As hospital violence grows, nurses seek reforms: 'Too many of us are being hurt'
CHICAGO _ One woman describes getting slapped and groped on the job. Another was punched in the head repeatedly. A third was bitten so hard that a spike in blood pressure burst an aneurysm in her brain, altering her life forever.
All three are nurses, who say their jobs place them in harm's way as the rate of violent incidents at hospitals appears to be growing.
U.S. Bureau of Labor Statistics data show that the rate of hospital employees intentionally injured on the job at the hands of another person is significantly higher than the rate across all private industries. In 2015, the most recent year available, there were 8.5 cases of injuries per 10,000 full-time hospital workers, versus 1.7 cases for all private industries.
The data also shows that injury number for hospital workers steadily rose from 2011 to 2014 but dropped slightly the following year.
According to an Occupational Safety and Health Administration guide on addressing violence in hospitals, 70 to 74 percent of workplace assaults between 2011 and 2013 happened in health care settings.
And hospitals in the Chicago area have not been immune to such violence in recent years.
In May, two nurses at Northwestern Medicine Delnor Hospital in Geneva were taken hostage by a Kane County jail inmate after he got hold of the gun of a corrections officer guarding him. One of the nurses was sexually assaulted, according to a lawsuit filed in the case, before the inmate was fatally shot by police, authorities said.
Less than a month later at Presence St. Joseph Medical Center in Joliet, a convicted murderer who was there for treatment used a makeshift weapon to hold a corrections officer and a nursing assistant hostage.
In 2014, a man who had been taken to NorthShore Highland Park Hospital after a car crash was shot and killed by police after removing a gun from his waistband, according to police accounts.
Experts say facilities across the country have been affected. In June, a disgruntled doctor opened fire at a New York City hospital, killing another doctor and injuring several other people before taking his own life. In 2015, at a Boston hospital, a man shot and killed the surgeon who'd operated on his mother before she died.
While such extreme examples are rarer, many health care workers _ especially nurses _ say they deal with more minor incidents of physical aggression or verbal abuse on an almost daily basis. Many have stories of intoxicated or delusional patients who spit, claw and hit, or angry family members who threaten lawsuits or even lives.
For too long, nursing advocates say, aggression toward hospital workers has been chalked up to just an unfortunate part of the job, and patients are rarely held accountable.
Yet a movement to change this culture seems to be gaining momentum, with nurses' groups speaking out at protests and on social media, and lobbying for legislation that aims to curtail violence against health care workers.
Nurses point out that they're the ones with the most contact with patients and their families, often during times of crisis and intense stress. Heartbreak over a serious diagnosis, anger over a long emergency room wait or even a general disdain for the health care and insurance fields _ all can translate into hostility toward nurses, experts say.
"Just going into work is a high-risk endeavor," said Lisa Wolf, director at the Institute for Emergency Nursing Research at the Emergency Nurses Association and a registered nurse who has studied emergency room violence. "You're going to work and people are in some ways feeling like they can kill you."
Nurses' groups generally would like to see more staffing and more training. Other observers say there's no single solution that would work for all hospitals _ an industry struggling to do more with fewer resources.
While many states, including Illinois, have enhanced penalties for offenders who attack nurses, there's also a push for federal legislation or an OSHA standard that would regulate hospital staffing levels and install other violence prevention measures.
Some who've studied the problem say it's even worse than the statistics suggest. Verbal abuse is not included in government reporting, and while many hospitals have a system for employees to report acts of violence, nurses say they often don't have or take the time to take advantage of them.
Trauma nurse Carina Johannessen said her job is somewhat like "being in an abusive relationship."
Nurses get hurt, but they keep going back to work, said Johannessen, 40, who is employed by an RN placement firm and has worked in several Illinois hospitals.
While on a shift at the emergency room at St. Joseph in Joliet, she said, a large male patient punched her in the head five times after he attacked someone else and she tried to intervene.
Johannessen, of Joliet, said she didn't suffer severe injuries and felt she had to finish her shift, despite a "raging headache." No one suggested she file a police report, she said, or even go home for the day. And if she had left, she said there wouldn't have been enough nurses to cover the rest of her shift.
"This just seems to be the culture. It's part of the job," Johannessen said, adding her "greatest fear" is that violence against nurses will only escalate.
On May 13, Tywon Salters, a Kane County jail inmate admitted to Delnor for medical treatment, was left unshackled by a corrections officer, according to a lawsuit filed by Delnor nurses.
Salters, 21 and in jail for alleged car theft, got hold of the officer's 9 mm handgun, and while the officer ran down the hall and hid, Salters found a nurse in a nearby office, threatened her with the gun and made her remove her clothes, the complaint states. When another nurse entered, he led her to another room, where he held her captive for hours in the dark, raping her and beating her at gunpoint, according to the lawsuit.
A SWAT team officer eventually shot and killed Salters. The fatal bullet also struck the nurse in the arm, according to the lawsuit.
Johannessen said the Delnor incident was partly what prompted her to speak out. She said she sometimes struggles to remember why she chose to be a nurse in the first place.
"It is so incredibly rewarding," she said, "but it's sad because it's becoming more and more infrequent that you get the patient who reminds you why you wanted to be a nurse."
ER nurse Valerie Zage said she's been subjected to regular verbal abuse in her 10-year career.
"People scream at you, they swear at you. I've been called so many names," she said. "It seems the culture of hospitals in general is, you kind of have to just take it."
Zage, 33, of Bensenville, said two incidents prompted her to file official reports, not just with her employer but also with police.
The first occurred a few years ago at Advocate Condell Medical Center in Libertyville, where Zage said a patient charged at her and slapped her across the face after being denied a pain pill prescription.
Zage was shaken and called police. She said the patient received a minor ordinance violation ticket but never appeared in court so the matter went unresolved.
More recently, while working at Advocate Lutheran General Hospital in Park Ridge, Zage said an intoxicated patient grabbed her breast while she was setting up an IV. Zage also went to police but said she found it "frustrating" that he too merely received a ticket and was fined $100.
Zage said she's developed a thick skin and focuses on the rewarding parts of her job.
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"You go through nursing school and you think, 'Wow, I'm going to help people and save lives,'" she said. "No one really warns you in school that people are as mean and horrible as they're going to be."
Sally Griepentrog, 52, of downstate Eureka, is an educator trying to prepare nurses for those realities of the profession. A workplace violence course she teaches to employees at OSF St. Francis Medical Center in Peoria includes techniques for recognizing cues for possible violence and de-escalation methods.
Griepentrog said she's uniquely suited for the job, as an act of workplace violence changed her life.
In 2015, Griepentrog was staffing a medical tent at a summer music festival. A young woman came in, topless, saying she had been taking drugs all day and was dehydrated. When Griepentrog tried to start an IV, she said the woman clamped her teeth down hard into the nurse's shoulder and would not let go.
It took the intervention of multiple staff members to eventually wrestle the woman away.
Griepentrog was treated for the gash in her shoulder, but a lingering headache led to further testing. Days later, doctors learned the pain from the bite caused her blood pressure to spike, bursting an undiagnosed aneurysm in her brain.
She underwent surgery and spent weeks in the ICU. She was left with short-term memory loss and said she can no longer read more than a sentence at a time.
"I've been swatted at, hit, spit on, puked on, you name it," Griepentrog said. "But this was the first time it almost cost me my life."
It might have cost her career, too, had Griepentrog not already had a master's degree and experience teaching. She can no longer treat patients but now works solely as an educator, using computer software that reads aloud to her.
The woman who attacked Griepentrog was eventually convicted of a misdemeanor and sentenced to six months in jail, court records show.
"Now that this has happened, I think, no more. This can't be considered part of our jobs anymore. I think too many of us are being hurt," Griepentrog said.
Alice Johnson, executive director of the Illinois Nurses Association, said it's time for hospitals to make nurses' safety a priority and dedicate resources accordingly.
"Nurses are taking action on their own as part of a grass-roots efforts to address this issue," she said.
Hospitals and other employers, on the other hand, "have a long way to go," Johnson said, adding they seem focused on the bottom line but not enough on the care of the workforce.
Adequate staffing is one key way to improve hospital safety, she said.
Pam Cipriano, American Nurses Association president, said mandatory staff training and better record-keeping should be done at all hospitals _ whether voluntary or through federal legislation.
"We need to be able to reverse the culture to make sure no nurse should ... be exposed to violence on the job," she said.
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Emergency medicine physician James Phillips started studying hospital violence after the surgeon was killed at the Boston hospital. At the time, he was working at nearby Harvard University, writing about mass shootings.
But when he turned his attention to medical settings, "I came across a plethora of nursing literature of violence in hospitals," he said. Last year, he published an article in the New England Journal of Medicine arguing that hospital violence is under-reported, tolerated and ignored.
Phillips notes that government statistics on workplace violence only track incidents that result in injuries and time off of work. He said more accurate tracking is important to persuade hospitals to put more resources toward security and violence prevention methods.
During Phillips' residency in Chicago with the University of Illinois hospital system, he was working a shift at a suburban hospital and was trying to calm an agitated, intoxicated patient when the man "spit a mouthful of blood right into my eye." Phillips soon learned the man was infected with hepatitis C.
The doctor never contracted the virus but had to undergo testing multiple times for months.
"I blew it off at the time. I thought it was part of the job," he said. "No one ever said, 'Did you file a police report? You were a victim of a violent crime.'"
Later, Phillips was working in Massachusetts when a patient spit in his face and threw a cellphone at him. In that case, he said he did call police, and the man was charged and served community service.
"I'm so sick and tired of being yelled at, screamed at and threatened," he said. "I finally thought it was time to stand up for myself."
Phillips said nursing and medical schools "should be the first place future doctors and nurses learn about the fact that they are entering into a violent industry and have a significant chance of being verbally and physically assaulted in their careers."
Active shooters in hospitals are rare, he stressed, but assaults on staff by patients and visitors are much more common.
Wolf, of the Emergency Nurses Association, said hospitals need to assess risk factors, down to things like poor lighting, and should implement detailed reporting systems and encourage staff members to use them. Hospitals also need adequate staffing and should take "a firmer stance on patients who start acting out."
Wolf said it's a challenge for hospitals to acknowledge any risks because "everyone wants to feel like the community is safe."
Wolf's group surveyed thousands of nurses across the country, and the results, published in 2009, showed more than half were physically assaulted at work. "This is a very, very common, deeply disturbing aspect (of the job)," she said.
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Several Chicago-area hospitals contacted by the Chicago Tribune declined to comment on security measures and staff training relating to workplace violence.
Advocate, Presence and Northwestern health systems issued statements, noting security is a priority and they take precautions, including de-escalation techniques and drills, and continue to study the issue.
"Unfortunately, this is something that continues to be seen more and more, and we continually have to talk about it," said Melissa Granato, associate vice president of security for Amita Health.
In 2015 at Alexian Brothers Medical Center in Elk Grove Village, one of the hospitals under the Amita banner, a man locked his estranged wife in a bathroom and stabbed her to death with a screwdriver.
Granato said the case prompted the security team to review and improve its procedures. Those approaches vary by location, she said, but can include drills and simulation training with staff. She also said they work closely with local law enforcement.
At the Chicago-based American Hospital Association and the Illinois Health and Hospital Association, the issue of workplace violence is taken seriously, officials said. Members can access resources on how to address security at their facilities.
But, every facility is different, said Dr. Jay Bhatt, AHA president. That's why he and others question whether a national standard on staffing levels or violence prevention for hospitals would work.
"Nurses aren't widgets, neither are patients," said Cathy Grossi, a vice president at the IHA. "One size fits all rarely ever works."
However, California recently enacted legislation that many nurse advocates say is groundbreaking and a potential model for a national standard. The law addresses the reporting of violent acts, staff training and correcting any violence hazards, including staffing levels. The union that lobbied for it is also pushing for OSHA to come up with a standard.
The Joint Commission, the Oakbrook Terrace-based nonprofit that accredits hospitals across the country, does not have a uniform standard related to workplace violence. But the commission does address safety and security when accrediting hospitals, and offers violence prevention resources, said Dr. Ana Pujols McKee, the commission's chief medical officer.
"We expect our organizations to understand security risks and respond in a proactive way," she said.
McKee said one challenge is finding a uniform way to gather data and use it to set guidelines. She uses the example of a nurse being hit by a patient with a brain tumor that has altered the patient's behavior. "Is that violent? To me, it is, but it may be perceived as a patient who has uncontrollable behaviors."
As the topic continues to be studied, McKee said she's watching California as a "test site," to see if the new law leads to a decrease in hospital violence.
Security experts also agree more study is needed to determine the best way to keep hospitals safe.
"The historic feeling that places like ... hospitals (are) sacred ground is gone," said Kevin Tuohey, president-elect of the International Association for Healthcare Security and Safety.
The Glendale Heights-based group researches and offers guidelines for the security industry, including hospital guards.
Another association official, Tom Smith, who runs a health care security consulting company, said hospitals are typically subjected to few regulations dealing with security, and some don't place enough emphasis on it.
"Family friendly and patient-centered doesn't mean it shouldn't be secure," he said.
The association has provided feedback to OSHA as the workplace safety agency contemplates hospital security regulations.
Some local law enforcement agencies, though, have already made changes in how they handle inmates who need outside medical care.
Within weeks of the Delnor attack, Kendall County updated their policies, including requiring detainees to remain handcuffed or shackled at all times unless medical staff specifically orders restraints removed or the detainee is giving birth.
Deputies who are guarding inmates at hospitals are also barred from using the phone unless there's an emergency, and may not use social media or the internet or play games. According to the lawsuit filed by the Delnor nurses, corrections officers assigned to guard Salters were seen sleeping or on the computer.
Sheriff offices in Cook and McHenry counties also listed several guidelines for transporting and guarding inmates who need outside medical attention, including the number of officers required to guard the detainee and when restraints are used.
The Illinois Department of Corrections, as well as DuPage, Kane, Lake and Will counties, declined to provide their policies, citing security concerns.
(Thayer is a Chicago Tribune reporter; Leone is an Aurora Beacon-News reporter.)
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