When visiting nurse Waneta Boatright went to see a home-bound patient in Girard, Kan., on Feb. 7, the scene she found stunned her–two people shot to death in the living room.
Police received her frantic call for help at 10 a.m. Three minutes later, they arrived to find Boatright, 51, dead from a gunshot wound. The patient’s son, Michael Bethel, was charged with the shooting.
For years, America’s nurses have accepted a dark reality about their profession: The patients they serve can injure or even kill them. For a long time they simply accepted risk as part of the job and resignedly sustained injuries ranging from sprained wrists to broken bones.
But nurses increasingly are taking their demands for a safer workplace to hospital administrators, state lawmakers and, in some cases, to the picket line.
According to the American Nurses Association, the rate of injuries among nurses exceeds the rate among workers in other, more traditionally injury-prone professions.
The most recent Bureau of Labor Statistics survey of occupational injuries found that about 118,000, or 4.6 percent of the nation’s 2.6 million nurses and nurse’s aides, suffered sprains, fractures, bruises and cuts on the job in 1997.
By comparison, 3.4 percent of the country’s 1.1 million carpenters sustained similar on-the-job injuries, as did 1.9 percent of the nation’s 641,000 police officers that same year, according to the Bureau of Labor Statistics.
While the specific causes of nurses’ injuries are not recorded, officials at the Washington-based nurses association say regional surveys indicate a substantial number of injuries, such as broken bones and bruises, arise from violence and abuse at the hands of patients, or their agitated family members or friends.
Studies don’t always reflect the extent of the problem, many nurses contend, because hospitals often fail to report some incidents. For example, a survey in the American Journal of Industrial Medicine revealed that Washington state’s psychiatric hospitals reported only one-tenth of the nearly 500 injuries to nurses in 1997.
As a result, nurses associations across the country have begun conducting local surveys. A 1998 poll of 600 nurses in seven states–including Illinois, Hawaii and Missouri–found that more than one-third reported assaults from patients armed with everything from guns to chairs.
These results came as no surprise to nursing professionals, particularly those who work with the mentally ill.
“Nurses in our mental health facilities have been battered, stricken, knocked to the ground, suffered broken bones and broken noses,” said Terry Roberts, executive director of the Kansas Nurses Association.
And hospital emergency rooms present a tricky challenge in balancing the safety of nurses and others while providing easy access for those with urgent or life-threatening medical problems, hospital officials say.
Benny Marrett, president of the Emergency Nurses Association, said that such urgent-care areas, with their open-door policy and 24-hour traffic, are particularly at risk for violent situations.
Boatright’s recent death left nurses from Alaska to Florida feeling vulnerable. Yet often, even such grisly events provoke only a shrug from some nurses. “I was shocked and saddened, but I wasn’t surprised,” said Stephani Monet, a nurse and lawyer for the Hawaii Nurses Association. “Incidents like these are becoming frequent and common.”
Nurses in Illinois became some of the country’s most vocal advocates for safer working conditions after a patient critically injured Mary Grimes in December. The disturbed patient pushed Grimes head-first into a metal doorframe at the Zeller Mental Health Center in Peoria, cracking her skull.
Grimes recovered from a coma but is far from regaining the life she once had. Instead of caring for patients, she has become a patient herself, needier than most of those she formerly nursed. She spends her days at a rehabilitation center in Carbondale, relearning how to walk, talk and eat.
Grimes’ case prompted Illinois state Rep. Lou Lang (D-Skokie) to hold hearings in Springfield recently to examine nurses’ safety complaints. “One nurse testified that her boss said it was her job to be assaulted,” said Lang. “There are some systemic problems that need to be dealt with.”
“The magnitude of Mary Grimes’ injuries was a real wakeup call for all nurses in Illinois–it illustrates the vulnerability of nurses,” said Wyleene Cottrell, executive director of the Illinois Nurses Association.
Also problematic for nurses is what they see as an increase in the number of patients who aren’t merely “troubled or confused,” but deliberately abusive, said Monet of Hawaii.
“Many patients know exactly what they’re doing, and they’re doing it to intimidate us,” she said. “That’s the biggest difference right now from the past.”
Many nurses have personal horror stories. Two years before Grimes was injured, a Zeller patient hit nurse Rick Foster in the face, fracturing his nose and breaking two vertebrae.
“I came very close to dying if they hadn’t gotten [the patient] off of me,” said Foster, who recently left Zeller. “The comment we heard from the staff is that if you can’t handle it, then get another job.”
When asked if she has ever been abused, Kathy Kiney, a nurse at Chicago Read Mental Health Center, holds up a finger with a crook in it–the result of a patient attack.
Ask Cottrell if she has ever been injured in her 35-year career and she will tell of the confrontation with a patient that left her with a broken arm.
Nancy Agard, associate director of the New York State Nurses Association, said a male patient once picked her up and threw her into a corner.
Nurses cite myriad factors for violence, ranging from angry or drug-abusing patients to relatives unhappy with services. Poor security measures and understaffed wards are among the most common complaints.
Brooke Beal, a nurse at Zeller, said that until the Grimes incident, administrators never took nurses’ concerns seriously. “Their response is this is the job you have and that is the risk you take,” Beal added.
Tom Green, a spokesman for the Illinois Department of Human Services in Springfield, which oversees facilities including Zeller and Read, denied that Zeller officials told nurses to deal with the threat of violence or find another job.
“In fact, the department has been looking at ways of providing appropriate treatment for patients who may be difficult,” he said. Green said a safety task force at Zeller recently instituted new safety measures, including issuing personal alarms to staff and adopting use of “humane blankets,” a cross between a straitjacket and a stretcher, to contain and transport out-of-control patients.
He said Zeller also has hired a California-based consultant to offer violence containment seminars. “[The] goal is to create an environment in which the staff is more aware of the patient’s behavior so that they may intervene before an incident becomes more violent,” he said. “The goal also is to help nurses find out what makes a patient angry.”
