even be able to file a police report.

The primary focus we have in H.R. 1309 is on prevention, with input from all areas of facilities. This matters because what I see as a nurse is different than my coworker sees in housekeeping, or my other coworker sees in security. Doctors have different risks they take than phlebotomists, and so all perspectives need to be included. As knowledgable as human resources and senior management may be about the data on violence prevention, they aren’t walking through their own hallways and engaging one on one with patients in the same ways the rest of us are, so they don’t see what we see at our eye level. This is why employee input needs to be legislated.

Reporting and investigation are required by this legislation. This does increase administrative burden on the employer. This is an unfortunate side effect that is still worth every minute and dollar spent on it. Much like a root cause analysis is used to prevent future healthcare mistakes and complications, an investigation into an assault can reveal vulnerabilities in the care provided and environment it is provided in. No prevention plan will seal every gap, but if we continue to investigate for gaps, we can get as many as possible.

Hospitals and other employers in social services and healthcare are not doing these things on their own. Healthcare consistently is the industry with the highest number of reported non-lethal assaults, but extremely little is done to prevent that. We not only need prevention, we need a continuously evolving plan that includes non-retaliation against a worker who reports a problem. The current method of handling assaults is too often blaming the victim for not preventing it, then simply doing nothing. Without systemic prevention, we are never going to be able to prevent these assaults from happening. We need prevention, and we need to know what goes wrong and why. Period. This is just a portion of why workplace violence prevention legislation matters to me.

There will be more messages on this to come. For now, I believe it would be refreshing to share a photo that circulated the internet some time ago. This manager should be commended for the support they showed their staff. If you are a manager, consider using this kind of honesty when a situation has gone way too far, and let your staff feel valued by you.

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