Contributor: Serena Tobar MSN, RN-BC, CVRN, BC
My heart has been heavy the last few days. Every time I open my social media pages, I am reminded of the tragedy that occurred in Dallas on October 22, 2022. Two healthcare workers, a nurse and a social worker, were senselessly killed while only trying to provide care. A few days before this incident, a psychiatric nurse practitioner was stabbed to death by her patient. These incidents are mere drops in the bucket when it comes to violence against nurses.
In 2019, the American Journal for Managed Care published an article titled “Violence Against Healthcare Workers: A Rising Epidemic” by Wallace Stephens. The article discusses how workplace violence against healthcare workers has risen as reported by emergency department physicians. The article further points out that while 70% of staff reported acts of violence, only 3% pressed charges. Furthermore, the article points out that healthcare has become like factory work. Staffing challenges, sicker patients, and less resources have stretched healthcare’s limits. Expectations of family and patients are high, leaving healthcare workers unable to meet their demands. Being able to “manage” the workload simply isn’t enough.
A Press Ganey analysis showed that, on average, 2 nurses are attacked every hour in the United States. Attackers included patients, family member, coworkers, visitors and intruders (Putka, 2022). It is important to note, that not all workplace violence is physical. Verbal assaults occur more frequently than physical assaults and come most often from patients, followed by their family members and/or visitors (Kim et al., 2021).
I have been a nurse for over 20 years. In those years, I cannot recall a single year that went by without some form of assault. While mostly verbal, I have also experienced physical assault. In the course of providing care, I have been cursed at more times that I can even think. I have been told I am stupid. I have been slapped, kicked, pinched. I have been grabbed to the point of having bruises on my arms. All for the sake of patient care. While my positive nursing experiences far outweigh these negative ones, I found myself questioning if those were the reasons I left bedside nursing. Had it become too much for me?
I see the posts on social media. The RN badge with the black line through it. The show of support, solidarity. But I also know that this is temporary. We will forget. We will move on to the next thing. In honesty, what have we accomplished? Our profile showed how much we “cared”, for a day, maybe a week. What have we accomplished?
Nurses are one of the largest professions in the United States. There is the old saying “power in numbers”. We have the numbers. Why do we not have the power?
After the shooting that killed 2 healthcare workers in Dallas, American Nurses Association president Ernest Gant released this statement:
“We mourn for the individuals who horrifically lost their lives, and we extend heartfelt condolences and deepest sympathies to the families and loved ones of the victims. Time is up. Violence against nurses is unacceptable. This must end now.”
Violence against healthcare workers must end. It is dangerous not only to those providing care, patients are suffering. We are suffering. We have the numbers. Now is the time to use those numbers. To gather and speak up against these violent acts. It is time to do more than change our social media profile picture for a day or two.
How can you make a difference? Talk to your legislators. Go to their offices. Write them letters. VOTE!. Time is up. It is now time to take action and become involved. It is time to use our power of numbers to make a difference for ourselves and future nurses.
References
Kim, S., Mayer, C., & Jones, C. B. (2021). Relationships between nurses’ experiences of workplace violence, emotional exhaustion and patient safety. Journal of Research in Nursing, 26(1-2), 35–46. https://doi.org/10.1177/1744987120960200
Stephens, W. (2019). Violence against healthcare workers: A rising epidemic. American Journal for Managed Care. https://www.ajmc.com/view/violence-against-healthcare-workers-a-rising-epidemic
Putka, S. (2022). Violence against nurses worse than ever, analysis finds. MedPage Today. https://www.medpagetoday.com/special-reports/features/100679
About Serena Tobar MSN, RN-BC, CVRN, BC
Serena is a nurse education specialist with a passion for nurse advocacy. Serena is currently pursuing a PhD in Nursing Science at Texas Woman’s University. She earned her MSN-Nursing Education from the University of Houston in 2019. Serena is actively involved with Texas Nurses Association, including Nurse Day at The Capitol. We have the power, we just need to use it.
NurseManifest 
Unfortunately, we nurses are on the frontline in a very conflicted relationship with our patients. I have tried to describe it in many different ways but the sad thing is that nurses are as much in the dark as their patients, their patients’ families, and the general public.
Perhaps the most significant change in health care over the last 4-5 decades has been the steadily increasing degree to which health care providers when it comes to patients. On the one hand, we have the Marcus Welby/Wilbur Stone/Florence Nightingale model where the health care provider treats all patients the same, regardless of whether the patient is the town drunk, or the person after whom the town is named. This doesn’t always go smoothly, but in the end, everyone gets the best care the provider can give, and almost everyone respects the provider because they were fair and they did the best they could.
But that is the old, much revered role. The other role is more like an insurance company claims adjuster. In this role, the health care provider is trying to settle claims as quickly, and at the least possible cost. Nurses, physicians, social workers, and the billing department all play parts in this role, but nurses are right there in the front. Let’s consider a tale of two patients.
Sue arrives at her physician’s office for a 9 AM appointment. She fills out a lot of paperwork, and at 9:30 someone calls her for her vital signs, and directs her to an examination room. A few minutes after 10 AM a stressed out NP/PA walks in, spends 3 minutes with Sue, explains that the “Doctor” is running late today and apologizes, listens briefly to Sue’s concerns, pulls out a prescription pad, writes a prescription, and exits the room. 10 minutes later a nurse or clerk knocks on the door and asks if Sue is ready to check out. On her way out Sue sees Fred walking down the hall with Sue’s physician. Fred and Sue’s physician are chatting amiably as they walk down the hall, and Fred leaves without going through the obligatory check-out process, and Sue’s physician didn’t seem to be rushed at all.
Sue remembers that Fred came into the office just as she was heading back for her vital signs to be taken, yet here is Fred leaving before she is, and she still has to go through the checkout process which will take another 15 minutes. Sue is also keenly aware that her appointment was with her physician, not with an NP or PA, but she didn’t get to see her physician. She had to wait more than two months for her appointment and still didn’t get to see her physician.
Why is Fred’s journey so much shorter, and his relationship with their mutual physician so much more personable and so much less rushed?
Both Sue and Fred have health plans. Both of them work for the same company. Sue selected a managed care plan. Fred pays considerably more out of pocket in terms of deductibles, co-pays, and monthly premiums for a real insurance plan. When Fred’s physician sees Fred, does diagnostic testing, provides treatments, and referrals, Fred and Fred’s insurer pay more. When Sue’s physician sees Sue, does diagnostic testing, provides treatments, and referrals, Sue’s physician has to cover the costs of this care out of the monthly capitation payments already received.
Every time Fred comes to the office Fred and Fred’s insurer give more money to the physician practice. Every time Sue comes in the physician practice loses money they already had. The same happens at hospitals and nursing homes and the nurses are the ones who are delivering the news, discharging one set of patients, while providing extended stays for others.
Most Americans, including most health care professionals, don’t understand the difference. They think once they arrive at the office, hospital, or nursing home they will be treated just like any other patient. They think they will be seen by Marcus Welby/Milburn Stone/Florence Nightingale. But, when a family member is sick or injured, when the chips are really down, they take note of who gets called first, who gets more attention, who is seen earliest, who starts treatment earliest, who doctors, nurses, and other personnel seem to treat better, and who gets better care, and perhaps even who gets nicer meals.
Until nurses understand that we are functioning as insurance claims agents, denying claims for some patients, while smoothly processing claims for others, we are unlikely to make the structural changes needed, to restore trust and stop the seemingly endless violence.
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Paragraph 2 should read:
Perhaps the most significant change in health care over the last 4-5 decades has been the steadily increasing degree to which health care providers have become de facto health insurers and health insurance claims agents for their patients.
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