Here’s a chilling statistic from one of Boston’s most prominent medical institutions: On any given day, two to three nurses at Massachusetts General Hospital are assaulted. The incidents can range from a shove or a kick to verbal harassment and even threats by patients, according to hospital officials.
And that’s almost certainly an undercount, in part because there’s little mandatory reporting or tracking of assaults inside Massachusetts hospitals or to the state.
“We believe that the reporting is lower than what the reality is,” said Colleen Snydeman, executive director for quality and safety in nursing and patient care at MGH. The hospital started collecting data on staff assaults in 2019, she said. “It’s been something that we've been very concerned about. Everyone is — the entire hospital.”
Last year, the hospital provided safety training for some 30,000 employees, officials said. And there are additional pilot efforts underway to help staffers detect signs of potential trouble. The hospital is going to test panic buttons for nurses, too.
COVID-19 has only exacerbated the problems, according to health care executives and national nursing surveys. Hospitals have lost nurses and patient care assistants during the pandemic, leaving many institutions short-staffed. That can mean nurses or aides carrying a heavier patient load, and having to enter rooms alone when it would be better to have backup.
And then there’s added anxiety in the current environment. Nerves are frayed all around, among staff and patients. Some patients are arriving sicker after putting off treatment during the pandemic. In some hospitals, bed and staff shortages mean patients may wait longer for care.
A portion of the patients who lash out have dementia or untreated mental illness, or behave aggressively after coming off anesthesia. Others are badly behaved in a variety of ways.
Bonnie Michelman, MGH’s director of police and security, estimated that assaults are roughly 60% “unintentional” and 40% “intentional.”
Intentional assaults can involve people altered by drugs or alcohol, she said. The unintentional cases are often older patients with dementia or Alzheimer’s “who have changed from their normal personality to a personality that can be radically volatile. Those are really sad cases,” she said.
But the ramifications are the same, Michelman said. Nurses, aides, doctors and others can be injured or have traumatic experiences dealing with patient outbursts. At MGH, it’s the busy downtown emergency department that has the most frequent reports of violent patients, officials said. The inpatient psychiatric unit also carries a heavy load. But the issue is hospital-wide — and industrywide.
In some parts of the country, hospitals have reported incidents involving members of the public who refused to wear masks or became angry about other COVID-related issues.
In a survey of 5,000 registered nurses published this week by National Nurses United, nearly one-third, or 31%, said they faced a small or significant increase in workplace violence, up from 22% in a March survey.
According to the U.S. Bureau of Labor Statistics, health care workers accounted for 73% of all nonfatal workplace injuries and illnesses due to violence in 2018.
The stresses of receiving and providing health care during the pandemic have surged, according to Katie Murphy, an ICU nurse at Brigham and Women’s Hospital in Boston and president of the Massachusetts Nurses Association union. And a shortage of psychiatric beds in the region has been a big contributor to the prevalence of patients lashing out.
“Patients are waiting for care and treatment” in some cases, she said. “When they’re in the hospital, they’re more vulnerable. They’re scared, they’re confused. And health care workers are right there, you know — often very, very close.”
Murphy recalled a fellow nurse being punched in the face a couple of months ago. But the incident likely went unreported, she said.
“She just said, ‘You know what, I have to go home,’ ” Murphy recalled.
Brigham and Women’s, in a statement, said, "We know that these events are under-reported and continue to be very challenging for those on the front lines of care."
The hospital is working to encourage more reporting, according to the statement, and taking such measures as increasing security in the Emergency Department.
At another major Boston hospital, Beth Israel Deaconess Medical Center, spokeswoman Terri Janos said workplace assaults have been a concern since well before the start of the pandemic. But tensions in health care have increased with “visitor restrictions, limited access to mental health care and strained nerves.”
Both the Massachusetts Nurses Association and the Massachusetts Health & Hospital Association are supporting bills in the state Legislature targeting workplace safety for medical workers. Both would, among other things, require more rigorous reporting and tracking of assaults.
The hospital association in a statement called incidents of violence “rare.” But the group’s vice president of clinical affairs, Patricia Noga, also said, “We share the urgency of nurses, doctors, and other care professionals in putting an end to unacceptable acts of violence in all healthcare facilities.”
Editor's note: This story has been updated to reflect adjusted numbers from MGH on the percent of intentional versus unintentional assaults.
This article was originally published on October 01, 2021.