Is this an ER or a War Zone?

Today I am on a plane heading for California. I have been invited to speak at a conference centered on ER Violence. It saddens me to think that there is even a reason to host a conference focused on a topic that shouldn’t exist. I will never understand why so many patients feel the need to abuse us. I have turned it over in my mind a million times. Every time I am cursed at, spit at, punched, kicked…I will never understand it. ER nursing is dangerous. It is dangerous every day. I work in an inner-city ER and we service a very diverse community ranging from the homeless to the wealthy. In that mix of patients, we also see a very violent sect of the community. Located smack dab in the middle of a gang-infested neighborhood, we commonly (and usually daily), see gunshot wounds, stabbings and deadly aggravated assaults. We care for women who have been kidnapped and forced into the sex-trade, prostitutes who have no other way to make ends meet, drug addicts and prisoners. It is not uncommon for us to remove weapons and drugs from our patients. It is terrifying. I don’t know too many professionals that are wide-open to danger like ER nurses. Law enforcement officers are, however they are armed with the tools necessary to defend themselves and to protect others. The military is but again, we provide them with very large guns, also. The only professions that I know to be under the same umbrella of danger are firefighters and paramedics. I used to work in a community where EMS wore bullet-proof vests under their uniforms to protect them from the danger they faced when responding to 911 calls. I work in a larger and more dangerous community now. I am sure that the reason my local FD and EMS don’t wear Kevlar is because it doesn’t look good…It would hurt the image of the department. Seriously. Think about that for a minute… I have had a patient deliberately throw HIV positive blood at me. I have been punched in the face by a grown man. I have been pinched and scratched. I have been kicked in the lower abdomen so hard that I peed blood. All of these things happened to me while on the clock. If I am not told to “Go F*!* (myself)” at least once in a 12-hour shift, I feel left out. It’s funny to me that hospital administrators don’t feel that all of this deserves some kind of hazard or critical care differential in our pay. We are the mouth of the beast, so to speak. We are on the front-lines. We are that row of continental soldiers that goes first, knowing that we will all be sacrificial lambs if and when it all goes down…and it will. All of the bullet-proof glass in the world won’t make a difference until we start treating the ER like the battle zone that it is. Triage areas around the country are enclosing the triage staff behind cubicles of 4-inch thick glass to protect us but at the same time are letting as many visitors in to see patients with no consideration of possible weapons, no tracking of names, no security checks whatsoever. The triage staff might not get shot in the face but no worries, they WILL get shot in the back. I have to show a driver’s license to enter into my daughter’s school in the name of safety….IN SUBURBIA. However, those same children and adults aren’t safe in an ER that is filled with violence. This is all in the name of image and patient satisfaction. Metal detectors are apparently insulting. If that special sect of patients was found wandering upstairs in the administrators’ offices on a regular basis, I have a feeling things would be handled much differently…and mahogany metal detectors would be installed. Commissioned police officers in the ER are a wonderful thing but until politics and tiptoeing cease to exist, it does very little good. Patients and visitors know that the police can’t do anything to them because the customer is always right. Emergency rooms actually have CLASSES that last an entire afternoon that teach staff members how to smile and nod no matter the situation in hopes that we can score a “Very Good” on a survey from a patient whose opinion really shouldn’t matter. I’m sorry but if you berate and abuse the staff in an ER, your opinion shouldn’t matter. You should also be asked to leave and to seek treatment elsewhere. This doesn’t happen, though. There is very little support from administration with these patients. They can act how they want. Do what they want. Dictate to the physicians the direction of their care. We are all walking around paranoid that the next crack-whore is the one that will get us fired. Not because of the care that we give or the manner in which we act, but instead because a person who wouldn’t be trustworthy enough to hire to mow your grass is suddenly the most credible witness on the planet when reflecting on their visit to your department. Violent and unstable patients are the captains of the ship. That is not okay. Don’t get me wrong. I don’t think that a patient’s ER visit should be the equivalent of visiting Dick’s Last Resort. I believe in customer service. I believe in kindness. I believe in a patient’s right to receive excellent health care from highly skilled professionals. BUT COME ON PEOPLE!!!!! If I went to a restaurant to eat dinner, started yelling, pushing the staff and cursing, I would immediately be asked to exit the premises. The funny thing is that the only pressure the wait staff has is to deliver food and drinks with promptness, accuracy, and a smile. ER staff members are SAVING LIVES and if a patient or a visitor starts in with that behavior, a supervisor will go to the area and attempt to calm the person down. If they are unsuccessful, the patient or visitor is still allowed to stay and the solution becomes one in which a new nurse is assigned to that room. ARE YOU FREAKING KIDDING ME?!?!?! These situations need to be nipped in the bud. Patients and visitors need to understand that it is a privilege to receive medical care and that they need to act as part of the team in their care. Step one is for them to be respectful to the staff. This feeling of entitlement in regards to berating medical personnel will continue to escalate and someone is going to get killed. Yes, I am pretty passionate about this topic and with good reason. You see, my name wasn’t simply drawn out of a hat to speak at this conference. I was specifically chosen because I have been forced to evacuate a Level I Trauma Center during an active shooter incident. I didn’t want to. I had to. I know what can happen when we let our guard down. The person you least suspect, or even the person that you suspect most, can be the one that changes your life forever. If you aren’t ready for it, you will probably walk around for the rest of your life shouldering the blame that people you loved and cared about were injured on your watch. Innocence Lost. That’s the title of my presentation. Until January 3, 2001, it never occurred to me that my life was truly in danger in the ER. I had almost imagined hospitals as safe-zones. A place where the sick and injured could come to be repaired… The goalie box of life…Switzerland…I was wrong. I used to be innocent and look at the ER through rose-colored glasses. I don’t do that anymore. My naiveté was stolen from me 18 days short of 15 years ago. I wish people would listen to me. I wish I could get through to them. I wish I could protect them from the incident that is coming. They shake their heads in agreement, acting as though they are hanging on every word…and yet very little changes. Innocence lost. Mine was stolen from me. Theirs will be stolen, too. It’s just a matter of time.