Violent outbursts directed toward health care workers from patients increased during the COVID-19 pandemic, when stress and anxiety escalated in places such as the emergency room.

Dr. Donald Yealy, chief medical officer at UPMC, said the rise in violent incidents contributed to the loss of health care staff members that has been seen over the past few years.

“A common insight when some of our workforce decides to exit is the feeling of lack of appreciation,” Yealy said. “It becomes one more burden in an already stressful job.”

The topic of violence directed toward health care workers has been discussed at meetings of the Western Pennsylvania Regional Chief Medical Officers Consortium since the group organized in 2020. The consortium is made up of chief medical officers for a variety of health care agencies and hospitals around Western Pennsylvania. The group meets regularly to talk topics and issues facing health care.

Dr. David Rottinghaus, chief medical officer at Butler Health System, is a member of the consortium. He said national reports have shown that violence and abuse of health care workers has risen since 2020, with up to eight in 10 nurses saying they have experienced physical or verbal abuse from patients in recent years.

“Statistics are showing that assaults are becoming more commonplace within medicine. This group has kept an eye on that,” Rottinghaus said. “There have been attempts to bring guns into these facilities ... reports of threat and verbal altercations.”

In the two separate and unrelated scenarios in February 2022, two Butler Memorial Hospital nurses were allegedly beaten, and one emergency medical technician was allegedly threatened while they were on the job.

According to the Centers for Disease Control and Prevention, health care and social assistance workers overall had an incidence rate of 10.3 out of 10,000 full-time workers for injuries resulting from assaults and violent acts by other people in 2020. The rate for nursing and personal care facility workers was 21.8, according to the CDC.

Data obtained from nurses in a major population-based study by the CDC showed a rate of physical assaults at about 13 per 100 nurses per year and a rate of nearly 39 per 100 nurses per year for nonphysical violent events.

Yealy said the verbal and even physical abuse of employees from people seeking care has always been a lingering issue for hospital staff members, especially the ones on the front lines like EMTs and nurses.

While health care staff members were being hailed as “health care heroes” for continuing to work during the peak of the pandemic, the frequency of abuse seemed to drop slightly. However, it has again become an issue as more people have returned to full in-person work and activities, Yealy said.

“There was lower demand, and there was organized and informal recognition of the special burden that people in health care were engaged in; they were going to work when no one else was,” Yealy said. “At first there was the dampening down, now there is a dramatic increase (in violence).”

The consortium was launched for chief medical officers to talk about the state of their agencies while tracking coronavirus. It grew to become a regular place to tackle issues other than those spurred by COVID-19, Yealy said.

Dr. Carol Fox, chief medical officer at Excela Health, said a person who could be experiencing an emergency may react badly to hospital workers due to the stress and uncertainty of their condition.

“We understand that we're living in very stressful times, and there is a higher level of stress and anxiety,” Fox said. “Of course when you're sick and feeling bad, that makes things worse.”

Yealy said reports of abuse are more frequent in the emergency department at UPMC hospitals, possibly because of the stress patients are under when entering.

“The frequency is more often verbal, and it can happen in any setting of health care,” Yealy said. “Emergency is one of the more common areas; we see lots of aggressive words and threats.”

Butler’s president of the Pennsylvania Association of Staff Nurses and Allied Professionals Tammy May, also a Butler Memorial Hospital nurse, said she has been threatened by patients and also punched and kicked in her 30-plus years on the job.

Rottinghaus said the emergency room at Butler Memorial Hospital has seen its share of altercations and that patients and their families can lash out when put under stress.

“Health care is frustrating, it's a time of high stress, not only for the people giving care but for the people seeking care,” Rottinghaus said. “They're fearful, and it's an out-of-control situation. I think that drives a lot of these incidents.”

The chief medical officers are seeking ways to mitigate confrontations and stop health care workers from being disrespected physically and verbally.

“We've developed expectations from those who visit us, and we try to reinforce those as much as possible,” Yealy said. “We want respectful interactions in both directions.”

Most, if not all, hospitals in Western Pennsylvania have security and check-in departments stationed at patient-entry points, which Rottinghaus said are typically the first line of defense against someone bringing weapons or other contraband inside.

Also, some employees are trained in de-escalation techniques.

“We do have to institute training and teams that can respond to situations, have security present,” Rottinghaus said. “We do train people and provide resources where people are prepared.”

Fox said employees in Excela Health hospitals have gotten de-escalation training as well.

“It has happened in pretty much every patient care area in the hospital,” Fox said. “We do teach some de-escalation techniques, particularly in places like the emergency department, where there's a lot of people coming and going. Also in behavioral health.”

In addition to the training some hospital staff members undertake, Fox said, the first lines of defense against potential abuse typically are security measures, such as personal emergency alarms and paging devices.

“We have some personal panic alarms, station panic alarms — we have 24/7 security,” Fox said. “Those are some things, and of course people can summon their colleagues, that's what we ask them to do first.”

Yealy said that by raising awareness of violence in health care and its effect on staff and patients, consortium members hope to lower the rate of violent incidents.

Likewise, Fox said there is no reason for anyone in health care to take abuse, because it could also lead to worse outcomes for a patient and even other patients in a hospital.

“Part of our efforts was to call out the fact that it's happening and that it can't happen,” Fox said. “People are not feeling well, you're not yourself. We understand you're not feeling yourself when you're sick. Verbally abusing someone or physically doing it is not the answer.”

Rottinghaus said members of the consortium also talk about best practices and developments in hospital leadership at their meetings, which is what led them to bring awareness to violence in health care.

“The intent was to say, ‘This is what we're seeing, feeling, hearing from colleagues,’” Rottinghaus said. “Having that understanding and mutual respect is what health care workers are looking for.”