KANSAS CITY, Mo. - Nurses do their job to save lives and help people heal, but an NBC Action News investigation found an increasing number of health care workers also fear for their own safety on a regular basis.
The issue of workplace violence inside hospitals is an issue mostly hidden from the general public, but NBC Action News searched crime reports, reviewed workers' compensation claims, and heard first-hand accounts of nurses attacked by the patients they are paid to care for.
Is it an inevitable part of the job, or are hospitals not doing enough to stop it?
On some nights, an ‘impossible' job
Gina Kelley, a nurse of nearly three decades, has plenty of stories to tell about her career.
After speaking with Kelley, it is clear there are nights when her chosen profession can be dangerous.
"Honey, I've been kicked, slapped, choked and punched across the room," said Kelley. "There are nights when it's an impossible job."
Kelley is a high-level labor and delivery nurse at Research Medical Center in Kansas City. Over the past 27 years, she believes people are increasingly showing up at hospitals stressed out about income and money, a state of mind potentially agitated by ER wait times or staff-to-patient ratios.
Health care experts say substance abuse often creates a hostile environment. Continuing cuts to mental health budgets also mean more patients with behavioral problems seeking care at general hospitals.
"I have patients that I know have guns and knives," said Kelley. "I have women throw brass knuckles on the table in front of me. They have open alcohol bottles in their purses. I have family members come in plastered or high."
On one occasion, Kelley said she missed three months of work because she couldn't use her left arm after a mother-to-be kicked her in the shoulder.
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Search through police reports uncovers assaults against nurses
NBC Action News tried to find out how often nurses are being confronted with violent patients by searching through crime reports filed at several major Kansas City area hospitals.
Among reports taken by police this year:
North Kansas City Hospital, a nurse said she was trying to wake up a patient when the woman awoke, yelled a profanity and hit the nurse in the chest hard enough to "knock the breath out of her."
Research Medical Center, a nurse said a man approached him in the hallway and yelled, "You killed my mother. You gave her blood too fast. You should have given it to her slow," before punching him in the stomach.
- At Centerpoint Medical Center in Independence, a nurse said she was pushed up against the wall by a patient, and then pushed in to the door, injuring her arm and hip. When a doctor intervened, he said the patient grabbed his throat and tried to choke him. The patient's mother later told police her son had been having blackouts and behavior problems for the past year.
A number of other reports detailed nurses being kicked, punched, spit on, or yelled at in a profane way by a patient.
NBC Action News also requested workers' compensation claims, which revealed some of the more serious injuries sustained by health care workers.
The Missouri Department of Labor performed a search, looking for claims filed by health care workers due to injuries inflicted by patients in Jackson County over a five-year period (2005-2010).
The search could not be narrowed to only nurses working in hospitals, so the 28 reports also included employees at nursing homes and mental health facilities.
Among some of the claims:
- An employee who reported a resident attacked her "repeatedly with a knife" at Senior Estates in Kansas City.
- An employee who reported a resident "ran at her, picked her up and threw her on her head" before "repeatedly kicking her for several minutes as she lay on the floor" at The Greens at Creekside in Kansas City.
- An employee "violently struck in the head with a walker" by a patient at Edgewood Manor in Raytown.
Out of the 28 reports, the most came from the Center for Behavioral Medicine (formerly the Western Missouri Mental Health Center) in Kansas City. Of the eight reports, one employee reported "gunshot wounds" while two others said a patient "struck them repeatedly in the head, causing head, brain, facial and dental injuries."
The facility is overseen by the Missouri Department of Mental Health and has a higher level of potential aggression from patients compared to general hospitals. Since July 1, a department spokesperson said there have been five patient assaults on staff that required medical intervention beyond first aid.
Many violent incidents go unreported
According to the Emergency Nurses Association (ENA), the health care industry leads all other sectors in the incidence of nonfatal workplace assaults.
The latest ENA survey of nurses found that in most cases of assault, nurses did not file a formal report, but did notify someone at the hospital. The survey also found that in almost half the cases of physical violence, no charges were pursued against the perpetrator. In a majority of cases, nurses received no response from the hospital about the assault.
Health care experts say part of the issue may be an attitude that a certain level of violence is inevitable and part of the job. Others may worry about a backlash from their employer if they contact the police.
It is one reason why Jill Kliethermes, CEO of the Missouri Nurses Association (MONA), would like to see a mandatory reporting process for workplace violence. She said some hospitals completely leave it up to employees to file charges; others help staff members through the process.
"There are so many variables out there and we don't have a good way to track incidents right now," said Kliethermes. "Officials don't want their hospital to make headlines about a nurse being a victim of an assault. Too many headlines like that and you might not want to go there, you know?"
NBC Action News found a large discrepancy in assault reports from hospitals in the KC area.
For instance, police responded to seven assaults this year against workers at Shawnee Mission Medical Center (thru September). But at Olathe Medical Center, Truman Medical Center and Saint Luke's of Kansas City, police could not find any reports in 2011.
And at University of Kansas Hospital, police reported 38 different assault reports.
"I didn't become a nurse to go to court and testify against people. I became a nurse to help people," said Andrea Jones, a nurse at KU Hospital for the past five years.
But Jones found herself taking the stand after a patient threatened her two years ago.
"He told me that he was going to kill me, kill the staff of my unit, kill my coworker as he walked to his car, and put a knife in the belly of a pregnant coworker," Jones said.
Given the high number of incidents, is KU Hospital more dangerous than other area hospitals? Or is it just taking a harder look at the problem?
Hospital officials point to a model it started using in 2010 called a Behavioral Response Team (BRT), a program intended to reduce aggressive and violent behavior toward staff members.
The BRT is made up of two people trained in crisis prevention—a psychiatric nurse and a nurse manager—who respond to calls 24/7 and work to diffuse threatening behavior before it escalates. Since the program's implementation, KU Hospital said staff members have activated the BRT about 270 times.
"You can use it whenever you want," said Jones, who activated the BRT during a tense situation with a patient in October. "I don't have to get permission and I don't get judged."
KU Hospital believes its BRT model is unique and should be used in other hospitals across the country. In surveys sent to hospitals by NBC Action News, several other health care facilities described similar response teams.
"Violence happens in hospitals everywhere," said Jeanne Fair, a KU Hospital nurse with a background in psychiatry who has responded to BRT calls.
Other proposals from nursing adovoacy groups for avoiding workplace violence include a constant presence of armed police or security officers, screening for weapons at hospital entrances, and more "panic buttons" that allow nurses to call for help in patient rooms.
Kliethermes said MONA lobbied for legislation this year that would have placed health care workers in the same protected category as police and emergency responders. The bill would have made any assault against a nurse an automatic felony. However, the legislation stalled because other groups (i.e. utility workers, transit workers) also wanted to be added.
Kliethermes said MONA is working with the Missouri Hospital Association to coordinate non-legislative policies and procedures that could enhance safety for health care employees.
Kelley, a member of National Nurses United, said she has watched some talented nurses leave the profession because of workplace risks, but she intends to keep fighting for a job she loves.
"Me walking away and taking a job somewhere else… that's the coward's way out. It's not going to fix things for the next nurse," she said.
Hospitals respond to workplace violence questions
NBC Action News contacted nine different KC area hospitals to ask about their workplace violence prevention measures and reporting policies.
We have posted each hospital's unedited responses on nbcactionnews.com
Are you a health care worker and been a victim of violence in the workplace? Tell your story in the comments below or e-mail Ryan Kath at firstname.lastname@example.org.