Health care has a dirty little secret. And if you aren’t part of the club, chances are that you don’t know anything about it. Aside from COVID-19, short staffing, and the lack of hospital beds to accommodate those who need them, another crisis has been overshadowed and hidden from public view.

What is the secret? Health care is dangerous.

In fact, so many doctors and nurses are choosing to leave the bedside because of this very reason. Patients have become more aggressive and violent than ever before. We are in constant danger while trying to provide care to our patients. We aren’t given body armor or weapons. We aren’t provided with appropriate security. We are essentially defenseless. We are given computer modules to aid us in de-escalation techniques, signage that boasts zero-tolerance, and debriefing after an attack to inform us of what we could have done to prevent the incident.

I am an emergency room nurse at an inner-city trauma center. I can’t pretend to understand what other areas in the hospitals are facing when dealing with their patients. Still, I can assume that after they are admitted to the hospital, their behavior doesn’t magically improve. However, I can only give the perspective from an ER nurse’s point of view, and this is what I know:

Violence in the ER has been a problem since before I began my career in the late ’90s. In the first decade of my career, I experienced being slapped, punched, and cursed at regularly. I was also involved in an active shooter and hostage situation in which patients and nurses were held against their will and physically and sexually assaulted. It was horrible and traumatizing and forever changed my life and many’s lives.

These incidents weren’t only happening in my trauma center out in West Texas. They were happening all over the country. So much so that nurses were joining forces to help create legislation making an assault on health care workers a felony in multiple states. It wasn’t until 2013 that the law was passed in Texas.

So many of us working in health care will be forever grateful for the diligence and dedication were given to the criminalization of assaults committed against health care professionals. When the law passed in Texas, I felt hopeful and empowered for the first time in my career.

Looking back, I have been verbally and physically assaulted many times in my 15 years as an ER nurse. As many of us understand, violence against nurses has always been considered “part of the job.”

Fast-forward another ten years in the ER, and nurses at the bedside are still being verbally and physically abused. From the lack of support from hospital administrators to police departments who discourage filing reports, the laws in place can only provide us with a certain level of protection. We need to do more, and we need to develop an approach that is proactive instead of reactive.

Every week in the ER where I am employed, nurses are threatened, intimidated, and physically abused by patients and visitors. While we can report these incidents to hospital administrators, little can be done to prevent this behavior. We can post signage that boasts a “zero tolerance” approach to staff abuse. However, the reality is that because of EMTALA, these violent and abusive patients still have the right to medical care through the emergency room.

Recently, a patient was angry because of long wait times. He was yelling and aggressive. He told the nurses that he was going to “rape (them) all and kill (their) children” and that he was going to call his cartel friends in Juarez to “rape and kill” the rest of the staff. EMTALA allowed this patient to remain on the property and seek medical care, which is well within his rights. Nurses are afraid and powerless.

Just a few weeks before that, another patient attacked a nurse in the lobby of a local ER. This patient was restrained by visitors and other patients who quickly acted to defend the staff member. Again, this patient was allowed to stay on campus to see the doctor and receive medical care because it is within his rights as a patient.

The stories that make it to the news are only the tip of the iceberg. From an active gunman that was shot and killed inside of an emergency room in Irving, TX, in late June of this year, to those that were killed when a patient opened fire at a hospital in Tulsa, OK, in early June of this year, these incidents continue to happen. Even when we know from experience how these situations can escalate to tragedy and loss of life, we do nothing to change the laws to protect the people who have dedicated their lives to caring for the ill and the injured.

Stories like these can be given in examples over and over again. I have my stories, my coworkers and friends have their stories, and I can confidently say that you have examples of your own to add to the long list of assaults. When is enough going to be enough? What will it take for the government to consider the rights of health care workers in regard to a safe work environment?

Earlier this summer, during a meeting to review EMTALA laws, nurses were reminded that we are mandated to provide care for violent and abusive patients and that it takes a certain level of “nobility to provide care to someone who is abusing you.”

In this new era of awakening, this is the type of gaslighting and victim-shaming that our society is attempting to rise above. Unfortunately, administrators everywhere are being forced to regurgitate similar semantics because their hands are legally tied.

This has got to stop. This behavior places health care workers in danger and jeopardizes the safety of innocent bystanders.

While EMTALA was originally created to protect the patient from being turned away due to lack of funding, I cannot believe for one minute that we have to disregard the safety of health care workers to meet the expectations of this law.

How can we amend EMTALA laws to aid in the guaranteed protection of our nation’s health care workers? What has to happen before someone hears our cries for help? Why do health care workers have to work in a fearful environment? I can no longer stand by idly and watch nurses leave our profession battered, bruised, and emotionally scarred. It is time to stand together. It is time for us to demand a safe work environment. It is time to prevent the abuse before it happens. And I, for one, am ready.

The author is an anonymous nurse.

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