Opinion | ‘I Have Never Felt Less Safe at Work’

On a busy Saturday night in our emergency department (ED), a rather large man involved in a car crash required evaluation for a suspected head injury. Suddenly, a shriek and a thump came from his room. Our team of several nurses and a physician assistant (PA) ran in to find him face down on the floor.

To treat him safely we needed to log-roll him onto his back, but he became upset when we tried to move him. Suddenly the patient grabbed the PA and tossed him across the room. He then turned to me and flung me into the wall as if I weighed little more than the scrubs I was wearing.

We were in a very dangerous situation. Security was called, but it was too late, the attack had already started. As we tried to reason with him, he grew more agitated and punched the PA in the face, then threw a nurse into the heavy medical equipment next to the bed. She sustained nasty injuries to her back and ribs.

I have decades of experience in emergency medicine, and this attack forever transformed me. I have never felt less safe at work as I did during that incident and its aftermath. By stripping away my self-reliance and sense of safety, this incident left me with a sense of loss that I have not been able to fully replace.

Physicians and their care teams deserve a support system that helps prevent these incidents and protects them when they occur. Imagine dedicating your professional life to helping people only to be assaulted by the patients who need your help the most.

Emergency physicians are all too familiar with these dangerous scenarios. In fact, nearly half of emergency physicians have been attacked on the job, according to a poll by the American College of Emergency Physicians. Nearly 7 in 10 of the emergency physicians polled said that ED violence had increased over the previous 5 years — and that was before the pandemic. Today, the threats are greater as high stress levels and societal tensions exacerbate many of the factors that contribute to violent incidents.

But statistics only tell part of the story.

The full impact of violence against healthcare workers is understated because so many incidents are never reported. The reality is that hospitals are challenged to accurately track physical or verbal attacks, and many healthcare workers decline to report them, whether that’s because they fear retaliation, or they believe the exercise is futile since there’s a strong likelihood that nobody will ever be held accountable.

It is not too much to ask to be able to do our jobs and help people without having to worry about being physically harmed or verbally abused. Fortunately, there is legislation under consideration that gives policymakers and hospital administrators an opportunity to make EDs safer for care teams and patients.

The “Workplace Violence Prevention for Health Care and Social Service Workers Act,” introduced by Rep. Joe Courtney (D-Conn.) and Sen. Tammy Baldwin (D-Wis.), takes critical steps to address ED violence. This bill would require the federal Occupational Safety and Health Administration to issue an enforceable standard that would make sure hospitals and other healthcare facilities implement violence prevention, tracking, and response systems.

Emergency physicians and emergency nurses united through the No Silence on ED Violence campaign are urging Congress to pass this legislation. We also urge Congress to explore additional measures for the protection of those on the frontlines, including working with the current administration to implement and enforce appropriate penalties for violence against healthcare workers.

We must strengthen protections for professionals on the frontlines. That effort can begin in earnest when everyone stops accepting violence in the emergency department as “just part of the job.”

The pandemic has shown everyone just how vital our healthcare safety net can be. We have every reason to do all we can to strengthen protections for emergency physicians and care teams so they can focus their energy at work on saving lives without fearing for their personal safety.

Rita A. Manfredi, MD, is an emergency physician in Washington, D.C.

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