Health Workers Press for Federal Bill to Prevent Workplace Violence

WASHINGTON — With violence and intimidation threatening to destabilize the healthcare workforce, support for federal legislation to criminalize such behavior is growing, said stakeholders during a congressional briefing hosted by the American College of Emergency Physicians (ACEP) and the American Hospital Association (AHA) on Tuesday.

ACEP President Aisha Terry, MD, MPH, of George Washington University in Washington, D.C., said she was sitting at her computer doing chart work when she heard a loud thump. She turned to find a nurse lying on the ground and a patient standing over her. The patient had punched the nurse in the face.

“When we heard that thump … everything stopped,” she said.

At least two nurses are assaulted every hour, according to a 2022 Press Ganey survey. These incidents can have lingering mental and emotional consequences, including post-traumatic stress disorder, Terry said.

Kate FitzPatrick, DNP, RN, chief nurse executive officer for Jefferson Health in Philadelphia, stressed that these incidents also have ripple effects on every hospital worker in the vicinity.

“Our higher-order thinking gets disrupted,” she said. The cumulative impacts of even “micro-aggressions” can lead to demoralization, depression, anxiety, sleep disorders, and absenteeism, as well as nurses leaving bedside care.

Terry said emergency medicine has also seen a decline in applications in recent years, which the environment has contributed to “without a doubt.”

Healthcare workers are five times more likely than any other employee to be assaulted on the job, said Rep. Larry Bucshon, MD (R-Ind.), a former cardiothoracic surgeon, citing a Bureau of Labor Statistics report. Yet, no federal law exists to protect hospital employees from being assaulted or intimidated, he added.

The Safety From Violence for Healthcare Employees (SAVE) Act, which Bucshon and Rep. Madeleine Dean (D-Pa.) introduced last year, mirrors protections adopted for aircraft and airport workers, such as flight attendants. It establishes legal penalties for people who “knowingly and intentionally assault or intimidate hospital employees,” according to a press release.

Penalties range from fines to up to 10 years in prison or both, with “enhanced penalties” of up to 20 years for acts that involve “dangerous weapons” or lead to “bodily harm.” The bill also includes exceptions for individuals who are “mentally incapacitated due to illness or substance use.”

Notably, the bill would also authorize $25 million for every fiscal year from 2023 to 2032 for grant programs used to fund training in de-escalation techniques and to address mental health crises; coordination with state and local law enforcement; and video surveillance, metal detectors, panic buttons, and “safe patient” and “safe staff” rooms, along with other violence prevention measures. Hospitals with a “demonstrated need for improved security” and a “demonstrated need for financial assistance” would be the first to receive the grants.

Mark Boucot, MBA, president and CEO of Garrett Regional Medical Center in Oakland, Maryland, and an AHA board member, noted that making small, rural hospitals safe is challenging.

“You’re barely breaking even or at a 1% operating margin, how do you make a decision to hire security guards when you’re still struggling to have nurses at the bedside?” Boucot said.

At a time when rural hospitals are scraping for resources, funds to pay for panic buttons and additional security would be very helpful, he said. He also stressed the need for more tertiary mental health facilities to care for patients with chronic and acute behavioral health needs. There are no inpatient psychiatric beds at either of his facilities.

And while the health system borders two states — Pennsylvania and West Virginia — a patient enrolled in Maryland’s Medicaid program typically can’t be transferred to an open bed in either without a great deal of persuasion.

“So, where do you hold these patients?” he asked.

The answer: the emergency department. That is an underlying contributor to these incidents of violence, Boucot said.

When asked about similar state legislation, Chad Golder, JD, general counsel for the AHA, said there’s a “patchwork” of state laws but those aren’t enough.

“There’s something powerful about seeing a sign at the front door that says, ‘You will face up to 20 years’ imprisonment under federal law if you assault a healthcare worker,'” Golder said.

The bill does not include mention of gun-free zones.

Terry acknowledged that that is another problem that needs to be addressed, but this legislation is still a “great first step,” and is bipartisan.

Sen. Joe Manchin (D-W.Va.) and Sen. Marco Rubio (R-Fla.) introduced a companion bill in the Senate last year.

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