the shootings at the johns hopkins hospital made national news. maybe i'm cynical, but i think it was because a doctor was shot. news reports say that dr. david cohen was updating the patient's son about her condition, and the man was increasingly unhappy with what he was hearing. after threatening to jump out of a window, he pulled out a gun and shot the surgeon in the abdomen. he was taken to the er -- and whoever went and removed him from the scene is certainly heroic! -- and then to surgery. latest reports are that he is doing well and expected to make a full recovery.
the visitor shot his mother and then himself.
this may seem like an isolated incident, but really it's just a progression of what we nurses put up with on a regular basis. shooting a doctor makes the news. threatening to shoot the nurse, even if you're armed and dangerous, does not. decking a doctor makes the news. beating up on mother's nurse does not. threatening a doctor gets attention; threatening a nurse is business as usual.
i've been kicked, bitten, slapped, punched and threatened with knives, guns and an "attack dog" while in the course of taking care of patients. once i was in the center of an armed confrontation between law enforcement personnel who carried guns and were unhappy with their relative's care and hospital security personnel. the situation was resolved without formal charges, and the visitors were back the next day. another time, when taking care of a prison inmate who was dying i was nearly knifed by his son (also an inmate) with a homemade machete he'd smuggled out of prison and into the hospital. withdrawing care on the patient was illegal -- it would be shortening the convict's life sentence. the son was intent on shortening the life sentence, although it's unclear whether he was doing it to ensure dad was indeed on his way to hell or if it would have been a mercy killing. (i wasn't particularly brave. i had my back to the visitor and was tackled by a prison guard to get me out of danger while two other guards wrestled the son to the ground and disarmed him.) it's made me reluctant to turn my back on visitors.
in some states, threatening or attacking a health care worker performing her job is a crime on the same level as assaulting a police officer. not in our state. the visitors are free to insult, assault and batter nurses and then come back to visit. in one incident, a patient's husband threatened me and another nurse with a handgun at 6 pm. it was 9pm before the police were notified, and midnight before the visitor -- who was in plain sight the entire time -- was in custody. he was back visiting by 6 am. our manager, bless her heart, wasn't concerned about the gun-toting husband because "he's from texas. everyone carries a gun there."
we need stiffer penalties for attacks on nursing staff, managers who will stand up for us and a visitor's code of conduct prominently posted in hospital entrances and waiting rooms and strictly enforced. (metal detectors and locked units would be nice, too, but i'm not holding my breath.) and we need it sooner, rather than later.
If your job allows that you need to find a new job. All hospitals are not that way and if they have to find new staff because of it yours won't be either. Have you talked to management about it? Who have you talked to? I don't know you personally of course but i see a lot of people who will complain about things like this every day and never tell anyone who can do something or do something themselves to change it. And it's different at all hospitals but still you need to do everything you can an if thy doesn't work go somewhere else. At my hospital if a nurse is assaulted we press charges is at all feasible (ideally the situation is dealt with before it would get to that point but obviously that doesn't always happen.
Kim, I think this is the best post in this thread. That is the best, bottom-line advice I have read. If one continues to work at a place that won't address violence issues and violence has happened to you, if you stay there, it's on you. You know it happens, no one did anything to fix it, and you stay .... sounds like an individual abuse situation. Staying means you condone violence if you have gone through the appropriate channels and it's not addressed. You can moan about it all you want, but staying means you are willing to risk being a victim again.
Disparity in reporting is a reality as evidenced in post #19.
The unfortunate reality in this fact can be attributed to sales revenue (money), and that is simply the way it is.
The issue for us is our personal safety and that of our patients and visitors in these public buildings. What we can do as Nurses, is advocate for effective prevention of such increasingly common events. Effective prevention taking the form of discovery and seizure of weapons in all public buildings as opposed to armed security as a deterrent.
I have to disagree with this proposed solution to increase workplace safety.
'Effective prevention taking the form of discovery and seizure of weapons in all public buildings': I believe to 'advocate' for the disarming of all for the hope of safety will lead to more violence, not less and is thus a disservice to the goal of safety. Not to mention I think it's morally repugnant to seize a weapon from a free person.
This is a simplistic solution to a complex problem that removes the best answer to predatory violence and that is protective violence. Yes, violence can be good, remember, the police one calls to handle an active shooter such as the subject of this thread are in fact prepared to commit the worst kind of violence. There are many other legal weapons in society other than police related, why place barriers between them and a potential threat.
'as opposed to armed security as a deterrent': There cannot be enough armed security and generally, I believe a person that is determined to commit harm and arm himself is at least capable enough to slip past that obstacle. Reaction is always slower than action and help is only minutes away when seconds count. (That's an old one but very true.) Also, the true deterrent to such violence is not the visible resistance to a planned attack, it's the unknown that prevents it. Violent crime is down in the US consistently since the passing of concealed carry laws in 48 of the 50 states. Criminals are unsure who is armed therefore confront fewer victims for fear of encountering an armed one.
As health care workers we are not trained combatants, we control things, things don't control us. WRT Violence, We tend toward the Feel safe rather than Be safe solution of No Weapons signage to feel safer at work. Fact is, weapon free zones are only free of legal weapons as those inclined to commit violence with them are the same people inclined to disregard posted areas. That help we holler for has been attenuated when we post a sign making a rule only you would follow. Why prevent a trained and proficient co-worker or a visitor from intervening if they choose to? I believe the reason is based on hoplophobia and dealt with by the defense mechanism of projection. that we fear what we cannot control may be the root of the issue..
Please keep in mind, this post is not intended to diminish the good intentions of the offered solution, just my opinion based on ~20 years of Hospitals from the ER to the Helipad and all floors in between, once being injured by a deranged family member and being cased for mugging twice.
Workplace security is a concern for me as a manager and it does not include futile No Weapons rules.
Highlights of the Bureau of Justice Statistics Special Report on Violence in the Workplace, 1993-1999
An average of 429,100 nurses per year reported that they were victims of violent crimes in the workplace, predominantly assaults.
The rate of workplace violent crime victimization for nurses (21.9 per 1000 workers) was not significantly different from that for physicians, however, nurses experienced workplace crime at a rate 72% higher than medical technicians and at more than twice the rate of other medical field workers (9-13 per 1000 workers).
Our main station was basically unlocked and unprotected in the evening for years. We complained to management over and over. now they have keypad entry. they promise keyless badge entry soon but its a start.
Highlights of the Bureau of Justice Statistics Special Report on Violence in the Workplace, 1993-1999
An average of 429,100 nurses per year reported that they were victims of violent crimes in the workplace, predominantly assaults.
The rate of workplace violent crime victimization for nurses (21.9 per 1000 workers) was not significantly different from that for physicians, however, nurses experienced workplace crime at a rate 72% higher than medical technicians and at more than twice the rate of other medical field workers (9-13 per 1000 workers).
Thank you for that advice but does minimum force necessary, whatever that means, apply only to nurses? We're not talking about hitting a man when he's down. As far as the law goes one is allowed to use the maximum force necessary to protect life and limb and that of others. Can you imagine someone attacking another nurse with a knife or a gun and one has to decide how much force to use? You move towards a police officer with a pocket knife and you're dead. So why are we held to a higher standard? I guess because we've been trained in Israeli martial arts at nursing school. I'm practicing my karate moves with my fingers right at this moment on the keyboards. Self-preservation first, I say.
I think I can take a stab at this one. (Punny:clown:)
As non trained persons we have no escalation of force rules when defending ourselves and are not held to a higher standard. The concern will be from an evaluation of the aftermath by the police and possibly a DA. They will evaluate and determine if what you did was reasonable for the circumstance. In any case you may be the subject of a grand jury and that will not be a good day. Deescalation and conflict resolution are better tactics If possible.
The trained person is held to the higher standard on EOF. Police can kill for the above mentioned knife but generally when ~21', that's the distance a knife can be used to kill before you could draw a firearm and use it to stop that threat. Lookup:Tueller drill or the Tueller Rule. They will not shoot someone holding a knife while on the other side of a glass door. They will for a gun though... see?
AFIK, If someone was being attacked with a knife, that's deadly force and a reasonable person can use whatever force up to and including deadly force to defend another life.
As I live in the UK, the stats that come up first are for the UK, so apologies if they are not directly relevant to the US.
http://news.bbc.co.uk/1/hi/scotland/525509.stm - this article cites 1 in 10 health professionals will face violence in the workplace, and 7 national health service workers per 1000 are attacked each month. THe percentage is higher for certain areas of work.
http://www.nhsbsa.nhs.uk/3013.aspx - The Security Management Strategic business unit of the whole National Health service reports "In 2008/09 there were 54,758 reported physical assaults against NHS staff in England. This is a reduction of 1,235 compared to the previous year. There were 941 criminal sanctions in cases of assault, compared to 992 in 2007/08."
- hardly the 'zero tolerance' policy they preach, I think.
http://www.nhsbsa.nhs.uk/2948.aspx - breaks it down further - 11,088 against staff on acute wards, 1240 agains ambulance staff, 38958 against mental health or learning disability staff and 3472 against people in primary care settings (GPs, etc).
Number of employees in the NHS - about 1,432,000, so 54758/1432000 = 0.038 assaults per person per year, or almost 4 staff in 100.
That's just the ones that people file an incident form about.
This is a publication that separates out violent threats and physical abuse and verbal abuse, saying that the most common assualts were actually against doctors, particularly in A&E (i.e. Casualty or ER), in the sexual health clinic, and mental health units. Also receptionists and complaints advisors came in for the most verbal abuse.
Sorry, I've going to leave it there for research - hoped to find some US figures, and some breaking the assualt figures down by profession, but I got distracted and now have to go and make dinner! Maybe someone else will be able to find some other stats.
I don't know if younger generations have heard the old saw regarding what's news. "When a dog bites a MAN, it's not news. When a MAN bites a dog, it is news."
Threats aren't newsworthy, shootings are. Journalistic priorities aside, the matter raised has validity. It would be very interesting to gather data about the number of female nurses vs the number of male nurses who receive threats, and what the differences are, in regard to who reports those incidents to authorities.
Hospital administrators are known to avoid adverse publicity, which the receipt of threats is. If you are threatened, even once, it is prudent (especially for a nurse who is supposed to care about her colleagues and a healthy milieu in general) to report to those who can do something about it. Nurses and security personnel are employees of the hospital, which costs their facilities money. Doctors bring in money (their insured patients). When it comes to action, it all comes down to money (which one can see clearly during these restrictive times).
Doctors usually have much more money, therefore greater social status and seeming value than nurses. While the incident at John Hopkins was as horrific as any other murders have been, there was the picture one got, of a powerful person being taken down by an obviously angry individual whose ire wasn't necessarily valid. We'll never know what his actual relationship with mom was, but conjecture can be fairly accurate, since he killed her after maming her doctor.
Can you see a man (who may have been the victim of long parental abuse) being told by his mother that he shouldn't have shot her doctor (if he told her that)? It didn't seem to me that he was capable of thinking that he was saving her the pain of a terminal illness, in his rage. Killing her may have been a longtime agenda, which he decided to do then, just before killing himself. That was the time to do it, his sick mind may have determined.
I don't think any of us can doubt the emotional instability of a trigger-happy someone who brings a hidden weapon into a hospital, with the intention to use it (or bullets would have been taken out of it). He may have needed to blame someone, and the doctor may have become the target, if his communication skills weren't totally empathic. We don't know if he'd had previous discussions with the son, during which he could have assessed the son's mental health.
However the nurses may have seen the son many times, been nice to him, and therefore weren't targets. Having been a nurse for 50 years, I can say that I've never been threatened by a hospital visitor or patient; and when I did Home Healthcare, I've been in "crack" houses, gone solo into dangerous housing "projects" without a qualm (silly me), and talked down some pretty angry and derranged characters. My first time participating with irrational visitors was as a student, when a young maternity patient died, and her relatives and friends created mayhem in the expensively appointed lobby of the hospital, in the "dark ages" of the late '50s.
A call to our nurses' residence demanded (not a request), that we report immediately to the lobby, after picking up syringes at central supply (glass syringes - nothing was disposable then), and vials of phenobarb were there, to place 1cc of that depressant in the syringes. No written doctors' orders or names of the recipients of the injections were given.
We did as we were told, and grabbed the arms of those expressing their grief inappropriately, and inject the meds therein, to allay their destructive actions. Although it took time for the sc or I.M. med administered (IV injections of meds at that time were hardly ever given), to have effect, some immediate restoration of calm occurred, since just the act of being given a medication for their comfort had a soothing effect on these careening folks. We were telling them that it was for their good, and it would help their grief (explaining the procedure to the patient).
Not one complaint of assault or inappropriate action was received afterward, which actually amazed me. I wasn't sure that the most appropriate action had been taken. Knowing the caliber (not of the gun) of the security "guards" I've known at hospitals, I think they would have been the last helpers I would have contacted although the protocol requires that they be called. Even in the many incidents wherein such wannabe cops participate in TV programs, their abilities have correctly been presented as not too helpful. What they can do, is call for outside help which we can do at least equally well. We're afraid to do that lest it reflect poorly on us and the facility, though.
Hindsight (especially now) being 20/20, I know that the need so many years ago was for grief consultants, not nurses armed with syringes. After all, that is now regarded as a means of chemical restraint. In today's world everyone would have been sued royally. I also realise that the incident bestowed a sense of sureness and authority for me, about the way I comport myself professionally.
That has stood me well in all my years performing nursing tasks, and also imprinted the "inform the patient of the procedure" (in a way that is readily understood by that individual). The latter point was learned in the Public Health Nursing courses I had, when "Education for Adults" was accentuated.
I do wonder what might have transpired at Johns Hopkins if nurses had spoken respectfully and supportively much earlier about her doctor, to the son regarding his mother. Knowing the history of her condition, might we have inferred to him that her condition wasn't looking good? That might have lessened the sudden impact of that information, and made it more familiar. Well, we may never learn how that situation could have been ameliorated, but hopefully its legacy will be more thoughtful communication practices and detection of early warning signs of aberrant thinking of mentally ill visitors.
Specializes in psychiatric, UR analyst, fraud, DME,MedB.
the shootings at the johns hopkins hospital made national news. maybe i'm cynical, but i think it was because a doctor was shot. news reports say that dr. david cohen was updating the patient's son about her condition, and the man was increasingly unhappy with what he was hearing. after threatening to jump out of a window, he pulled out a gun and shot the surgeon in the abdomen. he was taken to the er -- and whoever went and removed him from the scene is certainly heroic! -- and then to surgery. latest reports are that he is doing well and expected to make a full recovery.
the visitor shot his mother and then himself.
this may seem like an isolated incident, but really it's just a progression of what we nurses put up with on a regular basis. shooting a doctor makes the news. threatening to shoot the nurse, even if you're armed and dangerous, does not. decking a doctor makes the news. beating up on mother's nurse does not. threatening a doctor gets attention; threatening a nurse is business as usual.
i've been kicked, bitten, slapped, punched and threatened with knives, guns and an "attack dog" while in the course of taking care of patients. once i was in the center of an armed confrontation between law enforcement personnel who carried guns and were unhappy with their relative's care and hospital security personnel. the situation was resolved without formal charges, and the visitors were back the next day. another time, when taking care of a prison inmate who was dying i was nearly knifed by his son (also an inmate) with a homemade machete he'd smuggled out of prison and into the hospital. withdrawing care on the patient was illegal -- it would be shortening the convict's life sentence. the son was intent on shortening the life sentence, although it's unclear whether he was doing it to ensure dad was indeed on his way to hell or if it would have been a mercy killing. (i wasn't particularly brave. i had my back to the visitor and was tackled by a prison guard to get me out of danger while two other guards wrestled the son to the ground and disarmed him.) it's made me reluctant to turn my back on visitors.
in some states, threatening or attacking a health care worker performing her job is a crime on the same level as assaulting a police officer. not in our state. the visitors are free to insult, assault and batter nurses and then come back to visit. in one incident, a patient's husband threatened me and another nurse with a handgun at 6 pm. it was 9pm before the police were notified, and midnight before the visitor -- who was in plain sight the entire time -- was in custody. he was back visiting by 6 am. our manager, bless her heart, wasn't concerned about the gun-toting husband because "he's from texas. everyone carries a gun there."
we need stiffer penalties for attacks on nursing staff, managers who will stand up for us and a visitor's code of conduct prominently posted in hospital entrances and waiting rooms and strictly enforced. (metal detectors and locked units would be nice, too, but i'm not holding my breath.) and we need it sooner, rather than later.
really , i do not understand why they do not have a security in hospitals...lots of people in grief or crazy that could just walked in and out! the security should also be for the patients safety as well as the employees. the law is the law ...you touched someone, it is battery, no matter how you look at it. they need a metal detector, and security people in the hospital since this is considered a frail and open area to all. anybody could walk in a hospital, anybody without any proper identification ! now that is scary.
the hospital administration can only think of "business" and kiss a.. instead of protecting their staff. but you know what , they will think differently when there is a time where somebody walks in a hospital , goes to a room and shoot or kill a patient ............if i am the family of that patient , i will sue the hospital for allowing an unsafe environment such as this situation .......then the administration will sing a different tune!
it is sad that we mostly change things for the better ...after the fact!
Specializes in med surg, cardiac step down, rehab, geri.
in reply to you really? where are they I am going to take the high road on this and think you are really asking for the information not being sarcastic google violence against nurses and read them
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
i do wonder what might have transpired at johns hopkins if nurses had spoken respectfully and supportively much earlier about her doctor, to the son regarding his mother. knowing the history of her condition, might we have inferred to him that her condition wasn't looking good? that might have lessened the sudden impact of that information, and made it more familiar. well, we may never learn how that situation could have been ameliorated, but hopefully its legacy will be more thoughtful communication practices and detection of early warning signs of aberrant thinking of mentally ill visitors.
i hope you didn't mean for this paragraph to come across as blaming the johns hopkins nurses for the physician getting shot. but that's exactly how it sounds. if the nurses had . . . . . might have lessened the sudden impact of that information . . . .
or it could have gotten a nurse shot instead. probably not as bad as the publicity from shooting a doctor.
really , i do not understand why they do not have a security in hospitals...lots of people in grief or crazy that could just walked in and out! the security should also be for the patients safety as well as the employees. the law is the law ...you touched someone, it is battery, no matter how you look at it. they need a metal detector, and security people in the hospital since this is considered a frail and open area to all. anybody could walk in a hospital, anybody without any proper identification ! now that is scary.
grandmawrinkle
272 Posts
Kim, I think this is the best post in this thread. That is the best, bottom-line advice I have read. If one continues to work at a place that won't address violence issues and violence has happened to you, if you stay there, it's on you. You know it happens, no one did anything to fix it, and you stay .... sounds like an individual abuse situation. Staying means you condone violence if you have gone through the appropriate channels and it's not addressed. You can moan about it all you want, but staying means you are willing to risk being a victim again.