Your examples are inappropriate. If I startle a sleeping patient, I am rolling the dice. That was my choice not to wake the patient and therefore not allow them the opportunity to refuse care they possibly did not want.
Active shooter events are something different. Want to stop that, then medical facilities need metal detectors at every entrance, just like courts and airports.
In addition, we cannot "stop the violence" because ultimately we are unable to exercise control over the behavior of our patients and their family members. People control their own behaviors. A better example would have been, a nurse told a patient in the ED that the provider is not going to order Dilaudid. The patient then takes the call light and hits the nurse with it and says "I'll kill you".
However, it is important to call out the fact that there is a small subset of patients whom we care for who choose to abuse and assault staff on a repeated basis. It is this specific portion of the patient population who need to be flagged, tagged, followed and ultimately charged.
We can, via legislation, force employers and the general public to take notice that assaults against medical staff are not going to be tolerated by medical staff without repercussions for the institutions who employ us and the public we serve. I believe this would cause a shift nationally in the culture of violence against medical staff.
Legislation doesnt work? OK so there are "Magnet" hospitals. How about hospitals that attract staff with the additional benefit of "Staff Safety" certification. This could be an independent certification organization (just like Magnet) requiring an institution to implement certain policies, teams, and protocols to earn a Staff Safety rating and designation. Throw the metal detectors in with this as a certification requirement. I know where I would choose to work!
Independent nonprofit certification aside, nothing really has the permanence of legislation. The only way our employers are going to take this seriously is to have laws in place where the employer can be sued or fined when they dont follow the law. This is why employers are so afraid of OSHA.
1. FEDERAL LAW for specific criminal charges against individuals who assault on duty medical staff members of any kind. The state level is a mess, its different everywhere.
2. Outside and separate from criminal charges: enact federal laws that identify, track, flag and report individuals who perform or threaten assault against medical staff (just like the narcotics tracking systems). Once this individual is flagged, if they present for care in a medical facility, their flag displays and that medical facility is then under federal law required to provide a trained security officer escort for that patient as long as they are in the 4 walls of the facility. This could even roll up under OSHA.
3. Law for any facility giving short or long term admission to a patient including, dialysis centers, hospitals, SNF, LTACH, etc etc, where the patient is assigned a nurse who takes an admission of that patient, to have a Behavioral Safety Team (like Rapid Response meets Case Management, for behavioral safety issues). Patients who display behaviors that per the nurse's assessment make the patient a danger to the nurse or others, the nurse or physician can make a documented referral for that patient to Behavioral Safety Team. Example, patient who is yelling for ice water every 5 minutes but who is cooperative when redirected, no. Patient who throws ice water on a nurse, bites a CNA, or threatens to kill a physician can be submitted for admission to the Behavioral Safety Team. Then it is the responsibility of the facility to create a care plan for staff safety at the confluence of the patient's psychiatric, medical, purely behavioral, and criminal presentation. Nursing is removed from the inappropriate responsibility of having to diagnose behavioral disorders on the fly when the individual displays a history of dangerous behavior directed at staff. If the patient is discharged and later readmitted, and were admitted to Behavioral Safety service prior, Behavioral Safety automatically receives a consult and performs a new assessment each time the patient is readmitted. Behavioral Safety Team needs to contain a psych eval and is responsible for diagnosing whether the patient is competent to be accountable for their behaviors, or not, and Behavioral Safety must care plan accordingly.
What mentally competent, abusive patient is going to show up to a Staff Safety-rated emergency room with metal detector, a federal law in place against assault, and a Behavioral Safety Team who at the first threat or assault, ready to slap a security escort on them and assess them to be forever flagged? Either they will behave appropriately, they will leave voluntarily when they realize they will not be allowed to abuse staff, Behavioral Safety will discharge them for safety reasons, or they will assault someone and suffer federal charges. And society will get the message.