Colorado has a law making it a felony to hit staff in the emergency room, but the state still hasn’t been spared from the nationwide pattern of increasing violence against health care workers.
Amanda Miller, a nurse manager at UCHealth Poudre Valley Hospital’s emergency department, said nurses are accustomed to dealing with patients screaming at them, but patients have been more likely to escalate to physical assault in recent years. One nurse in her department needed several months of physical therapy after a patient injured her, and two quit because of the violence at work, she said.
“We don’t have bullet-proof vests. We have a stethoscope and scrubs,” she said.
Nationwide, the number of workplace injuries to staff in the health care industry that were deliberately caused by another person more than doubled from 4,010 in 2011 to 8,590 in 2020, according to the Bureau of Labor Statistics. Intentional injuries to all types of workers also increased over that time, but by a less-extreme 29%.
Pre-pandemic surveys found about seven in 10 emergency room nurses and just under half of emergency physicians said they’d been hit or kicked on the job, and about half of 2,500 nurses surveyed by National Nurses United in February and March reported that violent incidents had increased since 2020.
The Bureau of Labor Statistics didn’t have data specific to Colorado, though people working in health care here report they’ve seen a trend that’s similar to the national one.
In the early months of the pandemic, people tended to support health care workers and were less aggressive than usual, Miller said. That changed as stress piled up over time, trust in doctors and nurses broke down in some populations and mental health facilities had to close beds because of low staffing, which pushed patients back to emergency rooms, she said.
“Everybody else basically has the ability to say no, we can’t safely care for that patient,” she said. “So they get funneled here and they get stuck.”
Colorado passed a law in 2015 making it a felony to assault an emergency medical worker, as well as police officers and firefighters. People who attack other health care workers are still subject to the normal penalties for assault, which is typically a misdemeanor unless serious injury results.
UCHealth has a policy of pressing charges when patients attack staff, but it can still be a burden for workers who would have to take time off to go to court, especially since some were assaulted multiple times, Miller said. In her experience, it’s also relatively rare for patients to be sentenced on the highest charges, with most pleading to a lesser offense.
Josh Ewing, vice president of legislative affairs at the Colorado Hospital Association, said they’re working with mental health and disability advocates to expand the higher penalties for assault to all parts of hospitals, but with protections for patients who are too sick to understand their actions. In many cases, however, people are aware of reality but are angry and feel they can lash out with impunity, he said.
“Ultimately, we want to go after the folks who are acting maliciously,” he said.
The American Hospital Association called earlier this year for a federal workplace violence law focused on health care. The Safety from Violence for Healthcare Employees Act would allow up to 10 years imprisonment for assaulting or intimidating a hospital worker doing their job. The penalty would increase to up to 20 years if the assailant uses a weapon or commits the assault during a public health emergency. The bill has stalled out in the House of Representatives, where it was introduced.
While Colorado has a law increasing penalties, some states don’t, and a federal law could fill that gap, Ewing said. The law also contains grants to pay for training and physical upgrades to make hospitals safer, which would help prevent violence, he said.
The most important step would be to get the message to the public that hospitals aren’t an appropriate place to let their anger explode, and that it ultimately hurts patients in a vicious cycle, Ewing said. Many hospitals are short-staffed, meaning patients are frustrated by waiting longer for care and nurses may be working alone, increasing their vulnerability to assault. That can lead to more nurses leaving and even worse conditions for those who are still working and their patients, he said.
“We’re at a critical point here in the state, that we can’t afford to lose any more folks, and we need to turn the tide now,” he said.
Everyone at Poudre Valley Hospital gets training on how to talk to patients and family members who are getting agitated and how to identify needs, Miller said. One person may have specific triggers they need to avoid because of a previous traumatic experience with health care, some need their family to come back with them — or need aggressive family members to leave — and some might just need a nicotine patch if they’re starting to have withdrawal symptoms, she said.
“It’s a high-stress environment and people are often here on the worst day of their lives,” she said. “Aggression’s often a symptom of something underlying that’s untreated.”
Staff are also getting more training on how to safely restrain people or give medication involuntarily as a last resort, Miller said. Hospital security can help, but they aren’t law enforcement officers, and medical staff still have to be in the room to give care, she said.
Unlike most workplaces, an emergency room can’t send away abusive customers, Miller said. They do restrict visitors who’ve gotten out of hand in the past, but the law and medical ethics dictate they have to assess and stabilize anyone who needs emergency care, she said.
“They need to be here for their medical care, but we have no way to escape the violence,” she said.
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