Hospital emergency departments can be risky places for nurses. A survey from the Emergency Nurses Association finds a high percentage of its members have been physically assaulted at work, and verbal abuse is also common.
If you were going to take on an emergency room nurse at UCSD Medical Center, Michael Jackson probably wouldn't be your first choice.
He stands about six feet tall and is solidly built. Jackson is a former Marine, and he carries himself with a confident air.
Still, Jackson says, over the years he's been assaulted a number of times at work. One incident stands out.
"I was working out here in triage, maybe three, four years ago," Jackson recalls. "A guy comes in, he was pretty irate, and he actually pulled a knife in the triage area. I did grab his wrist, and was able to manipulate the knife out of his hand."
Jackson says it's not always the patient who gets aggressive. Recently, Jackson's emergency department treated a man who was accompanied by many members of his family. Jackson told them to clear out of the room so nurses could get to work. One person got into Jackson's face.
"He was a pretty big guy, so he was much bigger than me," Jackson says. "So he became violent, threatening, threatening to kill, destroy. But I stood my ground and told him no, you're going to have to leave the department, period. I wasn't about to cower or show any kind of fear."
The Emergency Nurses Association recently surveyed more than 3,400 of its members nationwide. Association president Bill Briggs says the results are disturbing.
"Over half of our nurses reported that they had had acts of physical violence, which included being hit, spit, kicked, bitten, and we found that one in four had reported as many as 20 incidents in the last three years," Briggs says.
Briggs says these incidents aren't confined to urban hospitals. He says even nurses that work in small town emergency rooms report being assaulted.
"When you look at non-fatal violent injuries in the United States, nurses have the highest rate," Briggs points out. "We have a higher chance of being injured by a patient than a police officer does."
Dr. David Guss is the chair of the Dept. of Emergency Medicine at UCSD Medical Center. He concedes there are certain aspects of emergency rooms that can be unsettling. There's a high level of activity, and people are sick and upset.
"And then of course intermittently, emergency departments can be very overcrowded, people can be made to wait a long time, so they're already coming in and they're stressed and nervous, being around in a disruptive, agitated environment may just help precipitate outbursts," Dr. Guss says.
ERs also treat many patients who are intoxicated, or who have psychiatric problems.
Guss says staff learn to recognize warning signs that someone may be about to lose their cool.
"Most of the times when I've been involved with a patient that's been violent, it's been anticipated," says Guss. "That doesn't mean that you can protect yourself entirely. Some patients have to be physically restrained, and it's possible to get injured in the course of physically restraining somebody. But we have policies and procedures about how to proceed there, both to protect the patient and the health care providers."
Some emergency departments have metal detectors and armed guards. Some even have guard dogs.
Nurse Michael Jackson says he's gotten used to a certain level of workplace violence at his ER. He believes it just comes with the job.
"But you know, I was just thinking, what's gonna happen to that co-worker that doesn't have the training, that doesn't have the experience that I have, or they don't have the size that I have," Jackson wonders. "Somebody's gonna get seriously injured."
In a recent national survey of 65 emergency departments, one out of four health care workers said they feel safe sometimes, rarely, or never.
