Dec. 16, 2015

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.


08.02.2016 18:38


ER violence occurs because patients know about net scores and management won't defend us the customer is always right

08.02.2016 16:12

Heather Edwards

I too had my innocence taken..3/3/ changed forever, only I was in a remote fly- in area in northern Canada in a health center....held hostage and shot at 12 times....Abusers are charged now..

28.12.2015 19:26


This is what war is really like. Have any of you seen this or experienced it in the ERs you have worked?

08.02.2016 16:15


Unfortunately this is all to frequent..have worked ear and remote areas for many years and see so much....

20.12.2015 09:08

Nurse J

Yet and still, nurses feel unsafe and get threatened Daily. We often discuss the need for us to be able to refuse care to those patients after ruling out a bleed

20.12.2015 09:06

Nurse J

I work in the ER in an urban community where things have gotten so bad that metal detectors are in place, our guards are armed, and patients have to be scanned when coming through stretcher triage

19.12.2015 00:40


I will make sure to pass On your sentiments to all the families of the dead soldiers and those serving to protect your rights

28.12.2015 16:32


I highly doubt the person writing this meant to decrease the significance of a war zone, and if that is all you got out of this article, maybe you need to reread the article.

19.12.2015 12:38


Your experiences influence who you are today. I thank you for your service. The author's use of "War Zone" best describes her experience. Unarmed, without back-up and unaware of who the enemy is.

19.12.2015 12:32


Kevin - I can assure you that the author of this post admires and reveres our military for their sacrifices and courage (as I know her personally), Cut her some slack for the term "War Zone".

18.12.2015 20:58


I am hoping that we come to the understanding that the 'leaders' do NOT need Mahogany surrounding them, they need their offices to be the entrance to ER....So they can see the real laborers

18.12.2015 05:44


Thank you so much for sharing your horrifying experience with us. You are a very strong women and an inspiration. I do believe that one day as we all ban together we can change the violence in the ER.

18.12.2015 04:19


Your presentation was fantastic, you are truly an inspiration. I believe that if we band together as nurses we can start to change this culture of violence.

18.12.2015 03:23


Offends? Man! Who doesn't get offended these days?? Who doesn't have their feelings always on their sleeve waiting for someone to knock it off in so they can start the next riot?

18.12.2015 03:10


Excellent article. Very well put.

18.12.2015 01:01


As a war veteran it offends me that people would even compare the ER to a war zone. If you have never served in an actual war zone you should stop referring to it as such. There is no comparison

19.12.2015 15:09


Kevin- I in no way meant to offend with the title of the entry. The point is that it is unacceptable for ERs to be unsafe, and they are. Thank you for your service.

18.12.2015 22:02

Just my opinion

There are different kinds of war zones, Kevin! To become offended by this article, and the use of the term, "war zone" is rather immature and ridiculous!

18.12.2015 05:08


Alicia, I am an ER nurse and a combat war veteran and the violence we face in the ED is in no way the same. I have faced violence in both arenas. PS. I am as light as a feather

18.12.2015 03:22


Agree with Kevin. I have both worked in an urban ER and gone to war. I understand the spirit of the article but there is no comparison. Sort of like a plastics surgeons office nurse relating to the ER

18.12.2015 03:08


Kyle, it was an attention grabbing statement. Ease up. Have you ever worked in an ER? It can be terrifying and dangerous. Violence happens towards staff daily. In a place that should be safe.

17.12.2015 15:15

Kyle Wiebold, RN

All too common in today's hospitals. As a critical care RN myself, I applaud your efforts at bringing this to the attention of the masses. Just your house unionized? Stay safe!

17.12.2015 20:53


I do not practice in a unionized state

17.12.2015 05:38

Kathleen burman

Have been there. What we do we choose but without the proper back up. Have been strangled, thrown to the floor, had a knife pulled on me twice and a gun. I still choose to do what I do . need back up

17.12.2015 05:11


You are such an amazing person, wife, mother, and nurse. Thank you for being our voice when others try to shut us down.

16.12.2015 21:14


You are a hero to me! So much truth here. Sad thing is, no the admirable thing is you still work in that environment. God bless you my dear friend!

16.12.2015 21:09


Great job Kimi, love u bunches! 💕

16.12.2015 20:51

Christi Shows

Awesome Kimi! Love your passion and wish people would listen.

16.12.2015 20:35

D'Ann Woolverton

Beautiful, Kimi. I know, all too well, that the violence in the ER can eat you up. Maybe someone will listen one day. It will, unfortunately, be a day late. ❤️

16.12.2015 20:15

Leslie Delatorre

Another gem, Kimi. ♡♡♡♡♡