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Nurses Reporting On-the-Job Assault from Patients

Because many states are cutting their spending on mental health care services, Americans are increasingly losing resources to treat their substance abuse and psychological conditions. Without specialized care, many cases of alcoholism, drug abuse, and psychiatric crises go untreated and worsen, and eventually land these individuals in the emergency room. In recent studies, the Substance Abuse and Mental Health Services Administration (SAMHSA) has reported on escalating numbers of emergency department (ED) visits across the country due to substance abuse and mental health issues. Not only are ED professionals undergoing heightened levels of stress, pressure, and criticality due to the rising onset of drug intoxication or mental health cases in the emergency room, but they are also experiencing increasing amounts of workplace violence.

In July, SAMHSA’s Agency for Healthcare Research and Quality (AHRQ) report showed that one in eight ED visits by adults was related to the diagnosis of mental health or substance abuse condition (MHSA). Alcohol- or drug-related ED visits were estimated to be 1.6 million in 2005; by 2008, this number has skyrocketed to 2 million. Furthermore, SAMHSA found that the number of ED visits resulting in violence had grown from 16,277 in 2006 to 21,406 in 2008.

In a recent study conducted by the Emergency Nurses Association, called “Violence against Nurses Working in U.S. Emergency Departments,” more than half of the 3,465 random ED nurses surveyed reported experiencing physical and verbal violence on the job. Assaults varied from being spit on, kicked, hit, pushed, shoved, or scratched, with a quarter of the nurses having undergone this type of violence more than 20 times in the past three years. Verbal abuse was tolerated more than 200 times during the same time period by one in five nurses. The study also found that intoxicated patients or visitors, psychiatric patients, overcrowding, prolonged wait, and shortage of staff were involved in more than half of these cases of violence against nurses.

The recession has taken its toll on Americans’ mental health. Job losses have left many without employment, homes, health insurance, and family support—causing growing percentages of depression, anxiety, substance abuse, and other serious mental conditions that are being left untreated. Resources for addiction and psychiatric support are running thin in areas that are most affected by the looming economic crisis. Local and state funding for hospitals, mental health programs, addiction recovery facilities, and mental health professionals continue to undergo budget cuts and eliminations. Those medical professionals who remain are now responsible for handling exponential amounts of workloads with fewer staff.

Anger and aggression are common characteristics of patients suffering from serious psychiatric disorders, psychoses, drug intoxication, or comorbid conditions. One grisly result of this surmounting mental health care epidemic is violence against ED nurses from these types of patients, but tends to be overlooked since violence is typically considered "part of the job." Medical personnel are familiar with the need to sometimes sacrifice their safety and rights for the sake of the patients’ care—but at what cost?

Some nurses are petitioning for the implementation of heightened security at their hospitals. The American College of Emergency Physicians has recommended such measures as bulletproof glass, 24-hour security guards, ‘panic buttons,’ or coded identification badges. Other hospitals have had luck with such precautionary measures as metal detectors and administration training programs for managing violence. Over 26 states are pushing to make assaults against nurses a felony instead of a misdemeanor. Most nurses are reluctant to file charges against violent patients due to the critical circumstances, but some have had to press charges for extreme injuries like broken bones or murder threats.

Recent studies by SAMHSA have found that in 2008:

? The most common MHSA condition seen in emergency departments were mood disorders (42.7% of all admissions), followed by anxiety disorders (26.1%), and alcohol-caused conditions (22.9%). Other common MHSA conditions that resulted in ED visits among adults were drug-related conditions, schizophrenia/psychoses, and intentional self-harm.

? There were 188,981 alcohol-related visits to emergency departments by patients aged 12 to 20, accounting for about one-third of the drug-related ED visits (32.9 percent) by this age group.

? On average, almost one in fifteen drug-related incidents involving a young adult was a suicide attempt. The rate of drug-related suicide attempts made by adolescents (under the age of 18) was double the rate of those by adults ages 25 and older.

The emergency department provides a great opportunity for medical professionals to perform interventions with patients suffering from life-threatening addictions or mental illness. Some nurses report that just “listening” to these patients can pave the way for successful interventions, which is the overall goal after treating patients’ emergency needs. Yet statistics are showing that the nursing industry has quickly become one the country’s most assaulted professions, hindering this opportunity for effective outreach.

Source: Emergency Nurse’s Association, More than Half of Emergency Department Nurses Have Been Physically Assaulted at Work, New Study Finds, July 28, 2010

Associated Press, Julie Carr Smyth, Nurses fear even more ER assaults as programs cut, August 10, 2010

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