Health care providers may have one of the most dangerous jobs out there — and it is only getting worse. Nearly 74 percent of workplace assaults occur in the health care setting, and health care accounts for almost as many serious violent injuries as all other industries combined. The statistics are alarming. Seventy-eight percent of emergency physicians report being targets of workplace violence in the last 12 months. One-hundred percent of emergency department (ED) nurses report being verbally assaulted and 82 percent report being physically assaulted in the last year.
Workplace violence is clearly harmful to our caregivers. Throughout the country, providers report being pushed, groped, spit on, choked, kicked, punched, stabbed, and even shot. Exposure to workplace violence contributes to subsequent psychological sequelae such as post-traumatic stress disorder, anxiety, and depression. Caregivers experience decreased job satisfaction and burnout, leading to mental exhaustion, depersonalization, apathy, and disengagement. Many ultimately leave medicine altogether.
The negative effects on providers are profound. The detrimental consequences on patients and the overall health care system are equally troubling. Health care leaders should understand and address the damaging effects of such pervasive violence. These include the following:
1. Patient distress. Dr. Albert Schweitzer once said, “Here, at whatever hour you come, you will find light, help and human kindness.” Patients expect that health care institutions will protect them, heal them and provide compassionate and safe care. Unfortunately, health care violence is visible to our patients. This exposure to violence adversely affects patients, both physically and emotionally. Moreover, in the emergency department, children are exposed to violence, vulgarities, and aggression. People who have been victimized in the past are being victimized again, except this time within a setting where they least expect it. This floods them with anxiety and panic as they watch escalating unsafe situations. Patients walk out of the hospital without being seen or before their treatment is complete because they do not feel safe. This is a troubling reality. Many facilities, unfortunately, lack strong safety plans or barriers in place to prevent patient exposure to unstable individuals, weapons or threats. This fosters an unsafe environment for patients and providers.
2. Correlation with substandard care. Workplace violence contributes to the development of provider burnout, and the relationship between provider burnout and patient care is all too clear. Studies have shown that health care professional burnout is inversely related to quality of care and is associated with an increased rate of medical errors and patient infections. Distracted and disengaged providers are less diligent and less detail-oriented, which negatively impacts their ability to provide excellent care to their patients. Therefore, workplace violence can lead to substandard care and poor patient outcomes.
3. Decreased patient satisfaction. Nurses and physicians cannot provide attentive care when they are afraid for their personal safety, distracted by disruptive patients or emotionally traumatized from prior violent interactions. This impedes clinicians’ ability to connect emotionally with their patients. When physicians and nurses are experiencing burnout, their patients report lower satisfaction with their care. Additionally, violent interactions at health care facilities tie up valuable resources and increase wait times for other patients, further reducing patient satisfaction. Patient satisfaction is important for obvious ethical reasons. It is also financially important as satisfied patients are loyal to the institution, provide referrals, are less likely to sue and are more likely to pay their bills. Patient satisfaction scores are also tied to Medicare reimbursement rates.
4. Contribution to provider shortages. As burnout increases, the likelihood that physicians will reduce their work hours in the next two years rises significantly. The U.S. Department of Health and Human Services (HHS) has predicted a shortage of up to 90,000 physicians by 2025, and one contributing factor is the loss of practicing physicians due to burnout. Additionally, employees may need medical treatment or may miss work due to injuries from workplace violence. Provider shortages create significant barriers to care for patients, increase wait times for evaluation and treatment, create further patient and provider dissatisfaction, and contribute to lost revenue.
5. Increased health care costs. There is a high financial burden associated with workplace violence. Damaged equipment or property not only costs money but also increases insurance premiums. If a health care employee requires medical treatment or misses work, it can be quite expensive for the hospital and may increase worker’s compensation claims. Replacing lost employees due to stress or injury is costly. A recent study estimates that the annual costs of burnout related physician turnover and reduced clinical hours in the United States is $4.6 billion. The economic cost at an organizational level is approximately $7600 per employed physician per year. These financial burdens can impact patients through cost-cutting, higher charges, and reduced services.
Workplace violence in the health care setting is a public health emergency. It is severely damaging to providers, patients, and health care institutions. Health care leaders need to immediately address this severe problem and prioritize a safe healing environment that is consistent with the overarching responsibility of the medical profession: Primum, non nocere. First, do no harm.
Amy Costigan is an emergency medicine physician.
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