March 16: This article has been corrected to accurately reflect that the Occupational Safety and Health Administration can require employers that have violated the general duty clause to take corrective action. The original version incorrectly stated that OSHA did not require employers to take corrective action or require inspectors to follow-up.
Last December, at about 2 a.m. in the intensive-care unit, Allysha Shin's patient attacked her.
Shin, a neuroscience nurse, was carefully monitoring the patient, a woman in her 20s who'd suffered a hemorrhagic stroke. She'd begun her usual overnight shift accompanied by a sitter, a person who helps supervise or care for high-need patients.
The sitter was called away after two hours to attend to another patient. Later that night, Shin's patient, whose stroke had likely affected her behavior, grew agitated. She twisted in the restraints that bound her wrists, kicked Shin in the face and punched her. Then, she ripped away the restraints.
Shin yelled for help. It took four nurses, a nurse's aide and other staff to wrestle the patient into a chair. In the process, she kicked Shin several more times in the chest and stomach. Shin, who works at Keck Medicine at USC in Los Angeles, took the next two nights off, her body aching from the attack.
In a statement, Anne Sy, Keck's chief nursing officer, acknowledged the incident but said she could not speak to the details. “Keck Medicine of USC takes the safety of our staff and patients very seriously,” Sy said. The medical center encourages all hospital staff to speak up when violence does occur, she added.
Violence in healthcare settings has risen steadily in recent years. That has taken a growing financial and human toll on the nation's 15 million healthcare workers and on its hospitals and long-term care centers, and has prompted executives, providers and policymakers to take action in myriad ways.
Hospitals have debuted technologies and launched awareness campaigns. States have proposed laws requiring workplaces, including in healthcare, to establish anti-violence protocols. Unions have pushed for minimum nurse-to-patient ratios.
The violence is due to a confluence of factors that defy easy solutions. In healthcare settings, nurses, aides and other caregivers are often shouted at, hit, kicked, beaten and shoved. The majority of the time, patients mete out the abuse—sometimes intentionally, sometimes not. In other cases, it comes from visitors or other staff. In one notorious incident, in 2015, the son of a former patient shot and killed a cardiovascular surgeon at Brigham and Women's Hospital in Boston.
Such violence not only poses a threat to people—nurses, physicians, healthcare staff, patients and visitors—but it also drives up costs and undermines both the quality of care and patient outcomes. Yet fashioning an effective response to the violence that routinely occurs in clinics, hospitals, nursing homes and other medical facilities has long frustrated providers and their advocates.
“We've been working on this for decades,” said Bonnie Castillo, a registered nurse and director of health and safety for the California Nurses Association-National Nurses United. “You can't predict exactly when they're going to happen, but you know that they are going to happen.”