By Angie Wang and Juan Torres-Falcon
Clare Lyons left the hospital around 7 a.m. after a 12-hour shift as an emergency nurse. It was a brisk New York City morning, and Lyons was waiting to cross the street in upper Manhattan with another nurse.
That’s when she saw him – a patient she had cared for all night, who had come into the emergency room high on bath salts. When the man began to rip off his clothing and chase Lyons, she ran with her friend toward the nearby Columbia University campus and then called 911.
Recounting the incident two years later, Lyons said that while she was treating him, the man had repeatedly threatened to wait outside the hospital and rape her. She had brushed off his declaration.
“If you take everything seriously, you’d lose your mind,” Lyons said.
She can’t remember exactly what had provoked her patient. It might have been something as trivial as denying him a drug he wanted but didn’t need, she said.
Lyons’ experience isn’t unusual. For emergency nurses and physicians, threats and assault have become commonplace. In the healthcare industry, incidents of workplace violence more than doubled from 2005 to 2014, according to the U.S. Bureau of Labor and Statistics. In 2011, about 25 percent of emergency nurses said they experience frequent physical assault, and most instances go unreported, according to a study conducted by the Emergency Nurses Association.
In April, the American Hospital Association issued a statement recommending administrators create their own safety guidelines after assessing risks specific to their hospitals, because a one-size-fits-all plan to reduce violence would not be as effective.
In their most recent policy agenda, the Emergency Nurses Association stated that violence in emergency departments has reached epidemic levels. Most of these incidents happen in hospital emergency departments because of their stressful nature and 24-hour accessibility.
Patients who are under the influence of drugs or alcohol or have pre-existing psychiatric conditions are more likely to be physically abusive, said Dr. Robert Chin, chief of emergency medicine at Woodhull Hospital in Brooklyn.
“It’s very challenging because they’re not necessarily responsible for their behavior,” Chin said.
The presence of drugs in communities directly influences how much violence the emergency staff experiences, Chin said. Brooklyn has been an epicenter of the synthetic marijuana, or K2, epidemic and those under its influence have become especially aggressive.
Dr. Deborah Croker, who worked as an emergency physician in Illinois and Minnesota for 35 years, said an inebriated patient once punched her, dragged her across the room, flung her into the cupboard and threw an IV pole at her.
Croker filed a restraining order against the patient, who never returned to the hospital. But she said it’s sometimes difficult to file criminal charges against patients who may be able to attribute their actions to other stressors, such as delirium or a high fever.
Nurses are placed in a difficult position because of their roles as patient advocates, said Lisa Baum, the occupational health and safety representative for the New York State Nurses Association.
Lyons said she didn’t press charges against the man who chased her because she didn’t want to further complicate his already troubled life. She and her friend even waited to make sure he was picked up safely.
“I’ve taken a left hook to the face more times than I can count,” Lyons said. “But regardless of whether or not you’ve hit me, I’m still going to take care of you.”
Long wait times or bad news about a loved one can trigger aggressive behavior, said Gordon Gillespie, a professor at the University of Cincinnati’s College of Nursing, and a former emergency nurse.
“People act out because they don’t know how to express grief other than through violence,” he said.
The key to dealing with agitated patients and family members is good customer service, Gillespie said. When nurses and doctors look patients in the eye and let them finish sentences, patients don’t feel the need to resort to violence to get attention, he added.
At Woodhull, staff members are trained to de-escalate situations by speaking in calm tones and giving distraught patients or visitors at least an arm’s length of space when possible, Chin said. His staff has also posted flyers reminding patients and visitors that it’s illegal to assault staff members.
Baum, the nurse representative, said many emergency rooms have been designed with open floor plans and limited security precautions to make patients feel comfortable, adding that such comfort may exposes nurses and physicians to harm.
Hospital administrators should do more to prioritize staff safety by adding physical barriers, increasing security and adequately staffing emergency departments, Baum said.
Patient comfort is often prioritized over safety because hospital administrators encourage staff members to “strive for five,” the highest possible rating, in customer satisfaction surveys, Gillespie said.
In 2012, the federal government implemented a program that ties Medicare payments to how hospitals perform compared to others, or how much a hospital has improved since its last evaluation.
Dr. Dan Egan, an emergency physician at a New York City hospital, said every patient who leaves the emergency room where he works is prompted to evaluate the care they received. Because Medicare reimbursements are tied to patient satisfaction, staff members feel pressured to fulfill unnecessary requests, like CT scans and opiate prescriptions, to secure higher ratings, Egan said.
Many emergency nurses believe that violence is endemic to their jobs, according to a 2014 study in the Journal of Emergency Medicine. Baum said nurses may think they can handle aggressive patients because the emergency department deals with anything that comes through the door – but they can’t.
“It wears you down and gets to you somehow, because you’re human,” she said.
For some, the danger becomes too much to handle. Lyons said she left emergency nursing in 2015 because she was tired of feeling unsafe at work.
“People’s threats aren’t always idle,” she said. “I didn’t feel like finding out the hard way.”