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The Other Epidemic: Violence Against Healthcare Workers

Giancarlo Toledanes, DO

Disclosures

August 30, 2021

After working two busy evening hospital shifts, I was eating breakfast with my children when I started reading about physicians confronted and verbally abused during school board meetings for advocating for face masks in school. The pandemic changed course with the Delta variant increasing hospitalizations, and it seems to me the public response to physicians and healthcare workers also changed.

During the first wave of the pandemic, public support accompanied healthcare workers’ sacrifices. Nightly applause rang through New York City, there were donations of food, and murals reflected public backing.

We as a nation rallied. We masked up and locked down. We produced vaccines. COVID cases decreased, and by spring, a hint of normalcy bloomed.

Then the virus changed, and the Delta variant spread. Pandemic fatigue set in. Healthcare workers asked for help with continued masking and increased vaccinations and instead were met with threats. The summer, already made difficult, makes the prospect of winter even more daunting.

This Kind of Abuse Is Persistent

Violence against healthcare workers is not a new dilemma. Stories abound of patients or family members physically attacking, verbally abusing, or harassing healthcare workers. A 2014 survey reported almost 80% of nurses attacked during their career. Data from the Bureau of Labor Statistics also reveals healthcare workers experience more nonfatal workplace violence, as compared to other professions.

Nurses, who often spend the most face-to-face time with patients, receive a litany of abuse. A 2019 nursing survey reported 59% of respondents experiencing verbal abuse from patients and more than 43% experiencing verbal abuse from patients’ families. Even more concerning is 23% of survey respondents reporting physical abuse, an increase from 20% in 2018.

Physicians, likewise, are not immune from the same maltreatment. A 2014 physician survey reported more than 71% of physicians in the United States have experienced at least one incident of workplace violence in their careers. Of the physician specialties, the highest rates of violence are in the emergency department and against less experienced physicians. This is likely due to the higher rates of patient frustration in emergency rooms as a result of long wait times, overcrowding, and boarding while awaiting an inpatient room.

These statistics are disheartening. However, what I find most discouraging is the almost submissive acceptance of this abuse in the healthcare field as almost 73% of healthcare workers feel that the abuse is part of the job.

COVID and the Increase in Violence against Healthcare Workers

The specter of COVID-19 has not only increased the problem of violence towards healthcare workers but has accelerated it at an alarming rate. As the Delta variant spreads, hospitals’ capacity to handle both COVID and non-COVID issues is further strained. Compounding this stress is the public’s pandemic fatigue and the ongoing battles with masking and vaccinations.

In San Antonio, healthcare workers faced verbal and physical abuse as they enforced masking and visitation restrictions for COVID patients. Online, healthcare workers, who advocate for masking or vaccination, are often subject to death threats, threats to family members, and verbal abuse on social media. Veiled threats of “we know who you are” and “we will find you” follow physicians who advocate for masking in schools.

This problem is not isolated to the United States. In Italy, a COVID patient spat at healthcare workers who asked them to wait, resulting in closure of an entire hospital ward. In the United Kingdom, healthcare workers were subject to the same abuse as those in San Antonio when trying to enforce masking in the hospital. In India, Pakistan, and Spain, a stigma exists against healthcare workers for being sources of contagion.

The presence of a growing divide between healthcare workers and those we serve threatens to undermine not only delivery of care but also our response to the pandemic. This is in addition to the mental health burden and compassion fatigue suffered by many healthcare workers who find their efforts in doubt. An already strained medical system will find it difficult to withstand the loss of its essential workforce.

Standing United Against Healthcare Worker Abuse

Despite the level of discord surrounding COVID-19, it is important that healthcare workers remain united. An effective response to the increase in violence towards healthcare workers will greatly depend on how we address the following.

First, we must actively work to combat the spread of misinformation that erodes the public trust in science and medicine. Transparency is paramount. Policy changes and plans for implementation should be open and free of political influence. This remains a challenge due to the CDC’s standing as both a federal and scientific institution. A steadfast and explicit presentation of scientific evidence by the CDC is a vital first step in repairing this trust.

In addition, we must become our own advocates. The passage of HR 1195, the Workplace Violence Prevention for Health Care and Social Service Workers Act, in the U.S. House of Representatives with bipartisan support is an indication that the time is ripe for sweeping change. Its supporters include the American Nurses Association, American Psychiatric Nurses Association, National Nurses United, and the American College of Emergency Physicians. Active opposition includes the American Hospital Association, which cites prohibitive cost as a source of objection.

HR 1195 now waits in the U.S. Senate for approval. We should alert local, state, and health system leadership to the violence against healthcare workers. We should demand increased protection for our most vulnerable colleagues in emergency rooms and hospitals. Our advocacy will produce a paradigm shift away from the acceptance of this abuse.

Lastly, we must be mindful of compassion fatigue and healthcare worker burnout. Cynicism threatens to take away our greatest strengths of empathy and humanity. In our work environment, we must lift each other up and increase our awareness of when our colleagues need help. Self-care and creative outlets are encouraged. Admittedly, I am blogging as a personal safeguard against compassion fatigue and burnout.

The pandemic will have enduring implications both positive and negative. It is my hope that support for healthcare workers not only endures but is also enhanced long after the pandemic ends.

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About Dr. Giancarlo Toledanes
Giancarlo Toledanes, DO, is an assistant professor of pediatrics and a pediatric hospitalist at Texas Children's Hospital and Baylor College of Medicine in Houston. His professional interests include quality improvement, health equity, faculty development, and social psychology. When he is not in the hospital, he is a cook and a handyman to his wife, an amateur LEGO builder to his son, an aspiring unicorn to his daughter, and a walking burp cloth to his baby daughter. Connect with him on Twitter: @ ToledanesGian

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