By Dorothy Brooks
Fed up with the continuing incidence of violence directed at healthcare workers and the dearth of resources needed to properly care for patients with mental health concerns, the American College of Emergency Physicians (ACEP) and the Emergency Nurses Association (ENA) are urging Congress to pass legislation they believe will take aim at these long-intractable problems.
The Workplace Violence Prevention for Health Care and Social Service Workers Act (H.R. 2663 and S. 1176) would instruct the government to require healthcare and social service organizations to develop and implement comprehensive workplace violence prevention plans that will provide safety for patients and healthcare workers. The Improving Mental Health Access from the Emergency Department Act (S. 1346) would establish a grant program that provides resources to EDs to develop care models for connecting patients in mental health crisis with resources in the community. The legislation would strive to expand access to inpatient mental healthcare and alternative care settings, thereby relieving strain on EDs.
Speaking at a news conference in Washington, DC, on May 3, ENA President Terry Foster, MSN, RN, CEN, CPEN, CCRN, TCRN, FAEN, said the threat of violence against healthcare workers compromises the ability of emergency nurses and the entire emergency team to deliver the highest-quality care to each patient. “Violence has left us with physical and psychological scars as emergency nurses, and it is forcing many to leave their jobs,” he said.
Foster also said while the mental healthcare crisis is evident in EDs, there is a lack of resources to provide patients struggling with mental health concerns with the proper treatment or to place them in a setting where the right care can be provided. In turn, this leads to long wait times for patients and boarding problems in the ED.
Also speaking in favor of the legislation at the news conference was Christian Stone, BSN, RN, CEN, an assistant nurse manager working in the ED of a small community hospital in the Washington, DC, area. He described a frightening incident that occurred one evening last year while he was working in the ED.
“Security alerted me that a patient was overdosing in the parking lot, and somebody had just dropped the patient off,” he explained.
Staff stabilized the patient, but the person began wandering around the unit two hours later. Stone directed the patient back to his room, and he did not seem to be aggressive — at first. “Suddenly, I found myself shoved into a corner and I was getting a bite taken out of my shoulder,” Stone related.
Fortunately, another nurse saw what was happening, dashed into the room, and pulled the patient off Stone — but not before the patient put his hands around Stone’s neck and squeezed. “I remember talking with other nurses on the unit, and everyone’s attitude was not to waste your time pressing charges. Nothing is going to change. Nothing is going to get done. It is a waste of time,” Stone said.
However, the next morning, Stone said he did go to the courthouse to press charges against the patient to demonstrate to his colleagues that workplace violence is not acceptable. “We have to talk about it, and we have to stand up for each other before it is too late,” he said.
Dan Nadworny, DNP, RN, FAEN, president of the Massachusetts ENA and a nursing director in the Boston suburbs, spoke about how the mental health crisis is affecting patients and staff in the ED.
“When patients come forward and are honest and vulnerable [about their mental health concerns] ... they are lost to a fractured system that lacks open access or community support,” he shared. “In our EDs, we are seeing the result of this fractured system. We see patients in crisis. We also see patients out of their frustration of having no other option but to seek care in our EDs.”
Nadworny said it is unfortunate these patients wait for days, weeks, or even months for the next step of care. “There is a lack of providers, a lack of behavioral health hospitals, a lack of technology, and a lack of investment in mental health,” he said. “The same passion that we have for other diseases [makes it] challenging for us as emergency nurses to come in each day and see the same patient sitting and waiting, sometimes in the hallway, for days on end.”
Nadworny said legislation aimed at improving mental health access to EDs is a step toward connecting patients with the care they need. “It’s our responsibility to advocate for these patients,” he said.
Speaking on behalf of ACEP about how the mental health crisis is affecting emergency care, Ryan McBride, the organization’s congressional affairs director, said EDs have been pushed past the breaking point. “Patients are waiting even after they have been stabilized and treated because there’s simply no place for them to go to receive the important follow-up care they need and deserve,” he said.
Regarding violence, McBride noted emergency physicians and nurses have experienced rapidly escalating rates of threats and assaults in the workplace.
“This contributes to the growing dissatisfaction and burnout, leading to more of these dedicated professionals leaving the healthcare workplace,” he said. “We can’t accept these conditions as just part of the job. We wouldn’t accept this in any other workplace, and we can’t accept it in the healthcare setting.”
Other efforts to address workplace violence in healthcare settings is occurring at the state level. Most recently, Georgia lawmakers passed a law that boosts penalties for people who commit violence against healthcare workers. The legislation also enables hospitals to create their own police departments using certified law enforcement officers. The bill, which goes into effect on July 1, was signed into law the first week of May, the same week a gunman opened fire at Northside Hospital Medical in Atlanta, killing one person and injuring several others.
RESOURCE
• American College of Emergency Physicians. How safe is your workplace? Checklist for assessment.
The threat of violence against healthcare workers compromises the ability of emergency clinicians to deliver the highest-quality care. Meanwhile, there is a lack of resources to provide patients struggling with mental health concerns with the proper treatment or to place them in a setting where the right care can be provided.
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