Taking care of health care workers: Security and workplace violence prevention at UNM Hospital

Attacks on health care workers continue to be a problem faced by hospital systems across the nation. To better ensure the safety of employees and providers, The University of New Mexico Hospital has implemented the Workplace Violence Program, a proactive approach to reducing incidents, enhancing response and supporting victims. The Workplace Violence Program is a collaborative effort involving hospital staff and leadership, hospital security, and the UNM Police Department.

Many who serve within the program have firsthand experience with violence at work.

"When I first became a nurse, I had a patient who was not a nice person," said Adelia S. Perea, DNP, RN, CNRN, recounting the first time she encountered an aggressive patient.

"He was upset with me because I didn't give him his medications when he wanted them," she continued. "I was in a different room with a different patient, taking care of an emergent situation. When I walked into the room-I'm 5-foot-3, he was 6-foot-2 and probably 280 pounds-he came flying out of the bed at me with his fist."

The young nurse acted quickly and dodged what could have been a devastating blow.

"It scared me a lot," Perea said.

When she reported the incident to her charge nurse, she was surprised by the response.

"I was in tears," she said. "I was scared, and the response I got from my leader was, 'Well, welcome to nursing.'"

Perea, now a leader herself, is the inpatient unit director for the 5-South Neuroscience Progressive Care Unit at UNM Hospital. She is also chair of the Workplace Violence Subcommittee, and she has vowed to never respond to a staff member's report of violence with complacency or indifference.

"I am never going to tell anyone who wants to become a nurse or work in health care, in any way, that you have to get used to it, because it's not something you should have to get used to," she said.

Not only is it not right, Perea said, but also it's a crime.

According to state law (NM ST § 30-3-9.2), assaulting a health care worker is a misdemeanor, aggravated assault against a health care worker is a third degree felony and battery on a health care worker is a fourth degree felony.

"Our staff have the ability to press charges, and you can be prosecuted," Perea said.

Responding to Reports of Workplace Violence

Patients and visitors may not be thinking of violence when they come through the doors of the hospital, but Perea said hospital staff not only think about violence-they experience it multiple times a day in multiple units. That often includes hitting, spitting and threats from patients and sometimes even from visitors.

"We see battery frequently, people being physically assaulted," said Kaitlin Koch, RN, MSN, CCRN, co-chair of the Workplace Violence Subcommittee and unit director of the Trauma Surgical Burn Intensive Care Unit at UNM Hospital. "Batteries are reported more than verbal assaults. Verbal assaults are significantly under-reported."

Since it was established three years ago, one of the subcommittee's goals has been to increase and encourage reporting from staff through a new notification system.

The Assault Alert system allows staff to report a violent patient through the hospital's secure messaging app so that others, including hospital chiefs, are aware of a potentially dangerous person. Once the alert goes out, the patient's chart and door are marked to warn other staff members assigned to treat them.

"Understandably, it doesn't make the situation any easier, but the staff are a lot more supported when those things do happen," Koch said. "Now that we've got the support, let's work on decreasing the number of instances."

In most cases, when a visitor commits an act of violence, they can be removed from the hospital by security. But when a patient commits a violent act, they remain a patient.

Katrina Anspach, the emergency services director at UNM Hospital and co-chair of the Workplace Violence Committee-which oversees the Workplace Violence Subcommittee-said unit leadership and a representative from the hospital Employee Well-Being Program will follow up with any staff member who is assaulted or battered within 24 hours to offer any resources they may need, from counseling to medical services or even time off work.

"The Workplace Violence Committee and Subcommittee have increased awareness of hospital violence at all levels," said UNM Hospital CEO Kate Becker. "Their actions, based on data they have collected, ensure violence on our hospital campuses will not be ignored or tolerated. Every member of our team deserves to come to work without fear that they're going to be hurt."

Both committees are only a part of a larger Workplace Violence Program at UNM Hospital.

The committees are made up of volunteer hospital staff members who meet monthly and collect data on workplace violence. Then, they present their findings to unit directors and supervisors, as well as provide training and resources for leaders so they are better prepared to help their staff when an incident occurs.

"It's one of the most productive committees I am currently on," Anspach said.

Other safety and security changes to come from this collaborative process include the addition of metal detectors in the Emergency Department and meetings with representatives from the Bernalillo County District Attorney's office to follow up on violence cases and prosecutions.

"That was a very common complaint we heard from staff," Anspach said. "We report, but nothing happens, and then (the patient) comes back and does it again."

Alert buttons have also been added to staff badges in the Emergency Department and Adult Urgent Care, so that staff members can immediately notify their supervisor when they feel threatened. Anspach said the goal is for every hospital employee to have a button on their badge, including in the new Critical Care Tower at UNM Hospital and at UNM Sandoval Regional Medical Center-A Campus of UNM Hospital (SRMC).

Whether or not there is an active alert, UNM Hospital Security is constantly at work with an entire system of safeguards, from monitoring more than 2,000 cameras, to patrolling hospital hallways and the grounds 24/7. Security is a crucial arm of the Workplace Violence Program.

"Security is designed to protect the facility's physical property and achieve relative safety for all people interacting with the health care system by helping to prevent loss, reduce risks, and create a more secure environment for patients, visitors, and staff," said Felix Funes, the executive director of UNM Hospital Security.

Funes said his department employs 115 proprietary security officers who deter crime and respond to calls. They also keep close watch on a robust combination of duress alarms, infant protection, weapons detection, and access control systems.

"The UNM Hospital Security Program is supported by managers focusing on workplace violence, preventing targeted violence, training, and regulatory readiness," Funes said.

Why is Violence in Hospitals Increasing?

Even with these collaborative teams and systems, violence still happens, and often.

According to a recent report from the American Hospital Association, incidents of violence in hospital settings have increased in the last 10 years.

Koch, Perea and Anspach have all seen this trend firsthand, noting that it seems to have worsened since the pandemic.

But why?

"I think that's a question that society needs to answer," Perea said.

"We understand that patients and families and visitors are probably experiencing some of the worst days of their lives here," Koch added. "We want to have a little bit of grace for those who are unable to deal with their feelings well, but then also make sure our staff is safe."

While the actions of others remain beyond what UNM Hospital staff can control, Anspach said they can work to effectively prevent and respond to acts of workplace violence and offer more support for victims and witnesses of violence.

"As a unit director, I see how hard our staff works to provide the best care that they can give," Anspach said through tears, overcome with emotion. "They give 110% every day, and to sometimes see the way they get treated-the way they get treated isn't fair. We have to give the staff 110% like they give our patients."