The Workplace Violence Issue

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​EDITOR'S NOTE:

Since the start of the recent Black Lives Matter protests, I’ve been making a greater effort to consider different situations from new perspectives. Savannah’s essay introduced me to a serious issue that I knew next to nothing about: harassment and violence against workers in the healthcare industry.

​Healthcare workplace assaults are directed primarily towards nurses, and affect female workers at a higher rate. For workers involved in mental healthcare, the likelihood of violence increases significantly. Studies conducted last year reveal that while 75% of workplace assaults occur in the healthcare field, only about 30% of nurses reported the incidents. The same reports recognize the damage done to both the employee and the patient, and reveal glaring flaws in a system that too often fails to support the people who are giving their all to serve vulnerable communities.

Savannah’s words truly opened my eyes to this issue, and encouraged me to analyze the situation more deeply rather than jumping to easy conclusions. While she does not take pleasure in the risks she faced in her workplace, she does not condemn the patient for his actions; rather, she criticizes the system that put her in a dangerous position and then provided no support or recourse when she was harmed.

I’d encourage you to read more about workplace violence in healthcare, and specifically in mental healthcare, by reading this brief article or exploring this report by the NIH. After giving so much to support those in need, our direct service workers are not always given the protections they deserve. They play an incredibly important role in our communities. We can start giving back by raising awareness about important issues like workplace violence.

- ASB

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IN A CORNER - Savannah K.

CW: physical violence

This is my personal account of the safety risks associated with working in the mental health field. There is a lot to unpack in this incident, from major systemic injustices in the mental health field, to the frequent incident mishandlings in locally managed companies. This is my story of being attacked by a resident while at work, how the company I worked for handled it, and why it will happen again.

For five years, I worked for a company in Chapel Hill that provides long term care for intellectually disabled individuals. I worked mostly twelve hour shifts that encompassed many different roles. While different, each of these roles had one goal: to assist residents to reach their highest possible level of independence. I helped with basic living skills, such as cooking, bathing, and personal hygiene, as well as more involved activities like reading, writing, mathematics, and nutritional maintenance. This was in addition to keeping up with the other house chores that could not be completed by the residents.

While these activities took up most of my day, my job also involved assisting in anger management with multiple residents and teaching coping techniques rooted in cognitive behavioral therapy. Essentially, this was a certified nursing assistant position that required additional de-escalation training and unconventional communication strategies to meet the needs of the community we were serving. Unfortunately, violence is common in this field, and every shift meant that I had to be prepared to protect my residents, other staff, and myself from any altercations that might occur between residents or between residents and staff.

On my last shift with the company, a resident with a violent history attacked me. It started when I requested that he be conscious of how much dessert he was consuming and to respectfully leave enough for his housemates. This made the resident extremely agitated at which time I responded with de-escalation techniques, while doing my best to help my resident communicate his frustration in a safer and calmer manner. I asked if he wanted to separate himself and talk more when he felt less angry, but this was met with more rage.

Though this had happened with this resident before, I didn’t foresee what would happen next. He charged at me, as he had done several times before as an intimidation tactic, only this time, when I did not move, he did not scream in my face as he usually did. Instead he drove into me, knocking me back and bashing my head into the cabinets. For a split second I looked over at my manager, who was frantically Facetiming my supervisor. When I looked back at my resident he was preparing to jump on me. He landed on me and began to windmill punch towards the top of my head. I was able to wiggle out from underneath him, stand up and put myself between him and my coworker and other residents. At this point he stormed off to his room, flipping chairs and tables as he went.

I know this sounds horrific but truthfully, this is a risk that is taken when working in a group home. My main issue is with the response of the company and how this, and most situations there, were handled.

I was relieved of my shift for the day and the director of intermediate care facilities (ICF) was notified of the incident. Not only did she not call to see if I was in need of medical attention, she did nothing to contact me to see if I was okay, or to debrief after the attack. Once I left the physical workspace, there was no communication. After reflecting on what had happened, I requested to meet with the director prior to my next shift, to ensure that there would be action taken to lower the risk of a similar situation happening again.

When I showed up to discuss how we could make that happen, I was met with what felt like thinly-disguised victim blaming. I heard: 

“We don’t blame you, we just want to get a better understanding of what happened.” 

“What did you say that could have triggered him?” 

“Where were you standing? Did you back yourself into a corner?” 

“Did you follow his behavioral support plan?” 

I was taken aback by the lack of support the company showed me, an employee who had given her all for half a decade. I answered that, yes, I had been in the corner to ensure that my resident had an exit available, as well as keeping other immobile residents safe during the situation. 

Throughout our discussion, the director made it clear that my safety was not a priority. In the middle of the conversation, she mentioned her annoyance that she had to come in on a day off to meet with me about the incident. I made suggestions to keep the staff safer, like moving the resident to a home that had male staff instead of all female staff, to which she responded that they had tried that in the past and that the environment was not suitable for him. I mentioned that we are consistently understaffed, and had we had the proper amount of employees on shift, this incident, like many others, could have been avoided or made less severe. Though she agreed that understaffing creates a risker environment, she denied that there was anything to be done. We agreed that I would be present during the meeting with the psychologist to go over the incident and what ways we could help the resident, but I was never contacted.

The hour-long conversation ended in my unfortunate but necessary resignation from the company. I could not continue working at a place where a staff member who did everything they were trained to do during an attack was left so unsupported.

Later I found out that the company was telling their employees that all parties in the attack were to blame. This resident had recently become increasingly violent, but the company had swept each previous incident under the rug and painted the employees as the instigators. Besides the lack of integrity, the larger issue is that this conduct enables the resident to continue this behavior, and allows them to use their disabilities to define them. Covering up these incidents does nothing to help the residents learn and grow, negating the entire purpose of a group home facility.

Furthermore, it gives new employees the illusion that if they follow all protocol and behavioral support plans they will be protected and supported by this company to ensure the safest environment possible. I learned the hard way that this is simply not true. 

This story is one of many that receives too little attention. Mental health care has only recently gained more awareness and funding, but it is far from where it needs to be. Maybe if there was more funding I wouldn’t have been working short staffed that day. Maybe if companies were more closely monitored employees wouldn’t be treated poorly. A lot needs to happen to start fixing mental healthcare, but until we start tackling some of these systemic issues, there will be a lot more stories like mine.

Artwork by Amanda Sin. @amandazsin

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MORE TO THE STORY

While Savannah’s experience with assault was of a different nature than some of our past contributors, it is not hard to notice the similarities to those such as our tenth (“Me Too”) or thirteenth (Workplace Harassment) Issues. In all of these cases, a female employee was put in an unsafe position and forced to either leave her job, or risk returning to that dangerous and uncomfortable situation. Check out those Issues here and here.
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WPV in the healthcare industry is a growing problem, exacerbated by staffing cuts in many fields - most significantly in psychiatric care. To learn more about violence against healthcare workers, read this brief article.

WPV includes physical and verbal assault, and sexual and racial harassment, disproportionately affecting female and minority employees. The NIH provides a report with statistics and recommendations for improving healthcare and risk-prevention. Read the summary or the full report here. For more information about Black and Asian healthcare workers’ experiences with WPV, check out this NIH report.

This study details more statistics and findings concerning WPV, specifically in acute psychiatric care. The researchers also encourage more comprehensive reporting of physical and verbal abuse. Check it out here.

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