Hospital Employees Seek Change In Culture As Workplace Violence Increases

When you visit the Cleveland Clinic emergency department on the main campus, a large sign directs you toward a metal detector.

The clinic has its own police force and an officer inspects all bags and backpacks and then instructs you to walk through the metal detector. In some cases, a metal wand is used.

Officers confiscate anything they consider a weapon – from a pack of matches to pepper spray or handguns.

The clinic and other Cleveland area hospital systems have beefed up security in response to what they say is an escalation of violence against healthcare workers. Cleveland Clinic CEO Tom Mihaljevic called violence against healthcare providers a silent epidemic in his State of the Clinic address last month, and U.S. Sen. Sherrod Brown (D-OH) recently co-sponsored a bill, which would provide more government scrutiny of workplace violence in healthcare and social service settings.

Local hospitals have ramped up security efforts in other ways as well. Some clinic employees have panic buttons on I.D. badges and there are more safety cameras and plain-clothes officers in ERs.

University Hospitals implemented the use of a special phone app that acts as a panic button for employees and MetroHealth also has a metal detector at the ER entrance on its main campus.

Despite all the safety measures, hospital officials say nurses and doctors deal with violence on a daily basis.

Employees Concerned about Safety

 “Most recently, we did have a patient with a behavioral health issue and a substance abuse issue who struck one of our nurses – punched them in the face,” said Dr. Stephen Meldon, Sr. Vice Chair of Cleveland Clinic’s Emergency Services Institute.

The patient was restrained and a police report was filed, he said, and though the nurse was OK physically, there was an emotional toll from the incident.                                                   

 “Even if you're not physically injured, I think there's the stress of that – of coming to work and worrying about that," said Meldon.

Cleveland Clinic ER nurse Bridget Lambert says she is lucky. A patient has never physically hurt her, but in 15 years of nursing Lambert has seen people who lash out because of confusion from medication or an illness.

 “So when you’re in that situation and you know what can happen – it’s scary,” said Lambert.

Serious workplace violence incidents are four times more common in healthcare than in private industry on average, according to the Occupational Safety and Health Administration or OSHA.

Culture of Silence in Hospitals

University Hospitals Chief Operating Officer Ron Dziedzicki says there are more sick people coming through the doors of hospitals these days.

 “We’re dealing with families at very stressful times in their lives. With healthcare we are seeing more acutely ill patients than we saw before,” Dziedzicki said. “Along with that comes more stress. In times of stress, you see changes in normal coping reactions.”

The uptick in violence statistics nationally is also related to healthcare workers feeling more comfortable in reporting these incidents, he said.

According to a poll from the American College of Emergency Physicians, nearly half of emergency physician respondents reported being physically assaulted. More than 60 percent of them said the assault occurred in the past year.

While there’s been some progress in employees reporting violent episodes, there is still very much a code of silence in healthcare, said Michelle Mahon, a representative of the national labor organization National Nurses United.

Employees are encouraged to accept physical and verbal abuse as part of the job, she said, adding that staff often underreport violent incidents out of fear retaliation.

“There is a definite culture inside this work environment – from management, from administration – that they should just learn how to deal with that. They are treated as if they are the ones who don't know how to do their job or that it's their fault,” she said.

Changing the Culture

Cleveland area hospital officials say they are taking steps to change this culture. Cleveland Clinic is elevating safety incidents to the executive level on a daily basis, for instance, Meldon said.

 “If you’re a victim of workplace violence you want to know that your supervisor knows about it, that you have all the support you need – whether it's assistance or a victim advocate program. So we want to make sure we get that to you and it's not just filed away and not acted on,” he said.

The legislation just introduced in Congress by Sen. Brown and others is another attempt to change the culture around employee safety in health settings. The Workplace Violence Prevention for Health Care and Social Service Workers Act is similar to a bill introduced in the House last month.

It would put more pressure on healthcare companies by directing OSHA to issue enforceable standards, said Sen. Brown in a news release.

The national legislation is based on a California law passed last year, said Mahon. The nurses’ union championed it, and it requires that hospitals create violent prevention plans, she said.

“The standard we’re recommending federally holds employers responsible for maintaining a healthy and safe workplace. It mandates reporting of incidents as well as transparency,” Mahon said.

Hospitals could also be fined for not reporting incidents to OSHA, she said.

The House version of the bill had its first hearing in Congress earlier this month.