Growing violence against health care workers prompts Mass. hospitals to adopt new codes of conduct

Hospitals across Massachusetts have agreed to enforce new codes of conduct to help shield health care workers from the growing threat of violence and abuse from patients.

The new policies will ban violence, as well as offensive, abusive and discriminatory language and behaviors. Any patient who violates the rules could be asked to leave and seek care elsewhere.

The commitment comes as the Massachusetts Health & Hospital Association reports that every 38 minutes, someone is assaulted, verbally abused or threatened at a Massachusetts health care facility. Most of the violent and verbal attacks come from patients and are leveled at health care workers.

This kind of behavior is on the rise. The hospital association surveyed its member hospitals, who reported 13,734 “abusive incidents” last year, a 28% increase from 2021. The numbers may represent an undercount since some incidents likely go unreported.

"Acts of violence are increasing, both here in the commonwealth, and across the country. And it's absolutely unacceptable," said Steve Walsh, president of the hospital association. "Our caregivers are working so hard in the most trying times. And as most of the public has moved on from the pandemic, our hospitals and caregivers have not had an opportunity to do that."

While there is no timeline for when they will be put in place, Walsh said the new codes of conduct are meant to be a "baseline," and that individual hospitals could go further.

Some hospitals have already done so. Mass General Brigham’s code of conduct, announced in November, specifically forbids patients and visitors from making offensive remarks about race, accent, gender and other personal traits. This includes refusing to see a health care provider because of their race.

Boston Children’s Hospital began upgrading security amid a barrage of harassment last year — including bomb threats — that was triggered by misinformation about its transgender surgery program. The harassment also included social media attacks and aggressive phone calls.

"We've become a political football," Dr. Kevin Churchwell, chief executive of Boston Children’s, said Friday at the hospital association’s annual meeting in Boston. "We've had to really develop more of a consistent evolutionary response to protect our caregivers."

After the first bomb threat last year, Boston Children’s began "de-escalation training" to teach staff how to manage aggressive behavior, hospital officials told WBUR. Now the hospital is rolling out wearable panic buttons that allow staff to rapidly call security if they feel unsafe.

When patients lash out in hospitals, nurses are often on the receiving end. The hospital association reported that according to its survey, 38% of abusive incidents in Massachusetts were directed at nurses last year. Security officers also were frequent targets, accounting for 27% of incidents.

Hospitals and the Massachusetts Nurses Association have been pushing state lawmakers to adopt different versions of legislation that could help prevent and manage violence in hospitals. Legislators didn’t take action on the bills last session, and their new session is just getting under way.

Joe Markman, a spokesman for the nurses union, said nurses generally support stronger codes of conduct. But he emphasized that hospitals need to do more.

"We want the state to go further by enacting laws that hold hospitals accountable for working with frontline staff on violence prevention plans, regularly reviewing those plans, providing strong support for assaulted workers, and improving violence reporting," he said in an email.

The nurses union and hospital association both support increasing penalties for people who assault health care workers.