I’ve worked in the emergency department long enough to witness a few, let’s call them, incidents.  One day, for example, I personally was punched in the gut by a schizophrenic patient.  While the patient who mistook me for a punching bag didn’t do any damage (my abs of steel totally blocked his fist), getting clipped on the job certainly increased my safety awareness at work.

Flippancy aside, incidents like this one, and those far more serious, are all too common in hospitals.  Nurses, NPs, PAs and MD’s are called on to treat all kinds of patients including those who are confused, intoxicated or suffering from psychiatric illness.  Many of these patients are admitted to the hospital against their will and understandably get aggressive at times.  Others patients are under stress and simply snap.

According to the Bureau of Labor Statistics, the rate of nonfatal assaults on hospital workers is 8.3 assaults per 10,000 workers.  This is much higher than the rate of nonfatal assaults for all private sector industries, which is 2 per 10,000 workers.  A 2009 survey of emergency department staff showed that more than half of emergency room nurses had been spit on, pushed, scratched or verbally assaulted at work.  One in four ER nurses reported being assaulted more than 20 times in the past three years.  In reality, the number of assaults on healthcare workers is probably much higher.  My fist-to-the-gut incident, for example, went unreported.

Assaults occur most commonly when healthcare workers set limits on things like eating, drinking and smoking or alcohol use as well as when patients are involuntarily admitted.  Studies show that healthcare workers are also vulnerable at times of high activity and patient interaction such as meal times and visiting hours.

While situations like these usually don’t result in serious injury, serious incidents have occurred.  For example, in Georgia a man who was dissatisfied with his mother’s care pulled a gun on her nurse tragically killing the nurse and another employee.  These cases, both the minor and more serious,  highlight the risk we as healthcare providers take, a risk that cannot be completely avoided.

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The nature of our jobs as nurse practitioners and physician assistants is up close and personal.  You can’t perform a neurological exam from the hallway.  As healthcare providers, we must be on alert and take precautions to avoid injury on the job.  Leave the door open when dealing with potentially combative patients.  Call hospital security to accompany you into a patient’s room when concerned for your safety.  Listen to your instincts warning you when a situation poses a threat.  Rehearse the best way out of your department from various locations in case something goes wrong.

If your hospital doesn’t offer adequate security resources, encourage administrators to step up surveillance in your department.  Although the hospital setting is a high stress environment and poses a risk to employees, its important that you don’t feel constantly on edge throughout your workday.  Educate yourself on staying safe at work and demand improved safety resources from your employer.

How would you rate the safety at your hospital?  Do you feel safe at work?


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