Workplace Violence and Healthcare Quality: Uncovering the Link

Cherry Hill, New Jersey is a township not far from the Delaware River, near Philadelphia. Cherry Hill is one of the Delaware Valley’s main commercial centers, with a high density of retail centers, restaurants, and entertainment venues. As of the 2020 U.S. Census, the township’s population was 74,553, with an average household income of over $150,000.

Cherry Hill is the adopted hometown of many of Philadelphia’s professional athletes.  Muhammad Ali purchased a house in Cherry Hill once, and lived there with his family from 1971 until 1974.

About a month ago, a police officer brought a patient to Jefferson Cherry Hill Hospital, early on a Saturday afternoon. Inside the emergency room, the patient lunged for the officer’s handgun. As they wrestled for control of the gun, several shots were fired. Luckily, no one was hurt.

This incident, occurring in a suburban community, highlights the fact that violence in America’s hospitals is shockingly commonplace.

A 2022 survey reported that more than two nurses are assaulted every hour in the United States, with most assaults occurring in emergency departments or psychiatric units.

A new study, released last week in the Journal of Emergency Nursing, revealed even more sobering statistics. Workplace violence in hospitals, particularly in the emergency room, is probably much worse than previous studies indicated, because of under-reporting.

One hospital in the northeast recently conducted a survey of its emergency department (ED) staff. It resulted in a snapshot of the violent environment there. A total of 97 percent of respondents reported both verbal and physical violence in the emergency department. A total of 29 percent of these respondents reported suffering an injury that required treatment. A more depressing statistic of the ED violence is the repetitive nature of the incidents. A total of 38 percent of respondents reported 10 or more violent events in the last 90 days! Fewer than 10 percent of the violent incidents were reported in the hospital’s reporting system.

The affected staff said that they mainly didn’t report incidents such as verbal threats and assault that didn’t require treatment because “nothing will change” (24 percent), “event was not severe enough” (21 percent), or “part of the job” (15 percent), with the remaining 40 percent noting various bureaucratic barriers to reporting the assaults.

It is important to say that violence in hospitals is more than an HR concern that contributes to staff burnout and turnover.

If nurses, doctors, and other staff are routinely in fear for their safety, or if they are mentally distracted by aggressive and abusive patients and visitors, they are not focused on their jobs, and they cannot provide high-quality care to their patients. 

That impact on the quality of healthcare in the U.S. dovetails with another recent headline concerning the American healthcare system. 

There was a headline that you might have seen recently: “U.S. healthcare system ranks last among developed countries.”

Sad, but true. 

The Commonwealth Fund issued a report that ranked the U.S. dead last in access to healthcare, equity of access to healthcare, and outcomes of healthcare treatment (measured in life expectancy.) The study found that the U.S. experienced the highest mortality rates and the highest number of avoidable deaths of the 10 measured developed nations included in the study.  

Premature deaths have been rising steadily in the U.S., for a number of reasons. There are fentanyl and opioid overdoses. Infant mortality rates are higher in the U.S. because of the lack of prenatal care, and one could expect these infant mortality statistics to get worse, because many OB-GYNs are leaving certain states after recent changes to abortion laws.

This year, the number of Americans who died because of extreme temperatures has spiked to around 8,000. It is estimated that in the next 25 years, the number of deaths associated with extreme temperatures may increase to somewhere between 19,000 per year to 26,000, depending on how the reigning political party feels about lowering greenhouse gas emissions.

On top of these issues, there is one of the biggest causes of premature deaths in America – one that makes us stand out from the rest of the world – and that is gun violence.

In 2023, more than 40,000 people died from gun violence in the U.S. That was an average of about 120 deaths per day. Not shootings. Not injuries. One hundred twenty deaths per day. 

In 2023, there were 142 mass shootings in the U.S., with 712 people killed and at least 2,692 injured. Other countries with mass shootings include Russia (21), France (8), Germany (5), Canada (4), Finland (3), Belgium (2), and Czech Republic (2)

Our healthcare system is not perfect. But when statistics show that the “U.S. healthcare system ranks last among developed countries,” they may be revealing as much about American society as how healthcare services are provided in America.

Just one more thing, as I’m providing this pessimistic message regarding the U.S. healthcare system and society.

Over the summer, in Italy, attacks on hospital staff have gotten really bad.

This summer, in Foggia, a town in southeastern Italy, a mob consisting of approximately 50 family members and friends stormed a hospital and attacked hospital staff after the death of a 23-year-old patient. In the days following, more attacks occurred across southern Italy. In the Naples province, patients and families grew violent when asked to wait in the emergency waiting room.

Italy’s National Hospital Association has requested that the government send in the Italian army to assist in suppressing violence against hospital workers.

We aren’t at this point in America.

But we may not be far away.