The New York State Nurses Association is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

This course has been awarded 5 contact hours.

• An RN at Montefiore Medical Center’s Einstein Division in the Bronx was nearly choked by a patient on November 20, 2003. An emergency room nurse at Montefiore’s Moses Division was stabbed in the arm by a patient on November 2, 2003.

• A nurse at Long Island College Hospital in Brooklyn was held captive for 30 minutes by a patient who held scissors to her throat on November 19, 2003. Two other RNs and a nurses’ aide have also been attacked within the past few months.

• A registered nurse at Mount Vernon Hospital in Westchester County was dragged around the emergency room by a disturbed patient and nearly choked to death on November 14, 2003.

There are many, many more examples of the violence that nurses encounter as part of their work. A few of them include:

Alda Ellington, a 47 year-old nurse, was working the nightshift at Savannas Hospital, a private psychiatric hospital in Port Lucie, Florida on April 11, 2001. She was in the process of admitting a patient, Alberto Serrano, who had been brought to the facility, through the Baker Act (allowing for persons who are a danger to self or others, to be admitted involuntarily for 72 hours while psychiatric assessment is made). Alberto Serrano beat Ms. Ellington to death; she was found in a pool of blood. He then attacked two elderly female patients, beating and bloodying them as well; they survived their attacks. Ms. Ellington was alone on the unit with Mr. Serrano (AP, 2001).

In March 2001 at a California hospital, Debbie Corning, an intensive care nurse for 11 years, was kicked in the spleen by a patient. She was sent flying across the room and had to be treated in the facility’s own emergency department. Debbie had reported that in her career as a nurse, she has been clawed, punched, choked with a stethoscope and threatened with death too many times to count (Reise-Koncor, 2001).

Mary Grimes, a registered nurse for 40 years, was an outspoken patient and nurse advocate. She was described by her co-workers as caring and friendly. On November 16, 1999 Mary came to the aid of a co-worker who was being attacked by a patient at the state-run Zeller Mental Health Center (Illinois). The patient pushed Mary so violently that she fell backward and hit her head against a metal door-frame. She was in a coma for several weeks due to the severe head injury. The patient, Bruce Perona was sentenced in November 2000 to 30 months' probation after pleading guilty to one count of aggravated battery and was confined to a maximum security mental health care facility for several months until reevaluated. Perona, a diagnosed schizophrenic, also was ordered to take medication as a condition of his probation.

In another incident, two nurses in Guam were killed at their workplace. Peter Aguon Maguadog, 44, fatally shot his estranged wife Lucia Maguadog, 43, another nurse, Bernadette Moreno, 27, and four others at a medical clinic in Guam. The gunman appeared to have singled out his wife and then shot the others at random, according to a February 26, 2002 Associated Press report.

And in yet another incident, a psychiatric hospital in Oregon had to close to new admissions until safety issues were corrected, following the fatal shooting of a patient by police. The April 1, 2002 shooting, which occurred after the patient escaped from a secured room and allegedly threatened police with a metal bar, raised questions about the facility's staffing levels, policies and procedures on seclusion and restraint of patients, and reliance on Portland police for security, according to an April 20, 2002 story in The Oregonian.

In 1991, at Alta View Hospital in Sandy, Utah, Richard Worthington, 42, shot emergency department nurse Karla Roth in the back, killing her. He held seven hostages for 18 hours, including nurse Susan Woolley, as well as other staff members and patients, including a woman in labor and several newborns. He was angry about the tubal ligation performed on his wife after the delivery of the couple’s 8th child.

In 1995 Jean Dooley, 71, was at Valley Lutheran Hospital in Mesa, Arizona recovering from a hysterectomy. She became upset and pulled a gun out of a bag brought in by her husband and began shooting at the nurse’s station. She shot a nurse in the arm and injured another healthcare worker (Washington Times, 2002).

In 1999, a dialysis patient at St. Mary’s Hospital in suburban Chicago became enraged when a nurse refused him coffee during dialysis. He shot the nurse multiple times, then killed himself. One month later the nurse was still in critical condition (Carroll, 1999).

In June, 2001, Brenda Maynard, a nurse for over ten years, was working on a psychiatric unit. Earlier that evening shift, a patient attempted to leave the unit against medical advice, but was brought back and was restrained. Later, when she was the only staff member on the unit that same patient attacked her, attempting to choke her from behind, angry for the earlier restraint. He punched her, threw her across the room and attempted to beat her with a piece of metal equipment. She was finally rescued by a fellow nurse. Ms. Maynard was treated in the emergency department of the hospital and later transferred to a trauma unit (Washington Times, 2002).

In 1995, Colorado home health nurse Edna Hooks was shot and killed by a wheelchair-bound patient (Carroll, 1995).

On July 14, 2002, a 21 year old man was charged with aggravated assault, simple assault and harassment for pushing and slapping a nurse in the emergency department of St. Luke’s Hospital in Fountain Hill, Pennsylvania. He was sent to Lehigh County Prison under $10,000 bail (The Morning Call, 2002).

As these dramatic examples illustrate, workplace violence is a serious concern for nurses. However, it is not just nurses who are victimized, nor is this violence limited to healthcare. According to the Department of Justice's National Crime Victimization Survey (NCVS) (2001), there were 1.7 million violent victimizations per year against workers in the US during the years 1993-1999. In addition to the non-fatal violence, during the same period of time, there were about 900 work related homicides per year. During this seven-year period, of all violent crimes, 18% occurred at the workplace.

Nurses, as the above examples illustrate so dramatically, are victims of violence in the workplace. Nurses experience violent victimization at a rate of 21.9 per 1,000 workers. The percentage of those workers who experienced violent victimization during the period between 1993 and 1999 who were nurses was 3.5%. This was the highest percentage, by occupation, with the exception of law enforcement officers, who made up 11.2%.

Safety in the healthcare workplace is not just about preventing accidents or injury to patients; it is more than the much publicized high incidence of medical errors; safety includes the health and wellbeing of healthcare workers. Nurses must protect themselves, through education and advocacy. This course will help to increase nurses’ knowledge and skill in preventing, and also in intervening in violence in the healthcare workplace.

© 2004 NYSNA All rights reserved.

Course Objectives

Upon completion of this course, participants will be able to:

• Discuss the prevalence of healthcare workplace violence.

• Define workplace violence.

• Discuss factors that have contributed to the underreporting of workplace violence in healthcare.

• Identify the impact of violence in the workplace.

• Discuss the categories of workplace violence.

• Describe the components of the NIOSH workplace violence prevention program.

• Discuss the concept of “Standard Violence Precautions”.

• Discuss assessment data that should be considered in all healthcare workplace settings.

• Utilize communication strategies to effectively defuse potentially violence situations.