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Ohio nurses, doctors call for legislation to prevent violence in health care settings

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Ohio nurses, doctors call for legislation to prevent violence in health care settings

Jun 11, 2024 | 4:55 am ET
By Nick Evans
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Ohio nurses, doctors call for legislation to prevent violence in health care settings
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Nurses around Ohio complain their profession is in crisis as hospitals struggle to fill vacant positions and the increased workload pushes more people to leave the field. Those staffing challenges are compounded, they argue, by a spike in violent encounters between health providers and patients.

Nurses’ biggest ask is legally mandated staffing ratios, a change hospitals vehemently oppose. But they’re also urging lawmakers to pass a bipartisan measure aimed at better protecting health care workers from violence on the job.

“Nurses across Ohio are being hit, kicked, scratched and verbally assaulted while trying to do their jobs,” Ohio Nurses Association Executive Director Rick Lucas explained last week.

Ohio House Bill 452, sponsored by Reps. Andrea White, R-Kettering, and Rachel Baker, D-Cincinnati, requires hospitals around the state to develop workplace security plans and a system for reporting violent incidents. The measure also requires hospitals to post notices that aggressive behavior won’t be tolerated.

Last Wednesday, proponents of the bill argued those changes were a necessary first step, but that lawmakers should tack on additional protections as well.

Yes, and…

Speaking on behalf of the ONA, Lucas praised the bill’s requirement that hospitals develop security plans for ensuring “hospital workers can have a say in how to keep everyone safe.” Still, he argued the committees tasked with developing those plans should have strong representation from bedside workers. At least half of the members should be “direct care providers,” Lucas argued, and seats should be reserved for patients’ rights advocates as well.

Lucas asked for simple security upgrades, like allowing workers to request ID badges with only their first name. He argued as well for regular de-escalation training and a minimum number of trained workers based on a unit’s bed count and relative risk.

But the biggest ask was also — and there’s really no way around it — pretty gross.

“I’m here to tell you that having someone use blood, saliva, urine, feces, semen, sputum, or vomit as a weapon against a health care provider is not ‘part of the job,’” Lucas insisted. “This is assault and should be criminally charged as a felony in the fifth degree. These actions are not just violent, they pose severe health risks including the transmission of infectious diseases.”

He noted the same penalties already exist for using bodily fluid as a weapon against law enforcement officers.

Rep. Brian Stewart, R-Ashville, voiced support for holding people who assault health care workers accountable — making it a “big boy, big girl penalty that you go to court for.” But he worried some of the other provisions put forward demand a murky level of accountability from hospital administrators without necessarily making workers any safer.

Lucas, however, defended the importance of deescalation training as a first step.

“Now, that doesn’t always work,” he explained. “And that’s why we need the criminal penalties when when folks escalate.”

Rep. Beth Liston, D-Dublin, who works as a physician, worried about “unintended consequences.” While she acknowledged there are circumstances where heightened penalties are warranted, in most cases she’s familiar with, patients aren’t in control of their faculties.

“I really struggle with saying an elderly, demented or delirious person who’s critically ill should be charged with a felony for lashing out when strapped down,” she said “As well as the — I don’t think it would do any deterrent impact, right? Because these aren’t people that are thinking clearly.”

Jacinta Tucker, a nurse speaking on behalf of the ONA, said it’s often not the patients themselves who are “kicking, cussing, fighting.”

“It’s when family members come in,” she said, “and they want everything done for that patient, and you’re in that room, and then all of a sudden, the patient’s family is the one kicking, cussing, pushing, shoving.”

Liston expressed skepticism, and Lucas pointed to willfulness as the distinction. He argued nurses are unlikely to pursue charges against a person with dementia who is not “willfully” harming them.

“But folks that are that are perpetrating willful acts against health professionals should absolutely face criminal liability,” he said.

Doctors weigh in

Next up, Drs. Nicole Veitinger and RJ Sontag from the Ohio chapter of the American College of Emergency Physicians attempted to contextualize the scope of the problem. Veitinger shared the results of a 2024 poll her organization conducted among its members. In all, 91% of respondents reported they or a colleague were a victim of violence in the previous year.

“The survey showed that patients committed nearly all assaults against physicians at 98%,” she continued, “And the most common types of assaults per this poll, were verbal assault with threats of violence at 64%, being hit or slapped at 40%, being spit on at 31% kicked 26%, and punched 25%.”

She argued the impact of violence in health care settings is “understated” because many workers decline to report assault or are even encouraged not to do so.

“I’m one of the 91% of emergency physicians who was assaulted in the last year,” Sontag volunteered.

“I was physically assaulted by a patient,” he went on, “and I was shocked to find out the hospital that I was serving in had no security in the emergency department, and had no system in place to even make a report.”

While he acknowledged doctors aren’t usually seeing patients “on their best day,” and not all incidents will rise the to the level of pressing criminal charges, it’s still vital for hospitals to have a reporting system in place.

“Physical violence, intimidation and threats are not accepted in any other workplace,” Veitinger said, “and they should not be allowed or tolerated in a health care setting.”

Follow OCJ Reporter Nick Evans on Twitter.