Violence Against Healthcare Workers: Do We Prosecute our Attackers?

Keith Carlson, BSN, RN, NC-BC

Keith Carlson, BSN, RN, NC-BC

Violence is often accepted by healthcare providers as an unavoidable part of the job. According to the Occupational Safety and Health Administration (OSHA), the rate of workplace violence faced by healthcare workers was four times that of private industries between 2002 and 2013.

Violence against staff members is a daily threat against those who hold the lives and well-being of millions of Americans in their hands. As a nurse whose job is to serve and treat the public, are you within your rights to press charges if assaulted? Are we taught to fear our patients during our training? And is being attacked just an unavoidable risk?

A Worrisome Reality

In a poll of 3,500 ED physicians presented at the 2018 American College of Emergency Physicians (ACEP) Scientific Assembly, it was reported that 47% of respondents had been assaulted at work. There are also startling statistics about on-the-job violence in a Huffington Post article from 2017:

There is currently no mandate for hospitals to report workplace violence to a federal agency, although the U.S. Bureau of Labor Statistics keeps track of the worst offenses — serious assaults that require staffers to take time off from work to recover. From 2011 to 2013, U.S. healthcare workers sustained 15,000 to 20,000 injuries from workplace violence that were so bad that victims had to take time off work for treatment and recovery.

Violence is also a more common cause of workplace injuries in healthcare than other industries. BLS notes that violence caused 10 to 11 percent of the serious injuries among healthcare workers, compared to the private sector’s 3 percent average

Until more standards are put in place, informal surveys of healthcare workers are all we have to help grapple with the scope of the problem. A 2014 survey of over 10,000 nurses, conducted by the American Nurses Association, found that 25 percent had been physically assaulted either by a patient or a patient’s family member.” 

This particular reality runs deep. The statistics only scratch the surface, failing to expose the impact of such violence on healthcare quality, patient well-being, and the attrition of highly qualified workers from an essential workforce.

To Press Charges or Not Press Charges?

A willful attack by a patient can be frightening and demoralizing. Yes, there is an obvious power differential between patients and providers, but this does not make any form of violence acceptable. Some dangers cannot be precluded, especially in high-stress environments like the emergency department or psychiatric unit. And when it does happen, how should we respond?

According to an article in The Washington Post, some American states have criminalized violence against healthcare workers, which is somewhat akin to the laws against assaulting a police officer.  

On one end of the prosecutorial spectrum, a provider assaulted by a patient can choose to shrug off the incident and excuse the patient’s actions. Sepsis, poorly treated mental illness, or dementia can certainly cause a patient to lash out, so these situations need to be carefully weighed. 

A patient who repeatedly attacks healthcare providers should be on the receiving end of something more than a notice in their chart. Lack of consequences can encourage repeat offenders, and some workers or facilities may balk at the idea of pressing charges. A restraining order is at least something, but we also know from tragic experience that women taking such legal action against their abusers often end up beaten — or worse.

The above-mentioned Washington Post article makes an interesting point: 

In 1991, Appelbaum co-wrote a paper about a model hospital policy by Worcester State Hospital in Massachusetts regarding the prosecution of patients; the policy included a statement of ethical principles for determining whether to prosecute patients and a 16-step procedure for pursuing criminal charges.

But these types of policies appear to be the exception. Surveys suggest many health-care facilities either lack clear policies for responding to violent incidents against staff or, if these policies exist, they are not enforced.”

Choosing whether or not to press charges against a patient who committed a violent act is not a black-and-white decision. If the assaulted worker has their employer’s support, that decision can be reached through conversation elucidating the details of the situation.

If the staff member who was attacked is left on their own, they may fear retribution by their attacker, or uncomfortable questions from other patients or even colleagues. It is not an easy choice.

No one can predict if pressing charges will make a difference, and when state or federal law fails to dictate the consequences, facilities and staff are left to make that difficult choice. Each situation is individual, and care must be taken to plot a course of action that can increase safety, send a strong message of deterrence, and help healthcare workers feel as safe as possible in an industry notoriously vulnerable to violence.

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