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It’s the 200th episode of Incident Report.

And there are few topics as important to our movement as preventing violence against healthcare professionals.

Read this article by a Stanford psychiatry resident for more thoughts.

Check out the original video here on Facebook and leave your ideas for improving our safety. Share this with your coworkers and administrators and politicians. #silentnomore

You can check out the free podcast version here on iTunes and Soundcloud.


– Okay, guys, it’s been a really tough week with the shooting at Chicago’s Mercy Hospital. It’s really shined a light on what violence against healthcare professionals really means. Those working on the front lines already understand, and this has been something we’ve been talking about for quite some time, even in the last month we’ve talked about gun violence, we’ve talked about violence against healthcare practitioners, we’ve done many shows on this as part of the #silentnomore hashtag and movement, but the real question, the action item is, with so many people suffering with healthcare related violence on the rise, 70% of all workplace-related violence, according to OSHA, happens in healthcare settings.

What can we actually do? And one of the real operative questions is when do we report healthcare violence as an assault in a legal sense?

Because many of us get very confused. We’re conditioned in healthcare to think that violence is part of the job, and we’re in a place of healing, we’re caregivers, the idea of changing from someone who’s caring for someone to someone who is reporting them legally and taking legal action is a very difficult transition.

On top of that, there’s a culture, particularly among administration, that, you know what, we just don’t even wanna pursue this because it’s a lot of work, it makes the hospital look bad, and it creates a conflict where we just want patient satisfaction to be high, and HCAP scores to be high, and we’re partially getting paid on the patient experience, so let’s sweep this under the rug, and in our medical training we’re conditioned to think that this is just a occupational hazard, but we’re not, you know, in medical training, we’re not taught to fear our patients.

We’re not taught to conflict with them, and yet here we are when someone can walk in with a gun and shoot people in a hospital, or you can be punched, we replayed Jimmy’s story, the nurse who was nearly strangled to death by a psychiatric patient, and it wasn’t clear that that patient wasn’t in their right mind when they attacked, and he talked about the struggle going through the process of filing charges, and going through the legal process, and feeling left adrift after all of that, and to add insult to injury, when a staff member or medical professional suffers an assault, often there’s no one to talk to.

There’s no process, they’re left with PTSD or worse, and these feelings of abandonment, feeling like they’re not worthy because maybe there was something they maybe could have done to prevent it, and in many times actually, higher ups will say, “Well, if you had just not been in the wrong place “at the wrong time or you had de-escalated the situation, “et cetera, you wouldn’t have been hit, or punched, or slapped, or, as a pregnant nurse, kicked in the stomach “and suffered a miscarriage.”

I mean, this kind of thing happens, and again and again and again we sweep it under the rug, and so there was recently an article in the Washington Post by a psychiatric resident at Stanford, a Dr. Morris I believe, and they were talking about when do you decide to press charges? Who makes the decision and how do we do this?

And the problem is that we have to understand, it’s a nuanced situation, it isn’t black and white. If a patient is delirious from medications, from illness, from sepsis, if they have dementia, if they are, again, medicated, if they have a psychiatric disorder where they are not in their right mind, when and if an assault occurs, do you prosecute them? Is it ethical to do so? These are the questions that often will tear us apart when we’re trying to decide what to do, and the thing is often we’re doing this in isolation.

It’s often the victim of the assault that has to make these very difficult decisions without help. That’s what we have to change.

So, yes, there are protocols, there are ways, and these have been done at certain hospitals. First of all, there can be laws at a high level to say okay, it’s a felony to put a finger on a healthcare professional, similar to hitting a police officer. Great, I think we need that, because we need to define what the crime is when you do it willfully and intentionally, and that has to be determined. If a patient is doing this repeatedly, willfully, and with clear intent without delirium, dementia, and being in the right mind from a psychiatric disorder, then it is a crime and we have to define it as such. That’s step one.

Step two then is having protocols in place where we say okay, once we determine the patient wasn’t suffering from delirium, dementia, psychiatric illness, well, now there’s a protocol. We need to file charges, we need the help of, whether it’s the security or administration, on behalf of the hospital professional to help them go through this process and ultimately it’s the decision of the victim but with support and the full understanding that if they report, if they press charges, there will be follow-through.

If repeatedly we’re trying to report and nothing happens, we get conditioned to go “it’s not even worth reporting.” You don’t think healthcare violence, as horrible as the statistics are, and as much as they’ve been rising in the setting of the opioid epidemic, and this change in culture of customer satisfaction, and the customer is always right, and entitlement, and this other BS, you don’t think that it’s still under-reported because people are just like what’s the point?

Absolutely it is, I hear about it all the time in private messages. Even my cat’s out there agreeing with me by meowing, and so in the setting of this, we need a protocol to help support us in reporting.

The district attorney and the prosecutor’s office need to support us in this when it’s an appropriate follow-through, it’s somebody, again, who was intentionally doing this, and remember, this isn’t just for our own, this isn’t like a selfish thing that we’re doing. We’re not trying to punish these patients. We’re trying to deter them, to set a culture that says healthcare worker violence is absolutely unacceptable and cannot be tolerated. There need to be signs all over the hospital saying you will go to jail if you lay a finger on a healthcare worker, you’ll be fined and you’ll go to jail.

There needs to be actual precedent. Oh, this patient did this and now they’re in jail, alright? That is absolutely necessary in a functioning civil society to have accountability and a standard.

In addition, there needs to be public shame around this. It should be absolutely unconscionable. This should be one of the worst things you could do, like walking into a church and punching the pastor. That’s what it should be like in terms of society’s eyes.

Instead, we consider it okay to hit a paramedic because, you know, you were mad and it’s an emotional situation being sick. No, no, yes, all that can be true, but it’s unacceptable. So we set that culture from on high, we create a culture of safety, we have protocols, our administration supports frontline healthcare workers, and we have an expectation of a zero tolerance, right, while doing our best to take care of patients, give them an experience, have them be heard, do not try to bully them and abuse our power in the hospital because it is a power differential and patients feel this, and that can trigger a lot of anger and emotion, right?

So we have to start with that, then we have to take our own responsibility to say okay, we need to teach our staff de-escalation techniques, we need to create a safer environment whether it’s key padlocks, whether it’s metal detectors, whether it’s armed security.

You know, my understanding is that the security officers at Mercy were not armed. What can you do when someone comes in with a gun, you know? We need to really look at practical and sort of evidence-based solutions to try to help us. We also have to study it, and I don’t think people are studying violence against healthcare workers.

In addition, this culture of silence, this culture of shame like oh, I’m the victim but really it was probably my fault, that’s gotta be transformed, which means we, as a movement, Z-Pac, have to rise up, and this hashtag #silentnomore is really saying we gotta stop staying quiet about this. If this happens, share your story.

We need to demand support, psychological counseling and, again, prosecutorial services and support when it’s necessary to prevent. What if that patient comes back, abuses another staff member? What if that patient comes back, abuses or injures another patient? It’s really our ethical responsibility to report these things, and it should be looked at as such.

So now, in summary, in a world where we’re hearing about increasing levels of violence against healthcare professionals, even in a world that’s overall getting safer, to see this happening in healthcare means we’re doing, something isn’t right, and yeah, you can blame opioid epidemic, you can blame customer service mentality, but you really also have to say we don’t, we need a better culture of safety, we need protocols, and, you know what, once hospitals start getting paid partially on professional satisfaction for their staff, and the safety of their staff, and the people like Joint Commission and others are actually trying to push this a little bit, when that happens, you’re gonna see a transformation because they’re gonna have to put their money where their mouth is because it’s gonna affect their bottom line, and we have to demand that, Z-Pac.

So the call to action is this, share this video, #silentnomore, keep making noise, share your stories, you can share them with me, you can share them on the internet, you can share them publicly, demand better from our leaders, we need to demand that they lead not just manage us and look at the bottom line, they need to look at all their assets, and their biggest asset is us.

We cannot care for others if they don’t care about us and we don’t care about ourselves, and if you think that what we’re doing in this movement is good, and just, and important, become a supporter of the show. This is my little pitch at the end. 4.99 a month and we talk about these issues in depth. When the Chicago shooting happened, I went live to the supporters and we had a really in-depth conversation with the nuance that’s necessary to have a conversation, and people disagreed politely and civilly, you couldn’t believe it was the internet. That’s the tribe of over 2,000 people we’ve created so far on the supporter page, and you can be a part of that and try it out and see what you think, because the money that you pay for that goes into creating an organization where we can actually spread your voice. We use those dollars to pay studio rent, internet costs, production fees, to hire, to have staff to help us do what we do. It’s so important and we so deeply appreciate it, Z-Pac, and so, again, hit share, stay safe, demand change, and we out.