Michigan nurses are fighting for better protection against violent patients
KALAMAZOO, MICH. — People who care for the sick and injured are facing a crisis.
Nurses and other front-line medical staff dedicate their lives to the well being of others, but the people they're caring for are threatening their own well being.
“I would say nurses experience some sort of violence in the workplace every day. It’s a very big issue, and it’s just now being talked about," said Ascension Borgess registered nurse Jamie Brown, who serves as president of both the Michigan Nurses Association and the Borgess Staff Nurses Council. “We have patients hitting us, spitting at us, slapping, biting. ... When I was pregnant with my daughter, I had an elderly gentleman try to hit me in my stomach.”
Brown has been fighting for better protection for nurses for 10 years, but she said the conversation is just now picking up steam.
"For so long we have been a women-dominated profession, and women have been taught historically to just take the abuse, and put up with it, and get on with your life," Brown said. “Even when they’re treating us horribly, we still take good care of them."
Brown said more than 90% of violence goes unreported in hospitals. She said one of the main problems is the lack of a solid reporting system.
"Because there’s nothing that they will do; it’s not a felony to commit violence against us," she said. “We can do a police report, but then nothing happens with it. So it’s pointless to do one.”
Unlike assaulting a police officer or firefighter, assaulting a nurse is not an automatic felony in Michigan. Normal assault and battery is a 93-day misdemeanor. Assaulting a police officer, without injuring them, is a two-year felony, with penalties going higher from there.
The U.S. Occupational Safety and Health Administration found healthcare workers were four times more likely to experience workplace violence than other private industry employees. Patients are the largest source of violence in healthcare settings, but they are not the only source. In 2013, 80% of serious, violent incidents reported in healthcare settings were caused by interactions with patients. Other incidents were caused by visitors, coworkers or other people, according to OSHA.
The American Nurses Association's 2014 Health Risk Appraisal reports that 21% of registered nurses and nursing students reported being physically assaulted, and more than 50 percent verbally abused, in a 12-month period. The appraisal surveyed 3,765 registered nurses and nursing students.
Hospitals are required by law to treat anyone, even the most violent criminals and those with a history of assaulting nurses.
Signs warning patients that violence is not tolerated are posted on the walls in Bronson hospitals. The hospital also offers de-escalation training to nurses. Some patients are given behavioral contracts, but with some patients, none of these things makes a difference.
Denise Neely, chief operating officer for Bronson Methodist, said nurses need better protection.
“It has really become a major concern," Neely said. “Many times they feel that they have to just take that, because they’re taking care of a patient. And that just kind of comes from the caregiver attitude. ... We have had some nurses who really have thought about not returning.”
Neely said she thinks the issue has gotten worse over the past decade, adding, she thinks it's a reflection of society.
“Some of the people that are violent take advantage of the people they see in a weaker category or state, and certainly nursing being caregivers," she said.
Neely said she supports legislation that would make assaulting a nurse a felony. She said the hospital system also supports nurses in filing charges when patients are violent without cause.
Often, she said, if a patient is demented or has a reaction to medication in a violent way, nurses aren’t inclined to prosecute, nor even report the incident.
“What happens to a nurse shouldn’t be treated differently than if she was on the street, and somebody punched or kicked one of our staff," Neely said.
Calhoun County Prosecutor David Gilbert said a patient being bedridden or having some other issue making it difficult to get them to court can make them harder to prosecute.
"Diminished capacity, lack of criminal responsibility and insanity are mitigating circumstances in any prosecution," Gilbert said. "However, it is not a defense for someone who is intentionally intoxicated or under the influence of drugs. They are completely responsible for their conduct while voluntarily intoxicated."
He said mental illness, including dementia, might preclude prosecution.
Neely said a better path to protection than harsher penalties is prevention.
Jon Hoadley, the Michigan state representative from Kalamazoo, agrees.
“It is hard to be figuring out exactly, you know, what additional penalty enhancements should be available for which careers," Hoadley said. "It is imperative that we put on the books some plans for hospitals to make sure that they’ve got a plan to deal with workplace violence. ... The best way to deal with violence in the workplace is to prevent it from happening.”
Hoadley works closely with nurses across the state. He said nearly 75% of nurses have reported some form of workplace violence, which costs $2.7 billion a year, or more, in lost wages and disruption to the workplace. He said hospitals need to report numbers of workplace violence incidents, train staff to adequately respond, and hire enough nurses and other front-line medical staff to keep patients safe.
“We know that workplace violence disproportionately affects nurses and other front-line medical staff," he said. “You want to make sure that when folks are taking care of the people that you love that they’re also being taken care of in the workplace, so they can provide their best quality care.”
House Bill 5089, which Hoadley sponsors, would require that hospitals create violence prevention plans, and report violence that happens. It's currently in the Health Policy Committee. The Michigan Legislature is also considering bills that would increase penalties for assaulting a nurse, including House Bill 4327 and Senate Bill 80.
Brown said she too agrees with the idea of prevention over harsher penalties. She said every situation needs to be taken in context, especially when treating the mentally ill.
“We don’t want to punish people that can’t make decisions," she said.
Hoadley said a lot of people wouldn't be covered by enhanced penalty violations, nor should they be involved in the criminal justice system in the first place.
“Patients that are dealing with Alzheimers, dementia issues, what they need is, if they act out violently, what they need is appropriately trained staff who have the appropriate number of hands available, and the training to then deal with those patients in a different way," he said.
Neely and Brown said violence is causing nurses to leave the industry, contributing to the nurse shortage. The nurses who stay then have to treat more patients, and more potential assailants.
"We work through it," Neely said. "We take deep breaths, and we come back every day.”
Hoadley said he supports the Safe Patient Care Act, which would provide reasonable limits on the number of patients who can be assigned to one nurse.
Neely said Bronson also offers critical stress management to nurses who deal with workplace violence.
___