This op-ed was shared in several publications including the Raleigh News & Observer and the Charlotte Observer on January 27, 2022
Picture this: You’re a physician, nurse or other hospital staff member working a Friday night shift in a busy emergency department — where tensions often run high. Local law enforcement officers usher in a violent patient. He is placed in a room, evaluated and kept under guard for several hours.
Before it can be determined that the patient can be released back into police custody, he violently assaults a staff member, as well as the police officer guarding him. He grabs the officer’s weapon and threatens everyone around him. Shots ring out. Hospital police use deadly force to subdue the once patient, now assailant, and staff and patients flee.
This very scenario played out Jan. 14 in the Emergency Department at Duke University Medical Center. Violence in emergency departments and other hospital settings is growing at an alarming rate. Not just in large, urban centers but across the spectrum of healthcare facilities. VA hospitals, small rural hospitals and local community hospitals are not immune from such violence.
According to surveys by the American College of Emergency Physicians and the Emergency Nurses Association, almost half of emergency physicians report being physically assaulted at work, while about 70% of emergency nurses report being hit and kicked while on the job. Nearly 7 in 10 emergency physicians say their hospital reported the violent incident, yet only 3% of the hospital administrators pressed charges. So it is no surprise that 80% of emergency physicians say violence in the emergency department impacts patient care. To compound the problem, the COVID-19 pandemic has increased emergency department use by patients with behavioral health and substance abuse issues, pushing already resource-strained departments to the brink. Unfortunately, state and federal legislators have thus far done little to introduce legislation to prevent such violence. Often focused on “punishment” in the aftermath, no current legislation empowers hospitals to take the necessary measures to prevent violence in the first place. Simple measures such as requiring metal detectors at hospital main and emergency department entrances have proven to be effective as a first line of defense.
Sadly, some hospital administrators feel this promotes a negative image to their “clients,” although multiple studies have proven the contrary. Certainly metal detectors do not seem to deter anyone from attending a sporting event! Fortunately, groups like the American College of Emergency Physicians and Emergency Nurses Association continue to advocate for meaningful legislation to address violent crime in hospitals. Only time will tell if their efforts will put an end to the violence. But, quite frankly, time is running out. The frequency of violent attacks on nurses, physicians and patients in our nation’s emergency departments is unconscionable and unacceptable. For medical professionals, being assaulted must no longer be tolerated as “part of the job.” As one of the Duke Emergency Medicine residents said to me shortly after witnessing the events of that recent Friday night: “I never thought I was entering a profession where I could be killed!”
Michael Utecht is an emergency medicine physician in Durham and current president of the N.C. Medical Society.