Protecting Health Care Workers from Violence at Work

A patient at a Long Island hospital last summer kicked his doctor unconscious and lit his bedsheets on fire after not receiving the care he demanded. In January, a paramedic in Portland, Oregon was stabbed while sitting in an ambulance. Last month, a Louisiana emergency room nurse died from blood clots caused by a physical altercation with a patient.

Their experiences are not unique. Rates of violence against health-care workers are 12 times higher than rates for the overall workforce, according to federal data. (The numbers are likely worse than the data suggests, as many hospital workers do not report violent interactions to their superiors.) 

The possibility of violent encounters with people health professionals are trained to care for, along with the stresses inherent to the day-to-day duties of emergency personnel, can affect patient care and lead to mental and emotional health issues among providers. The pace of that work is also a key risk factor—one study found that 69 percent of EMS workers have "never had enough time to recover between traumatic events," leading to depression, stress, post-traumatic stress symptoms and suicidal ideation, according to a 2018 report by the Substance Abuse and Mental Health Services Administration.

“I think what we’re starting to realize is that we deal with people’s worst conditions every single day and the results of that have a cumulative effect,” said Jim Albright, director of Emergency Services in Guilford County, North Carolina. “It’s not necessarily a single event, but the effects of what we do over time.”

The problem is somewhat understood, but solutions aren't widespread. Some public agencies have implemented standards of care for distressed employees—Albright, for example, employs a mental-health professional who evaluates staff on a regular basis; a recent assessment found that 30 to 50 percent of employees were at risk of developing a stress disorder. However, these kind of evaluations of staff don't exist everywhere.

A bill introduced earlier this year in the U.S. House by Rep. Joe Courtney, a Democrat from Connecticut, would try to tackle the problem of employees who aren't getting the help they need by mandating protective measures on the job for health and social-service employees. Another piece of legislation, by Rep. Ami Bera, a California Democrat, would provide resources to emergency personnel, including paramedics, who suffer emotionally due to violence occurring during work.

The first bill, titled the “Workplace Violence Prevention for Health Care and Social Service Workers Act,” would require that the Occupational Safety and Health Administration (OSHA) create a national standard for workplace violence prevention. The agency would then require that health-care and social-service employers develop and implement comprehensive plans to identify and mitigate threats in the workplace.

There is currently no federal standard for workplace violence prevention, though 26 states, the U.S. Virgin Islands and Puerto Rico have “OSHA-approved state plans.” Twenty-two of those cover public and private employees, while the remaining six address only state and local government workers.

The legislation would address that by spelling out the parameters of workplace violence and instituting a reporting mechanism to help providers identify it, according to Albright, who supports both bills.

“Often, physical violence is a purposeless assault, caused by a medical condition, like seizures or a head injury. Those patients are by nature combative, but they’re not trying to assault anyone, they just have that fight-or-flight reflex,” he said. “But that’s carried over now to, ‘I’ve been drinking, so it’s OK if I take a swing at you.’ I don’t know that that’s appropriate. What we’re trying to do is quantify it, because we’ve done a poor job of knowing what the incidence is of on-the-job violence.”

In addition to establishing a national standard for workplace violence, the legislation would allow employees, including nurses, firefighters and paramedics, to weigh in on mitigation efforts, alerting their superiors to obvious solutions including lighting, alarm systems and surveillance practices that could help reduce the risk of violent interactions.

The second bill, the “Helping Emergency Responders Overcome (HERO) Act,” is geared toward first responders, including EMS, police officers and firefighters. It would establish a grant program to provide peer-support services and require federal resources for mental health professionals to better understand the culture of first-responder professions and direct the Centers for Disease Control and Prevention to collect data on suicide among public safety officers.

The accounting is particularly important, as many paramedics and firefighters work on a volunteer basis and so that aspect of their work lives are not listed on their death certificates, meaning suicide among them may be far more prevalent than the data suggests.

Together, the bills represent movement in an ongoing discussion about the risks—and rewards—of this kind of work, Albright said.

“I think we’re really starting to focus a lot of attention on the people that take care of everyone else, which hopefully will keep more of those people in the profession,” he said. “I want people to come to work, work hard, and go home satisfied with the work they did. I don’t want them to go home and fixate on the negatives of the job and the people they took care of who at times are not as gracious.”