Health care workers’ safety increasingly at risk

Clarification:  The third-degree assault charge against Leah Campanelli reported below was dismissed by the Clark County Superior Court on Jan. 7, 2019.

Shannon Sathre was supposed to have the day off, but a staff shortage and the prospect of time-and-a-half pay lured her from her couch into the intensive care unit at PeaceHealth Southwest Medical Center.

Hours into that Dec. 20 overtime shift, one of Sathre’s patients lashed out, kicking the 49-year-old registered nurse multiple times in the chest, according to a Vancouver Police Department report. As other staff rushed into Room 5108 to help, the patient allegedly began swinging her arms and spitting at anyone who tried to restrain her.

After the adrenaline wore off, Sathre realized how much pain she was in. Her chest was sore, the left side of her neck was tight and she developed a severe headache, according to the police report. Still, 45 minutes after the incident, Sathre returned to the room to continue caring for the 47-year-old woman who allegedly attacked her, according to the report.

That violent encounter wasn’t the first for Sathre, who has been a nurse for more than 20 years, and it wasn’t the only workplace violence incident at the hospital last year. Sathre’s incident was one of 147 incidents reported to PeaceHealth Southwest administrators in 2017.

Workplace violence isn’t unique to PeaceHealth Southwest; Legacy Salmon Creek Medical Center recorded 91 incidents last year. And, at both hospitals, those only account for the incidents reported by staff. Hospital officials suspect the number of actual incidents of violence is greater.

“This is just a piece,” said Kelly Espinoza, chief nursing officer at Legacy Salmon Creek. “We know it’s under-reported.”

But the actual prevalence of violence against health care workers isn’t clear. In addition to relying on staff to self-report, no single agency is tracking or recording assaults against health care workers. The state Department of Labor & Industries tracks workplace injuries, but that doesn’t capture the acts of violence unless they lead to missed work time.

“If a patient falls and breaks a hip, you have to report it. If a person dies at the hands of health care, you have to report it,” said Joelle Fathi, director of nursing practice and policy at the Washington State Nurses Association. “The same isn’t true for nurses being assaulted.”

But surveys of nurses suggest the problem is widespread.

A survey last year by the Washington State Nurses Association — which represents more than 16,000 nurses in Washington, including those at PeaceHealth Southwest — found 86 percent of nurses have experienced or witnessed violence in the workplace; 56 percent of the respondents said they’ve been physically injured. And a 2014 survey conducted by the American Nurses Association found that 25 percent of more than 10,000 nurses and nursing students surveyed had been physically assaulted by a patient or a patient’s family member.

The numbers that are available appear to show an increase in workplace violence involving health care providers, particularly those in nursing.

Registered nurses and nursing aides filed more claims last year for assaults and violent acts with the state Department of Labor & Industries than they had in any year during the last decade. In 2017, registered nurses filed 113 claims, up from 91 claims in 2008. Nursing aides filed 316 claims in 2017, up from 176 a decade earlier.

And locally the number of workplace incidents are on the rise.

The 91 incidents of violence at Legacy Salmon Creek last year included verbal and physical threats and contact. In 2013, the hospital had 42 reported incidents.

The 147 incidents at PeaceHealth Southwest last year included actions such as verbal abuse, physical threats, physical contact and spitting. Five years earlier, PeaceHealth Southwest staff reported 64 incidents.

“This is something that really concerns me,” said Dr. Lawrence Neville, chief medical officer and patient safety officer for PeaceHealth Southwest Medical Center. “It is a little tough to know if the absolute incidence is going up or if people are reporting it more. Whatever it is, it does seem to be somewhat on the increase.”

Social changes

While an emphasis on reporting incidents may account for some of the increase, Neville suspects societal and demographic changes play a role as well. The growing number of elderly patients with dementia is one factor. Those patients are brought into an unfamiliar environment and may act in ways they normally wouldn’t, he said.

The country’s opioid crisis is also impacting local hospitals, Neville said. Patients under the influence of drugs may act out against providers. And the number of people with significant behavioral health issues — and a shortage of such services — means more of those patients are brought into the hospital for stabilization and medication, Neville said.

“They can act in ways that are concerning,” he said.

Assaults by patients are most often committed against nurses, who provide most of the direct patient care, Neville said. And emergency department staff are more often impacted than those in other departments, though staff in the intensive care unit see a fair amount of incidents, as well, he said.

At Legacy Salmon Creek, like PeaceHealth Southwest, nurses are more often the victims of assault because they are the center of the patient’s care, said Espinoza, the chief nursing officer.

The incident reports don’t point to one unit experiencing a higher rate of incidents than others, said Bryce Helgerson, hospital president. Instead, the reports most often involve a surprise patient — a patient who had a good relationship with providers and then suddenly acted out, he said.

The emergency department, however, may have more incidents going unreported, Helgerson said.

“I think they see a lot more of it and don’t report it,” he said.

Acceptable hazard?

The reasons for staff not reporting incidents of violence are wide-ranging.

Sathre, who works in the intensive care unit at PeaceHealth Southwest, said many nurses won’t report incidents involving patients who don’t realize what they are doing. A patient coming out of sedation, for example, may lash out in fear or confusion.

Nurses may also be reluctant to report what they perceive to be minor incidents because, at the end of a 12-hour shift, they just want to get home, not fill out paperwork, Sathre said. But, most often, nurses don’t report incidents because they accept them as an on-the-job hazard, she said.

“Most nurses don’t bother to report it because it’s become the culture that it’s part of our job,” Sathre said.

Leaders at both local hospitals say they’ve heard the same explanation, and they’re pushing back on that acceptance and encouraging nurses — and all health care providers — to report incidents when they happen.

“It is possible to downplay that in your own mind and say, ‘Well, that’s just part of being a nurse here or a technician here. That’s part of the job,’ ” Neville said. “But we’re saying, ‘It does happen, but it’s not OK. And it’s not just part of the job.’ ”

Few prosecuted

Sathre not only reported the incident with her patient to PeaceHealth Southwest, she called the Vancouver Police Department to report the alleged assault.

“There’s a law against it for a reason,” Sathre said.

Assaulting a nurse, physician or other health care providers who are performing their duties at the time of the assault is a felony in Washington. Sathre’s patient, Leah Campanelli, is due in Clark County Superior Court on Tuesday to face allegations of third-degree assault stemming from the incident.

But the number of assaults that result in police reports and legal action is small compared with the number of reported incidents.

In 2017, the Vancouver Police Department took seven reports of assault against nurses and physicians at PeaceHealth Southwest Medical Center — the year the hospital had 147 reported incidents. That incident number, however, includes encounters that don’t rise to the level of third-degree assault. The hospital doesn’t track the nature of the incidents more specifically than whether they result in injury requiring medical treatment or missed work. Last year, there were seven such injuries.

The Clark County Prosecuting Attorney’s Office received six cases from Vancouver police last year. Four of the cases resulted in sentences; one case was dismissed and one is set to go to trial in July.

The Clark County Sheriff’s Office took eight reports of assault against Legacy Salmon Creek staff in 2017, a year in which the hospital had 91 reported incidents. The prosecuting attorney’s office received five cases, four of which resulted in sentences. In one case, the suspect was referred to Western State Hospital.

For years, Legacy Salmon Creek also just tracked incidents in totality. But that changed late last year after a series of events at the hospital; in particular, one that involved an assault on a nurse, Espinoza said.

“I met her and talked with her. It broke my heart,” Espinoza said of the injured nurse. “She needed so much more, but she quietly went about her work.”

“We felt like we need to do this different and better,” she added.

Tracking incidents

Before leaders at Legacy Salmon Creek could address the problem of workplace violence, they needed a better understanding of what was happening. In late 2017, the hospital began tracking incidents in four categories: verbal disruptions, verbal threats, physical threats and physical contact. During the last three months of 2017, there were 12 reported incidents of physical violence against hospital staff by patients.

The hospital made addressing workplace violence one of its five priorities for 2018, Helgerson said. The hospital created a steering committee with nurses, physicians, security, a staff chaplain and others, including workers who have been assaulted. The committee is focusing on three areas: prevention, in-the-moment response and post-incident needs, Espinoza said.

The hospital has for years provided training to address the prevention and in-the-moment response focus areas, but leaders now recognize the need to invest more attention to post-incident response, Helgerson said. Providers experiencing repeated trauma, or witnessing repeated incidents involving co-workers, pile up over time, he said.

“You have to do something to take some of the layers off,” Helgerson said.

Sathre can relate. Less than two weeks after her incident in December, she was tasked with caring for someone under arrest by police. She had to unlock his restraints when he was released.

“I was scared that day,” Sathre said.

Likewise, she saw a nurse have a panic attack and another colleague trembling with fear after uneventful encounters triggered past traumatic experiences.

“None of us signed up for this,” Sathre said. “I used to think I was safe working in the ICU, but anymore, you never know.”