Phillips, James P.

Sweetser, Peter W.

English

George Washington University: Health Sciences Research Commons (HSRC)

Himmelfarb Health Sciences Library, The George Washington University Health Sciences Research Commons URGENT Matters School of Medicine and Health Sciences 3-15-2023 Personal perspective: Violence against Healthcare Workers in US EDs Peter W. Sweetser James P. Phillips Follow this and additional works at: https://hsrc.himmelfarb.gwu.edu/smhs_URGENT_Matters  Part of the Medicine and Health Sciences Commons Personal perspective: Violence against Healthcare Workers in US EDsPeter W. Sweetser and James P. Phillips, MD03/15/2023Several years ago, while working as an ED technician, I was kneed in the face by anintoxicated patient for whom I was caring. Like many other intoxicated patients in the ED, thispatient became increasingly aggressive and required restraint for the safety of all around. Myinitial response to being subjected to physical violence was to assume, “it’s just part of the job.”However, on reflection, I realize I should not have accepted that being assaulted at work isjustifiable. Unfortunately, violence against healthcare workers is a growing problem and shouldbe unacceptable to everyone.Violence in US EDs and other healthcare facilities comes in many forms. Perpetrators canbe verbally violent: using threatening, insulting, or harassing language. Or, they can engage inphysical violence through assault, battery, and physical intimidation with a weapon. My friendsand colleagues working in the ED have been verbally assaulted, threatened, bitten, andphysically attacked by patients. One colleague even had his wrist broken. Incidents ofphysicians, nurses, technicians, and ancillary staff being seriously injured or even killed bypatients have been reported in US EDs.Threats of violence may contribute to the healthcare shortage we are facing in thiscountry, possibly explaining the 555 initially unmatched EM residency slots this year. A reportby the Emergency Medicine Residents’ Association (EMRA) indicates that emergency medicineresidency applications have decreased by 20% since 2020. While this drop is undoubtedlymultifactorial, it may be a warning sign that threats of violence are diminishing the appeal ofemergency medicine. Fewer nurses, physicians, advanced practice providers, and ancillarymedical staff will negatively impact healthcare delivery and health outcomes. Prioritizing theability of doctors and nurses to work in a safe environment should be a priority, lest we deterpeople from entering emergency medicine.Over the past year, violence against healthcare workers has occurred in Tulsa, OK, LosAngeles, CA, Rutland, VT, and Irving, TX. A report from the American College of EmergencyPhysicians (ACEP) in September 2022 showed that “eight in ten ED physicians believe the rateof violence in EDs has increased” and that this violence has negatively impacted patient care,decreased physician productivity, and increased physician anxiety. ACEP has focused on thistopic as a legislative priority and is working with congressional leaders on legislation to expandED workplace protection and implement reporting systems to better quantify and qualify thisproblem.Fortunately, I was not seriously harmed in my case, and I resumed work to finish my shiftand continued with my medical career. Years later, I am now a medical student and aspiringemergency medicine physician, yet my experience with violence in healthcare gives me pause.Shockingly, working in healthcare is now the most violent non-law enforcement profession in theUS.I love working in healthcare, and I am grateful to be learning how to care for patients andfamilies. However, the risks of violence in the ED have affected my approach tophysician-patient interactions. In addition to focusing on bedside manner and conveying empathyfor the patient, I check that I have a direct route from patients’ rooms in case I need to exitquickly. I remain mindful of the patient’s mental state, noting aggressive language, posturing, oremotional escalation. I hope with more training, I will find a greater sense of security. At thispoint, medical school has not fully prepared me to navigate these risks.Reducing violence against healthcare workers may improve the patient care experienceand reduce burnout for doctors and nurses. Quelling violence against healthcare workers requiresa concerted effort across multi-disciplinary health professionals to prevent attacks byimplementing evidence-based protocols. Medical education across disciplines should includediscussions about the reality of violence against doctors and nurses in any clinical environment.In addition, legislation such as recently proposed federal legislation (H.R. 1195, S.4182, H.R.7961) should be passed to provide greater protection for staff. I am hopeful that this situationwill improve for the next generation of ED physicians like me.The authors have no conflicts to report.

Personal perspective: Violence against Healthcare Workers in US EDs

https://hsrc.himmelfarb.gwu.edu/cgi/viewcontent.cgi?article=1009&context=smhs_URGENT_Matters

Personal perspective: Violence against Healthcare Workers in US EDs

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