ER Doc: Protect Your Staff From Workplace Violence

Physician says hospitals are too tolerant of assaultive behavior by patients and their loved ones.

Amy Costigan, MD, wants to be able to practice emergency medicine without being punched in the face.

Healthcare staff carry a heavy workplace violence burden, with about 74% of workplace assaults occurring in the healthcare setting. Workplace violence is prevalent in the emergency department—78% of emergency physicians have reported being targets of workplace violence in the prior 12 months.

Costigan wrote about her workplace violence experience in Annals of Emergency Medicine. She had lost a young woman in cardiac arrest, then went to a family room to inform the woman's mother.

When she entered the room, the ER physician had a choice—sit in a chair near the door or sit on the couch next to the young woman's mother. Costigan picked the couch.

After she shared the bad news, the enraged mom punched her in the face.

"I do things a little differently now when giving bad news. I never go alone," Costigan wrote in the journal. "Sometimes I have security stand around the corner. The door always stays open. I know my exits. I always choose the seat by the door."

Extended impact of workplace violence

Costigan, a member of the Department of Emergency Medicine at the University of Massachusetts Medical School in Worcester, shared her views about workplace violence with HealthLeaders last week.

In the healthcare setting, workplace violence erects barriers between physicians and patients in two ways, she said.

"First, we can never provide good patient care when workers are scared for their safety. It creates distraction, mistrust, apathy, poor care, and disengagement with patients. You don't want your doctor or your nurse to be afraid to sit with you, hold your hand, or sit there and cry with you. Unfortunately, workplace violence is slowly stripping our ability to be physically and emotionally present with patients.

"Second, an unsafe environment for staff is an unsafe environment for patients. In the emergency department, patients are witnessing violence. It is traumatizing and scary for those patients. They are also at risk."

Costigan said being the target of workplace violence has compromised her ability to be compassionate with her patients and their loved ones.

"We are taught in medical school to sit with the patient when giving bad news. You are supposed to put a hand on their shoulder. You are supposed to be close emotionally and physically. Most of the time now, I try to figure out the best place to sit for my safety. I still try to be close and emotional, but I never go alone and sometimes I have security outside the room. That's not the way I want it to be."

'We are tolerating it'

In healthcare, the widespread practice of abstaining from pressing charges in cases of workplace violence is making the problem worse, Costigan said.

"Workplace violence is persisting and increasing because we are tolerating it. It's never OK to assault another person, not when you're drunk, not when you're sick, not when you're having a bad day—it's just never OK. To my knowledge, violence is not tolerated in any other profession."

The emotionally challenging environment in healthcare settings does not excuse assaultive behavior or justify exposing healthcare workers to violence, she said.

"We work in emotionally charged and high-stress situations, but our protection in the hospital shouldn't be any different than what is afforded to everybody else. We don't tolerate assault in a courtroom, or a library, or a restaurant. The same rules should be applied and enforced everywhere because everybody has a right to feel safe, supported, and protected in their workplace."

There must be some accountability when workplace violence incidents occur, Costigan said. "Healthcare workers need support from the administration, the police, the district attorney, and judges. The only way to stop this violence is to send a clear message that it is not acceptable."