A hospital or other medical center may seem like a safe space, but for health care employees, the workplace can be a dangerous environment.
A new article in the New England Journal of Medicine highlights just how often health care workers face violence in the workplace. The review of multiple studies points out that three out of four workplace assaults occur in the health care setting.
While the killing of health care workers is rare, other violent attacks, both verbal and physical, are quite common. The most common form of workplace violence in the health care setting is perpetrated by patients or visitors against health care providers, accounting for 75 percent of aggravated assaults and 93 percent of all assaults against employees in hospitals, according to the findings.
Lead author Dr. James Phillips, an attending physician at Beth Israel Deaconess Medical Center and Instructor at Harvard Medical School, reviewed prior studies of attacks and the numbers are startling.
He found a variety of reports, including that health care workers are almost four times as likely to miss work because of violence than from other injuries.
According to one study, 4.5 percent of violent health care incidents occur against emergency medical services (EMS) providers. Patients were the attackers in 90 percent of these attacks. While 80 percent of EMS personnel experience physical violence during their careers, slightly less than half of these are reported to the police.
The highest rates of abuse in hospitals are against nurses and nursing aides, likely because of the significant time spent with patients. One of the studies featured found that 39 percent of nurses involved reported verbal assaults annually, and 13 percent reported physical abuse.
Another study showed almost half of nurses experienced some kind of violence during their last five shifts, and one-third of those reported physical violence.
Hospital physicians are not immune to violence, either. About one in four emergency medicine doctors reported being physically assaulted in the prior year, and almost four out of five reported some kind of workplace violence. One in 10 physicians experienced workplace violence each year between 1993 and 2001.
Psychiatrists are at a particularly high risk, with 40 percent of them reporting physical attacks. One study of all staff members in a psychiatric facility demonstrated an annual rate at 99 percent for verbal attacks and 70 percent for physical assault.
The problem extends to other physicians, as well; even one in three pediatrics residents report they were assaulted during their training.
Jane Lipscomb, professor of nursing and public health at the University of Maryland, told ABC News that the American Nurses Association is doing a lot to combat this problem.
“Raising awareness is really, really important, part of the problem is that it has always just been considered part of the job. I think part of why it’s been accepted is that there is always this question of, ‘Well, the patient didn’t intend to act out.’ I think we need to get away from that,” Lipscomb said today. "Regardless of intent, it’s a problem. Any health care organization that takes a proactive stance against this is going to benefit from it.”
Despite such large numbers in the studies, Phillips suggests that the prevalence of health care violence is actually higher than what has been reported.
Violence against health care workers is also grossly underreported, according to the review published today. One survey mentioned in the review found episodes of violence were only reported by 30 percent of nurses and 26 percent of doctors.
Phillips blames a health care culture that minimizes the risk for violence against providers, and many providers believe such violence is just part of the job.
“The next step is a nationwide conversation and admission that we are overlooking a serious workplace safety issue,” Phillips said.
With no proven fix for this expansive problem, Phillips advocates for increased reporting of workplace violence, as well as a multifaceted, multidisciplinary approach to reduce violence. He discusses the need for more research to address potential solutions.
“Administrators are already working with limited budgets and would be reluctant to dedicate money and time towards efforts that haven’t been proven to be effective,” Phillips said.
He also cited a need for more discussion about workplace violence as a part of medicine, starting in medical school and nursing school. An ideal approach would involve training in self-defense and de-escalation of aggression, security measures and possibly other interventions to minimize the risk factors.