There was a time during my emergency medicine rotation as a third-year resident, I saw a woman who had come in for axillary adenopathy. I did a detailed physical exam looking for additional nodes and a potential source for what appeared to be an isolated lesion. The node was firm, immobile, progressive in size, and I was worried. She was also uninsured but clearly needed follow-up. I spent time establishing a referral for our surgery clinic, called the surgical resident on-call so he was aware of the case, my concerns about a malignancy, and established a follow-up. I brought a social worker in to begin the Medi-Cal conversations as her progressive, fixed adenopathy was going to need longitudinal care. I felt good about getting a plan in place, an explanation of my findings, and what would happen next. I thought everything was OK.
A week later, I got a phone call at my apartment (this is when we used landlines) from a woman who began to yell at me. She called me all sorts of names. I had no idea who she was until I realized it was the woman I had provided care to earlier. She felt it should have been a woman doing the exam, that the exam was excessive, and I was inappropriate. She berated me. I couldn’t even say anything. It shook me to my core where I had to get help to regain the courage to evaluate patients. It affected the physician I became and how I have done my clinical work since then.
The Current State of Workplace Violence
Today, over 85% of all workplace violence incidents in the US occur in health care. In the second quarter of 2022, two nurses are assaulted every hour. Healthcare workers and staff are five times more likely to experience workplace violence than any other profession. Verbal assault, physical violence, and harassment have increased by over 70% over the past 10 years.
The reasons for the aggression can vary: patients’ anger and confusion about their medical conditions and care; grief over the decline of loved ones; frustration while trying to get attention with our staffing shortages, delirium and dementia; mental health disorders; as well as the rise of political and social issues, or patients, like mine, where something bad happened in her eyes and she let me have it.
The Toll of Workplace Violence
Consistent, pervasive exposure to violence in the workplace, or the risk of it, has a significant impact on a care team member’s well-being, morale, anxiety, fear, and depression in work when those very issues are already soaring in our health care workforce. It’s estimated that 17 percent of our nursing workforce has or plans to leave due to workplace violence. Taking action to advance workplace safety is a fundamental action of organizations, leaders, teams, and all of us who are committed to engaging, retaining, and protecting ourselves and our people.
Workplace safety is emerging as a centerstage priority. We see an ongoing and progressive need to develop individuals, teams, and leaders in raising awareness, prevention strategies, reporting, de-escalation, post-event support, and building a culture of “we protect our people” that is both top-down and bottom-up as a stake in the ground, big rock priority.
Having been the recipient of a brief incident on a phone call that has impacted me for the rest of my career, I cannot even imagine what it must be like to see this again and again and again. I have spoken to so many medical staff members, nurses, advanced practice providers (APPs), and physician colleagues who report stories that are difficult to hear, and the clear progression of violence against us over time. I do not know the answers to the extraordinarily complex issue of workplace violence, but I do know action is possible, accessible, and required to protect our people. As a clinician who has dedicated my life to developing people, the topics of workplace violence awareness, prevention, response, reporting, and follow-up are now emerging as one of our most important skill sets and competencies. My team here at Practicing Excellence are committed to doing all we can as we harvest and spread ideas, actions, and approaches to reduce violence against healthcare workers. In light of this commitment, we are launching our new program, Workplace Violence, coming this July, for healthcare teams, leaders, and organizations to keep their people safe.
Thank you… Keep your head up, and take care of each other.
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Stephen Beeson, MD is the CEO and founder of Practicing Excellence. An author of two national best-selling books, Dr. Beeson has become a national thought leader in building organizational approaches and cultures that support patient connection, team collaboration, and transformative leadership.
