Incidents of abuse and violence against health care workers already occurred at an alarming frequency two years ago.
Then COVID-19 hit, and incidence rates of verbal abuse, threats and outright physical violence have escalated further with the high anxiety, frayed nerves and short tempers that have spun out of the pandemic.
In the last few months, leaders at hospitals and health systems have increasingly spoken about what doctors, nurses and other health care workers face these days as people lash out at them because of long ER wait times, visitor restrictions, requirements to wear face masks — or whatever else happens to set them off. The situation only adds to the deep wariness, fatigue and emotional toll the pandemic has taken on health care workers who for two years have handled high patient caseloads.
“We are seeing a pandemic of violence amongst health care workers with the number of incidents we have. It’s no longer an exception or every other day. In our daily safety calls, we’re hearing about five to 10 or 15 incidents a day of workplace violence against our team members, which could be a verbal assault, but it’s (also) hitting, kicking, spitting,” said Chad Tuttle, senior vice president for hospital operations at Spectrum Health. “We have had team members cut, we have had team members have broken arms, and we have seen serious violence against health care workers.”
Some of the rise in incidents stems from more people coming to hospitals with behavioral health issues, “but some of it is just explained by the frustration of people who are tired of having to wait for care or wait for service,” he said.
The “polarization around topics like vaccinations and unproven health care treatments” also contributes to the rise in incidents, Tuttle said.
“We have seen people get very upset because we will not prescribe Ivermectin in our hospitals,” Tuttle said. “We hear stories that shock our team members on a daily basis about how people will come in for care but have such strong personal beliefs against the medical advice of their provider. It’s very frustrating because all we want to do is help them and heal them.”
Administrators at other hospitals speak similarly about the problem that has been growing for some time.
At a December media briefing, Mercy Health Saint Mary’s President Dr. Matt Biersack described the situation as “the third crisis we’re dealing with in COVID.”
“Staff is yelled at, hit, scratched. We hear about it on a day-to-day basis,” Biersack said. “It is unrelenting.”
The U.S. Bureau of Labor Statistics reported two years ago that as of 2018, nearly three-quarters of non-fatal workplace injuries and illnesses involved health care workers.
According to a September 2021 survey by nursing union National Nurses United, 31 percent of responding RNs said they’ve seen a small or significant increase in workplace violence. That’s up from 22 percent in a prior survey six months earlier.
Physical and verbal abuse against health care workers “is something we hear about on a very, very regular basis now, both in our urban and rural hospitals,” said Brian Peters, CEO of the Michigan Health and Hospital Association.
The problem only worsens the acute staffing shortages at hospitals at a time when many are operating at or near full capacity, Peters said.
“You add that to the mix and if you’re a nurse or another person that comes in contact with patients and their families on a daily basis, and now you’re concerned with dealing with that sort of abuse, that does not help us in our efforts to maintain an adequate workforce to provide access to everyone in the community,” Peters said. “We’ve really lifted up the request for the public to show some patience and to show some grace.”
University of Michigan Health-West CEO Dr. Peter Hahn last month called the situation “unacceptable” and “tragic,” and said its contributing to staff leaving health care — “people we vitally need not just now, but obviously in the future.”
Hospitals have sought to respond to the problem through heightened security and increased training for staff, including how to de-escalate a potentially volatile situation.
Security staff at Spectrum Health, for instance, are trained in how to intervene “appropriately, compassionately and safely,” Tuttle said.
“And they do this multiple times a day, every day, alongside the nurses, physicians and others in our emergency departments and other units,” he said.
Workplace violence against health care workers has historically been “drastically underreported,” making the rise and severity of incidents hard to quantify beyond anecdotally, said Carrie Mull, a registered nurse and director of administrative and clinical services for the Psychiatric Medical Unit at Mercy Health Saint Mary’s.
Some workers in the profession have grown to view incidents as a part of the job, Mull said.
“People have learned in health care to tolerate violence in the workplace,” she said. “We kind of always have experienced violence in health care. People come in and oftentimes it’s the illness in and of itself that leads to violence. Patients come in with dementia or confusion, patients come in a bit intoxicated or a bit delirious from a brain injury or some sort of neurological illness and that oftentimes leads to agitation, and we get that.”
The difference now is that “everyone seems to have a lower threshold for coping with everyday frustrations,” both patients and workers, Mull said.
Mercy Health Saint Mary’s in the last few years has sought to improve reporting of incidents. That has resulted in about a 20-percent increase each year in reported incidents, although “it’s hard to know if workplace violence or violence in the workplace is increasing, or is it about the same and our reporting is increasing?” Mull said.
Prior to the pandemic, Mercy Health Saint Mary’s was experiencing a decrease in “moderate” and “major” injuries, the latter of which involves staff requiring time off work to recover from their injury, she said. A moderate injury is when a health care worker needs treatment beyond routine first aid, Mull said.
Since the pandemic started in 2020, Saint Mary’s has had a “pretty significant increase in those minor and major injuries,” she said. The rate of major injuries doubled in the past year after flattening out in prior years from efforts to curb incidents, Mull said.
“So the severity of violence seems to be on the rise,” she said.
The pandemic has limited the ability to continue efforts such as de-escalation and self-defense training, and having mental health professionals doing regular rounds in the hospital to talk with nurses, identify high-risk patients and put a plan in place to mitigate the risk, Mull said. Mental health and security staff also previously worked as a team to respond to and de-escalate situations.
“We had interventions in place that were working very well. We’ve had to redeploy those resources to the bedside. The resources that we had pre-pandemic we don’t necessarily have in place now,” she said. “We don’t have the luxury of having that resource anymore because of the staffing shortages that we’re experiencing.”
State legislation introduced late last year would require health facilities and local health departments to create violence prevention committees. Workers who provide direct patient care would make up at least half of the committee membership.
The legislation — House Bill 5530, sponsored by Rep. Richard Steenland, D-Roseville — also would require local health departments and health facilities to conduct training and create reporting procedures for employees, and to track and disclose violent incidents.
Jamie Brown, a registered nurse and president of the Michigan Nurses Association, said in a statement when the bill was introduced that it would “go a long way toward preventing the violence that takes a heavy toll on us health care workers and hurts our ability to do our jobs.”
“We shouldn’t have to put up with abuse, but nurses and other health care workers deal with violence on the job on a regular basis,” Brown said. “Whether it is a patient, visitor or family member, no one has the right to attack a health care worker.”
MiBiz Managing Editor Andy Balaskovitz contributed to this story.