Barely 5 feet tall and with a wispy build, behavioral health counselor Toni Sladek did not have much of a chance fighting off a dangerously agitated patient last year.
The woman was mostly silent while Sladek talked to her in a room at Poudre Valley Hospital in Fort Collins that was designed with physical safeguards to keep troubled patients from injuring themselves and others.
Sladek said she really didn’t notice the patient slowly scooting forward. When her back was turned the woman launched herself from her bed and onto Sladek. “She jumped me from behind and she pulled me to the ground,” Sladek said. “I don’t know how she got to me so quickly.”
A hospital resident pulled the woman off Sladek and a police officer, who just happened to be in the facility at the time, shocked the attacker with a Taser and took her to jail. A shaken Sladek took some time away from patients after the attack to deal with her PTSD.
Sladek, who is also a social worker, had worked at Poudre Valley Hospital for 27 years, often in close proximity to patients in emotional distress. But she had never been battered by a patient until last year.
Like other nurses and health care workers in hospitals and clinics in Colorado who have suddenly found themselves in new and more dangerous territory, Sladek sees more patients than ever lashing out at their hospital caregivers with punches, kicks and verbal abuse in unprecedented numbers and intensity.
“I usually have good instincts about patients, but not this time,” Sladek said. “There is just this increase in aggressiveness from patients. They are not as predictable as they used to be.”
Colorado has joined a national trend of hospitals and clinics reporting an increase in violence against staff members due to both increased incidents and more reporting, according to the Colorado Hospital Association.
“It’s probably the most workplace-related issue raised in nearly all our 80 hospitals and clinics, both in our rural and urban settings,” said Jeff Tieman, president and CEO of the hospital association. “It’s deeply concerning and it speaks to the safety of people who put themselves in harm’s way.”
“I hear of hospital workers being punched, spit on, kicked and dealing with similar acts of aggression as well as verbal abuse,” Tieman added.
Red-hot antagonism toward nurses and others reached an apex during the COVID-19 pandemic, when patients and family members grew frustrated with restrictions imposed by hospitals, officials say.
A National Nurses United Survey found that nearly half of nurses reported an increase in workplace violence, a 119% increase from March 2021, according to the CHA. On average, a nurse is assaulted every 30 minutes — more than 5,200 nurses were assaulted in just the second quarter of 2022, the CHA states.
Christopher Powell, UCHealth’s chief security officer, said nurses and other workers are the easiest targets because they are physically close, taking blood pressure or checking pulses and trying to keep patients comfortable, Powell said.
Although COVID-19 rules have eased, frustrations among patients remain, Powell said. Staffing shortages in hospitals means some patients feel they are not getting immediate attention and their resentment boils over.
Emergency room personnel are also seeing more people brought in for care with severe alcohol, drug and mental health problems. Those patients can react violently to hospital caregivers, Powell said.
Nurses have always had run-ins with patients as part of the up-close-and-personal nature of their work, he said. But today’s society is more prone to turn to fists and cursing than ever before.
“It’s all part of a big gumbo of problems more and more hospitals are dealing with right now,” he said. “This is not new, nurses and health care providers have always had their asses kicked. However, the intensity has heightened. It is much worse.
“And there is not just enough protection for our health care professionals.”
UCHealth and the CHA are among the groups that say they will work together next year to lobby the Colorado legislature to make assaults against health care workers in hospitals and clinics a criminal offense.
Powell said Colorado could enact a state law that mirrors a federal statute that says if someone physically abuses a flight attendant, they could face a second-degree assault charge.
“I think it makes sense that nurses and other health care workers get the same protection as a flight attendant,” Powell said.
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Better hospital staffing could be even more effective
At least 38 states have established or increased penalties for assaults on nurses, according to the American Nurses Association.
But some states only apply an assault law to certain health care workers or settings, the ANA says. Local officials say that also applies to Colorado, where lawmakers in 2019 added emergency medical care providers to the list of potential victims of assault in the first or second degree under certain circumstances.
Lawmakers should expand those protections to those who deal with irate patients every day, said Colleen Casper, director of practice and government affairs of the Colorado Nurses Association, noting that a single law may not be the complete answer to workplace violence in hospitals.
“We as a professional organization are trying to get to the root causes of this violence,” she said. “How as a community can we get to some of the triggers of this violence?”
One avenue, she noted, would be to ensure hospitals and clinics have enough staff members to deliver care.
“A new law,” she added, “doesn’t prevent everything.”
The passage of a 2022 bill that addresses hospital staffing may help, Casper said. House Bill 1401 requires the state to track violent incidents against hospital workers, which could shed light on exactly what they face each day.
“As of now, we don’t have a system to let us know precisely what is going on out there,” she said.
Hospitals in Colorado have implemented efforts and technology to keep patient attacks at a minimum, officials say — including more training for nurses and health care workers to recognize potentially dangerous situations.
“We often assess the room and that person to see if there will be a problem,” Powell said, adding that nurses and others also note the closest exits and the easiest access to them.
Visitors at UCHealth hospital emergency rooms are asked to check in at the security desk, where the protocol includes a photo, driver’s license scan and creation of a sticker they must wear, Powell said. Patients and visitors are required to follow a code of conduct.
“If someone threatens a nurse, the next time they show up we will have a conversation,” Powell said. “Someone may be escorted out of the facility.”
Assaults on nurses reported almost daily in Fort Collins
Amanda Miller, nurse manager for PVH, said assaults on nurses are reported almost every day, with the most common type being verbal. Besides being cussed out and threatened, nurses also often are bitten, punched and shoved.
“It’s pretty much an everyday occurrence,” Miller said, adding the fears over an unsafe workplace have led some nurses to leave the profession. “They are just afraid to come to work, they feel anxious and worried. The strain for some is too much.”
About 100,000 registered nurses left the workforce during the past two years due to stress, burnout and retirement and another 610,388 reported an intent to leave the profession by 2027, according to the National Council of State Boards of Nursing.
The council suggests that to stem the tide of nurses leaving the profession, officials should invest in nursing schools, increase pay for nursing faculty and enact federal protections for health care workers against workplace violence and intimidation.
Miller said she understands the sentiments of nurses who quit. But the 14-year nursing veteran said she has stayed because she still enjoys serving patients and being part of a team of health care workers at PVH.
“Really all any of us want to do is to make sure everyone can heal and care in a safe environment,” she said. “That’s what we signed up for.”
CORRECTION: This story was updated at 11:10 a.m. on Friday, Oct. 13, 2023, to clarify the groups that plan to lobby the Colorado legislature next year to make assaults against health care workers in hospitals and clinics a criminal offense.