Odd, isn’t it, that even though there has been a significant increase in the number of violent incidents directed against doctors, nurses, orderlies and technicians throughout the world’s health centers, these unfortunate episodes have been given no special classification or nomenclature. By now, surely, the frequency and seriousness of what is going on deserves to be referred to as something like Hospital Rage, if for no reason than to make clear what is being discussed.
It’s no secret that there can be long term consequences as a result of these violent outbursts, which have been known to severely and negatively impact the physical, psychological and emotional wellbeing of those who are already employed in the pressure-filled environments typical of the healthcare sector. It’s not at all unusual for victims of Hospital Rage to develop PTSD symptoms or experience nightmares of the episodes in which they were involved, and have been found to be a contributing factor to workplace depression and burnout. For the most part, security guards and the police are called in after the fact; the fear has already set in and the personal injury has taken place by the time they arrive. Effort must be made to provide a safer workplace for those who care for others and provide measures of adequate protection against abusive patients and their families and friends.
Prior to any discussion on this subject, however, there must a universal understanding that there are no perspectives, points of view or extenuating circumstances that can excuse or justify harmful temper tantrums, or that that there can be nothing but zero tolerance for engaging health care workers in physical or verbal violence or altercations. Granted, seeing a friend or loved in distress or pain can be maddeningly stressful and hospital emergency rooms may appear to be chaotic and unresponsive to those waiting for attention and treatment. Most ERs, though, are anything but. What appears to be an arbitrary and capricious selection of who receives treatment is in fact governed by protocols that, not unfairly, treat patients based on the seriousness and gravity of an ailment or injury. This may not make the frustration that comes with waiting any more bearable, but it does, or should, keep tempers in check and remove the feeling of being helplessly stuck in a traffic jam.
This is not to imply, by any means, that the status quo is acceptable and that health care workers should shrug and hope for the best. On the contrary, any idea that such confronting such behavior is the norm and “part of the job” must be eliminated. The violence that erupted in Galilee Medical Center last week, for example, is indicative that a more proactive approach is needed, one that prevents the violence rather than merely waits for it to happen.
Enlarging the hospital or facility, increasing the number of attending professionals and acquiring additional diagnostic equipment are obvious approaches, but given the limited budget provided for health-related services, such expenditures would hardly be considered as an immediate solution. Nonetheless, actions can be initiated that would incur minimal cost but, at the same time, ensure safer working conditions for those whose hands we put our health and well-being into.
There should be, initially, a thorough examination the hospital or medical facility setting, and provide the staff appropriate training on how best to deal with and mitigate violent altercations. This includes, for example, emphasizing the importance of projecting the right attitude as well as the need for empathetic customer service. This is not to suggest that the staff or personnel contributes in any way to the onset of violence in healthcare settings, but may play an important role in prevention and deterrence.
There is little doubt that improved communication has been proven to be a critical component in successful conflict resolution in both the private and public sectors, and have the promise to be no less effective in the healthcare sector as well. A number of both public and private hospitals now post real-time tracking and updates on a patient’s location and treatment. This provides, at the very least, relief that a patient has not been wheeled into a side corridor or, worse, left alone and forgotten somewhere. Tracking patients from the time they are admitted to the emergency room and indicating the approximate time when treatment is expected be provided will undoubtedly create a more relaxing and confident atmosphere for those pacing back and forth with worry and concern.
Consideration, in addition, should be given to implementing the state-of-the-art Nursing Observation and Virtual Assistance (NOVA) solution, which provides for remote patient monitoring as well as integration of various communication modes and devices. This system, and other similar ones, enhance staff safety by allowing the observation of multiple rooms and facility areas, thereby providing the facility’s personnel a greater sense of security. It’s not at all unlikely, by the way, that the cost of such a system would be offset by lower insurance rates.
Experts in the area of belligerent behavior stress that the tendency toward violent behavior is not something that can be easily camouflaged. Verbal cues and body language often telegraph well in advance when anger is dangerously rising and self-control is on the verge of being lost. The medical staff should be trained to recognize the signals – clenched fists, heavy breathing, threatening posture – indicating that someone is likely to lash out, and have the means to call for assistance before it happens.
Safe places, unfortunately, have become fewer and fewer. In addition to hospitals and healthcare facilities, schools, houses of worship and community centers are no longer free of concern about safety and security. We’re not far from the point, I’m afraid, when it might be advisable for doctors and nurses to carry pepper spray or some other form of self-protection. And it does indeed sadden me to say that it’s becoming commonplace to provide healthcare workers training on basic self defense techniques and maneuvers.
More importantly, Israel must recognize the serious impact that Hospital Rage has on the physical and emotional safety of those employed in healthcare settings. Stringent legislation is required to ensure appropriate punitive measures for such violence, and charges against those who commit such acts must be aggressively pursued.
Not that long ago, healthcare workers were regarded as the nation’s heroes as they were the first responders in the battle against COVID. While their valor has by no means been forgotten, the lessening of the pandemic’s severity has returned the world – and, of course Israel –to the fondly remembered norms of two years ago. A nurse from one of Israel’s southern hospitals put the threats healthcare workers into perspective. “I don’t want to be a hero,” she said. “I want to be a mom and a nurse. I want to be considered a person who chose a career that they love, and they deserve to go to work and do it in peace. And not feel like they’re going to get harmed.”
Not very much to ask, is it?