Introducing #SilentNoMore

What happened the first time you witnessed or experienced an assault in the workplace?

Introducing #SilentNoMore

Warning: graphic content contained in the beginning of this article. To avoid it but still read the main part of the article, scroll to below the quote box.

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Jessica went to work, like any other day. It was Thanksgiving of 2016. She worked as a psych tech in triage at a walk-in clinic connected to both inpatient and outpatient services. It was a special time for her family. She just found out two days prior that her 6-year old was about to have a baby brother. She was nineteen weeks pregnant.

No other techs were scheduled to work with her that day, probably due to it being a holiday. Jessica received only one patient in the morning: a male who had been previously assessed and sent home the day before. His discharge had included instructions to come back if anything got worse. He decided to come back, and he brought his father. They waited for paperwork to be completed and for him to be admitted inpatient. During this wait, the crisis worker assigned to the patient stepped out of the office to get something to drink, leaving Jessica alone.

This is when the patient began to stab Jessica 105 times.

When he began the attack, Jessica attempted to reach a phone to call for help. He grabbed her and threw her to the ground instead. At one point, he stepped back to look her over, as if in surprise - how had she not died yet? Jessica was taken over by a mothers' instinct and her military training, which told her to curl into the fetal position. She knew to protect her baby and her vital organs. Jessica screamed for someone to call 911. The patient's father called, and the stabbing continued.

Police arrived, and they ordered the patient to drop the knife. The patient resisted all commands. When it became apparent he was not going to stop for anything, they shot him. His lifeless body fell to the floor next to Jessica. The assault ended.

EMS transported Jessica to the ED, where she was stabilized and transferred to a trauma center's ICU for eight days. She then spent two weeks closer to home for rehab. Her injuries were extensive. In addition to scars that cover her back, neck, head, and face, she is blind in her right eye. Her spinal cord had been severed, leaving her with inability to feel one side of her body and inability to feel temperature on the other. Other motor and sensory deficits remain.
When she describes the injuries that still affect her, she says they are too numerous to list. Her physical and mental health have prevented returning to work. She remains in intense physical therapy. She hopes to see things get easier, but understands the injuries that still remain are permanent.
One incredible miracle, besides Jessica herself, is her son. He was born full-term, months after the attack, and turned two last month. She has relished in this time they have had together. Of course, that isn't always easy. The road to recovery has been long and arduous. There is still far more to come.

{End of graphic content.}

You’ve probably noticed that violence happens a lot where we work. Healthcare, in general, has the highest incidence of non-fatal workplace violence out of any other industry (almost combined), including law enforcement. In Jessica’s case, psychiatric technicians and aids are at a higher risk of violence than any other role. Data gathered by BLS paints a grim picture of what we face when we go to work: it is dangerous there. In state-run hospitals, assault is the number one cause of injury requiring time away from work. In private and local hospitals, assault is the third leading cause of injury leading to time away from work.

Let’s bring this back home, though. The statistics are staggering. The evidence is there. We know this; we’ve experienced this.

Let’s talk about what is right in front of us now. Let’s talk about YOU.

Have you experienced violence while working in healthcare? What happened the first time you were assaulted at work or witnessed violence? Was it the patient who assaulted you? Were you injured? Did you contact the police?

How well were you treated by your employer after? Did you receive workers compensation? Did you take time off?

More importantly, how are you? Have you healed? Not just physically, but psychologically — are you better now?

I am Angela, and I am the National Director of Silent No More Foundation. We are working on elevating this conversation in meaningful ways. We hope that by being #SilentNoMore, we can build a movement that ensures violence is actively prevented, the severity of assaults are reduced, and the victims receive adequate support and protection from employers after. This is our first of hopefully many posts and articles to come. We’re looking forward to getting to know you all!

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Silent No More Foundation

About Silent No More Foundation

Silent No More Foundation is on a mission to protect healthcare workers before, during, and after an assault in the workplace through education, awareness, and legislation.

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Specializes in Primary Care, LTC, Private Duty.

I forget my very first time, but the message has consistently been the same from my coworkers AND superiors: "It happens, you knew what you were getting into when you chose nursing [especially in my first couple of years after licensure], suck it up, and get over it". Something needs to change drastically, but if you try to speak up then you're labeled a "problem".

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That story is horrifying. Working primarily in NICU and peds, I feel fortunate that I've had minimal exposure to workplace violence.

I do wonder: as nurses, is it ever really possible to avoid the risk of violence? I understand that leadership and admin could do a lot more to back up nurses against patients who chronically assault staff. The situation described above could have been ameliorated (although perhaps not entirely prevented) with improved security and more staff. However...

It seems as though there will always be a certain subset of patients who are violent (especially within the dementia and psychiatric crisis populations). No matter how supportive admin is, those patients will still exist, and they'll still require hands-on, up-close-and-personal care. It's like being a lion-tamer and asking how you can protect yourself with absolute certainty against a lion attack.

I think of my own grandfather who had Alzheimer's. He was an incredibly kind, thoughtful, decent guy throughout most his life. Unfortunately, through his disease progression, his mind deteriorated while his body remained surprisingly limber and strong. We had to move him to a SNF once he started wandering out of the house. Every day he needed to be bathed, and every day, he'd yell and kick and swat at the staff. Like I said, he remained surprisingly strong; I'm sure his actions put people's personal safety at risk. As sad as it makes me feel, he probably injured some of his nurses and CNAs. And if he were of sound mind, I'm sure he'd be horrified by his actions.

Unfortunately, I'd imagine that there are tons of patients and nurses in our country who face that exact same predicament. In cases like my grandfather's (as well as other dementia and certain psychiatric patients), is it even possible to provide quality care while keeping staff safe? In practice, what does that look like?

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This is so sad that we as RNs passionately to help others have to go true nightmares...

I worked 9 months in a hospital and decided to quit not because of the patients but because of coworker's and management; they were extremely unprofessional, bullies and rude; i had a ex coworker who one morning decided to start pulling and pushing the reclining chair that the patient was going to use for the treatment just because i said that the patient port was in the opposite side of the chair; let me tell you it was 6am and the patient's parents were scared because not only that ex coworker was pushing and pulling, loud words were coming out of the mouth. I reported it and they didn't do absolutely nothing. I got stuck in a harassment scenario were i reported as well and nothing was done. I decided to quit.

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Specializes in critical care, med/surg.

Fortunately I have never been involved with a physical assault other than the ETOH withdrawing Veteran or Alzheimer dementia patient. As a male in the profession I have that advantage but the facts remain, nurses and tech and everyone in healthcare at the bedside is at risk. Once the ICU's opened up I expected to see more violence perpetrated what with all the addicts now, constant shootings, revenge attacks etc. Security needs to be more present and yes, allowing staff to conceal carry are options in my opinion.

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Specializes in ICU, trauma, gerontology, wounds.
On 5/18/2019 at 6:47 AM, adventure_rn said:

Unfortunately, I'd imagine that there are tons of patients and nurses in our country who face that exact same predicament. In cases like my grandfather's (as well as other dementia and certain psychiatric patients), is it even possible to provide quality care while keeping staff safe? In practice, what does that look like?

While we may never eradicate violence in the health care workplace, that is not a reason to give up. Nurses deserve good security in our workplaces. We deserve the right to prosecute patients and visitors (and coworkers) for assault. We deserve administrators who listen to our concerns. Violence should not be "just part of the job," yet most nurses I speak to have experienced it.

What it "looks like" to me is: support from managers to engage in self-care after an assault (no matter how severe the physical injury), a policy to ensure no nurse is ever left alone with a potentially dangerous person, and rapid responses from security personnel when a nurse calls for help.

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I work in home care, and my agency (I just started working for them) sent me to the home of a mentally ill man they knew had issues with women in the past. I went in and he was wearing a black outfit, and had a huge pentagram around his neck, I didn't see it at first, I'm so busy, I didn't notice until I came in and realised he blacked out the windows and turned off all the lights. I turned on my phone light and saw this flouridly psychotic man. I have many years in hospital psych, so I knew he was dangerous and also had been waiting for me and preparing. I used my best skills and asked him about his thinking and gave him and opportunity to tell me what his deepest thoughts were (again, using my skills to depress my anxiety and appear calm). He had delusions he was satan, and he was fighting the christians. I could only think of how the day before I was in a store and saw a cute pair of earrings with a cross on the bottom. I love wearing crosses, although I consider myself more spiritual than religious. I do believe if I would have bought those earrings he would have murdered me that day. He locked me in with a deadbolt and chain, and it happened so fast you know, nurses are supposed to see these patients and not complain. I did actually ask if I should go since the man had c called me a bunch of times after I scheduled the visit. He was huge, towering, and I found out later that he's been in and out of inpatient. They closed the state hospitals and my mom and dad were both clinicians in them when they did that. I always remember how it was supposed to be better, but in the end, these mentally ill people who need more care just ended up being streeted and then sent home. My concern is he will kill someone eventually, as he is playing with the idea by: goating nurses, locking the doors, blacking out the windows, unscrewing the lightbulbs. This was all intentional, and it's how people build to a point where they do finally kill and murder someone. He thinks he's satan. He tells me he shouldn't be honest about what he wants to do. And yet, this man is sitting out there, after I call everyone and his family, his social worker, the police, they already know, and will do nothing. It's because of the poor care, the lack of funding, and honestly, advocates that wanted better realities for people like this also went into the groove of closing state hospitals. My fear is he will end up in psychiatric prison, once he finally kills a nurse.

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Specializes in New nurse, nursing assistant 5 years.

Just punched at work the other day trying to pass meds. I shrugged it off because unfortunately alot of my jobs have had a certain amount of violence. In my mind I know people who have had it worse and I have never felt like my life was in danger. My heart goes out to the nurses that work in areas with high incidents of violence. This issue definitely needs to be addressed.

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Specializes in Home care, assisted living.

In early 2006 I was sucker-punched by a resident in assisted living.

He had recently moved into our facility from another country and spoke no English. He had dementia and a past history of violent behavior. Our managers figured the Spanish-speaking staff could translate for him on whatever shift we were on. At the time there were none for overnight shift and the first night he was there he pinned my coworker into a corner and tried to break her wrists. That night we had to call 911 because he was combative and trying to attack us both. Again, managers were clueless. Thought we should hide all night from him.

One day (by this time I had moved to day shift) I was assisting him in the bathroom, and he just looked at me--and his fist FLEW. Popped my lip open. I reported this to management, filed a report and went to the ER (because it was a Sunday and the only place accepting Worker's Comp at the time. Doctor's offices were closed.) The ER staff called it an "occupational hazard" rather casually and patched me up. Lucky for me my teeth were intact. I went home and my employer picked up the ER tab.

The executive director visited him the next week in his room and concluded that "you can't read him". He could stare at you with blank eyes and then knock you out. He actually became afraid of him that day.

Shortly after this, the resident was evicted and his family was ticked off. But by this time, he had punched several other staff members before me. The others didn't bother reporting it because who cares, right? But I wasn't about to take it. (Even one of the Spanish-speaking caregivers, who blamed us because "you don't speak his language" got boxed in the ear by him after she said that.)

I hope I haven't shared too much information here, but this happens in assisted living, too. I don't work in one anymore, but need to make people aware that this happens.

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Specializes in ER OR LTC Code Blue Trauma Dog.

I've been through it all. Kicked, scratched, spit on, food trays and bedpans thrown at me, grabbed by the neck and shoved against the wall, sucker punched by crazy people on street drugs. ...You name it, I probably have a badge for that.

When reported, they always tell you the same thing in the end. The problem is always about "YOU" not them. They always shift the blame and say it was caused because you aren't properly trained to address and handle the situation blah..blah..blah...

After several nurses had similar encounters they gave us crisis intervention training as some kind of band aid solution. However, in the real world that training doesn't really stop violent crazy people from physically assaulting anybody though.

This sort of thing is nothing new. It's been going on with nurses for at least several decades now.

I would think more about why nothing has ever really changed in all that time.

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Specializes in LTC & Rehab Supervision.

Fantastic article, a very horrific read in the beginning as well.

As a CNA, I experienced this a bit, with the patients scratching, pinching, punching and no one bats an eye. The seasoned CNAs saw it as normal. I never thought it was okay.

As a new nurse, I hope I can put an end to workplace violence, or at the very least get CNAs/nurses to stand up for themselves. It's simply not right.

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