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On May 12, hundreds of nurses flooded Capitol Hill, demanding an end to workplace violence and unsafe staffing ratios. A week earlier, emergency nurses and physicians met with lawmakers to support the re-introduction of a bill that would require setting a standard for healthcare worker safety. In this report, we follow up on what has happened since these two events and provide an update on efforts to prevent violence in healthcare settings.

Unlike the airline industry where videos of unruly passengers being thrown off a plane can go viral before that plane leaves the ground, much of the violence in emergency departments goes unseen, said Ryan McBride, director of Congressional affairs for the American College of Emergency Physicians (ACEP).

While violence in hospitals has been a problem for decades, incidents are rarely reported because healthcare workers -- including emergency physicians -- assume doing so won't change anything, McBride noted.

But this year brought a rising tide of pushback from healthcare workers who are starting to demand action.

"Nurses are conditioned by our employers to just take it, to accept that violence is part of the job, but we are not willing to take it any longer," Jean Ross, RN, president of National Nurses United (NNU), said during an with lawmakers in early May.

"I think there's a growing realization that, no, it doesn't have to be part of the job," McBride added.

A patchwork of state laws exist to protect healthcare workers. Some have stiff penalties, while others offer essentially no protection, McBride said. Eight states require employers to run workplace violence prevention programs, and at least 40 have penalties for assaulting a nurse, according to the . Yet enforcement can vary.

Given those gaps and the increasing demand for action, Congress is considering a handful of bills to help better protect healthcare workers against violence.

Worse Than Ever Before

Violence against healthcare workers appears to have worsened during the pandemic. During a 3-month stretch in 2022 in the U.S., 57 nurses were attacked each day on average -- that's two nurses every hour -- according to a Press Ganey analysis of its National Database of Nursing Quality Indicators.

Nurses working in psychiatric units and EDs experienced the highest number of assaults, but nurses in pediatric burn, rehabilitation, and surgery units also were frequently attacked, according to the analysis.

An from April 2022 found 48% of nurses polled reported an increase in workplace violence -- more than double the percentage over the prior year.

Emergency doctors also experienced increased violence. In 2022, two out of three reported being assaulted in the past year, according to . At least two-thirds of those surveyed said the COVID-19 pandemic brought increased rates of violence and diminished levels of trust between patients and physicians or other ED staff.

Restrictions on patient visitors or long wait times for care have been cited for triggering violent responses from patients and family members, but there are myriad reasons for the attacks.

In June, at the Saint Francis Health System in Tulsa, Oklahoma, a man shot and killed his surgeon, Preston Phillips, MD, and three other people, including another physician, Stephanie Husen, DO, .

The gunman, Michael Louis, reportedly blamed Phillips for pain following a recent back surgery.

In October, June Onkundi, NP, a psychiatric nurse practitioner, was reportedly stabbed and killed by a patient in Durham, North Carolina at the Freedom House Recovery Center, .

That same month, Jacqueline Ama Pokuaa, a patient case manager, and Annette Flowers, a nurse, were in a maternal-child unit at Methodist Dallas Medical Center.

The alleged shooter was on parole after a prior prison term for aggravated robbery and was visiting his girlfriend. In a fit of jealousy, he reportedly told his girlfriend they would both die that day and that he would shoot "whoever comes in this room," .

But not all of the violence is physical, said Jennifer Schmitz, MSN, president of the Emergency Nurses Association.

"I think when you say the words 'workplace violence' people assume physical injury, and the more frequently occurring [kind] is the verbal abuse," Schmitz said, which in some cases can have "just as much of an impact on a nurse."

Legislative Solutions

In May, Sen. Tammy Baldwin (D-Wis.) re-introduced the .

A that was brought forward in the House by Rep. Joe Courtney (D-Conn.) had been approved by that chamber on April 16. It calls for the Occupational Safety and Health Administration (OSHA) to put forward a standard requiring healthcare and social service employers to develop and implement workplace violence prevention plans.

"As part of the plan, employers would be required to work with employees to identify and correct hazards, develop systems for reporting threats of violence and injuries, provide training for workers and management, and protect workers from retaliation for reporting workplace violence incidents," Fred Redmond, secretary-treasurer of the AFL-CIO, said during the same online press conference at which Ross spoke in May.

The bill, however, still has not passed the Senate.

A spokesperson for Baldwin told MedPage Today in an email that Republicans appear to be blocking it, but would not speculate on why.

McBride said Republicans aren't "huge fans of OSHA" or of increasing regulation in general, and hospitals, which are already subject to a "laundry list" of rules, likely were not enthusiastic about adding to that list.

In addition, many hospitals have said they take threats to their workers seriously and already have violence prevention initiatives, he said.

Still, ACEP believes having a federal standard could mean better adherence, McBride said.

Meka Ingram, DNP, RN, president of the North Carolina Nurses Association (NCNA), who mourned the "senseless and tragic" loss of Onkundi, said despite a making it a felony to assault a hospital worker, NCNA members don't feel supported when prosecuting such attacks.

"We need every court, district attorney, and magistrate to enforce the prosecution of those who assault healthcare workers to the full extent of the law," she said.

In June, Rep. Larry Bucshon, MD (R-Ind.) and Rep. Madeleine Dean (D-Pa.) introduced the .

This bill, which is modeled after current protections for flight crews and airport workers, would "criminalize assault or intimidation of hospital employees," according to a from Bucshon's office.

The bill includes "[e]nhanced penalties for those who knowingly assault and intimidate hospital employees" as well as protections for those who "may be mentally incapacitated due to illness or substance use," according to Bucshon's office.

It also calls for appropriating money to develop workplace violence strategies tailored to each department's individual needs, McBride said.

These monies could be used for training hospital personnel in de-escalation techniques, purchasing new technologies such as metal detectors or panic buttons, and "safe patient and staff rooms," according to the bill.

The bill intentionally doesn't specify which measures a department should employ, McBride said. For example, some EDs may not want metal detectors at their front doors, because that could signal to patients that the department is a "dangerous or violent place," he added.

While it has the support of both ED staff and hospital groups, the SAVE Act has yet to pass the House.

McBride expects the bill to be tweaked before it is re-introduced in the next Congress, but he said the inclusion of a "law-and-order angle," may make it more attractive to Republicans.

Todd Haines, RN, BSN, state council president for the Tennessee Emergency Nurses Association and a former law enforcement officer himself, who spoke at a press conference in May, said it was "a big disappointment" that Baldwin's bill stalled.

But regarding the SAVE Act, "with bipartisan support in both houses," he said, "I think this one has some promise."

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