Calls for more safety measures to counter violence against NJ hospital staff
Taken from NJ Spotlight News
September 25, 2023
A patient shot and killed himself at Inspira Medical Center in Vineland early this month, endangering the nurse trying to save his life and prompting a police lockdown.
In a separate incident in August, a patient admitted to the psychiatric unit at Jersey Shore University Medical Center tried to strangle a nurse with a blanket, according to the nurse’s union, until other staff members, aided by another patient, freed the victim. The perpetrator remained on the unit for several days after the attack, the union said.
“Staff were terrified. The other patients were terrified,” said Daniel Hayes, a nurse on the psychiatric unit at Jersey Shore, part of the Hackensack Meridian Health system. “It was really just a scary thing for everyone,” said Hayes, the local president for HPAE, the state’s largest health care union.
Hayes and other leaders say these incidents are part of a growing trend, in part exacerbated by the COVID-19 pandemic, that illustrates the danger nurses and other health care workers face at hospitals throughout New Jersey. While recent state-specific data is hard to find, hospitals here reported nearly 10,000 violent incidents in 2021, up nearly 15% from 2019, according to an industry report issued last year. Most of the incidents involved patients verbally or physically harassing or attacking health care workers.
Staffing levels
Violence can also be impacted by staffing levels, union leaders said, an issue that has dominated the recent negotiations between striking nurses and management at Robert Wood Johnson University Hospital in New Brunswick. More staff per shift would lead to better patient care and safer working conditions, nurses there argue.
Hayes said he wonders what would have happened if fewer nurses were on shift at the Jersey Shore Medical Center the day his colleague was attacked. Violence of that level is rare on the psychiatric unit there, he said, but staff throughout the hospital regularly encounter yelling, spitting, hitting and more from sick and frustrated patients.
“Staffing is about the quality of care and it’s about safety for the staff or the patient,” Hayes said.
Hospitals in New Jersey have taken multiple steps to improve workforce safety over the past decade, prompted in part by state and federal laws that require active safety programs designed with staff input. In addition, the penalties for people who attack doctors, nurses and other clinicians or staff were increased in the Health Care Heroes Violence Prevention Act, which Gov. Phil Murphy signed in May. State officials were unable to say if anyone had been prosecuted under the new law as the incidents are usually considered disorderly persons offenses, which are tried in municipal courts.
Staffing levels
Violence can also be impacted by staffing levels, union leaders said, an issue that has dominated the recent negotiations between striking nurses and management at Robert Wood Johnson University Hospital in New Brunswick. More staff per shift would lead to better patient care and safer working conditions, nurses there argue.
Hayes said he wonders what would have happened if fewer nurses were on shift at the Jersey Shore Medical Center the day his colleague was attacked. Violence of that level is rare on the psychiatric unit there, he said, but staff throughout the hospital regularly encounter yelling, spitting, hitting and more from sick and frustrated patients.
“Staffing is about the quality of care and it’s about safety for the staff or the patient,” Hayes said.
Hospitals in New Jersey have taken multiple steps to improve workforce safety over the past decade, prompted in part by state and federal laws that require active safety programs designed with staff input. In addition, the penalties for people who attack doctors, nurses and other clinicians or staff were increased in the Health Care Heroes Violence Prevention Act, which Gov. Phil Murphy signed in May. State officials were unable to say if anyone had been prosecuted under the new law as the incidents are usually considered disorderly persons offenses, which are tried in municipal courts.
Inspira praised the staff and first responders for their “rapid and compassionate response” and efforts to maintain patient care during the violent episode at the Cumberland County hospital. It said free counseling was immediately made available to workers and it continues to talk with union leaders about additional improvements at the Vineland facility, something HPAE confirmed.
“We wish to reiterate that every effort to protect our patients and staff is an abiding, constant priority,” Inspira said in a statement. “We remain relentless in ensuring that processes, technologies, and resources that enhance safety measures for caregivers, patients, visitors, and others will continue to be reviewed and renewed.”
‘Laws are woefully inadequate’
But leaders at HPAE and other health care unions said hospitals in New Jersey have not done enough to effectively protect staff. “This highlights the fact that these laws are woefully inadequate,” said Debbie White, HPAE president and herself a nurse. HPAE represents 14,000 workers in New Jersey, including those at Inspira Regional Medical Center, the Vineland hospital.
White said these incidents are not isolated. HPAE members have reported at least four attacks in the past month in addition to the attempted strangling at Jersey Shore and the suicide at Inspira, she said, adding that “If you can get two weapons into the hospital, something is wrong.”
Doug Placa, executive director of the health care union JNESO, said his members have also raised concerns about a recent increase in workplace violence, with some facing regular harassment on the job. “It’s great to pass a law, but to ensure the safety of the staff it has to go further,” he said. “In an incident like (the Inspira shooting), it’s not just about the physical aspect, it’s the mental aspect.”
These union leaders said they would like to see greater use of metal detectors, which are not in place at all hospitals, and tighter security screenings for those entering hospitals, although Placa said security can’t be limited to any one feature, like a metal detector. “Someone can bring in a wooden club,” he said. “And [security guards] can’t just be at the entrances and exits.”
HPAE also called for more detailed data collection around violent incidents, accommodations to ensure staff can attend regular anti-violence trainings, plus greater focus on sustained support for staff who are victimized. “Too many times the onus is put right back on the staff person,” White said. “It’s too reactive. We need to focus on violence prevention.”
Increase penalties?
While the Health Care Heroes Violence Prevention Act focused on punishments, hospitals hope it will also serve as prevention, with requirements for signs warning of increased penalties for violence against a health care worker.
Hackensack Meridian Health underscored its support for the law in its statement and said it cooperates with law enforcement and state regulators to improve workplace safety.
“The safety of all our patients, clinical staff, nurses, frontline teams, and team members is our top priority at Hackensack Meridian Health. We have a robust, multifaceted safety and security program throughout our network,” the statement reads, noting security teams that are stationed at key points and also circulate, annual and refresher safety training for staff, and other features, like security camera systems.
“Even greater precautions are taken, with additional security measures, in areas where behavioral health care is provided and in our emergency departments,” according to the statement.
Violent incidents are not limited to one hospital or health care system, or to New Jersey. Studies show that in 2019, the most recent year analyzed by federal regulators, health care workers in the U.S. were nearly five times more likely to be forced to take time off to recover from workplace violence than other employees and more than three times more likely to be attacked on the job. Hospitals and nursing homes were the site of many incidents, but psychiatric hospitals were even more dangerous, the statistics show.
The New Jersey Hospital Association, which represents the state’s 71 acute care facilities, surveyed members in 2021 to determine the nature and evolution of this violence over three years. More than 8 out of 10 incidents involved a patient verbally or physically attacking or harassing a hospital worker, it found, although the rate of staff-on-staff violence had ticked up since 2019. The data did not include incidents at nursing homes, where federal studies show staff is more likely to encounter violence.
But the report containing the 2021 data — which predated the Health Care Heroes Violence Prevention Act — suggests that while changes have been made, more safety measures are needed. A 2007 state law directed acute care facilities to create violence-intervention plans, which has led many hospitals to create staff training programs, increase the presence of security staff and upgrade safety measures at entrances and parking lots, the survey found. In 2021 the state allowed health care workers to be identified by first name only on their badges, an attempt to better protect them from harassment.