One morning, the upset husband of a patient told a Las Vegas nurse he was going to bring his gun to the hospital at 3 p.m. and hurt her. The nurse immediately reported the direct threat to her supervisor, who passed it up the chain of command, but they heard nothing back. Anxious and fearful for her life, the nurse eventually called the local police herself — a decision that was later questioned by her employer.
Nurses expect their job to be stressful, but they say too often patients and family of patients are crossing the line and subjecting them to verbal and physical abuse, and they say their employers are not doing enough to minimize the dangers. Nurses and other health care workers are now pushing legislators to take action to address the often hostile work environments faced at hospitals and other medical facilities, arguing their abuse should not be considered just “part of the job.”
Several unions representing Nevada nurses and other health care workers are pushing for the passage AB 348. The bill would require certain medical facilities to develop and implement a plan for the prevention of workplace violence. It would also require facilities to report incidents of workplace violence to the state.
The bill passed the state Assembly 29-12 and now sits with the Senate Commerce and Labor Committee, which held a hearing but took no action on the bill Friday. It faces resistance from hospital management and associations, who say they care about safety but are worried about setting mandates and standards around them.
Assemblywoman Michelle Gorelow, the bill sponsor told the senators workplace violence against nurses and other patient-facing health care workers is on the rise both nationally and locally.
In 2017, National Nurses United, a union representing more than 2,000 registered nurses in Nevada and 155,000 nationwide, surveyed 286 registered nurses. Only 17 percent reported experiencing no workplace violence within the past year; 63 percent reported they have been verbally threatened, 26 percent have been slapped, punched or kicked, 24 percent have had objects thrown at them, and 12 percent have been groped or touched inappropriately.
The majority of workers who experienced workplace violence reported injuries or side effects. More than half — 54 percent — expressed having “anxiety, fear or increased vigilance.” Eighteen percent took time off work. Seventeen percent reported physical injuries. Nine percent reported they changed or left a job because of workplace violence.
Testifying before the Senate Committee on Commerce and Labor, pediatric nurse and SEIU 1107 member Jody Dominic told legislators it was a struggle to narrow down which experience to share because there have been so many. She recalled being pregnant and expected to provide care to a larger male patient with a history of being combative toward staff. Hospital security was stretched too thin to provide her assistance.
In testimony submitted to the committee, Patricia Wright, a mental health technician at Rawson-Neal Psychiatric Hospital, stated she has twice sustained serious injuries after being attacked by patients. First in 2016 when she suffered a meniscus tear requiring surgery, then in 2019 when she was diagnosed with a concussion.
“Over these three years, our facility did not take actions to protect staff from patient attacks,” wrote Wright. “When staff bring up possible solutions, we are often ignored or shut out of the process.”
It’s not just nurses and technicians who face physical and verbal assault.
A 2018 survey by the American College of Emergency Physicians of more than 3,500 emergency doctors found almost half had been physically assaulted at some point in their career, and that 60 percent of those who’d been assaulted had been assaulted within the past year. The most common incident involved being hit or slapped, but being punched, kicked or spit on were also reported.
If these numbers seem high, it’s because they are, say workers rights advocates. According to the Occupational Safety and Health Administration (OSHA), incidents of serious workplace violence (defined as incidents requiring days off) were four times more common in healthcare than in private industries overall.
Some hospitals and facilities have panic buttons, metal detectors, security presence, reinforced doors and specific processes for handling threats. But not all do.
In 2016, an emergency room doctor allegedly used a Taser on a combative patient at Northeastern Nevada Regional Hospital in Elko. SEIU 1107 called attention to the incident, arguing the “lack of trained security have resulted in staff resorting to Tasers, pepper gel and fisticuffs to protect themselves.”
AB 348 mandates medical and psychiatric hospitals have a plan for addressing and reducing workplace violence, and that those plans be reviewed annually in collaboration with employees and union organizations. Plans could include the installation of alarms or communication systems, having more security or staff, or infrastructure changes such as affixing waiting room chairs to the floor so nobody can pick one up and throw it at a nurse.
Reno nurse Christy Tolotti told the Senate committee she witnessed a medical technician get stabbed at her hospital: “There’ve been improvements in safety but it has been reactionary. My hospital only adopted safety after my coworker was nearly killed. That should not have happened.”
SEIU lobbyist Marlene Lockard suggested gender might play a role in why workplace violence within the healthcare industry has largely been tolerated or gone unaddressed. She noted that OSHA has specific standards and requirements regarding mining and contractors.
“Those are often male-dominated industries,” she said.
By contrast, many health care fields, including nurses and medical aides, are female-dominated. Thirty percent of respondents to the National Nurses United survey reported being verbally harassed because of their sex or appearance.
Lockard continued: “We don’t have the same standards for health care workers in hospital settings. This industry should be held to no less of a standard for safety.”
The Nevada Hospital Association, Sunrise Hospital, Dignity Health, Nevada Rural Hospital Partners and Renown Health all oppose the workplace violence prevention bill.
Jesse Wadhams, a lobbyist for the Nevada Hospital Association and Las Vegas Metro Chamber of Commerce, said opposition was due to implementation mandates and confusing definitions found within the bill. He also noted the negative fiscal impact it would have on hospitals: “Potentially costly physical plant remodels. Staffing components. All at a time when healthcare is already unaffordable.”
Lobbyist Chris Bosse for Renown Health echoed that, calling the proposed bill “more invasive than the industry believes is necessary.”
A proposed amendment submitted by the Nevada Hospital Association is considered unfriendly, but Assemblywoman Gorelow told the committee she is still working with opposition on definitions and other issues related to the bill.