Rising Threat: Health Care Workers Facing Increased Violence
Scripps leads way addressing issue to ensure safety
Scripps leads way addressing issue to ensure safety
Andrew Accardi, MD, was making his patient rounds in the emergency department at Scripps Memorial Hospital Encinitas. His next patient sat in a nearby exam room — a 6-foot-5-inch muscular male, brought in by police for treatment, but in restraints.
“As I entered the room, I took a quick assessment and, as usual, I asked the patient how he was doing,” says Dr. Accardi. “It was right then that he lunged straight at me from the bed.”
“It happened in a millisecond, so fast that I fell back as he swiped at me, but he missed,” he adds. “I’d intentionally left the door to the room open, so police ran in to catch me. They then quickly wrestled him back onto the bed, but I’d say this was the closest I’ve ever felt to being prey.”
Health care has become a dangerous job
According to the U.S. Bureau of Labor Statistics, 73% of non-fatal workplace violence victims in the United States are doctors, nurses and other health care workers.
Ongoing clinical training — a standard in health care — is now regularly augmented with training in violence de-escalation, self-defense and the proper completion of police reports. Special wristbands and door emblems help to identify patients who may be violent, and unique codes are called overhead for de-escalation assistance or help from security.
Katrina Grossmann, RN, has been an emergency room nurse for 10 years. She worked at multiple hospitals in the US before happily landing at Scripps Mercy Hospital San Diego, last year.
“At every emergency room I’ve worked in, staff have experienced some form of violence from a patient or family member on every single shift,” says Grossmann, who recently witnessed a patient grab and physically threaten an emergency worker. “Sometimes it’s verbal and sometimes it’s physical, but it happens daily and it wears on everyone who experiences it.”
From heroes to victims
During the COVID-19 pandemic, health care workers were heralded as heroes. Community members showed up at hospitals and clinics with signs, banners, meals and more to show their love and support. But a long pandemic saw tensions rise, and violence against health care workers spiked. The numbers are still rising.
“Demeaning comments, verbal abuse and assaults now happen in all areas of hospitals and clinics, in addition to ERs, trauma centers and urgent cares,” says Scripps President and CEO Chris Van Gorder, a former police officer and volunteer reserve assistant sheriff.
“In San Diego and across the country, physicians, nurses and other health care professionals are concerned and frightened. Some are leaving their health care careers entirely rather than face this type of continued threat.
“This is a far broader issue than one hospital, one health system or one region,” Van Gorder says. “As a community, we need to do better.”
Van Gorder delivered the same message to San Diego law enforcement leaders last year. It was the catalyst behind San Diego’s new Hospital Violence Task Force, a group that includes senior representatives from local hospitals and health systems, law enforcement agencies and the San Diego County District Attorney’s Office.
“The task force is already making a difference,” says Ghazala Sharieff, MD, MBA, chief medical and operations officer for acute care at Scripps Health. “Group discussions have led to a better understanding of the issues on all sides, as well as law enforcement and DA visits with hospital staff, procedural changes and better connections between hospital security staff and law enforcement.”
Let’s be careful out there
In the 1980s television series Hill Street Blues, a tough but caring police desk sergeant ended each morning’s briefing with prudent advice for his officers: “Let’s be careful out there,” he’d say.
It’s much the same for health care workers today. While security can continuously be enhanced, the first defense against violence is prevention.
Scripps’ de-escalation training helps staff recognize tense situations, set proper boundaries and maintain control of difficult circumstances. Likewise, tools like electronic patient records offer ways for caregivers to silently alert other staff to potentially difficult situations.
“If, despite these efforts, a person does become violent or threatening, our security teams quickly respond,” says Todd Walbridge, senior director of Scripps Health safety and security, and a former FBI agent.
“In addition, we’ve created quick-response behavioral health teams, implemented high-tech metal detection where needed, limited building and elevator access and updated our camera monitoring systems.
“We also work closely with local and regional law enforcement to align our processes and procedures when it comes to violent or potentially violent patients,” adds Walbridge.
“We do whatever is possible to ensure the safety of our staff, patients and visitors without negatively impacting access to the care people need.”
Be kind
Sometimes those efforts include reminding patients and visitors that they’re in a place of healing.
“We recognize that some patients struggle with behavioral or addiction issues, but they account for just a fraction of violent incidents we see,” says Grossmann.
“When someone is sick or hurting or scared, that’s a bad place to be and we’re going to help,” she says. “But there are often lots of other patients we’re helping, too.
“I promise we’re doing our best. Please, be kind.”
Task force making progress
Since its first meeting last April, the San Diego Hospital Violence Task Force has continued to add new members from health care, law enforcement and the San Diego County District Attorney’s Office.
The first two meetings were sobering, as health care staff and physicians shared stories of violence committed against them and those they work with.
Now, a year later, there is better communication and policy alignment, regular site visits to hospitals by law enforcement, improved training and a renewed focus on prosecuting violent crimes against doctors, nurses and other health care workers.
“I wanted to get law enforcement and health care leaders regularly talking with each other about these issues so there would be a better understanding on all sides,” says Van Gorder. “That’s the first step toward any solution, and we’re all committed to that purpose.”
As violence in health care continues to rise across the country, the San Diego task force is becoming a model for other communities.
“Without safety, nothing thrives,” says San Diego County District Attorney Summer Stephan, who started the group along with Van Gorder.
“Reducing the threats and violence and preventing potential crimes that put health care workers in danger is critical to making our health system the best that it can be. This task force is already a positive step in that direction,” Stephan says.
This content appeared in San Diego Health, a publication in partnership between Scripps and San Diego Magazine that celebrates the healthy spirit of San Diego.