Hospitals are places where emotions, tempers, stress and anxiety can get out of hand, and health care workers have always had to deal with people who need to be calmed down.
However, the COVID-19 pandemic has brought new challenges as patients and family members who don’t want to comply with safety precautions become abusive, either verbally or physically.
Providence St. Patrick Hospital in Missoula has experienced a significant increase in the number of incidents with aggressive patient and/or visitor behavior since the onset of the COVID pandemic.
“I don’t know if there’s words to say how stressful that is,” said chief nursing officer Beth Hock. “Can you imagine someone standing in front of you, yelling at the top of their lungs?"
No amount of training in the world can soothe a nurse trying to do his or her best for a sick patient in that situation.
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"We train caregivers to use de-escalation techniques, but we're all human," Hock said. "Caregivers are here to serve and try to be helpful. But when they're called names and obscenities, those things really cut to the emotional core of our caregivers and it's not OK.”
Recently, the hospital was forced to post signage in front of the building warning that physical assault, verbal harassment, abusive language, disruptive behavior, threats or sexual language directed at others will not be tolerated.
“We value our staff as much as our patients and have zero tolerance for any form of aggressive or disruptive behavior,” the sign reads. “Visitor incidents may result in removal from our facility and prosecution.”
'I don't need this'
Hock said that unruly patients and visitors have taken a toll on staff who are already stressed by the work that they do trying to heal people.
“In the last year, I would say over 50% of caregivers have seen or been on the other side of verbal abuse by a visitor,” Hock said. “And that’s really not acceptable. We’re here as a service industry to care for our patients, and to have those distractions can really weigh heavy on caregivers.”
According to Morning Consult, a polling firm, nearly 20% of health care workers have quit their jobs since the pandemic hit. Many cited the virus and burnout as reasons.
“Absolutely, I can’t tell you the number, but we have had nurses and CNAs (certified nursing assistants) who have left the profession because they’re just ‘I don’t need this’ and have walked,” Hock said. “With the shortage (of workers in the industry) as it is, it is something that is certainly not something we want to tolerate. We can’t lose caregivers. We need to keep them safe.”
Hock said the stress of the job is enough without having to deal with outbursts from patients. Hock was careful to say that all caregivers understand that patients and families themselves are often under an immense amount of pressure and stress when they’re at the hospital, dealing with sick loved ones or grim news. However, she said, it’s just not acceptable to allow people to subject health care workers to abuse.
St. Pat’s has a number of programs, systems and protocols in place to protect caregivers. That includes measures to protect from COVID-19. In an era where disinformation and false information about the virus has run rampant, hospital workers bear the brunt of people’s rage when they’re told that only certain amounts of people can be in a room with a patient at one time, for example.
“Our primary focus is to protect patients and caregivers,” Hock said. “We’ve tried to focus on that being the priority. Sometimes visitors just don’t see themselves as transmitters. They really don’t care to hear our reasoning because they feel it’s not substantiated. They don’t think they have COVID, and for them to hear that we’re making global decisions to protect the overall population, they as an individual don’t feel like they fit into that.”
The hospital doesn’t make exceptions, Hock said, and people “get pretty emotional” about that.
“We try to recognize where they’re coming from,” she noted. “Their loved one is sitting in a hospital and they don’t have access to them. But we can’t keep making exceptions in order to protect caregivers. That’s not something that’s always well understood.”
Recently, the hospital has updated its inpatient visitor policy due to reduced COVID transmission rates in the region. However, the hospital is still limiting the number of visitors in patient rooms at one time.
Hock said the security team at the hospital has been “phenomenal” in helping support a zero tolerance policy for abuse.
Dean Chrestenson, the security manager at St. Pat’s, said physical abuse very rarely, if ever, happens. But verbal abuse is another thing.
“Unfortunately, it has been a daily occurrence at different levels, different locations,” he explained. “The last two and a half years have been a trying time for everyone and health care has not been immune to that. In fact, we’re right on the front lines, and we’ve become a place where, unfortunately, individuals have come in here with their frustrations.”
Chrestensen said the hospital’s administration has taken a very serious stance on the issue, meaning they’ve given him the resources to enforce a zero tolerance policy. Chrestensen said he’s seen some health care workers decide to leave the industry after incidents.
“They say, 'This isn’t what I got into health care for,'” he said. “We need to educate the public so they understand this is unacceptable behavior.”
At Community Medical Center, staff go through regular training on verbal de-escalation techniques, as well as physical techniques to avoid being put in a compromised situation by a patient who grabs or punches. Physical maneuvers are rarely if ever needed, but hospital safety leaders say they want their staff to have a plan in case anything happens.
Jessie Martin, a nurse and the employee health program manager at Community, said the issues came up long before COVID happened.
“I do think that the pandemic may have exacerbated some of those situations,” she explained.
Some people don’t agree with mandates, or the type of care they’re getting, or the type of medication they’re given for COVID.
“I think that offering our staff members education and training on how to handle those situations, or how to identify the cues of when aggressive behavior could happen and how to approach that, I think is important,” Martin said. “To give them some tools and make it something they can utilize to address those types of situations.”
Hospital staff learn how to calm a person down during the exercises. They also learn how to, for example, break away from someone grabbing their hair or trying to choke them. Security staffers are always nearby, but those few seconds before help can arrive are what the rehearsals are designed for.
“I think that the pandemic has brought on a lot of concern and anxiety around all those situations,” Martin said. “And if we continue to offer these types of trainings and how to identify these cues, how to identify when aggression is maybe escalating, maybe we can use the verbal techniques before it ever gets to a true violence situation. And that’s our goal.”