ER assaults put nurses at risk

Drugs, mental illness behind rise in violence.

Emergency department nurses patching up gunshot wounds and lacerations are often themselves the victim of violent assaults as an increase in drugged-out and psychotic patients puts hospital personnel increasingly at risk.

In one such incident, an emergency department nurse and physician’s assistant at Miami Valley Hospital suffered bruises and bite marks late last summer as they attempted to treat a psychotic patient being discharged from the hospital.

The alleged assailant, Anthony L. Compaleo, 44, grabbed the nurse, threw her to the floor and began punching her in the face as she was trying take his blood pressure, according to a police report.

The physician’s assistant, who tried to restrain Compaleo and the Dayton police officer who eventually arrested him, were both bitten in the melee.

According to the Substance Abuse and Mental Health Services Administration, visits to hospital emergency departments for drug- and alcohol-related incidents climbed from about 1.6 million in 2004 to nearly 2.5 million in 2011 — the most recent figures available. During the same period, the number of those visits resulting in violence jumped from about 16,000 to more than 21,000, the agency reports.

A 2011 study from the national Emergency Nurses Association found an astonishing 86 percent of emergency room nurses indicated that they had been physically assaulted at work since 2009.

That study was the impetus for Ohio House Bill 62, signed into law by Gov. John Kasich in 2012, which stiffened penalties for assaults on health care workers.

Locally, some hospitals have installed bullet-proof glass, panic buttons and metal detectors to limit violence. Ohio’s Assault Against Healthcare Workers Bill makes assault against health care workers a fifth-degree felony when the offender has previously been convicted of an assault against a health care worker.

The law, which also allows a $5,000 fine for assaults and other abuse, received overwhelming support from Ohio Nurses Association (OHA).

“Nurses shouldn’t have to work in fear of violence, and the evidence showed that violence against nurses, especially in the ER, was happening, and nurses did not feel safe,” said Tiffany Wenter, a spokeswoman for the OHA. “We realized something had to be done.”

Stricter laws sought

Wenter described the worker protection law as a first step, but said it’s still too early judge how effective the law has been. “We really don’t have enough data yet to measure it’s effectiveness, but we’ve heard from some of our members that they believe the law isn’t strict enough,” she said.

State Rep. Denise Driehaus, D-Cincinnati, who was one of the original sponsors of the House bill, said she thinks the law’s efficacy would be greatly enhanced if more hospitals followed its guidelines authorizing them to post warning signs that abuse or assault of hospital staff could result in a felony conviction or fine.

“When we first offered the bill, it was in response to the number of assaults that were happening, especially in emergency rooms,” Driehaus said. “Of all professions, research showed that health care professionals were assaulted at a higher rate than any other profession. That’s what was so compelling about the idea for the legislation.

“Now that we’ve passed a law to say there is an increased penalty for assault against these health care professionals, the general public needs to know,” she said. “So it’s important to have the notice posted in an obvious place so people understand that there are increased penalties.”

Tim DeLong, interim safety and security manager at Springfield Regional Medical Center, said the hospital hasn’t installed the warning signs, mainly because the signs would be less of a deterrent than the security measures the hospital has already implemented, including a metal detector to screen for weapons — installed in November last year — 24-hour security guards, coded ID badges, and panic buttons.

“We felt we already had a pretty safe environment,” DeLong said. “We just wanted to take a few extra steps to head off any future problems.”

DeLong said heightened security has coincided with a surge in the number of drug addicts, alcoholics and psychiatric patients showing up at the hospital emergency department, reflecting a nationwide trend, driven largely the widespread heroin epidemic that has killed hundreds of Miami Valley residents over the past several years.

Bryan Bucklew, president and CEO of the Greater Dayton Area Hospital Association, told the Dayton Daily News this month that from 2007 to 2014, emergency rooms in the region saw a 40 percent increase in mental health-related visits.

“The numbers speak for themselves,” Bucklew said. “In real terms, we’re seeing about 41 patients a day in an emergency room in the Dayton region for mental behavior and health.”

Brenda Kuhn, chief nursing officer for Kettering Health Network, said warning signs would have limited impact on the populations most likely to resort to violence.

“It’s not the person sitting in the waiting room reading the sign that is going to be the problem,” according to Kuhn, whose hospital hasn’t installed the signs. “When somebody comes in, if they’re escalating, it is not the time to threaten them with a felony. That’s not a technique that would de-escalate a situation.”

Hospital officials declined to discuss specific security protocols or the number of violent incidents in their emergency departments, in part, because there is no standardized reporting system for emergency department assaults, Kuhn said.

But, she said, Kettering places an emphasis on defusing volatile situations before they spin out of control, and all hospital staff are required to undergo crisis-intervention and de-escalation training at least once a year, learning to recognize signs of impending violence and calm patients with their tone of voice or body language, among other techniques.

The training offers reassurance to hospital staff that are vulnerable to assault or verbal abuse that “we take the issue seriously,” Kuhn said.

The hospital network has not seen an uptick in violent episodes over the past two years, Kuhn said.

“We’ve seen an increase in (traffic) in all of our areas, but at the same time, we have not seen an increase in violence from our patients,” she said.

Visible police presence seen

Officials at Miami Valley Hospital in Dayton — one of the busiest emergency department’s in the state — said assaults and verbal abuse have been kept in check in their hospital’s emergency department as well.

But when violent incidents do occur, they’re immediately reported, and a team of doctors, nurses, administrators and campus police work to determine whether the situation could have been prevented or better handled, according to Mark Shaker, the hospital’s president and CEO.

“We have a pretty robust reporting system,” Shaker said. “We have a safety review every morning. If we do have an incident, no matter where it is in the organization, it pops up in those sessions, and we make sure that there is a really quick turnaround on follow-up to see what could we have done differently to prevent it. Our No. 1 concern here is the safety of our employees, our medical staff and our visitors.”

To that end, the hospital ensures that its campus police are highly visible in all areas of the emergency department, including nurses’ stations, corridors, hallways and patient rooms, where most incidents of physical violence against emergency nurses occur, according to the ENA survey.

“They’re not only in the front, they’re in the back, they float around, they communicate with the nurse,” Shaker said, referring to the hospital police. “They’re essentially part of the treatment team, and that’s how we view them. They’re there to help. They help visitors, they help with parking situations; and then if we get a situation where something is a little out of control, they’re there at the beckon call of the nursing staff.”

In December, hospital police quickly responded to a nurse who was being assaulted at Good Samaritan Hospital on Philadelphia Drive. An officer had to deploy his Taser on Dec. 26 to a suspect who reportedly punched a nurse in the face, according to a police report.

Changing the mindset

Despite all the precautions, perhaps the biggest obstacles to curbing workplace violence in emergency departments are the emergency nurses themselves, according to OHA’s Wenter.

“Nurses have always had this mindset that “Oh, it’s a part of my job,”’ Werner said, noting that the ENA study found 65 percent of survey participants who were victims of workplace violence did not file a formal report with the police. “We’re trying to change the mindset of the nurses so they know they they don’t need to take this. Violence isn’t part of the job, and they should be reporting these incidents so we can better address the issue.”

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