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Violence in Hospitals: A Growing Epidemic That Demands Attention

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The ongoing and escalating violence in and around hospitals in the U.S. is a clear and present danger to hospital staff and visitors. This pandemic of violence represents a public health emergency that demands the attention of our elected leaders.

The Shocking Reality

Over the last few years, the media has been filled with stories of assaults, stabbings, and other violent events including mass shootings at hospitals, clinics, and other healthcare facilities. For many of us, this has been a great surprise since we have always believed health care facilities are oases of peace and caring.

An Alarming Increase in Violence

Since the pandemic, there has been a marked increase in violence against healthcare workers. The American Hospital Association (AHA) reports that healthcare workers suffer more workplace violence and injury than any other environment.

The AHA also states that 44% of nurses report an increase in physical violence since the pandemic and a majority (68%) report an increase in verbal abuse. Those unfamiliar with daily events in healthcare institutions may be shocked to learn that violent altercations are so common.

Impacting Patient Care and Safety

According to the American College of Emergency Physicians (ACEP), approximately 80 percent of physicians believe that ED violence has impacted patient care and safety. In this high-stress environment, 50% said that patients have been physically harmed, and 47% of emergency physicians have stated they have personally been assaulted at work.

A Growing Crisis

In fact, an April 2022 survey by National Nurses United revealed more than a 100 percent increase in workplace violence compared to a prior survey of nurses in March 2021. The net effects of workplace violence and emotional trauma are major risk factors for burnout, and moral distress and injury.

Preparation and Training

Safety starts with having open discussions between staff, visitors, patients, and hospital administration prior to the occurrence of a major violent event. Preparation and training can rapidly diffuse a potential violent encounter. But it’s equally important that such preparatory training begin at orientation and onboarding of new staff. A comprehensive preparation on how to deal with violent outbursts and agitated patients should be a part of every healthcare worker’s training.

Securing the Facility

The main hospital entrance and entrance to the emergency department (ED) are the two primary areas that create vulnerability in safety and security in any healthcare facility. That said, side entrances can also be problematic, making it essential to limit the number of entrances that can be used by the public.

Because an overly aggressive security presence can be off-putting to patients and visitors, the goal is to instill measures that are invisible. Staff with security training can welcome visitors, and direct them to elevators, clinics, labs, and various units within the hospital itself.

Communication and Security Measures

It’s imperative to issue "passes" or ideally take digital photos and maintain a log as to who is in the building at all times. Entry to the intensive care unit (ICU) should also be controlled with a locked door that can only be opened by unit staff to allow visitors in. Closed circuit video cameras are also a key part of "perimeter security" both as a screening system, but also as a recording device that can be used to later identify an individual that was violent at the bedside.

The facility should also have "safe areas" for staff, visitors, and patients. A medication or storeroom fitted with bullet-proof glass and a door bolt as well as staff lounges and locker rooms are areas that can be made secure.

Communication is paramount; having a nonverbal set of cues known to staff, along with "panic buttons" that connect to 911 and local police departments are strongly advised.

De-escalation Techniques and Staff Training

In preparation for a violent threat, it’s vital for staff to practice de-escalation techniques—ideally by simulation or virtual or augmented reality-based modules—but also by viewing and participating in interactive online tutorials. In this regard, it’s important to train every team member of every department to learn to recognize signs of agitation and potential violence among patients and visitors.

Addressing the Crisis

The epidemic of violence in the U.S. and spilling in and around our nation’s hospitals continues with no end in sight. It doesn’t have to be this way. We hope that with care, training, and caution we can make health facilities safe again.

Importantly, this ongoing pandemic of violence across U.S. society at large needs to be addressed by our leaders. Without their guidance, leadership, and attention, addressing the crisis will be quite challenging. Local grassroots efforts to draw attention to this pandemic of violence will be crucial.

We must restore respect and safety and help our health care professionals as they care for us and our families; hospitals need to remain as sanctuaries that heal, devoid of the epidemic that has permeated every aspect of our society.

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