When Gordon Gillespie got his start in nursing, he expected to be a health care provider—not a patient. Yet that is the position he sometimes found himself in as an emergency nurse in Ohio, where he was assaulted dozens of times during nearly two decades on the job. On one occasion, he was beaten so badly that he suffered a wrist injury requiring treatment. “I was the only male in the department,” he says. “Any time patients became aggressive, I was told to jump in.”
The abuse, he says, came from people with mental illness and substance abuse problems, elderly patients with dementia, family members and caregivers who were under extreme stress, and others.
Gillespie, PhD, RN, FAEN, is now working to change a culture that he says tolerates and even dismisses violence against nurses and other health care providers. As an associate professor at the University of Cincinnati College of Nursing and a Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholar, Gillespie is studying interventions to protect health care workers from abuse and promote resilience among victims. “This is not something that should be part of the job,” he says. “People can go to jail for hitting a police officer or talking back to a judge, so why are they free to abuse nurses?”
Increasingly, they are not. In June, Colorado became the 32nd state to enact a law making it a felony to assault or batter emergency nurses or other emergency medical providers, according to the Emergency Nurses Association.
Epidemic Levels of Violence
Violence against nurses is at epidemic levels. In 2014, three in four nurses experienced verbal or physical abuse—such as yelling, cursing, grabbing, scratching or kicking—from patients and visitors, according to a January study in the Journal of Emergency Nursing. Three in 10 nurses reported physical abuse, the study found.
Between 2012 and 2014, nurses and nurse assistants experienced higher rates of workplace violence injuries than other health care sector workers, according to an April study by the U.S. Centers for Disease Control and Prevention. The problem is getting worse, the study found. Nurses’ and nurse assistants’ rates of workplace violence injuries rose steadily over the two-year period.
Nurses are especially vulnerable to violence because they are the largest sector of the health care workforce, spend more time with patients than other health care providers, and interact with almost all patients who come through the door—regardless of their condition when they arrive, says Charlotte Mather, MBA, BSN, RN, chief nursing officer at Sheridan Memorial Hospital in Wyoming and an alumna of the RWJF Executive Nurse Fellows program. “It has to do with face time,” Gillespie adds. “The longer you are sitting in a room with someone, the greater chance you have of being victimized.”
Mather has witnessed the problem at Sheridan Memorial, and says it’s getting worse due to insufficient support for people with mental health conditions or substance abuse problems. “As we see more mental health patients in the emergency room, we also see the number of injured nurses go up,” she says.
Despite its prevalence, violence against nurses is often considered “part of the job,” warns Jane Lipscomb, PhD, RN, FAAN, a professor at the University of Maryland School of Nursing. She recently wrote a book about violence against nurses after a close friend—a nurse—was killed at work. “This topic is personal for me,” she said in a news release about the book.
But Gillespie is optimistic about curbing the rate of violence in health care. For his RWJF-funded research project, he asked nurses and other emergency department workers and administrators about strategies to prevent this violence and help victims recover. He used the findings to develop a series of interventions, which include raising awareness about violence in health care settings and training hospital registration and security staff to identify potential perpetrators and take preventive action. He hopes to test them in the near future.
Even so, Gillespie concedes that violence against nurses will never completely end, in part because many patients lack the cognitive ability to control themselves, especially in stressful environments like emergency departments. That’s why health care workers and administrators need to take universal precautions to prevent violence—much like they do to prevent contracting infectious diseases, he says. “If we take the stance that everyone has the potential to be violent, then nurses will interact with people differently and be more likely to protect themselves.”