What’s behind an alarming rise in violent incidents in health care facilities

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• John Yang:

  Government data shows that health care workers are five times as likely to experience workplace violence as other workers. They accounted for 73 percent of non-fatal injuries from violence in 2018, the most recent year for which numbers are available, and there are signs it's getting worse.

  And a National Nurses Association survey last year 40 percent of hospital nurses said they'd seen violence increase. Earlier, I spoke with Karen Coughlin, a retired registered nurse who worked for the Massachusetts Department of Mental Health for 34 years. She's now chair of the Massachusetts Nurses Association, Workplace Violence and Abuse Prevention Task Force. I asked her about her experiences with workplace violence.

• Karen Coughlin, Massachusetts Nurses Association:

  I would say that over my career, I had too many incidents of workplace violence. I would not be able to count them actually over 34 years, it's well over 100. And it would run the gamut from verbal threats to actual physical assaults.

  So I was bit, kicked, punched, spit at and had weapons, you know, tried to use be used against me, this is not something that's new. And I'm not the only nurse who has experienced this. So, it's one of the things that I think needs to be addressed. Now is the time, it has only increased over the last several years to an alarming rate. And something needs to be done because our employers are not keeping us safe, the patient safe, the staff safe, anyone safe.

• John Yang:

  Were most of these incidents involving patients?

• Karen Coughlin:

  Yes. And typically, I would say statistics and data has shown that the majority of assaults on healthcare workers are perpetrated from patients. That is not to say that we don't face risks otherwise. We have had, you know, assaults from family members, patient on patient assaults, et cetera. And it doesn't affect just nurses. It affects many people in healthcare settings. So it could be social workers, housekeeping, transport workers.

• John Yang:

  And what's been the response of your hospital administrators to this?

• Karen Coughlin:

  So there's a lot of, you know, Oh, I'm so sorry this happened to you, et cetera. But there are no real concrete changes being made in many of our hospitals. That is not to say that some hospitals don't do better than others, because there are some that have addressed it.

  We have nurses who are leaving the profession, because of the risks that they face on the job. And in all honesty, it's not what we signed up for. We went to school and got our licenses in order to provide good quality care to our patients. And it's time that hospitals, they now are starting to acknowledge that there is a problem, but there's also a need to address it.

• John Yang:

  There's some people listening to us may think while you work today, facility run by the Department of Mental Health. Is this across the board though, in other facilities as well?

• Karen Coughlin:

  People automatically assume that all workplace violence incidents happen in emergency rooms and in psychiatric units. That is not the case. We are seeing workplace violence incidents across the gamut of healthcare, whether it's in home health, or whether it's at doctor's offices, whether it's on a medical surgical unit, in maternity units, in you know, post-anesthesia units, you name it, we are seeing it.

• John Yang:

  You mentioned it that it seems to be going up over the past few years. Are there reasons that you think account for this increase?

• Karen Coughlin:

  It's almost like the perfect storm. So nurses are dealing with the inability to provide care to the patients in the way that they would like to be provided in a timely manner. If you have too many patients to care for, you can't get to everyone. You can't be in 10 places at once.

  The other thing is there, you know, we've learned there are no consequences oftentimes for these types of behaviors in facilities. You know, patients are allowed to, you know, assault, verbally threaten, verbally abuse staff without any consequences to those behaviors. Visitors aren't banned. They're not, you know, they're not screened before they come in. We have, you know, weapons in general all across the country. You know, and hospitals are hesitant to put in, you know, metal detectors you know, for visitors coming in.

• John Yang:

  What more can you, would you like to see hospitals do? What more would you like to see laws changed?

• Karen Coughlin:

  We want to see legislation that addresses the end makes it a requirement that health care facilities make an assessment of the risk factors related to workplace violence in their particular hospital, and then make a plan with the input from direct care staff related to how they can address it. And then a reevaluation every year.

  But also along with that, to have reporting mechanisms so that we have data that can show and red flag, but it's like the Department of Public Health should be aware of these types of incidents that are going on in facilities. And hospitals, quite frankly, are reluctant to do that. But they should. Something that's set in place that they have to adhere to, because there would be penalties, there would be reporting requirements, there would be time off given to those victims of workplace assault, because right now, they don't get time off in order to address it if they decide to make, you know, charges, legal charges. And then we also have legislative bills that would increase the penalties for workplace assaults against healthcare workers.

  Because right now, we don't have that, at least here in Massachusetts, although there are at least 32 states in the nation that have that in place that make it a felony. In total, there are like I think 38 states in the nation that have laws addressing workplace violence against healthcare workers and nurses.

  I think the other one is that, you know, I think more data has been done related to when there is a working, measurable, enforceable workplace violence prevention program in place, that it shows the quality of care increases, that workplace violence incidents have gone down, and that staff is more comfortable working there.

  And there's an ability to be able to not only recruit but to retain your staff that you've got. They should feel supported, and have the ability to work through a workplace violence incident with the support of their administrators, employer, and you know, colleagues.

• John Yang:

  Karen Coughlin, thank you very much.

• Karen Coughlin:

  You're welcome. Nice to be with you.