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Nurse on the Run

Violence in the Hospital

Published February 17, 2014 1:50 PM by Lorettajo Kapinos

This year, I am President of my local chapter for the Emergency Nurses Association (ENA). Close to the end of last year I asked local members what they would like to learn or talk about at meetings for 2014.

I received mutliple requests for a discussion on workplace violence.

While preparing for the meeting, I was overwhelmed with the resources provided by the ENA. There's a whole page dedicated to the topic, including numerous research papers.

I also stumbled upon a blog The First to Say No, written by a veteran ED/Critical Care/Trauma physician who knows what it's like to work in a setting where violence is the norm.

As I sit here now and think about the tagline "Workplace Violence" I come to realize how numb I am to the reality of it.  I see nurses get verbally assaulted everyday. And I have seen my coworkers physically assaulted as well. It doesn't bother me like it used to.

"It's all part of the job," we say as we brush off our wounds and keep trucking along.

That "part of the job" is partially why I had to leave the bedside. The first time sarcasm dripped off my tongue and felt good, I realized I needed to do something. It 's been a few years since then, and I am still trying to heal that part of me.

And from where I sit now, it feels like the violence is getting worse. My colleagues obviously agree.

This frightening reality needs to be addressed STAT.

Do you believe in armed guards and metal detectors?

What other measures is your facility taking to keep you safe?

This blog is sponsored by: 



All of the RN, Doctor's, LPN', CNA were extremely on point during my tenure until I suffered a "stroke" and none of them called it but one by the Name of Marci --- She saved my life ---- I can say more but I want. !!

Hopefully the Ebola Crisis will cause those that say this is their Profession of Care will "tighten up" in a Positve way by following every "Protocol" when it comes to "human life".....

The Lady N, Hospice Care - Hosipice Chaplain, West Coast October 16, 2014 12:03 PM
Tahoe CA

I have seen first hand how aggressive patients and visitors have become in my 2years as a security officer.  Security officers should be (SPO) special police officers with the ability to arrest.  This will reach the community stating we are safe and we will not accept this behavior.  Security officers carrying weapons?  Well, this is up to your State.  Maryland will not allow it.  The one stop shopping for any criminal for drugs, food, supplies, and money.  Also, for terrorists you have medical grade radioative isotopes since they can not make it steal it.  I hope this was helpful.    

Dean Stokely, Security - Cpl., GBMC May 13, 2014 11:45 PM
Towson MD

A few years ago I was trying to prevent a confused patient with very unstable gait from leaving the hospital and walking out into traffic. I was walking backwards in front of her trying to reason with her. She grabbed my hand with both of her hands and tried to twist it off the end of my arm.  The security guard I had asked for help left me alone with her while he "went to get the police". People in scrubbs coming into work (it was early morning), walked right by as this was happening. I had warned the MDs prior to this happening that she was becoming agitated, and they just laughed. I ended up with permanent injury to my wrist, some limitation in strength, and permanent pain. This was only the beginning. I got no support from my supervisor or employee health, just the feeling that they were frustrated at having to deal with this issue.  I had to use my PTO time for doctor appointments and physical therapy. The following week, the same woman was readmitted to the hospital with no notation on her chart that she was capable of physical violence and very real harm. It took a long time to feel safe again in my work place. For the longest I would tear up at just a harsh word. There was no one for me to talk to about this.

Carol Wright, neurology - RN March 16, 2014 4:59 AM
Houston TX

I received more abuse from the Supervisor. She humiliated me,demeaned me,and insulted me in front of my peers and patients. So much so it has made me very depressed.

Virginia Mann, Rehab - Staff RN, Scripps Encinitas March 12, 2014 1:12 PM
San Diego CA

I know I shouldn't be surprised at the number of responses to this blog, but I am. I see a picture of violence much clearer now--it comes from all angles. What's the solution? Has anyone tried something that worked to improve safety?

Lorettajo Kapinos March 10, 2014 3:42 PM

I worked in a ER in Boston for 23 years.  In the 1980's there was always a police detail in the ER . No one ever swore at you in triage, threatened your life,just that show of force had people stay in control.   We also had up to eight security guards who were trained to handle restraining patients. Then downsizing started , beds were closed,security guards were laid off, nurses were laid off. Standards of care slipped. Nurses used to retire from the ER now they leave disabled after assaults. Bring back the police details, More trained security personnel and trained nurses in self defense as well as deescalation techniques. Lock doors , metal detectors, escort threatening patients and visitors out. Patients personnel and visitors want to feel safe. Anyone who flies puts up with security measures. We live in an increasingly violent society. The ER is a snapshot of any community. People are at their worst there, upset anxious and stressed. Many are out of control from drugs and drinking and mental illness. Keeping them safe and in control is therapeutic. That means 4 point restraints and chemical sedation, show of force, arrest if warranted. Hospitals need to realize people don't want to visit or be in an environment that is not safe. The hospital that I used to work in is always in bankruptcy and near closing they don't get that they have a reputation of being a violent and scary place. Most of the other nurses I worked with have also left. It used to be a good hospital, now I am ashamed I ever worked there.    

Virginia, er - RN March 9, 2014 10:53 PM
Dorchester MA

Although I received abuse from one patient in a Methadone clinic, most of the abuse I received in my long career has been emotional from Nursing supervisors and sometimes head nurses. That is, put downs, humiliation, implying inferiority, picking and more. I left it all behind and am an actor.

ann mcgowan, general hospital and home - RN March 9, 2014 6:47 PM


SHARON , med surg?psych - rn, disabled March 9, 2014 7:11 AM
delanco NJ

In my hospital unit we are trained in PHYSICAL CRISIS INTERVENTION

In fact, until I retired I was not only the trainer for our unit but for the entire hospital which included the Security staff.  We had very few successful attacks with minimal injuries.  We also had the ability to call the city police if we felt it was necessary.  Those calls were few because of the training.   I was never afraid to intervene in a violent situation because we all knew how to handle acting out patients and no event ever took more than 20 minutes to complete. A  prepared staff is a safe staff.

Helen, Psych - RN, Lakewood Hosp March 9, 2014 1:22 AM
Lakewood OH

I have been a mental health nurse for over a decade and impulsive patients are apart of the population. However, nurses need debriefing after these episodes so they can share their thoughts and feelings about what has happened in the workplace.

lashun sharpless, behavioral health nurse March 8, 2014 4:37 PM
wilson NC

Violence in the workplace is a hot topic at most hospitals. However, when asked to speak about it, we all suddenly don't want to be quoted. Personally, I have been verbally and physically assaulted in the workplace by physicians. The "no tolerance" regarding violence in the hospital is typically in place, but usually not enforced. In the assault case I filed criminal charges against the surgeon, reported him to the medical board, and the union at our hospital. Apparently, he had a history. The best thing to do is to stop immediately and speak loudly to bring others attention to the situation, call Security and report the incident electronically or in writing to your hospital. This affects the care of patients at our hospitals! PTSD exists more often than diagnosed in the work setting. Nurses, the largest group of workers in a hospital setting need to band together to stop the violence. There is power in numbers and documentation.

B.B., Same Day Surgery - RN, Community Hospital March 8, 2014 3:13 PM
Washington DC

My father was a young surgeon in training in the early thirties and was working the ER one night when a cop brought in a drunken prisoner that required suturing.  As my Father began the process, the prisoner, who was on his back on the table,  began to curse and threaten him. The veteran cop took his nightstick and tapped him very lightly on his front teeth and said, "Now James, it's not the doctor's fault that you went out tonight and got torn up.  You just lay there quietly while he fixes you up."  Not another peep was heard.

Physicians and Nurses are not dogs to be mistreated by violent patients OR hospital managers and their monied corporate owners and lawyers.  

In my view , there is an urgent need for the law to adjust its permissions for hospital security, so that adequate protections can be provided in all hospitals; to include trained, sworn officers, metal detectors, video surveillance, and well trained ER security. Until this is done, violence will come into the hospitals.  Why ? Because it can.  And also because a hospital without security is no different than a school without it.  Has the lesson not been learned  ?

As it happens, I was in a court house today and had to submit to both a metal detector, and a wand just to visit an office.  A pocket knife I carry was taken from me and returned when I exited the building. Pretty good security.

Is that because lawyers and judges understand something about self esteem and self respect, or because, although they may arrange it so your employer provides no protection for you, they are more than realistic about providing for their own.  Or both ?  

Brad, RN March 7, 2014 7:56 PM

Witnessing assault on another can be just as emotionally degrading as having a violent assault upon yourself. I too suffer from PTSD not just from patients but more from the actual managment team who expected you to accept the abuse. Work Cultures have a large role .Nursing Unions seem to have more avenues to address an end. While Unions may not be the answer for some , agree with Karen Lawton OK.Trained crisis teams or domestic experts in violence - available 24/ 7 as staff advocates. I do not mean EAP systems either,  primarily in place to prevent litigation from traumatized staff. Lastly   the best solution may be a formal investigative research by qualified clinicians and psychologists to come up with Evidence-based Best practice .

Ellen, E.D. and Critical Care - R.N B.S.N Case Mngr, Acute Care March 7, 2014 4:32 PM
Columbus OH

The work place violence, both physical and verbal, the management fails to take the nurses, CNA's side noting "The patient and their families are always right."  Therefore, more patients and families feel they can get away with causing harm to the staff without facing any ramification.  The healthcare worker is then considered 'guilty' and, as many have noted, the staff are the ones that suffer the consequences, not the patient / family.  I have been injured at work and required surgery to correct the damage done to my shoulder by a patient who jerked my arm so hard, the space between my humerus and clavical no longer had any spacing between them, causing movement of my arm next to impossible.  The patient was not considered the cause, it was me, according to the facility, not using proper body movement.  Because I was requiring surgery, the facility told me I would have to reapply for my job once I was released to return to work.  I then questioned about FMLA and then they backed off.  My husband, also a nurse, got injured by a patient, along with 12 others on his unit, by the same patient.  Several had to have corrective procedures, some unable to return to work.  My husband coded twice while undergoing treatment and is now disabled.  Later it was found out that this patient had been considered unsuitable for admission to their rehab facility.  They transferred the patient to a psych unit at which he injured 13 more staff.  Violence is definitely real in the facilities.

Unfortunately, patient and family violence is not the only abuse we suffer at work.  There are many cases of verbal and physical abuse by some of the managers and there is nothing you can do.  If you report it, you are the one who suffers and possibly loses your job.  All forms of abuse need to be investigated and actions taken.  I have been a nurse 38 years and have seen workplace safety change significantly for the worse.  I think management plays a big role in this, caring more about the picker scores than their employees.  JACHO has also played a part for medical staff safety with the mandate of not using restraints when they are needed.  I don't know how this can be corrected but it most certain that something needs to change.  Nurses, along with all other hospital employees need to unionize to have support and back up in these matters may be a place to start.

Becky, nursing - RN, IU West March 7, 2014 12:39 PM
Avon IN

When a zero-tolerance code of conduct is applied consistently to medical care consumers, everyone will fare better. The excuse of "he/she is just upset/under stress/tired, that is why the acting out, etc." is not an acceptable reason for expressing rage. Mislabeling bad manners and dangerous acting out this way minimizes the seriousness of violence while sending the wrong message to owners of anti-social behavior. Allowing these unchecked rants also frightens others nearby who are too sick or physically unable to protect themselves should the abuse escalate. In over 3 decades of nursing, I have dealt with thousands of upset/stressed/tired doctors, peers, family members and patients who voiced their dissatisfaction to me without resorting to assault or battery.  All health care providers should have the same laws protecting them from workplace violence that law enforcement officers and Paramedics currently have.

Margaret Mills, RN March 6, 2014 11:37 PM
Sarasota FL

Lorettajo I am not shocked by what you have uncovered.   In fact I agree with my colleagues comments.   At my job residents and family members, also called customers, believe staff should be targeted for verbal and physical abuse.   Granted if staff were to retaliate he or she could either be disciplined and even be reported to the state and possibly terminated.%0d%0a%0d%0aAs the supervisor, I have had many instances where I have to intervene with families getting in the faces of staff and threatened to call 911 to have them remove if the inappropriate verbal and physical behavior is not ceased and an apology given.   That stance have always worked for me because I believe in hearing both sides but if the customer is wrong by all means I am going to back my staff.%0d%0a%0d%0aSometimes I have worker's remorse believing I went into the wrong profession.   I am glad I stopped myself short of continuing with the NP because I do get frustrated at times with the violent acts I have to deal with.%0d%0a%0d%0aGreat article and nurses please lets continue to support each other.  If we fight violence in the workplace as an army of nurses we will come out victorious!%0d%0a%0d%0aMMC has posted security guards at the front until 8:00 P.M.  But what about the remainder of the evening and night shift?   I believe metal detectors are an option and changing the culture in which families, residents or patients interact with nurses and staff would be a step in the right direction.  For example, reporting the physical or verbal threat to the police should become part of the education to visitors and resident if should attacks were to occur.   Let the courts deal with the mental cases appropriately.

Miriam D. Linton, BSN, RN, Nursing - RNS, Medford Multicare Center March 6, 2014 12:05 PM
Medford` NY

Lorettajo I am not shocked by what you have uncovered.   In fact I agree with my colleagues comments.   At my job residents and family members, also called customers, believe staff should be targeted for verbal and physical abuse.   Granted if staff were to retaliate he or she could either be disciplined and even be reported to the state and possibly terminated.

As the supervisor, I have had many instances where I have to intervene with families getting in the faces of staff and threatened to call 911 to have them remove if the inappropriate verbal and physical behavior is not ceased and an apology given.   That stance have always worked for me because I believe in hearing both sides but if the customer is wrong by all means I am going to back my staff.

Sometimes I have worker's remorse believing I went into the wrong profession.   I am glad I stopped myself short of continuing with the NP because I do get frustrated at times with the violent acts I have to deal with.

Great article and nurses please lets continue to support each other.  If we fight violence in the workplace as an army of nurse we will come out victorious!

Miriam D. Linton, BSN, RN, Nursing - RNS, Medford Multicare Center March 6, 2014 11:47 AM
Medford` NY

Workplace violence is a very emotional subject for me. I have been a nurse since 1975 and enjoyed my profession knowing I was doing something to improve someone's health. Many days I felt safe performing my duties even during disruptive behavior. Never once did I ever think on September 20, 2010 my life would change. I was attacked by a patient that attempted to take my life. My life changed that day. I was diagnosis with PTSD. I was away from work twelve months total. Everyday is a recovering process. Unless you have experienced a traumatic event you have no idea how powerful the mind works. Today I will never and I use the word never, will I be competent to deliver direct patient care. The fear from that day takes over me and with all the psycho-therapy, drugs and praying; my mind returns to that incident. I need God every minute all day to live as near a normalcy life. Violence in the hospitals are at a high and in the organization I work in the numbers increase daily. The madness is after you are injuried is how your employer wants to throw you away. Now in your weaken state of healing you must now fight with your employer not just to keep your job but fighting discrimination in the workplace. The same place where you were injuried. Please be as caring for your injuried co-worker as you are for your patients. You might walk in their shoes one day. I need my job to support myself but I also need my job for healing.

Dianne Stewart, FEE - BSN, RN, VAMC March 6, 2014 11:25 AM
Dallas TX

I appreciate all the comments and the allowance to vent but what is the solution to this problem. What can we do to change this ongoing Dilemma?  

Catina, long term care - lpn March 6, 2014 7:45 AM
gaffney SC

At my job, the patients and the family's can talk to the nurse any way they want, disrespectfully, bossy, and they get away with it. The management says the patients, and their family can say what they want! They can even state that they do not want that particular nurse taking care of them and then the nurse has to work on another unit, until that patient is discharged from the facility. I was placed on administrative leave too, due to being worked to death, an admission, a discharge, and countless patients to monitor, along with cna's, and in the process I forget to document something, then bam! I'm suspended.

rosalind March 6, 2014 1:33 AM
chicago IL

Aside from Drs. who use sarcasm and such to demean nurses, perhaps the issue of nurses abusing other nurses should be mentioned also.  When a baby with osteo imperfecta was missed in the initial RN exam and the on-call MD exam, the primary found it in his office a week later, came into the nursery and demanded to know which nurse was on duty at the time of the admission.  The other nurses were all saying it was "her".  I pointed out how they were acting, and asked why the doctor hadn't said something to the admitting doctor - hmmm?  Why are we all attacking one another?  Why are we nurses always ready to offer each other up for blame?

Toni, In-home Infusion Nurse - RN, foothills infusion rns March 5, 2014 11:51 PM
San Andreas CA

After working as a nurse for 29 years in a variety of hospital areas the last two being in-patient Psych unit and ER.  I have found that most hospitals have no concept of what is a safe working environment for staff.  In this day and age it is more about keeping the budget inline and staffing at the minimum.  Violent patients and/or family members are considered part of the job and there is little or no support from hospital security.  I had a security staff person refuse to help with a agitated patient because he didn't want to "get hurt" when if he had any concern for the nurses in ER his response what that was "your problem".  To his credit the staffing for security was worse than that for the nursing staff.  I am sure that this problem is endemic with most all the hospitals in this country.

Gary, ER/Psych - RN March 5, 2014 11:28 PM
Fort Wayne IN

I am so glad this subject is being discussed. There are many nurses who feel being kicked and punched and spit at is part of the job. When did our culture change to have such beliefs?

Part of the whole thing now is this "patient Satisfaction" and the belief that the patient and family is always right.The nurse ends up with very little support, not only from other nurses, but hospital administrators and managers.The nursing community needs to Stand together and change this.

patricia anne kelly, ICU retired staff nurse - RN BSN CCRN March 5, 2014 8:26 PM

post note re; Violence in the work place Fort Worth Texas:

Assault=verbal abuse, threats or threatening behavior

Battery=physical contact, physical violence

Bottom line with Surgeon violence either Assault or Battery they make money for the hospital, the RN costs the Hospital money. When you want the truth follow the money trail, check out my initial comments re; Fort Worth & Florida

william bornman, OR RN - fort worth March 5, 2014 7:52 PM
Fort Worth TX

As a nurse, working in the emergency room, I too have been assaulted by a patient, I have been a nurse for over 25 years and never have had anything like this happen to me before.  In this one incident, 3 nurses were bloodied by ONE patient before security had a whole of this patient. Out of  the three nurses I was the only one who pressed charges against this patient. The other nurses felt "it was part of our job". Before I had presses the charges I did do my research on this patient and found that this patient had never been diagnosed with any mental problems,however, he did have a history of "violent behavior". The facility that sent this patient to us  never communicated this behavior. As, a result I have taking on the challenge of having CPI training provided to our nurses as a project. As nurse's we need to stop just thinking this violent behavior is acceptable because it is not.

valerie jackson, Nursing - RN March 5, 2014 6:58 PM
Indianapolis IN

It seems to me that that violence in general is increasing in society as a whole and it's on both sides of the law.  There is a diminishing lack of respect for each other as human beings.  There are increasing use of drugs and alcohol that exacerbate the issue in institutions (hospitals, schools, other work places) as well as in the home.  There is also a growing feeling of entitlement that spurs bad behavior - from bullying to road rage and the need to take what does not belong to us to pay for extravagances that we could not otherwise afford.

When we find ways to increase our societal morals and learn to respect those around us, stop the wide spread us of substances that lower our inhibitions and stop looking for others to pump up  our lifestyle -  then and only then will the violence decrease.

I don't mean to imply that everyone is bad, but as an example there used to be a time when people could leave their doors unlocked without worrying that someone would come inside and steal valuables, or murder the entire family.  The term "going postal" was just recently coined. Kids used to carry pocket knives and hunting rifles to school and no one thought anything about it. You used to be able to call your family doctor on the phone if you were sick and either s/he would come to you or you could go to the office to see him/her. Now you wait for hours regardless of where you go (hospital or office), which becomes more and more frustrating for people.  Not a reason to kill or maim, but frustrating just the same. The government has shut down all the old mental hospitals where people who were mentally ill could work (they farmed and learned trades) and live under supervision getting the medications they needed.  Yes there were Nurse Ratcheds, but is it better having people living in the street and under bridges lashing out at others - dying in the cold?  

Linda, RN March 5, 2014 6:22 PM

Three nurses started this website www.stophealthcareviolence.org%0d%0aback in 2009 Please check it out and listen to the videos of the nurses stories of going home from work fracture ,hear what they say about their family members horror and listen to the public opinion (they don't even know healthcare workers get injured.)%0d%0aI have read Dr Andersons book the first to say NO ,It is right on.Also 4DTEMS is a site to look at ,it gives all sorts of information to keep safe. there are many of us working to be safe but we all need to work together. This includes CEO"and administrators!

sheila wilson R.N.BSN MPH, stopworkplace violence - co founder, self employed March 5, 2014 6:00 PM
Quincy MA

Violence in the work place, try this on for size, a surgeon assaulted me at work, I wrote him up, a VIP chief of Ortho Trauma

the facility went on a witch hunt against me instead of the surgeon.

I also have had another surgeon assault me in Florida, same thing facility went after me instead.

There is multiple incidents of surgeon violence in the Operating Rooms around the country, I know of three RN's who committed  suicide because like me they wrote the surgeon up, and like me the facility went after the Nurse instead of addressing the issues.

Safe Harbor only works if an Attorney will take your case, most often they will not without a $ 5,000 retainer, therefore the whistle blower laws, safe harbor laws are usless unless the RN has lots of money and time.

In my case they placed me on admin leave and a fit for duty evaluation , then they went after me for performance , when both didn't work they came up with three bogus reasons to forse me to leave.

Nurses are being battered at work, they are killing themselves and NO ONE CARES,NOR DO THEY REPORT SAME IN THE NEWS. all three nurses were blacklisted where they lived d/t assault in the Operating Room, they all committed suicide . This is very similar to Domestic Violence where the Surgeon  has all the power, why isn't anyone writing about this ???

My two event occurred at Methodist THR Fort Worth and Celebration Florida, I know of multiple OR Nurses who exp verbal and or physical abuse at work in the OR's around the country. Once a RN blows the whistle the RN suffers,the Surgeon gets away with it. I also attempted to file criminal charges but the Magistrates office refused to file charges as this was a "internal issue" they stated. How special  

william bornman, OR - RN March 5, 2014 6:00 PM
Fort Worth

In reading the above comments, it has become evident to me that there is disconnect between a safe work environment and a secure environment. Metal detectors and armed guards are great deterrents to make the building secure but a person that is bent on doing harm will get around them. Safety is a mindset and awareness of your surroundings and your patients and families will serve you better. No one has to tell you to run if you find yourself in a tough situation, so be aware and don't get into one. If you feel the situation is questionable, don't go.

Chris, RN,BSN March 5, 2014 5:40 PM
Bakersfield CA

As a former trainer in CPI, I found staff somewhat indifferent to violence training, but it's my opinion that the apathy by the leadership could be a factor in that.

Staff would listen and comment on incidents and situations that others had encountered, but when it came to concepts and physical techniques staff showed indifference or disbelief in the adaption of them.

Larry, Security - Officer/Trainer, Baptist Health February 24, 2014 9:32 AM
Paducah KY

Congratulations on your new role and thanks for mentioning my blog and book. You and I must remember that we are on the same team. What little differences physicians have with nurses on this issue is minuscule compared to the things we can agree on.  Our biggest enemies are complacency and apathy. If there is anything I can do to help you, don't hesitate to contact me.

Charles Anderson, EM, CCM, Trauma - Retired Physician February 19, 2014 5:04 PM

I just completed my capstone project for my Master's on violence in the ED.  Unfortunately it is a pervasive problem not only nationally but also internationally.  Many facilities believe they are addressing the problem adequately but staff surveyed do not agree.  I believe this culture of violence will not be corrected without a focused effort by a combination of resources: administration, law enforcement, and the nurses.  Nurses need to stop saying that this situation is "part of the job."  No longer should this situation be accepted.  In my project we actually taught the nurses self defense techniques in the hopes that at the minimum they could at least protect themselves from harm. But my hopes for the future is that we, as nurses, can say no to this situation loud enough to create a culture of change.

Karen , Education - RN, GPTC February 19, 2014 7:32 AM
Lawton OK

I have been working on www.stophealthcareviolence.org please check out the website.

The facility I worked in : Painted the walls only put up Dunkin Donut sign, left no violence sign off the wall.

Fired a security guard because they felt he was using too much force but the patient threatened many staff members and their families. One staff member needed surgery and can't go back to work.

We asked for metal detectors ,administrators felt it wouldn't look good and might scare the patients

They stopped meetings on workplace violence.

This facility hasn't changed for the better of the staff. Dr.Anderson's book is great"First to say NO"

sheila wilson, ER - R.N.BSN MPH February 18, 2014 9:15 PM
Quincy MA

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