In Harm’s Way: Why Hazard Pay for Nurses Is Overdue

Diane M. Goodman, BSN, MSN-C, APRN


September 15, 2021

I was a young nurse working in Gaithersburg, Maryland, when a patient suffering from delirium tremens attempted to shove me out a second-story window. He had painstakingly removed the window screen with shaking hands and was on his way to crippling me or worse when his roommate intervened.

I was lucky.

Shortly thereafter, I took the hardest slap of my adult life from a frail 96-year-old white-haired lady when I leaned in to interpret her words. She lacerated my nose and bent the frame of my glasses. I had not been told she was both hard of hearing and severely demented, despite looking sweet and frail.

I learned early in my career that nurses are working in harm’s way.

Nurses have been assaulted, shot, and stabbed. According to OSHA statistics recorded in 2018, approximately 2400 nurses are victims of violence every year, data which represented a 30% increase from reports of the Bureau of Labor Statistics in 2012. However, statistics might be underreported, as many incidents are considered “part of the job,” according to the same source.

Additionally, victims of violence may be ignored by the same institutions where their services are so sorely required.

Unfortunately, these incidents were conveyed before nurses were emotionally and psychologically traumatized by the unrelenting distress of COVID-19. Now, nurses are leaving the profession, especially in high-acuity areas such as the emergency department, the ICU, and acute care units at rates higher than ever.

On Think Out Loud, Lisa Powell, vice president and chief human resources officer at Providence St. Joseph Health, Oregon, describes the pandemic as an “accelerant,” leading to nurses resigning in numbers not seen previously. The vacancy rate at Providence St. Joseph is 12% a year, when it had been at a manageable 8% before the pandemic.

In addition to COVID, nurses were stressed about gun violence (eg, an “active shooter”), or the idea that “anything can walk through the door.” Experienced nurses may feel more competent to deal with the threat of potential violence, but novice nurses do not.

Southern hospitals have lost thousands of nurses since the beginning of the pandemic. Bidding wars and travel nursing companies initially tempted nurses to pick up and move to distant and/or greener shores, but many simply became exhausted. Kipp Shipley, a nurse practitioner from Vanderbilt University Medical Center in Nashville, Tennessee, told the Beauregard Daily News that he worked with COVID patients until he could not fight any longer. According to Shipley, the battle itself and the work with dying patients were not what worried him. It was when he began to feel “numb.”

Many states have lost hundreds of thousands of battle-weary nurses who have become demoralized by the lengthy fight. Coaxing nurses to travel to COVID surge areas through bonuses or sign-on pay is not a long-term answer, but paying them more in their home state could be.

Is the idea of hazard pay for frontline providers overdue?

The U.S. Department of Labor defines hazard pay as work duty that causes “extreme physical discomfort and distress which is not adequately alleviated by protective devices” and imposes physical hardship. Nurses working in specialty areas or working amid a surge of COVID patients could qualify as workers meeting the definition of hazard pay. Statistics demonstrate healthcare professionals are seven times more likely to have severe COVID than non-professionals, whether by the sporadic availability of PPE or by other causes, such as ethnicity.

More than 3600 United States health workers died of COVID during the first year of the pandemic. “Low-paid workers who handled everyday patient care, including nurses, support staff and nursing home employees, were far more likely to die in the pandemic than physicians were,” according to Kaiser Health News. It is time to recognize the danger in the work we perform; in fact, it is overdue.

We owe it to any nurse who could potentially be assaulted, shot, stabbed, traumatized, or demoralized to the point of feeling numb. That would describe hundreds of thousands of nurses doing the work performed. Every. Single. Day.

Does it describe the scope of what you are performing? Let us know how you feel.

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About Diane M. Goodman
Diane M. Goodman, BSN, MSN-C, APRN, is a semi-retired nurse practitioner who works from home contributing to COVID-19 task force teams and dismantling vaccine disinformation, as well as publishing in various nursing venues. During decades at the bedside, Diane worked in both private practice and critical care, carrying up to five nursing certifications simultaneously. Yet she is not all about nursing. She is equally passionate about her dogs and watching movies, enjoying both during time away from professional activities. Her tiny chihuahuas are contest winners, proving that both Momma and the dogs are busy, productive girls!


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