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A health care team including nurses, physicians, chaplains and psychologists help defuse potential workplace violence situations involving patients, visitors and staff.
Cynthia Reeves | SBJ
A health care team including nurses, physicians, chaplains and psychologists help defuse potential workplace violence situations involving patients, visitors and staff.

On Defense: Heath care systems struggle with rising workplace violence against staff

Posted online

 Workplace violence against health care workers was prevalent before the coronavirus pandemic but has deepened in the nearly two years since COVID-19’s arrival, local health care leaders say.

At CoxHealth, which comprises six hospitals among its footprint in southwest Missouri, 4,127 incidents of aggression or violence were reported in a 12-month period, ending Sept. 30, 2021. Beth Polivka, chief nursing officer, said that total resulted in 637 assaults and injuries for a health system worker in 322 instances. 

She said examples of aggression include verbal abuse, threats of violence and even physical altercations involving patients or family members against health care staff. Polivka, who’s worked at CoxHealth for 18 of her over 25 years in nursing, said she’s experienced workplace violence in her career.

“Honestly, it’s hard to find a health care worker who hasn’t,” she said. “Myself, personally, I’ve been punched, I’ve been pinched. It only happened to me once, but I had a patient spit on me.”

The health care industry is far from the only one that encounters aggressive behavior, but it makes up the majority of nonfatal workplace violence incidents, according to U.S. Bureau of Labor Statistics data. In a 2020 BLS report, medical workers in 2018 – the most recent national data available – accounted for 73% of those injured due to violence. The report noted intentional injuries against health care workers requiring a day or more off from work in 2018 was 10.4 per 10,000 full-time workers, compared with the all-worker incidence rate of 2.1.

Mercy Springfield Communities President Craig McCoy said the national incidence level is almost certainly higher in the years since the BLS report. Mercy Hospital Springfield reported 217 physical assaults and 51 verbal assaults last year, according to officials. 

Both CoxHealth and Mercy officials were uncertain if the number of incidents reported last year were record highs.

A National Nurses United survey of 15,000 registered nurses in November 2020 noted 20% of respondents said they were experiencing increased violence on the job.

“It’s heightened a lot of tensions, a lot of frustrations over everything with the restrictions that are based with COVID,” McCoy said, pointing to hospital rules regarding the number of visitors allowed inside and face mask requirements. “People have not appreciated having any kind of restrictions there. It’s created challenges of people being short-tempered.”

Being proactive
After assaults at Cox Medical Center in Branson tripled to 123 in 2020 from a year prior, roughly 400 staff members working in the emergency department and inpatient hospital rooms were provided personal panic buttons. The safety button system, which Polivka said was implemented late last year, was funded by a $132,000 grant from Branson-based nonprofit Skaggs Foundation.

The button is attached to the employee’s ID badge, and when pressed, a tracking system is launched to notify security of the person’s whereabouts.

Cox Medical Center South trialed the use of the buttons in 2020 after the idea was proposed at the health system’s annual Innovation Accelerator. Polivka said rollout of the buttons to all areas of Cox South was finished last year. The company’s investment in the buttons was not available by press time, but officials said they were used at Cox South an average of 45 times a month between July and December 2021.

“The panic button element is one element that is used within the health care system, but it’s by no means the end all, be all,” Polivka said. “We try to do everything we can to prevent use of that.”

Both Polivka and McCoy said de-escalation education is a key focus for their staffs to keep tense situations from becoming physical. 

At Mercy, behavioral and incident response teams made up of clinicians and public safety employees are utilized in the hospital. 

“But a lot of the work that is taking place is additional training to our co-workers around de-escalation to basically try and deter threats of violence,” McCoy said. “We’re working to head things off on the front end. Some of it is communication for patients and visitors as well around expectations within the health care facility around safety.”

Helping educate staff to be proactive is important, Polivka said, noting that involves being alert for verbal and nonverbal cues of agitation among patients or visitors.

She said CoxHealth has a crisis care team involved in defusing and debriefing incidents. Team members include nurses, physicians, psychologists, chaplains and social workers. 

“It’s a multidisciplinary team that is comprised of different folks,” she said. “You need a 24/7 process. It’s not a process that’s Monday to Friday, 8 a.m. to 5 p.m. We have a lot of groups that receive training and education. Many on the health care team have those tools within their toolbelt to help prevent us from ever getting to a situation of violence.”

When incidents of violence do occur, she said the team is also there to support the employee. That includes counseling with a psychologist.

“Sometimes, the negative side effects of being assaulted in the course of doing your job don’t kick in right away,” she said. “That’s part of those one- and two-week follow-ups.”

Mercy officials said not every incident is reported to law enforcement, as it depends on the willingness of the health care worker to speak with authorities. CoxHealth officials said they don’t track that kind of data.

Speaking up
In the aftermath of a workplace violence incident, CoxHealth takes stock of possible improvements that could lead to a more positive result. 

“We take every situation and kind of do a debrief,” Polivka said. “Could we have done anything different earlier? All of that helps us get better.”

McCoy said he knows through conversations with co-workers that workplace violence incidents are underreported. That’s for a variety of reasons, he said, including employees who downplay the seriousness of the incident or don’t want to take the time to fill out a report.

“Unfortunately, I’ve heard a lot of
co-workers say it’s kind of become part of the job,” he said of attacks against employees. “That’s really unacceptable in health care.”

Polivka agreed, noting officials encourage more reporting when talking with employees after an incident. 

“It’s not part of the job to be screamed and yelled at,” she said.

Signed into law late last year by Gov. Mike Parson, Senate Bill 53 includes language that protects victims from revealing their current address or identity beyond initials in court filings if they allege such a disclosure would endanger them.

Polivka said that could provide reassurance to employees fearful of stalking or other threats outside of work.

“Those types of things offer support that it’s not acceptable and we don’t just expect people to put up with that,” she said, noting employees also are asked to have additional co-workers in the hospital room when possible.

“We do what we can to prevent. We can’t separate health care workers from patients,” she said. “It’s more about how we do it a little safer.”

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