Emergency rooms often dangerous; new law helps protects staff

Austin American-Statesman, September 7, 2013

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[ER nurses] have been yelled at, grabbed, hit, kicked, spit on, purposely vomited on, cut, bitten, scratched and shot. A survey conducted by the Emergency Nurses Association found that 86 percent of respondents reported being a victim of physical violence during the preceding three years.

On the outside of an emergency department door, it’s a felony to assault emergency personnel. On the inside, it’s a misdemeanor. That is, until now. Last session, Texas joined at least 26 other states to make it a felony to assault emergency room staff.

Nurses are the most likely to be assaulted and injured in the ER, as their role brings them into direct one-on-one contact with patients. They’ve been yelled at, grabbed, hit, kicked, spit on, purposely vomited on, cut, bitten, scratched and shot. A survey conducted by the Emergency Nurses Association found that 86 percent of respondents reported being a victim of physical violence during the preceding three years.

Emergency departments can be pressure cookers. People are distressed, feeling vulnerable and with a loss of control. Long waits, overcrowding and uncomfortable waiting rooms compound their anxiety and frustration. Some patients may have a history of violence; others may be in the midst of an acute psychosis; others may be under the influence of drugs or alcohol. Access to firearms, a culture of violence, understaffing and a lack of staff training to avoid and manage crises with volatile patients can all contribute to the volatility of the setting.

Nursing and hospital organizations pushed for this bill the two previous legislative sessions. Why did it pass this time? The riveting testimony of those in the trenches may have made the issue real to legislators. Imagine sitting at the dais as a member of the House Criminal Jurisprudence Committee on April 2 and hearing the following:

• Norma Broadhurst, an ER nurse from Corpus Christi, testified that during spring break 2011, an intoxicated, disruptive patient bit off her right ring finger. She has not been able to work since the incident.

• Jeff Scott, an emergency medical technician and clinical researcher from Dallas who formerly worked as an ER tech, testified that most violence that happens in a community ultimately distills into an ER. The field, which has multiple responders and often law enforcement backup, often is a more controlled environment than a hospital ER where staff may be alone with the patient. Yet workers in the field had more legal protection.

• Linda Waggoner, a longtime University Medical Center Brackenridge ER nurse, told her story. In 2011, the police had brought a patient to the ER in handcuffs for a psychiatric evaluation. He had thrown a chair through the window of a bank and threatened to kill people. Once inside the ER, the patient seemed to gather himself, and after awhile the police removed his handcuffs and left. Waggoner had developed a rapport with the patient, who told her he was beginning to feel anxious. She obtained an order for a sedative and was taking the pill out of its packaging when the patient exploded off the stretcher and punched her in the face, knocking her to the ground against a wall. She covered her neck and head with her arms as he continued beating her. It took several people to pull the patient off her and restrain him. Waggoner sustained severe bruising on her face and back and received multiple sutures above her swollen left eye. She received short-term counseling for the traumatic event and transferred to a less volatile work environment, the surgery recovery room.

The testimony left committee members visibly stricken, and they unanimously passed the bill, which passed both houses and was signed into law by the governor. A former registered nurse, Rep. Donna Howard, D-Austin, skillfully led her bill, HB 705, through the legislative dance.

“The law has helped the people who work in the ER feel safer,” said Chris Ziebell, medical director of the University Medical Center Brackenridge Emergency Department. “It has also helped change the culture. Before the law passed, people felt like getting assaulted was just a necessary evil, a part of the job, and most never pressed charges. The law demonstrates the appropriateness of such prosecutions, and now they understand that they can expect justice. They feel empowered to protect themselves.”

Will the stiffer penalty make ERs safer? The research is inconclusive on deterrence. What the law does do is tell the public that assaults in hospital emergency departments will not be tolerated. It reinforces the standard that violence is not part of the job. And it says to nurses and other ER staff that the state believes that they are as important and valuable as peace officers, firefighters and emergency medical technicians.

Toni Inglis, MSN, RN CNS (retired), FAAN, a lifelong Austin resident and retired neonatal intensive care nurse and editor of NursingNews, writes a monthly opinion column for the Austin American-Statesman editorial page.