Doctors and nurses have battled for more than 18 months to contain the spread of COVID-19. All the while, they have worked to confront another threat to health care staff — an outbreak of aggression from patients and their families.
While patient hostility has always been a concern for hospital staff, agitation over COVID-19 and pandemic regulations has heightened tensions in New Jersey and elsewhere.
AtlantiCare is among the health systems that has experienced this increased hostility. James A. Kilmer Jr., AtlantiCare’s vice president and chief administrative officer for its Atlantic City campus, said the company’s health care workers have had to deal with more “inappropriate behavior” since the pandemic began.
“We know the multifactorial impact of pandemic-related changes on society can lead to increased stress and incidents of violence at home, in the workplace, or in the community,” Kilmer said in a statement Tuesday night.
Paul Sarnese, an executive at Virtua Health in New Jersey and president of the International Association for Healthcare Security and Safety, said studies show health care workers are more likely to be victims of aggravated assault than workers in any other industry.
Federal data shows health care workers faced 73% of all nonfatal injuries from workplace violence in the United States in 2018, the most recent data available.
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Some hospital staff, however, report an increase in support for health care workers.
Brian Cahill, a spokesperson for Shore Medical Center in Somers Point, said that while patients have occasionally been frustrated by visitation restrictions, people have gone above and beyond to show their appreciation.
“COVID has presented incredible challenges for everybody in health care over the past 18, 19 months,” Cahill said. “The patient community has been very supportive of everybody who works in the hospital, and the great job that our heroes have done, and we have not seen any behavior issues.”
Sarnese said the pandemic has given hospitals an opportunity to revisit their safety protocols. Limiting entry points to enable COVID-19 screening, for example, allows hospitals to funnel visitors past security cameras.
Amy Mansue, president and CEO of Inspira Health in Vineland, said COVID-19 has prompted her company to strengthen its anti-violence policies. She said employees are being trained in verbal de-escalation techniques that emphasize empathizing with patients and “working to understand the underlying feelings a patient or visitor is trying to express.” Mansue said other employees, including security staff and staff who work in high-risk areas, are “receiving advanced training on these topics.”
“With acts of aggression and violence toward health care workers up nationally during the pandemic, Inspira is fortifying its staff education in the areas of personal safety and de-escalation,” Mansue said. “We continue to enhance our policies and programming to further enhance the safety of our Inspira team and everyone who enters our doors.”
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AtlantiCare has similar programs in place to prevent violence. Kilmer highlighted AtlantiCare’s Violence Prevention Committee, as well as its annual anti-violence training and additional de-escalation training for security officers.
Kilmer added that most patients and visitors are cooperative with AtlantiCare policies.
“It is our priority to ensure the safety and well-being of all of our patients, staff and providers,” Kilmer said. “We are grateful for the understanding of, and appreciation for our health care team, and adherence to our policies that most patients and families demonstrate.”
Jackie Gatz, vice president of safety and preparedness for the Missouri Hospital Association, said a lack of behavioral health resources can spur violence as patients seek treatment for mental health issues and substance use disorders in ERs. Life also can spill inside to the hospital, with violent episodes that began outside continuing inside or the presence of law enforcement officers escalating tensions.
A February 2021 report from National Nurses United offers another possible factor: staffing levels that don’t allow workers sufficient time to recognize and de-escalate possibly volatile situations.
COVID-unit nurses also have shouldered extra responsibilities during the pandemic. Duties such as feeding patients, drawing blood and cleaning rooms would typically be conducted by other hospital staffers, but nurses have pitched in on those jobs to minimize the number of workers visiting the negative-pressure rooms where COVID patients are treated. While the workload has increased, the number of patients each nurse oversees is unchanged, leaving little time to hear the concerns of visitors scared for the well-being of their loved ones.
In September, 31% of hospital nurses surveyed by the union said they had faced workplace violence, up from 22% in March.
While several states, including New Jersey, have rules to address violence in hospitals, National Nurses United is calling for the U.S. Senate to pass the Workplace Violence Prevention for Health Care and Social Service Workers Act, which would require hospitals to adopt plans to prevent violence.
“With any standard, at the end of the day you need that to be enforced,” said the union’s industrial hygienist, Rocelyn de Leon-Minch.
Nurses in states with laws on the books still face violence, but they have an enforceable standard they can point to when asking for that violence to be addressed. De Leon-Minch said the federal bill, which passed the House in April, aims to extend that protection to health care workers nationwide.
Kaiser Health News contributed to this report.
Contact Chris Doyle