This is an excellent and needful essay, Theresa. Burnout is about the moral conditions of work. To say that “moral resilience” and “wellness” programs are the solution is to absolve management of treating nurses immorally. By the way, I don’t know what “moral resilience” is. “Resilience” is a word borrowed from metallurgy to describe the maximal pressure under which an alloy can be placed before losing its elasticity. Is that what we want to find out from anyone, much less people whose profession is to care for the vulnerable?
Wow, Mark--you hit the nail on the head! Great question about "moral resilience," and thank you for pointing out that resilience basically means the breakdown point for metals. At a conference once I was on a panel with a CEO who talked about Navy SEALS and how they are trained to calm themselves down through breathing. The implication is that health care workers need to do the same. So many things wrong there. First, we are caregivers, not elite soldiers like Navy Seals, who are trained for clandestine military missions. Second, Navy Seals have YEARS of training on stress management because they are put in such dangerous situations. Health care is not supposed to be a battleground or a metallurgy shop. Your formulation is fantastic--that focusing on resilience training rather than burnout is immoral. As always, you see the problem in clear moral terms, making the inhumanity of the problem clear in the process.
Nursing students have a much higher baseline of childhood trauma than the general population (Clark, 2021). This makes them vulnerable to tolerating unacceptable situations for too long, and possibly believing that if they try harder, things will improve. Unfortunately, this creates a financial benefit to the broken system! In the trauma course I teach at Pitt, I teach my social work students what a toxic workplace looks like and feels like, so they can get out rather than try harder! I also happen to teach Mindfulness Based Stress Reduction, which promotes the ability to see things clearly and act skillfully. Any good wellness program will make it MORE likely that a person will abandon an oppressive and abusive situation.
Brilliant, Barbara! Thank you for this important info. My decision to leave the bedside was difficult and painful, but also to me a sign of not wanting to be in such a hard and thankless work environment. I am glad you teach your students what a toxic workplace feels like. Imagine of nursing schools did the same! That would be wonderful.
You are so correct to be angry at the suggestion that nurses need only take a deep breath every time they use hand sanitizer to alleviate burn out. Not only does it make it seem as if the problem is minimal and nurses need to do things on their own to solve the problem, but it also ignores the fact that quite often nurses must use sanitizer to save time when under pressure before they go about their next patient contact when indeed soap and water washing might be a better option. I am also tired of listening to ideas that put the onus of reducing burnout on what nurses need to do on their own. We need health care systems to support us with such things as better staffing, staffing ratios, and flexible scheduling. There needs to be adequate staffing so that nurses are confident that they have the resources to provide safe care and also be able to take a meal breaks. Hospital administration needs to seek and respect nursing input on what should be done. A system should be in place for this. Many nurses are also parents of young children. Lack of flexible scheduling and available childcare also leads to burnout. Health care systems should have onsite childcare in place as well as sick childcare for when nurses' children are sick. Another helpful touch would be prepared meals that staff could purchase and bring home for their families after having worked a long shift. The executives that run hospital systems need to be aware of what needs to be done if staff burnout is to be alleviated. Thank you for writing about this.
Thank you, Patricia, for this thoughtful comment. Management seems to have so little understanding of what nurses (and other hc workers, including some physicians) go through on shifts. When was the last time they worked 12 hours being responsible for people's lives with no breaks and sometimes very little food? I wish managers would take a walk in nurses' shoes to see what we are up against. I love your idea of having prepared meals to take home. My husband always made dinner if I was working a 12 hour shift, but for many nurses that is probably not happening and meals they could buy would be wonderful.
After reading your article I read this from the San Diego Union Tribune…. Sooooo troubling from so many angles:
Hospitals in county look for ways to cut attacks on workers.
Patient assaults on health care staffers in U.S. nearly doubled from 2011 to 2020
BY PAUL SISSON
One year ago, a jail prisoner receiving treatment at Scripps Mercy Hospital in San Diego wrested away the gun of the deputy sheriff who was guarding him and fired three rounds before a nursing assistant helped disarm him.
Internal documents reveal that the incident sent caregivers scrambling for cover. Fortunately, no one was hurt. But even today, many who suddenly found themselves in harm’s way relive those moments.
“Any time there’s an incident across the country, I hear from the 10th floor at Mercy, because they’re concerned that it’s going to happen again,” said Chris Van Gorder, CEO of Scripps Health.
While there are plenty of anecdotes to illustrate the point, such as last week’s fatal shooting of a Tennessee hand surgeon or the 2022 murder of a Tulsa surgeon by a patient angry with the outcome of his back surgery, the numbers also document a growing trend.
According to the U.S. Bureau of Labor Statistics, the number of intentional injuries against health care workers and technicians has increased from 6.7 to 12.9 per 10,000 workers from 2011 to 2020. A survey of health care workers nationwide conducted in early 2023 found that 40 percent reported that they were directly involved in workplace violence in the previous two years.
Van Gorder, a former police officer turned health care executive, said Scripps’ own tracking systems show that violence against its workers was up 28 percent in the previous 12 months. In two other recent cases, he said, patients in custody of Border Patrol agents tried to take sidearms.
The executive said something has to change.
“I get worked up on this one; I’m in charge of all of these people, these are my people,” Van Gorder said. “They’re getting hurt.”
That feeling seems to be widely shared.
After pitching the idea of a task force to a narrow group of San Diego County health and law enforcement leaders, the idea has quickly grown, now pulling in leaders from every health system operating a hospital across the region as well as the law enforcement agencies that respond to medical facilities in an emergency.
An inaugural meeting of the full task force in late June included three medical personnel sharing stories of instances where they had been personally affected by violence in their workplaces. The meeting’s minutes detail cases where patients have choked, punched and pulled their caregivers to the ground by their coats, even doing hand-to-hand combat with officers in the middle of busy emergency rooms.
Dr. Asia Takeuchi, an emergency medicine specialist at Sharp Memorial Hospital, attended the meeting and shared that her facility has been calling “code green” more often than used to be the case. That’s the phrase that goes out over the facility’s announcement system when a medical provider urgently needs assistance from security personnel.
From January through May of 2023, she said, the smallest number of code green calls that Memorial experienced in a month were 34. The largest was 64. That’s between one and two incidents of significant violence per day.
Recently, she said, the hospital instituted a Taser protocol in its emergency department for situations when a patient can’t be calmed down with words or medications. One incident, she said, involved a severely agitated patient who picked up a metal medical stand and threw it into the light fixture of his room.
“Unfortunately, he just continued to escalate and escalate; he required restraints and, unfortunately, ended up having to be Tased,” Takeuchi said. The hospital also has recently added metal detectors, she said.
It’s not hard to find other local examples.
Last week, Van Gorder said, a patient admitted at Scripps Memorial Hospital La Jolla, which is not yet scanning all incoming patients with metal detectors as is the case at Scripps Mercy in Hillcrest, was found to be carrying two weapons.
“While they were securing his belongings they discovered a six-inch Bowie knife and a silver-plated revolver,” Van Gorder said. “We ended up confiscating that as we always do when we find weapons ... when the guy was discharged and he found out his gun and knife wasn’t there anymore, he threatened our security officers.
“Of course, you know, carrying a concealed Bowie knife and a gun without a permit are both felonies in the State of California.”
Both weapons, he said, were turned over to the San Diego Police Department.
The task force, Van Gorder said, is designed to increase the amount of communication going on, both among hospitals experiencing violent incidents and between health providers and law enforcement.
Better communication, he said, is especially necessary in common situations such as bringing patients picked up on “5150” holds when incidents in the community cause officers to suspect someone may be a danger to themselves or others or gravely disabled and unable to take care of themselves. Different officers from different departments may handle such a situation differently, with regular disagreement on what constitutes a valid involuntary hold and what does not.
“We are extraordinarily supportive of law enforcement, and they’re generally very supportive of hospitals, but there are issues and sometimes, when it comes down to managing these situations, it’s really important for us to have a liaison that we can contact literally 24/7 to be able to discuss issues that come up like threats made against hospital staff,” Van Gorder said.
San Diego County District Attorney Summer Stephan is part of the task force and said this week that hearing the stories of health care workers who have been harmed by patients during treatment made it clear that more should be done.
She said her office does pursue reported incidents of assault, but few of those that occur are forwarded to her office for review.
“Nationally, we can see that there has been an increase in violence in hospitals against doctors, against nurses, against hospital staff,” she said. “I think what’s happening is that it’s under-reported.
“I think that, sometimes, the hospital staff thinks that, because they’re in the business of caring for people, that they have to take, take the abuse.”
The DA said that she has allocated a special prosecutor and an investigator to work on hospital violence reports. Hospitals, though, are different from almost any other kind of venue, especially because they treat people whose medical conditions may cause them to behave violently.
Many health care workers may refuse to cooperate with law enforcement, regardless of how much they were personally harmed.
Stephan said she believes that there is enough discretion available to handle such situations.
“In my mind, it’s important that these incidents are investigated and prosecuted if appropriate because, you know, then you send a clear message that the hospital workforce is something we value and we’re going to take care of,” Stephan said. “But, within the justice system, there are different, very humane ways to deal with people with, for example, mental health (issues), through behavioral health court, collaborative courts, mental health diversion.”
Takeuchi, the Sharp emergency physician, said she agrees that hospital personnel could benefit from reporting incidents and from changes to current criminal laws that make assault inside a hospital a lesser legal infraction than it is for an identical infraction out in the community. A bill proposed in 2018 that would have equalized penalties for assault on health care workers did not pass.
“Those moderate aggressions that you just kind of ignore because you kind of assume that they’re just part of the job, eventually those add up,” Takeuchi said. “They just eventually lead to bigger aggressions if they’re ignored, and so bringing them up and bringing them to light more often, hopefully, will make people realize what’s happening, and that’s how change can happen.”
Hospitals, Van Gorder noted, face particular challenges around security in that they must take all comers in their emergency departments and patient rooms, in most cases, cannot be locked.
Part of the task force’s early work, he said, is asking local police departments to make visits and recommendations on how the physical security of workers and patients can be increased without violating rules and regulations.
“We’re different than any other industry, we’re not a normal business with normal clients that come here,” Van Gorder said.”
Thank you for posting this important article. It's honestly terrifying to me to hear about patients bringing guns to hospitals. The scariest part of this article, though, is the escalation of violence nationwide against health care workers. Why are people so angry? I'm sure that Covid has something to do with it, but also maybe the feeling that care is so scattered and lacking in compassion. That in no way excuses violence from patients. Nothing excuses that. But a turn in focus from profits to people might help. Might. I'm so glad the Mercy CEO is taking the issue seriously.
There was an incident in Geneva, IL at a highly renowned hospital system-Northwestern -Delnor in May 2017. A young inmate had threatened suicide by eating his plastic shoe, then hospitalized for surgery. During his time there the nurses regularly called management since the COs were not shackling him back up after using the restroom.
He finally acted out, wrestled with the CO for his gun. The CO ran away. One nurse then 2 nurses entered his room. He ordered the 1st nurse to take off her scrubs, since he was naked. Then took the 2nd hostage. In a hospital. For 4hrs. She gained his confidence to bring them away from other staff/patients by going into a housekeeper closet. He made her FaceTime a relative, his aunt, who begged the nurse to make sure he lives. He demanded a get away car. He raped her brutally and slammed her head with the gun when he didn’t get the car.
After 4 hrs, the SWAT team enters the room shooting. She get shot through the arm as the same bullet blew his head off. When I heard these details 2 wks after the horrific event, I cried in my car at my employer’s parking garage. Because the only details we heard that day was-- the perp was dead, everyone else is fine. Several of my nurse tribe were so enraged, we decided to have a rally to raise awareness of healthcare violence in Aug 2017.
I reached out to the media, legislators, law enforcement, nurses, teachers, firefighters and AFL-CIO union leaders. That day we heard many personal stories of violence. The nurses brother spoke, thanking us, “my sister gets up everyday because of all of you” Not a dry eye...
The Senator whose district was the hospital-also had a daughter NP who worked in the ED and he explained he never knew it was this bad. Another IL Rep Kifowit walks up to me and says-- “Doris I’m ready to write legislation to protect you”. Within one month we introduced legislation, passed both houses unanimously and the IL Healthcare Violence Prevention Act 100-1051 became law 1/1/2019.
It mandates the OSHA Workplace Violence guidelines to be instituted in hospitals, whistleblower protection, signage, mental health for those hurt, mandatory reporting, etc. Yet even shooting deaths of a beloved former UIC MD, and 3 others at a nearby Chicago hospital didn’t prompt my hospital administration to have metal detectors in the ED. It only happened as more and more patient relatives brought in knives and guns to Labor and Delivery, ED, etc threatening all lives. But even then as a member of our Violence Prevention Taskforce--they still wanted to tone down the language of signage. I couldn’t get the law language in to mandate all hospitals have metal detectors. “Sends a negative message, we’re a healing environment“. Talking about wanting to punch ...
I know my colleagues still suffer daily. And suffer from PTSD due to the increasing violence. And that nurse? She and the other RN sued the County, the CO company, but oddly NOT the hospital. I can only hope they were approached by hospital administrators with a settlement not to prosecute them. Because they were just as guilty to not listen and intervene. And the last I heard, she never returned to work at Delnor.
Doris, I'm so impressed with your advocacy. Amazing work. And I'm so sad to hear these stories. Nurses and doctors are there to care for sick people. The fact that they have to worry about getting shot, beaten up, raped--it's sickening. Thank you for sharing this story and for your important work for nurses, and all health care employees.
Why be so rude? It's possible to have rules and say what they are without treating employees like disobedient children. I'm sorry you had that experience, especially when you did the right thing by being honest about having Covid.
Yes. That’s a definite con working as a traveler. When you say your boss— is it your agency boss? No benefits there? No hospital I know of has paid travelers benefits except during the emergency act which expired Dec 2021. Sorry…My recommendation would be to go back to hospital employment. Find a union facility. Your rights are better protected. I knew the previous Union President for the Massachusetts Nurses Association- Donna Kelly-Williams. She fought the good fight. And MNA continues to do that with another ratio legislation effort. …best.
Hi Mimi--I'm happy to learn we have being second career nurses in common, and arts/humanities backgrounds. I hope Doris's advice was helpful. I say, do what works the best for you. Trust your gut. Here's hoping you find a good place to be, wherever that is.
Your column stirred up a lot of feelings for me, Theresa. First, anger at those individuals not providing direct patient care who promulgate asinine and disrespectful solutions for the challenges faced by professionals caring for sick people. Your comment about the sudden rage you experienced at the “take a cleansing breath” comment resonated deeply with me. Second, as a primary care clinician, I have always thought that providing entry level care within the health system is less a white-collar profession and more of a blue-collar one, and I am completely fine with that. I have great respect for those individuals who provide essential services, and I always felt both a kinship with folks in that sector and alienation from those members of the healthcare industry who have either forgotten their service roots or fled from them. Perhaps our current system may need to fail to achieve something better, but that prospect disregards the tremendous efforts being made by nurses, doctors, and other healthcare personnel who show up to a tough workplace environment and provide professional and, yes, loving care to their fellow human beings day in and day out... ok
Keep up this advocacy through your writing, Theresa; it is a powerful weapon in the struggle to reform our system.
Hi Lou--I love your description of "asinine and disrespectful solutions"--those are the words for it. And I, too, think that waiting for the system to fail is a terrible idea that disregards the work being done and leaves patients increasingly vulnerable to the multitude of cracks showing up in the system as it devolves further into chaos. People may think I (we?) sound unduly alarmist, but the things I hear from people doing the work are not good. I will keep writing. Your encouragement helps!
By all means, use “we”; being considered alarmist doesn’t mean that “we” can’t offer reasonable solutions. I am honored to stand with you and others raising serious concerns about our healthcare system.
Yay Teresa! Give me an amen, shout it from the rooftops!
I am one of those people who has taught wellness and resiliency programs to thousands of nurses for more than 20 years!
Every word you say in your article is true and along with you I’ve been on that bandwagon for more than 20 years. Nothing changes as far as management improving the work environment specifically with increased staffing.
When I first started introducing my wellness and stress relief programs to my local board of nursing and beyond to obtain continuing education credits, they resisted. I was shocked to hear them say that they were not interested in these kinds of programs for nurses!!!!…that I needed to position my teachings and trainings for patient care, NOT nurses. insert face palm here or your fantastic right on banging your head poster.
Fast forward, nursing leader ship organizations, finally caught on, and the word self-care and self-care programs are now ubiquitous. Then came the buzz word resiliency, and it was all about resiliency. Sigh. OK, self-care, resiliency, they are absolutely needed for a quality of life, both personal and professional, that being sad in the professional arena of medicine for both nurses and doctors who are in the front lines, the priority should be, and has always been on a safe adequately staffed Supportive environment. Alas, in my experience with thousands of nurses all over the world and the feedback that I have gotten, it is the same old, same old, did I say same old story from all of them - that this support is missing and has always been missing.
In my view, both interventions are needed -the wellness programs and resiliency teachings, although hardly a cure all, are a start from leader ship. I do know when staff attend these programs it helps, even if only a little, even if it’s only a drop of hope and help. I remember that mother Theresa when cornered to help the poorest of the poor, who leader ship (government) had abandoned, that what she was doing was only a drop in the Ocean.
Mother Theresa’s response? “ yes, this is true. However, that drop would be sorely missed.”
Theresa l hear you, l feel it. It took years to get my stress relief programs into the healthcare system for staffing. It has been years we are standing up for safe staffing. Nurses have been more vocal at this time globally than any time in history on this topic of standing up and shouting out and picketing For patient safety first! There have been baby step incremental improvements. We have a long way to go before we can walk with empowerment, instead of disempowerment, with energy, instead of depletion, and with renewed, faith, hope and love in our selfless service to humanity. I have hope. I believe. We shall overcome.
Gratitude to you for your gutsy, truthful and powerful article, you inspired me to write a comment and that is a rarity for me lol. May health, peace and love always be with you, Teresa.
This is such a lovely and heartfelt response--thank you! I agree with you that resiliency and wellness programs have a place. They are important and in fact should not be seen as independent of improving the work environment, as you say. Being able to eat lunch and go to the bathroom are part of wellness, and getting the time to debrief and collect oneself after a difficult moment on shift will build resilience better than any app or webinar can. I very much appreciate you commenting, especially since you say you rarely do. Your words add a lot, especially since you have so much experience with trying to help nurses feel better on the job. Hugs!
You had me at this line--“but I suddenly wanted to punch that person, not out of anger, but to make the point that Zen practices are useless against real threats to personal safety, whether that’s one’s own safety, or the safety of our patients. “
And CCTT is dead on. Thank you again for speaking the truth.
Thank you, Doris! I know you are a tough advocate for nurses so if you feel I spoke well then I have done my job. The idea that taking a "cleansing breath" at work will make everything better...well, it's a way of not taking nurses' struggles seriously. And of course the downside is that nurses and patients suffer as a result. Big hugs to you!
I have worked in nursing homes throughout my career as a nurse. I often feel that administration does not care about staff burnout and high levels of stress. It is all about the money and making sure the beds are filled. I agree with your point about administration playing an active role in making sure nurses are supported and treated fairly. I gulp down my lunch for about 10-15 minutes because there is not a place to eat your meals, unless you sit in your car. There is also not a refrigerator to keep staff food so I bring a non nutritional meal that will not go bad until I consume it. I could go on and on with all the injustices that myself and other nurses have to deal with. It is no wonder that few people are going into the healthcare field. The documentation is constantly increasing all the time as well.
I’m so so tired of this profession . I’m hanging on by a thread . The money I make is good but I have to ask is it worth my exhaustion and unhappiness . ????
Hi Mimi, I feel your dilemma. The money is good and the work can be rewarding--very rewarding--but working as a nurse is so hard right now. Only you can make the very hard decision to stay or go. I wish you all the best and send hugs!
It’s a betrayal— by nursing leadership of many decades. I am tired as well. Luckily I had the opportunity to have a huge voice in my nurses union the last 8yrs. I was a thorn in management’s side and worked hard for nurses at my hospital and statewide, as well has cultivating relationships with union leaders and politicians. I wanted them to see and hear nurses. Of course COVID changed the strategy, but after 2 of our nurses died, and over 200+ infected at our hospital, having daily calls with management, arguing, pleading with them, we finally got commitments on universal masking (surgical) before CDC recommended in March— because we went to the media when only 12 were infected. And then hazard pay for EVERY nurse in late March. I am proud of that. And then we went on a 7 day strike in September 2020 because of their refusal to discuss ratio staffing and unwillingness to give us raises. We did win 200 FTEs, hazard pay and 90 day rolling PPE, etc. Then mom became ill in FL. I had to leave. I made excellent money by the time I retired, after 38yrs, and felt—guilty to leave my colleagues in early 2021 and guilty that I had an incredible state pension. Here I was retired, at the top of my career, retiring to care for my now 89yo mother. It wasn’t a choice. It was the only way. I was lost. And angry. I’m working it through. And politically active here in Florida now x2 yrs, at the local, county and state level, still fighting... And mom is good. Get help if you can. Now comes the ANA announcement on 7/13 they’d consider ratios— too little and hopefully not too late for many, many nurses and their patients.
Quite a story. Thank you for letting me know about the ANA announcement, too. They're late to the party, but better late than never. Maybe I will rejoin. The new President is impressive. She gets it and really seems to care. I'm glad your mom is OK. Hugs to you and gratitude for your advocacy for nurses.
That is so terrible. I understand completely why you feel fed up. When I got H1N1 I was told I had to be off for 1 week, and then was reprimanded for missing too many shifts. Terrible. Your situation is terrible, too. So sorry.
What state are you in? Are you a federal employee? What is your hospital policy? Any others infected by these patients? I would fight it. Together. Go up the chain. Contact HR. If you can provide dates of care, dates of initial sxs, have your private MD write letter when diagnosed. Here in Philadelphia the employer must still pay for time off due to Covid. “Starting March 9, 2022 until December 31, 2023, employers with 25 or more employees must provide up to 40 hours of additional paid sick leave to eligible employees when they are unable to work for certain COVID-19 reasons” https://www.phila.gov/documents/covid-19-pandemic-paid-sick-leave-resources/
This is an excellent and needful essay, Theresa. Burnout is about the moral conditions of work. To say that “moral resilience” and “wellness” programs are the solution is to absolve management of treating nurses immorally. By the way, I don’t know what “moral resilience” is. “Resilience” is a word borrowed from metallurgy to describe the maximal pressure under which an alloy can be placed before losing its elasticity. Is that what we want to find out from anyone, much less people whose profession is to care for the vulnerable?
Wow, Mark--you hit the nail on the head! Great question about "moral resilience," and thank you for pointing out that resilience basically means the breakdown point for metals. At a conference once I was on a panel with a CEO who talked about Navy SEALS and how they are trained to calm themselves down through breathing. The implication is that health care workers need to do the same. So many things wrong there. First, we are caregivers, not elite soldiers like Navy Seals, who are trained for clandestine military missions. Second, Navy Seals have YEARS of training on stress management because they are put in such dangerous situations. Health care is not supposed to be a battleground or a metallurgy shop. Your formulation is fantastic--that focusing on resilience training rather than burnout is immoral. As always, you see the problem in clear moral terms, making the inhumanity of the problem clear in the process.
Nursing students have a much higher baseline of childhood trauma than the general population (Clark, 2021). This makes them vulnerable to tolerating unacceptable situations for too long, and possibly believing that if they try harder, things will improve. Unfortunately, this creates a financial benefit to the broken system! In the trauma course I teach at Pitt, I teach my social work students what a toxic workplace looks like and feels like, so they can get out rather than try harder! I also happen to teach Mindfulness Based Stress Reduction, which promotes the ability to see things clearly and act skillfully. Any good wellness program will make it MORE likely that a person will abandon an oppressive and abusive situation.
Brilliant, Barbara! Thank you for this important info. My decision to leave the bedside was difficult and painful, but also to me a sign of not wanting to be in such a hard and thankless work environment. I am glad you teach your students what a toxic workplace feels like. Imagine of nursing schools did the same! That would be wonderful.
Here, here 🙏
You are so correct to be angry at the suggestion that nurses need only take a deep breath every time they use hand sanitizer to alleviate burn out. Not only does it make it seem as if the problem is minimal and nurses need to do things on their own to solve the problem, but it also ignores the fact that quite often nurses must use sanitizer to save time when under pressure before they go about their next patient contact when indeed soap and water washing might be a better option. I am also tired of listening to ideas that put the onus of reducing burnout on what nurses need to do on their own. We need health care systems to support us with such things as better staffing, staffing ratios, and flexible scheduling. There needs to be adequate staffing so that nurses are confident that they have the resources to provide safe care and also be able to take a meal breaks. Hospital administration needs to seek and respect nursing input on what should be done. A system should be in place for this. Many nurses are also parents of young children. Lack of flexible scheduling and available childcare also leads to burnout. Health care systems should have onsite childcare in place as well as sick childcare for when nurses' children are sick. Another helpful touch would be prepared meals that staff could purchase and bring home for their families after having worked a long shift. The executives that run hospital systems need to be aware of what needs to be done if staff burnout is to be alleviated. Thank you for writing about this.
Thank you, Patricia, for this thoughtful comment. Management seems to have so little understanding of what nurses (and other hc workers, including some physicians) go through on shifts. When was the last time they worked 12 hours being responsible for people's lives with no breaks and sometimes very little food? I wish managers would take a walk in nurses' shoes to see what we are up against. I love your idea of having prepared meals to take home. My husband always made dinner if I was working a 12 hour shift, but for many nurses that is probably not happening and meals they could buy would be wonderful.
After reading your article I read this from the San Diego Union Tribune…. Sooooo troubling from so many angles:
Hospitals in county look for ways to cut attacks on workers.
Patient assaults on health care staffers in U.S. nearly doubled from 2011 to 2020
BY PAUL SISSON
One year ago, a jail prisoner receiving treatment at Scripps Mercy Hospital in San Diego wrested away the gun of the deputy sheriff who was guarding him and fired three rounds before a nursing assistant helped disarm him.
Internal documents reveal that the incident sent caregivers scrambling for cover. Fortunately, no one was hurt. But even today, many who suddenly found themselves in harm’s way relive those moments.
“Any time there’s an incident across the country, I hear from the 10th floor at Mercy, because they’re concerned that it’s going to happen again,” said Chris Van Gorder, CEO of Scripps Health.
While there are plenty of anecdotes to illustrate the point, such as last week’s fatal shooting of a Tennessee hand surgeon or the 2022 murder of a Tulsa surgeon by a patient angry with the outcome of his back surgery, the numbers also document a growing trend.
According to the U.S. Bureau of Labor Statistics, the number of intentional injuries against health care workers and technicians has increased from 6.7 to 12.9 per 10,000 workers from 2011 to 2020. A survey of health care workers nationwide conducted in early 2023 found that 40 percent reported that they were directly involved in workplace violence in the previous two years.
Van Gorder, a former police officer turned health care executive, said Scripps’ own tracking systems show that violence against its workers was up 28 percent in the previous 12 months. In two other recent cases, he said, patients in custody of Border Patrol agents tried to take sidearms.
The executive said something has to change.
“I get worked up on this one; I’m in charge of all of these people, these are my people,” Van Gorder said. “They’re getting hurt.”
That feeling seems to be widely shared.
After pitching the idea of a task force to a narrow group of San Diego County health and law enforcement leaders, the idea has quickly grown, now pulling in leaders from every health system operating a hospital across the region as well as the law enforcement agencies that respond to medical facilities in an emergency.
An inaugural meeting of the full task force in late June included three medical personnel sharing stories of instances where they had been personally affected by violence in their workplaces. The meeting’s minutes detail cases where patients have choked, punched and pulled their caregivers to the ground by their coats, even doing hand-to-hand combat with officers in the middle of busy emergency rooms.
Dr. Asia Takeuchi, an emergency medicine specialist at Sharp Memorial Hospital, attended the meeting and shared that her facility has been calling “code green” more often than used to be the case. That’s the phrase that goes out over the facility’s announcement system when a medical provider urgently needs assistance from security personnel.
From January through May of 2023, she said, the smallest number of code green calls that Memorial experienced in a month were 34. The largest was 64. That’s between one and two incidents of significant violence per day.
Recently, she said, the hospital instituted a Taser protocol in its emergency department for situations when a patient can’t be calmed down with words or medications. One incident, she said, involved a severely agitated patient who picked up a metal medical stand and threw it into the light fixture of his room.
“Unfortunately, he just continued to escalate and escalate; he required restraints and, unfortunately, ended up having to be Tased,” Takeuchi said. The hospital also has recently added metal detectors, she said.
It’s not hard to find other local examples.
Last week, Van Gorder said, a patient admitted at Scripps Memorial Hospital La Jolla, which is not yet scanning all incoming patients with metal detectors as is the case at Scripps Mercy in Hillcrest, was found to be carrying two weapons.
“While they were securing his belongings they discovered a six-inch Bowie knife and a silver-plated revolver,” Van Gorder said. “We ended up confiscating that as we always do when we find weapons ... when the guy was discharged and he found out his gun and knife wasn’t there anymore, he threatened our security officers.
“Of course, you know, carrying a concealed Bowie knife and a gun without a permit are both felonies in the State of California.”
Both weapons, he said, were turned over to the San Diego Police Department.
The task force, Van Gorder said, is designed to increase the amount of communication going on, both among hospitals experiencing violent incidents and between health providers and law enforcement.
Better communication, he said, is especially necessary in common situations such as bringing patients picked up on “5150” holds when incidents in the community cause officers to suspect someone may be a danger to themselves or others or gravely disabled and unable to take care of themselves. Different officers from different departments may handle such a situation differently, with regular disagreement on what constitutes a valid involuntary hold and what does not.
“We are extraordinarily supportive of law enforcement, and they’re generally very supportive of hospitals, but there are issues and sometimes, when it comes down to managing these situations, it’s really important for us to have a liaison that we can contact literally 24/7 to be able to discuss issues that come up like threats made against hospital staff,” Van Gorder said.
San Diego County District Attorney Summer Stephan is part of the task force and said this week that hearing the stories of health care workers who have been harmed by patients during treatment made it clear that more should be done.
She said her office does pursue reported incidents of assault, but few of those that occur are forwarded to her office for review.
“Nationally, we can see that there has been an increase in violence in hospitals against doctors, against nurses, against hospital staff,” she said. “I think what’s happening is that it’s under-reported.
“I think that, sometimes, the hospital staff thinks that, because they’re in the business of caring for people, that they have to take, take the abuse.”
The DA said that she has allocated a special prosecutor and an investigator to work on hospital violence reports. Hospitals, though, are different from almost any other kind of venue, especially because they treat people whose medical conditions may cause them to behave violently.
Many health care workers may refuse to cooperate with law enforcement, regardless of how much they were personally harmed.
Stephan said she believes that there is enough discretion available to handle such situations.
“In my mind, it’s important that these incidents are investigated and prosecuted if appropriate because, you know, then you send a clear message that the hospital workforce is something we value and we’re going to take care of,” Stephan said. “But, within the justice system, there are different, very humane ways to deal with people with, for example, mental health (issues), through behavioral health court, collaborative courts, mental health diversion.”
Takeuchi, the Sharp emergency physician, said she agrees that hospital personnel could benefit from reporting incidents and from changes to current criminal laws that make assault inside a hospital a lesser legal infraction than it is for an identical infraction out in the community. A bill proposed in 2018 that would have equalized penalties for assault on health care workers did not pass.
“Those moderate aggressions that you just kind of ignore because you kind of assume that they’re just part of the job, eventually those add up,” Takeuchi said. “They just eventually lead to bigger aggressions if they’re ignored, and so bringing them up and bringing them to light more often, hopefully, will make people realize what’s happening, and that’s how change can happen.”
Hospitals, Van Gorder noted, face particular challenges around security in that they must take all comers in their emergency departments and patient rooms, in most cases, cannot be locked.
Part of the task force’s early work, he said, is asking local police departments to make visits and recommendations on how the physical security of workers and patients can be increased without violating rules and regulations.
“We’re different than any other industry, we’re not a normal business with normal clients that come here,” Van Gorder said.”
Thank you for posting this important article. It's honestly terrifying to me to hear about patients bringing guns to hospitals. The scariest part of this article, though, is the escalation of violence nationwide against health care workers. Why are people so angry? I'm sure that Covid has something to do with it, but also maybe the feeling that care is so scattered and lacking in compassion. That in no way excuses violence from patients. Nothing excuses that. But a turn in focus from profits to people might help. Might. I'm so glad the Mercy CEO is taking the issue seriously.
Thank you for the reply…. I would like to reply to you but would like to do so privately. Is this site private?
Thank you
Hi Mimi--You can email me: TheresaBrown@hey.com.
There was an incident in Geneva, IL at a highly renowned hospital system-Northwestern -Delnor in May 2017. A young inmate had threatened suicide by eating his plastic shoe, then hospitalized for surgery. During his time there the nurses regularly called management since the COs were not shackling him back up after using the restroom.
He finally acted out, wrestled with the CO for his gun. The CO ran away. One nurse then 2 nurses entered his room. He ordered the 1st nurse to take off her scrubs, since he was naked. Then took the 2nd hostage. In a hospital. For 4hrs. She gained his confidence to bring them away from other staff/patients by going into a housekeeper closet. He made her FaceTime a relative, his aunt, who begged the nurse to make sure he lives. He demanded a get away car. He raped her brutally and slammed her head with the gun when he didn’t get the car.
After 4 hrs, the SWAT team enters the room shooting. She get shot through the arm as the same bullet blew his head off. When I heard these details 2 wks after the horrific event, I cried in my car at my employer’s parking garage. Because the only details we heard that day was-- the perp was dead, everyone else is fine. Several of my nurse tribe were so enraged, we decided to have a rally to raise awareness of healthcare violence in Aug 2017.
I reached out to the media, legislators, law enforcement, nurses, teachers, firefighters and AFL-CIO union leaders. That day we heard many personal stories of violence. The nurses brother spoke, thanking us, “my sister gets up everyday because of all of you” Not a dry eye...
The Senator whose district was the hospital-also had a daughter NP who worked in the ED and he explained he never knew it was this bad. Another IL Rep Kifowit walks up to me and says-- “Doris I’m ready to write legislation to protect you”. Within one month we introduced legislation, passed both houses unanimously and the IL Healthcare Violence Prevention Act 100-1051 became law 1/1/2019.
It mandates the OSHA Workplace Violence guidelines to be instituted in hospitals, whistleblower protection, signage, mental health for those hurt, mandatory reporting, etc. Yet even shooting deaths of a beloved former UIC MD, and 3 others at a nearby Chicago hospital didn’t prompt my hospital administration to have metal detectors in the ED. It only happened as more and more patient relatives brought in knives and guns to Labor and Delivery, ED, etc threatening all lives. But even then as a member of our Violence Prevention Taskforce--they still wanted to tone down the language of signage. I couldn’t get the law language in to mandate all hospitals have metal detectors. “Sends a negative message, we’re a healing environment“. Talking about wanting to punch ...
I know my colleagues still suffer daily. And suffer from PTSD due to the increasing violence. And that nurse? She and the other RN sued the County, the CO company, but oddly NOT the hospital. I can only hope they were approached by hospital administrators with a settlement not to prosecute them. Because they were just as guilty to not listen and intervene. And the last I heard, she never returned to work at Delnor.
Doris, I'm so impressed with your advocacy. Amazing work. And I'm so sad to hear these stories. Nurses and doctors are there to care for sick people. The fact that they have to worry about getting shot, beaten up, raped--it's sickening. Thank you for sharing this story and for your important work for nurses, and all health care employees.
I felt my hand making a fist just reading that.
Yes--It is enraging. Simply enraging.
I’m in Massachusetts
Working as a traveler for a local VNA
So basically they just firmly said ‘WE DONT PAY FOR SICK
TIME’
My boss advocated but the were pretty rude i don’t have the fight in me
The rudeness is beyond
Why be so rude? It's possible to have rules and say what they are without treating employees like disobedient children. I'm sorry you had that experience, especially when you did the right thing by being honest about having Covid.
Yes. That’s a definite con working as a traveler. When you say your boss— is it your agency boss? No benefits there? No hospital I know of has paid travelers benefits except during the emergency act which expired Dec 2021. Sorry…My recommendation would be to go back to hospital employment. Find a union facility. Your rights are better protected. I knew the previous Union President for the Massachusetts Nurses Association- Donna Kelly-Williams. She fought the good fight. And MNA continues to do that with another ratio legislation effort. …best.
I’ve been a hospice and home care nurse for almost 20 years (second career…. Should have stayed selling art in a gallery :o) ….
It is hard to get back into the hospital .
Cape cod is a funny little place . A lot of antics .
I sooo appreciate your advice
I will look to see the jobs at the hospital .
Hi Mimi--I'm happy to learn we have being second career nurses in common, and arts/humanities backgrounds. I hope Doris's advice was helpful. I say, do what works the best for you. Trust your gut. Here's hoping you find a good place to be, wherever that is.
Your column stirred up a lot of feelings for me, Theresa. First, anger at those individuals not providing direct patient care who promulgate asinine and disrespectful solutions for the challenges faced by professionals caring for sick people. Your comment about the sudden rage you experienced at the “take a cleansing breath” comment resonated deeply with me. Second, as a primary care clinician, I have always thought that providing entry level care within the health system is less a white-collar profession and more of a blue-collar one, and I am completely fine with that. I have great respect for those individuals who provide essential services, and I always felt both a kinship with folks in that sector and alienation from those members of the healthcare industry who have either forgotten their service roots or fled from them. Perhaps our current system may need to fail to achieve something better, but that prospect disregards the tremendous efforts being made by nurses, doctors, and other healthcare personnel who show up to a tough workplace environment and provide professional and, yes, loving care to their fellow human beings day in and day out... ok
Keep up this advocacy through your writing, Theresa; it is a powerful weapon in the struggle to reform our system.
Hi Lou--I love your description of "asinine and disrespectful solutions"--those are the words for it. And I, too, think that waiting for the system to fail is a terrible idea that disregards the work being done and leaves patients increasingly vulnerable to the multitude of cracks showing up in the system as it devolves further into chaos. People may think I (we?) sound unduly alarmist, but the things I hear from people doing the work are not good. I will keep writing. Your encouragement helps!
By all means, use “we”; being considered alarmist doesn’t mean that “we” can’t offer reasonable solutions. I am honored to stand with you and others raising serious concerns about our healthcare system.
Yay Teresa! Give me an amen, shout it from the rooftops!
I am one of those people who has taught wellness and resiliency programs to thousands of nurses for more than 20 years!
Every word you say in your article is true and along with you I’ve been on that bandwagon for more than 20 years. Nothing changes as far as management improving the work environment specifically with increased staffing.
When I first started introducing my wellness and stress relief programs to my local board of nursing and beyond to obtain continuing education credits, they resisted. I was shocked to hear them say that they were not interested in these kinds of programs for nurses!!!!…that I needed to position my teachings and trainings for patient care, NOT nurses. insert face palm here or your fantastic right on banging your head poster.
Fast forward, nursing leader ship organizations, finally caught on, and the word self-care and self-care programs are now ubiquitous. Then came the buzz word resiliency, and it was all about resiliency. Sigh. OK, self-care, resiliency, they are absolutely needed for a quality of life, both personal and professional, that being sad in the professional arena of medicine for both nurses and doctors who are in the front lines, the priority should be, and has always been on a safe adequately staffed Supportive environment. Alas, in my experience with thousands of nurses all over the world and the feedback that I have gotten, it is the same old, same old, did I say same old story from all of them - that this support is missing and has always been missing.
In my view, both interventions are needed -the wellness programs and resiliency teachings, although hardly a cure all, are a start from leader ship. I do know when staff attend these programs it helps, even if only a little, even if it’s only a drop of hope and help. I remember that mother Theresa when cornered to help the poorest of the poor, who leader ship (government) had abandoned, that what she was doing was only a drop in the Ocean.
Mother Theresa’s response? “ yes, this is true. However, that drop would be sorely missed.”
Theresa l hear you, l feel it. It took years to get my stress relief programs into the healthcare system for staffing. It has been years we are standing up for safe staffing. Nurses have been more vocal at this time globally than any time in history on this topic of standing up and shouting out and picketing For patient safety first! There have been baby step incremental improvements. We have a long way to go before we can walk with empowerment, instead of disempowerment, with energy, instead of depletion, and with renewed, faith, hope and love in our selfless service to humanity. I have hope. I believe. We shall overcome.
Gratitude to you for your gutsy, truthful and powerful article, you inspired me to write a comment and that is a rarity for me lol. May health, peace and love always be with you, Teresa.
P.S. absolutely adore the painting. ♥️
This is such a lovely and heartfelt response--thank you! I agree with you that resiliency and wellness programs have a place. They are important and in fact should not be seen as independent of improving the work environment, as you say. Being able to eat lunch and go to the bathroom are part of wellness, and getting the time to debrief and collect oneself after a difficult moment on shift will build resilience better than any app or webinar can. I very much appreciate you commenting, especially since you say you rarely do. Your words add a lot, especially since you have so much experience with trying to help nurses feel better on the job. Hugs!
You had me at this line--“but I suddenly wanted to punch that person, not out of anger, but to make the point that Zen practices are useless against real threats to personal safety, whether that’s one’s own safety, or the safety of our patients. “
And CCTT is dead on. Thank you again for speaking the truth.
Thank you, Doris! I know you are a tough advocate for nurses so if you feel I spoke well then I have done my job. The idea that taking a "cleansing breath" at work will make everything better...well, it's a way of not taking nurses' struggles seriously. And of course the downside is that nurses and patients suffer as a result. Big hugs to you!
I have worked in nursing homes throughout my career as a nurse. I often feel that administration does not care about staff burnout and high levels of stress. It is all about the money and making sure the beds are filled. I agree with your point about administration playing an active role in making sure nurses are supported and treated fairly. I gulp down my lunch for about 10-15 minutes because there is not a place to eat your meals, unless you sit in your car. There is also not a refrigerator to keep staff food so I bring a non nutritional meal that will not go bad until I consume it. I could go on and on with all the injustices that myself and other nurses have to deal with. It is no wonder that few people are going into the healthcare field. The documentation is constantly increasing all the time as well.
I’m so so tired of this profession . I’m hanging on by a thread . The money I make is good but I have to ask is it worth my exhaustion and unhappiness . ????
Hi Mimi, I feel your dilemma. The money is good and the work can be rewarding--very rewarding--but working as a nurse is so hard right now. Only you can make the very hard decision to stay or go. I wish you all the best and send hugs!
It’s a betrayal— by nursing leadership of many decades. I am tired as well. Luckily I had the opportunity to have a huge voice in my nurses union the last 8yrs. I was a thorn in management’s side and worked hard for nurses at my hospital and statewide, as well has cultivating relationships with union leaders and politicians. I wanted them to see and hear nurses. Of course COVID changed the strategy, but after 2 of our nurses died, and over 200+ infected at our hospital, having daily calls with management, arguing, pleading with them, we finally got commitments on universal masking (surgical) before CDC recommended in March— because we went to the media when only 12 were infected. And then hazard pay for EVERY nurse in late March. I am proud of that. And then we went on a 7 day strike in September 2020 because of their refusal to discuss ratio staffing and unwillingness to give us raises. We did win 200 FTEs, hazard pay and 90 day rolling PPE, etc. Then mom became ill in FL. I had to leave. I made excellent money by the time I retired, after 38yrs, and felt—guilty to leave my colleagues in early 2021 and guilty that I had an incredible state pension. Here I was retired, at the top of my career, retiring to care for my now 89yo mother. It wasn’t a choice. It was the only way. I was lost. And angry. I’m working it through. And politically active here in Florida now x2 yrs, at the local, county and state level, still fighting... And mom is good. Get help if you can. Now comes the ANA announcement on 7/13 they’d consider ratios— too little and hopefully not too late for many, many nurses and their patients.
Quite a story. Thank you for letting me know about the ANA announcement, too. They're late to the party, but better late than never. Maybe I will rejoin. The new President is impressive. She gets it and really seems to care. I'm glad your mom is OK. Hugs to you and gratitude for your advocacy for nurses.
About 3 weeks I contracted Covid
Exposure to two patients yet I did not receive pay . They demanded I was out 5 days yet didn’t pay me .
That is so terrible. I understand completely why you feel fed up. When I got H1N1 I was told I had to be off for 1 week, and then was reprimanded for missing too many shifts. Terrible. Your situation is terrible, too. So sorry.
What state are you in? Are you a federal employee? What is your hospital policy? Any others infected by these patients? I would fight it. Together. Go up the chain. Contact HR. If you can provide dates of care, dates of initial sxs, have your private MD write letter when diagnosed. Here in Philadelphia the employer must still pay for time off due to Covid. “Starting March 9, 2022 until December 31, 2023, employers with 25 or more employees must provide up to 40 hours of additional paid sick leave to eligible employees when they are unable to work for certain COVID-19 reasons” https://www.phila.gov/documents/covid-19-pandemic-paid-sick-leave-resources/
I am with you, sister. I am still working as a nurse to pay my bills. But I often question if the stress and exhaustion are worth it.
I am renewing my contract and will be back to a visiting nurse 40 hours a week 7 patients a day - august 2nd
My contract will end october 28th?
I have to maybe find a different profession .
I’m am thankful for the encouraging comments and support here . Thank you 🙏