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Posted January 03, 2023 by Keith Blough, Robin Brown and Tracy Carter
Listen to this episode of the Healthy Vitals Podcast.
Violence is rising in the healthcare setting. According to the American Hospital Association, 44% of nurses reported experiencing physical violence, and 68% reported experiencing verbal abuse nationwide during the COVID-19 pandemic as of June 2022.
Unfortunately, we know this reality to also be true at Summa Health. It is estimated that 3% of patients are considered violent on a daily basis. Violent situations make it more challenging for nurses and other staff to provide quality patient care, especially when they fear for their safety.
We have asked our nurses and frontline staff to share the stories of their experiences with patients being violent or abusive. Their stories deserve to be heard. The policy needs to change.
Scott Webb: There's an alarming trend in healthcare that predates COVID that involves verbal and physical threats and violence against healthcare workers. Joining me today to try and help us understand what's happening and what's being done at Summa in Ohio and federally to help protect healthcare employees are robin Brown, she's a registered nurse and system director of Environmental Safety and emergency preparedness.
Tracy Carter, system Director of Government Relations and Health Policy, and Keith Blough, chief of Protective Services and Police, and they're all with Summa Health. This is Healthy Vitals, a podcast from Summa Health. I'm Scott Webb. So first off, wanna thank you all for joining me today. As I was mentioning to Robin before we got rolling here in doing some research and reading about this topic was sort of alarmed to find that healthcare workers, healthcare employees across the country are having to worry about their safety, are fearful for their safety.
Like that just doesn't seem like it should. Thing, especially healthcare workers, healthcare heroes, should be able to go to work and feel safe. So that's kind of what we're talking about today, the safety from violence for Healthcare Employees Act and some other things. So as we get rolling here, Robin, I'll start with you. Our policy changes to protect our healthcare workers from verbal and physical violence, difficult to change.
Robin Brown: I would say that our policies are not hard to change because you can change a policy, but changing behaviors and changing the way we do business is harder to change. So we've spent years. Years and years trying to build processes around this issue to protect our employees. We've developed means of identifying patients who have a propensity for violence so that the healthcare worker can be knowledgeable when they enter a room and be better prepared to, keep themselves safe from a particular patient.
And we've done many, many things. And, in spite of all those things, we continue to see it happening. And I wanna convey that this is every single day. It happens every single day, multiple times a day. We're a large health system, so it is multiple times a day we identify the patients and there are typically 20 to 30 patients identified on any given day that have some propensity for violence. Sometimes it's verbal violence where they're name calling. Other times it's physical violence. It's spitting. It's swearing at people, it's throwing feces at nurses.
Throwing urinals at nurses. It is unimaginable. Kinds of violence that in any other job you would never accept. But in healthcare, it has been accepted and it's been longstanding such that. There's a campaign to say, it's not part of the job because nurses have said for years, well, it's just part of the job, I know. It's just part of the job and they keep taking it and taking it, and they shouldn't. So, as related to policy, no, it's not difficult. Policies have existed for years. Patient rights, patient responsibilities, those have existed for years. But in spite of all of our efforts, we keep sort of banging our head against the wall with making significant change.
Scott Webb: Yeah, I see what you mean. So besides a policy change, what other types of tactics have you considered or have you actually deployed, employed, whatever the right word is?
Robin Brown: As I alluded to the identification of the patients so that when we walk into a room, we can be better prepared and, keep ourselves at a safer distance from the patient if that might be necessary. That was an initiative that's taken a couple years to really get it hardwired into our system. The other initiatives that we're taking have to do with helping those healthcare workers that have been victims of violence, you know, The impact to the emotional state of our nurses, , and other healthcare workers that have been victimized over and over again, it's fragile. And so we've built processes around those victim, employees to assure that they're cared for, they're cared for by, our human resources and the, employee assistance program in order to keep them on the job. Because we find that people wanna leave nursing because they didn't really realize that they were gonna be into this kind of a job where it was violent. So, those are the measures that we've recently taken.
Scott Webb: Well, that's interesting, you bring up that, at one time it was sort of understood as you said that, you know, nurses would just say, well, what are you gonna do? It's a part of the job. But more and more we're hearing that there's a show. Shortage of nurses, especially because so many are leaving this sort of Great Resignation within healthcare. Do you think it's the violence, is violence one of the primary reasons in the healthcare space that you're seeing so many people leave, so many nurses leave this resignation, if you will?
Robin Brown: You I'm not sure that I could make that statement, but there's no doubt that some nurses are leaving because of experiences that they've had that have been a violent attack. No doubt about that. Is it influencing the Great Resignation? I don't know. Nurses are leaving for many, many reasons. Some of it has to do with this stress that we've been under with COVID. Some of it has to do with this ongoing shortage. So it's perpetuating itself. You know, people are leaving and making the situation even worse, and then there's less people choosing to go into nursing. So the refill rate, isn't equal to the number of people that are leaving.
Scott Webb: Yeah. It always seems to come back to that right Robin. Supply and demand and the demand in this case, is greater than the supply. And Keith wanna bring you in. I know that you're the chief of Protective Services, the police basically at Summa Health. And Robin touched on this a little bit about how things have been worse since COVID. So I know that it's been reported that there's been this increase in violence against healthcare workers, especially during COVID. I'm sure we can connect dots or not, but that's sort of interesting and surprising and yet not surprising for some reason. I guess I'm wondering, have you seen that at Summa?
Keith Blough: Well, I want to take a step back and look before COVID. There was a steady trend in healthcare of increased violence, and that stemmed back before 2010, when the joint commission then became involved and put a couple mandates in. And put some alerts out there to all the healthcare organizations about a trend that was trending upwards as far as an escalating violent environment, and the healthcare system. So prior to COVID that trend was steadily increasing in violent episodes and. I would not disagree. Based on articles, based on, other expert, assessments that COVID was an element likely in exacerbating that trend. And kind of pushing the gas pedal down a little bit. I feel like even without COVID, that trend would've continued to increase.
Scott Webb: Yeah, that's interesting. I see what you mean. That it was already trending in this direction, in the wrong direction, if you will. And maybe COVID just sort of added a bit of fuel to the fire. Robin did give us some examples earlier, but maybe you can give us some more just to really, you know, drive this home for listeners what's really happening on a daily basis to the healthcare workers at Summa?
Keith Blough: Well, again, I want to take a step back and look at what violence is. We did allude to a couple of those elements of violence. Most of the time when we talk about violence, the first things that pop into people's heads are punching and hitting and kicking and assaults. But the violence also includes the verbal harassment, the sexual harassment, the intimidation, the bullying, the threatening behaviors. There are other elements that are included in violence that. As Robin stated, occurred daily, multiple times a day across their system. So a couple of the incidents, Robin touched on some of the patient, examples of what is happening to our healthcare. It's also visitors. It's also just going to and from vehicles.
It's also outside of the patient care environment that we've seen the violence and the feelings of safety really is what it comes down to, occurring. And there's where there's many examples and I wanna pause and reflect on, let's just say one of those examples. One of those examples could impact the patient care and the safety of the environment for multiple patients. Even when we talk about, on one nursing unit or in one area, one incident happens that doesn't just impact that nurse and that patient that has the ability to impact that every patient that, that nurse takes care of.
The rest of that shift or the patients around them and the impact on the patients around them, that whether they observe, they see, or the care that is provided or the environment itself. So it has a rippling effect. And again, that occurs daily. And there's been incidents or examples of some situations, in some circumstances that have literally impact over a hundred employees from one patient. We had a patient that was in our hospital, in an inpatient care setting for more than 30 days.
Over that 30 days, the amount of verbal abuse, the amount of threatening behavior, the amount of, physical incidents that had happened had impacted over a hundred staff members over those days. And that includes nurses, that includes therapists, that includes management, that includes my officers, that includes social workers. It includes environmental services, employees, food nutrition employees. It has a traumatic impact on many, many people. Many examples of those, types of incidents have occurred daily, weekly, monthly, and over that years. And, along the timeline of that trend, even before COVID.
Scott Webb: Yeah, and I can certainly understand that sort of ripple effect. You know, that, as you say, in this one case with somebody who was in the hospital for that long impacting a hundred employees in not a positive way and not a feel good kind of way. And you touched on your officers there, and that's probably the thing that most of us would be familiar with seeing officers or cameras, things like that. But wondering what are you doing to keep healthcare workers safe? What are the future plans for implementation? There's probably maybe some things you can't tell us because you don't want people to know. But in general, what do you do on a daily basis to try to stem the tide, to stop this ripple effect?
Keith Blough: Robin identified one of the things we do, which we daily review inpatients across the system. We have, a collective list of, you know, concerns of those that have a higher potential to maybe have a violent episode that we do share. And we share that For employees and anybody that are interacting with those rooms or those areas to be cautious and to be warned, take a pause, be safe before you enter this room or before you interact in this way. That's one of the things that we do. Increased rounding from our officer's standpoint in those areas.
And check in with staff, check in, with visitors sometimes if there's a good relationship created there. Some of the other things that we do include: we've put up signs, to educate the public, to educate our patients, about our hospital, zero tolerance in workplace violence, behaviors towards staff members. We've also referenced the Ohio Revised Code in the laws to protect healthcare workers against such behaviors. And, we've passed that out, that's another action that we've taken. We've taken some more physical actions such as physical facility actions.
We've installed some metal detectors at two higher-risk areas and are considering down the road. Are those gonna be the solution for some other, access points. We've really stepped up our training for employees. Our non-violent training, and also our response to violence training. So two different aspects of training. One focuses on how to deescalate and how to, prevent acting out. And the other focuses on when acting out happens what are your response options? So we've really stepped those up and continue to evaluate and recommend. And tweak those trainings and what is offered and how many, offerings we have, what is required and not required.
Scott Webb: it seems like a good time to bring in Tracy. Tracy, I know that you're sort of the government relations and health policy person, right? So it seems appropriate now to have you jump in here and talk about some of the barriers to keeping healthcare workers safe. I'm assuming one of them is sort of, you know, getting the support you need at the state level, at the federal level, but in your words, what are some of the barriers?
Tracy Carter: I think for our sector, our healthcare sector, not a lot people know what's going on behind closed doors. So it's our obligation to educate our legislators, the staff, and the broader community about the reality of violence and intimidation occurring against our healthcare workforce. And so one of the tactics we are activating is to ask our employees to share their stories. So that we can have, more, of a sense of what's happening wide and deep within our own organization. And for me, stories bring humanity and reality to the statistics that are being reported at a national level about this situation.
And I can tell you that the stories that we have collected from our employees, we are sharing them with our federal leaders. Just today I did share 10 stories, employee stories with our, Summit County, representative. And one of those stories pretty much said this: unfortunately, facing abuse is something I, as well as many of my coworkers are used to. It is often that we have patients and visitors that become violent and verbally aggressive towards staff. I haven't called every name in the book. On my unit we have been hit, spit, etcetera. It is safe to say that our security and police staff are often making appearances on my unit.
Recently, I had a family member of a patient rip my badge off my chest and threatened to shoot me with a gun. It was a distressful situation as I was only doing my job. That is only a small glimpse into what we face on a day-to-day basis. There are some days where I do not feel safe, and so stories like that, we are sharing what our legislators with the hope that they can use their policymaking authority to change law. I can tell you on the state side, it is our hope that we can amend a statute that's concerning assault.
Right now there is, a law in the book that says if you do assault a healthcare worker, the penalty is a misdemeanor. We'd like to work with our state representative to change that law, to elevate the charge to a felony because we think assaulting a nurse, assaulting anyone who's working. Healthcare deserves a harsher penalty, so that's a priority for us. On the federal side, there is hope. There is a federal bill that was introduced this year. Called the Safe Act. It's HR 79 61, and it's the safety from violence for healthcare employees. And so this, bill would also impose harsher penalties against those who intimidate or commit violent acts against healthcare workers.
And so it's our hope in 2023, we can partner with our new congresswoman, our senators to advance that bill. And again, it's just one tactic of many policy would help mitigate some of the concerns we have now with our Workforce and safety and having law on our side, state and federal would certainly help provide a safer environment for not only our employees, but the patients and visitors and guests.
Scott Webb: Yeah. Safety for all right. As I said, I was gonna rely on you all to sort of educate me about this today and educate listeners, and that does sound like a big component. Of this is getting the word out, sharing the stories of what employees have suffered while just trying to do their jobs. And I commend all of you for everything that you're doing. I hope, Tracy, that we can get the state and, you know, federal government to support you from misdemeanor to felony and passing the Save Act and so on. It's incomprehensible to me that we live in a world where healthcare employees, healthcare heroes have to worry about their safety when they go to work.
That's a hard one to get my mind around. At least today, you've helped to educate me and inspire me, and I'm sure listeners, and hopefully everybody else to try to do something about this. So thank you all. You all stay well.
Robin Brown: Same to you. Thank you.
Tracy Carter: Thank you.
Keith Blough: Have a good holiday.
Scott Webb: And we encourage all of you to follow up with your federal representatives about co-sponsoring HR 79 61. That's the Safety from Violence for Healthcare Employees Save Act. And the best way to do that is to go to govtrack.us/congress/bills/117/HR7961. And if you found this podcast to be helpful and informative, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is Healthy Vitals, a podcast from Summa Health. I'm Scott Webb. Stay well, and we'll talk again next time.
