For ER Nurses: Survey Shows Violence Is Pervasive in the Workplace

I’ve always known being an ER nurse can be a dangerous gig.

I’ve heard stories and seen it firsthand. Once, when reporting on area emergency rooms for our local newspaper, I witnessed two incidences of violence. I spent several hours in the ER waiting room to get a sense of what it was like for both patients and nurses. During that time, I saw the triage nurse assaulted by what looked to be a homeless man, and about an hour later, by a woman who appeared to be hyped up on some substance.

I remember thinking that this triage nurse must have real moxie to show up at work every day knowing the chances were pretty good that she may get decked. Nevertheless, I was still surprised to learn, in a survey published in the July/August 2009 issue of the Journal of Nursing Administration, that violence against Er nurses “is highly prevalent.”

The Emergency Nurses Association investigators polled 3,465 ER nurses, and during their research, found that data on the extent of violence in this setting was mostly lacking. For this reason, objectives of this Violence Surveillance Project were to establish just how much ER violence occurs on any given day; to learn the extent of underreported workplace violence; to discover if and how incidences are reported; and to find any trends in ER violence.

Here’s what the nurse investigators found:

• More than half of ER nurses surveyed said they've been physically assaulted while working.
• One quarter claimed they have been victims of assault more than 20 times in the last three years. This includes being kicked, scratched, pushed, hit and spit upon.
• Verbal abuse is common. One in five respondents said they were the object of verbal abuse more than 200 times in the last three years.
• Drugs, alcohol and psychiatric disorders play a considerable part in these assaults.
• Nurses said that patients were upset and frustrated about short staffing, long waits and crowded emergency rooms.
• Nurses said they often didn’t report incidences because of lack of support from supervisors and administration and fear of retaliation.
After reading about this report, I had to do a little Web cruising to find out what ER nurses are saying about this. They had some strong words. Here are few excerpts from blogs written by ER nurses and comments on those blogs:

• Nurses have the right, like any other worker, to be treated with respect…to work in an environment where violence in any form is not tolerated…to expect management to develop a specific policy in which abusive patients are dealt with. Nurses have the right to expect the hospital to make [it] clear …that any kind of violence will not be tolerated. Who is going to make these changes? Nurses.
• Many hospitals have policies in place that amount to little more than lip service… If you want to test the theory, try kicking someone out and watch the response. In one case I got a lecture from both the charge nurse and the doctor as to how inappropriate it was for me to do so.
• This issue should and cannot be ignored anymore. The growing concern with patient satisfaction has armed the public with the belief [they] can do as they wish…management does little to protect staff from such behavior and it is even encouraged to report staff for sticking up for themselves.
• Working in the larger hospital, I have to say that we are still mindful of patient satisfaction, [but] the hospital has adopted a zero tolerance towards abusive behavior. Patient abusive towards me? That's a call to police, and we do have our own police department inside the hospital.

These nurses have spoken their minds.

How about you?

A Salute to Combat Nurses: You Go, Girls and Guys

We all remember Margaret “Hot Lips” Houlihan from the popular television series M.A.S.H.

Sometimes ditzy in the social arena, she was a highly skilled and knowledgeable nurse when it came to performing in the battlefield OR during the Korean War. She and the surgeons sometimes had to operate under perilous conditions, and while the show was a sit com, it made some strong points about the morality of war and the sacrifices these M.A.S.H. surgical teams had to make.

Military nurses of every age and time deserve a lot of credit and recognition, especially in today’s theaters of war. I’ve known and interviewed a few of these nurses, and read about others in books and in their blogs and emails. The work combat nurses do and the things they experience are unlike anything most nurses will ever know. Those who work near the battlefield are often asked to do the impossible.

The experience of one nurse working in Afghanistan was recently chronicled on a Web site for nurses. Army Capt. Michelle A. Racicot, RN, who is currently stationed in September at Brooke Army Medical Center in San Antonio, wrote about her experiences:

“I had an interesting moment one day when I was filling out an application for a master’s degree program,” she wrote. “One question asked, ‘Briefly describe your experience working with cultures other than your own.’ Before I could type my response, I was asked to fly with the medevac team to evaluate three pediatric patients hit with shrapnel from a rocket propelled grenade.

“We flew to a remote FOB (forward operating base),” she continued, “and I was greeted by one of the Polish medics who attended my classes. One of the children had an eviscerated bowel and was having shortness of breath and nausea. While I was covering his wounds and drawing up medication to give him, he would not let me let go of his hand. I later learned that he did not survive.

“It was a reminder that even with all we can offer with medicine and surgery, sometimes it isn’t enough.”

Pretty heart-wrenching stuff and something that will no doubt remain with Racicot for a long time – if not forever.

Not all nurses are reactive; some are proactive.

Take Col. Susz Clark, RN, the second-in-command of the Army Nurse Corps and the former top Army nurse in Iraq, recognizes that medical care in the field needs revamping.

Currently, members of combat care teams first meet after they are deployed to the combat zone. Clark thinks this should change. She calls for “small, interdependent groups of professionals” whose members would work and train together regularly from the beginning of their careers. She believes doing it this way would create fast and adaptable teams that are highly proficient and ready to roll the minute they arrive in the combat zone.

“In a counterinsurgency environment, such as Iraq or Afghanistan, medical care must occur ‘curbside to combat,’ ” Clark told a reporter.

Seems totally sensible and obvious, but it took a nurse to see it.

Kicking the Habit: Let Them Know Nurses Care

The Great American Smokeout is just around the corner. This year the event happens on Nov. 19.

The Great American Smokeout has been coming around annually on the third Thursday of November since 1976, but its origins date to 1971. That’s when a man in Massachusetts asked people to give up smoking for one day and donate the savings to a local high school. I’m not sure whether he was thinking more about raising money or getting people to quit smoking – or maybe it was both – but he wasn’t the only one with this idea.

That same year, a Minnesota newspaper editor created the first “D Day” (Don’t Smoke Day) and the idea began to spread. In 1976, the California chapter of the American Cancer Society encouraged people to stop smoking for a day. A year later, the society took the event nationwide.

Today, nearly everyone knows about the Great American Smokeout. It has become as much a part of our culture as smoking has become a cultural no-no. I never could’ve envisioned such a turnaround when I was growing up in the 1950s. Anyone who complained about having to breathe smoke-filled air 50 years ago was considered a pariah, a party pooper, a whiner.

When I entered nursing school, maybe 20 percent of the students smoked. When we graduated, more than half did. I can’t forget all those late nights in the dorm when we’d study together, play bridge or watch television in the lounge. Cigarettes were as integral to the scene as popcorn and soda pop. On any given night, you’d find a layer of smog in our living quarters. By today’s norms, it was appalling.

I can still smell the uniforms of the hospital nurses I worked with – all that white nylon and acetate reeking of foul odors after they returned to the floor following a few minutes in the break room. Our so-called break room was actually an oversized closet; get five or six nurses smoking in there and it was like entering a toxic soup.

Maybe even worse was the odor I remember when being cared for by a nurse who was a smoker. I can still smell her cigarette-tainted uniform as she bent over my body to turn me.

I know a lot of nurses and I can’t think of one who still smokes. Caring for patients with COPD made a lot of nurses quit. They didn’t want to be looking at their futures in their patients.

We all know that smoking costs society in many ways, but the actual numbers are pretty eye-popping. The Campaign for Tobacco-Free Kids states that smokers cost the economy $97.6 billion a year in lost productivity. Even if it is half that amount, it’s enough to make you choke.

An additional $96.7 billion is spent on public and private health care due to tobacco use, and every American household spends $630 a year in federal and state taxes because of smoking.

According to Centers for Disease Control and Prevention, smoking causes about 440,000premature deaths in the United States and about $157 billion in health-related economic losses annually. This includes the more than 35,000 people who die due to second-hand smoke.

Additionally tragic are the babies who die every year because their mothers smoked during pregnancy: about 600 boys and 400 girls. How terribly sad is that?

Smoking is a powerful addiction and the addicted must want to quit. According to research, smokers are most successful in kicking the habit when they have support. It can be a nicotine patch, prescription meds, counseling, Web-based programs, guide books, support groups and encouragement of family and friends. Probably a combination of these is best.

What can nurses do?

If you know a smoker on a personal or professional basis who is considering quitting, give him or her all the support and encouragement you can. Let them know that you understand giving up smoking is one of the hardest things they’ll ever have to do and that you really care about their health and happiness.

I think when a nurse cares, it means a little more.