Do No Harm Must Also Apply to Healthcare Professionals

I remember when I was first allowed to go to a hospital. My favorite elderly aunt was dying, and my mother took my sister and I to visit her. Before we got out of the car, she told us, "Now, I want you to remember that this is a hospital. The people are sick, so be quiet and be on your best behavior." She then explained that the doctors and nurses had to concentrate on helping patients and did not have time to deal with misbehaving children. We both were so careful to speak softly and mind our manners. While I remember saying goodbye to the beautiful soul that had nurtured me as a child, my Aunt Mary, the memory that stayed with me and ultimately led to my choice of career was the quiet but bustling nurses' station full of white-clad women with matching caps on their heads. They moved effortlessly from room to room, offering care and delivering treatments. To me, they looked like angels. Additionally, patients and families seemed so grateful for each interaction with the doctors and nurses. There was a palpable, open display of respect and reverence for these people, and I knew I wanted to be a part of this exchange of caring and appreciation. My aunt died that day. I was ten.

Things have changed. According to a 2018 Bureau of Labor Statistics fact sheet on workplace violence, healthcare and social service employees experience the highest rate of injury caused by workplace violence and are five times as likely to suffer a workplace violence injury than workers overall. A recent study by National Nurses United found a frightening trend of "countless acts of assault, battery, aggression, and threats of violence that routinely take place in health care settings." Unfortunately, these disruptive behaviors by patients and family members have increased worldwide. The World Medical Association has most recently declared violence against healthcare workers as "an international emergency that undermines the very foundations of the health system."

Of note, while organizations often encourage staff to report such incidents, these violent acts continue to be vastly underreported. Recent information published by the Occupational Safety and Health Administration (OSHA) highlighted the fact that a healthcare professional's training and perceived ethical duty to "do no harm" may be key deterrents to reporting the aggressive acts perpetrated against them. Other factors included: feeling that experiencing violence is part of the job, recognizing that some injuries caused by patients are unintentional and therefore accepting them as routine or unavoidable, and unwillingness to stigmatize perpetrators due to their illness or impairment.

One recommendation by the Joint Commission is for leaders to focus on a safety culture that includes a robust employee safety program, encouraging reporting of workplace violence by patients or visitors, and supporting involved staff members. Some organizations "flag" violent patients and/or family members to alert staff and address safety concerns for both scheduling and treatment purposes. Others are even urging staff to press charges against perpetrators when appropriate.

Across the country, dozens of states now have laws that punish violence against healthcare professionals. Alaska, Hawaii, New York, and Utah have penalties for such assaults and may prosecute these crimes as felonies. North Carolina expanded its felony criteria from assaults against "emergency department personnel" to assaults against any "hospital personnel." In Tennessee, assaulting a healthcare professional has similar penalties as attacking a police officer, including substantial fines. Since 2014, California hospitals must report all assaults against healthcare workers and develop an effective violence prevention plan or face penalties up to $25,000 for the first offense and $132,765 for repeated violations.

Although organizational support and appropriate laws are welcomed, I still mourn the loss of an era of civility and respectful treatment of the people we recently called "heroes." It is my hope this will soon be the norm once again.

Joann Wortham, RN, MSN, JD, is a senior risk management consultant and workplace culture expert.?