Phil Rau (Host): Punched, kicked, slapped, spit on, assaulted with pencils, chairs, backpacks, even weapons; healthcare workers, especially in emergency departments across the country, are among those with the highest risk of suffering violence while on the job. But while violence has long been an ever present risk for these altruistic men and women; in recent years, emergency care teams across UVM Health Network have seen an extraordinary rise in attacks against everyone who provides support or care to patients in need of emergency medical attention.

Today, we'll hear from nurses and providers who come to work each day in the emergency department at UVM Medical Center, knowing there's a good chance they'll be attacked, perhaps even severely injured, by people they're trying to help. We'll hear some of their stories, gain insight into the scale of the problem, and learn what they and care teams across our health system are doing to address the issue of violence against healthcare workers.

 This is Health Talk. And I'm your host, Philip Rau.

Thank you for joining us today as we explore this disturbing topic and help end the silence on healthcare violence. Violence against healthcare workers is so frequent and widespread that many of the men and women who provide emergency care and support don't even report being assaulted.

The problem is so serious that in the emergency department at UVM Medical Center, the hospital has created a new position dedicated solely to developing anti violence policies and procedures and teaching de-escalation techniques to employees to reduce the number of physical and verbal assaults that occur.

Let's start by hearing from Matt Looft, a long time Registered Nurse and avid outdoorsman who has been both a witness to and victim of violence while on the job. Matt, you're an imposing guy who has spent more than a decade in the emergency department as a bedside nurse. What episodes of violence have you experienced and what have you seen happen to your colleagues and coworkers while they are providing care?

Matthew Looft, RN: In our department, we experience the threat of violence or violence on a daily basis. And for our staff, that's often a patient that is punching or kicking or spitting, that's relatively low level. We've had nurses and some of our support staff, our mental health techs and our EMTs that have had hands broken, that have had facial bones broken. We've had multiple staff members that have been punched in the head and have lost consciousness, have had mild traumatic brain issues and injuries. And that is a daily occurrence in emergency departments, basically across America.

Workplace violence for us, kind of runs a gamut from these nonviolent verbal encounters, which we think of as verbal assault, where folks are using either really vulgar or directly threatening language, threatening violence, and then that continuum going up to kind of low level physical altercation, spitting, pushing, to kicking, punching, fighting. I've been headbutted in the face, I've been punched and knocked out, so things like that. One of our mental health techs was stabbed with a pen recently. So, there's a pretty continuum from low level verbal assault all the way up to significant physical assault.

Phil Rau (Host): Matt and his colleagues recently shared their stories with the New York Times, helping to create an award winning video op ed that shines a bright light on violence against healthcare workers. Let's listen to a brief clip from Matt from that video to help drive home what he and his colleagues are facing each day as they provide emergency care to members of our community.

Matt Looft: I was knocked unconscious by a patient, been punched, kicked, spit on. I've had my life threatened, my family, like, I'm gonna come to your house and kill you, kill your kids. I'm really here to help folks on their bad days. And to be threatened for that, to have my family threatened for that, my physical safety, like, you end up doing this calculus, is it worth it?

Phil Rau (Host): While most of us can't imagine being involved in a violent altercation like Matt describes, the fact is the majority of healthcare workers in the emergency department already have been. A 2022 study by the American College of Emergency Physicians found that two thirds of physicians reported being assaulted in the previous year. And that's likely not the full scope of the impact, says Dr. Julie Veith, Assistant Medical Director of Emergency Medicine at UVM Medical Center.

Julie Vieth, MD: I think if we look at all comers, at least 75% of people working in healthcare in the emergency department have experienced some type of violence, whether that's verbal or physical. And I think it's just really important to note that that's just what's being reported.

I think it's really hard to go day in and day out and not be witness to some type of assault on one of your colleagues. And what's also unmeasured and difficult to ascertain the true scope of the problem is the amount of emotional and moral distress that happens amongst ourselves when we're either witness to this or victims of this. I like to think that I'm the lucky one because I have people like Matt that are constantly looking out for other physicians such as myself. And the nurses and our techs are truly the ones at the front line of this.

Phil Rau (Host): One of those nurses is Amanda Young, who joined UVM Medical Center's ED team as a nurse educator focused on anti violence. She called the surge in verbal and physical assaults something that impacts the way healthcare workers show up at the bedside.

Amanda Young, RN: Our emergency department is averaging greater than 30 assaults a month. What I'm seeing is people really chomping at the bit wanting to get more training to help manage these really tough behaviors that we're seeing. You know, I was at the bedside just a couple months ago, and knowing that we had this increase in violence made me a much more hypervigilant nurse and more cautious around the patients than I ever wanted to be. So I'm hoping to help deliver a whole lot more training and care to our patient facing staff so they can feel more comfortable at the bedside and not as scared.

Phil Rau (Host): With incidents of verbal and physical violence so widespread and impacting healthcare workers in so many different ways, UVM Medical Center has mounted a multi dimensional response that involves everyone from employees to elected officials. And as Matt will explain, it's changing much about how the emergency room looks and feels to patients and visitors.

Matthew Looft, RN: So in our emergency department, we have instituted magnetometers or metal detectors at our waiting room. So, all patients and family members that come in through the front door are screened for weapons. As part of that, we also have started screening all patients that come in by ambulance. And we are trying to limit the amount of things that are brought into the department, so we have instituted a clear bag policy, so as a patient or family member, you might be asked to leave a large bulky backpack in your car and just have things in a small clear bag.

We have increased our security staffing so that we have more in our waiting room and more that can circulate through our department. We've done things like increased lighting in our parking lot. We have instituted increased PPE, or personal protective equipment, that our staff can use when interacting with patients who might be violent.

These are significant changes from our baseline. But it's simple things like this that we're trying to do to reduce the incidence of a event.

Phil Rau (Host): Simply changing the way emergency departments work isn't enough though, is it Amanda? We've got to change the way healthcare workers do their jobs, give them more tools to protect themselves and deescalate situations, and make sure our public safety agencies and elected officials understand the seriousness of this issue and the negative impact it is having on both individuals and healthcare workers in general.

Amanda Young, RN: What I'm seeing is people really chomping at the bit wanting to get more training to help manage these really tough behaviors that we're seeing. What we're working on is just really increasing our training. We're gearing up for dealing with this huge influx of violence. So, we're increasing our training for our patient-facing staff. We have several workplace violence committees that are happening all over the hospital.

We're also seeing burnout and some compassion fatigue when people are facing aggression and instability all the time, with a workforce that just came out of COVID and are being hurt, and we're working on a staff support team to be able to respond to staff who are having a hard time as well, so we can really support the staff.

Phil Rau (Host): From working to make emergency department operations more safe and secure to increased anti violence training for healthcare workers who are face to face with patients and families, there's a lot of work going on at the hospital to address this issue.

Is there also a role for our law enforcement agencies and lawmakers to play here, Dr. Veith? What are the consequences of leaving the issue unaddressed?

Julie Vieth, MD: What we're seeing is some recognition at the state level, in conjunction with at the federal level, that this is a real issue and it's leading to healthcare workers leaving the healthcare system in droves.

We have had a recent law come into play in Vermont called S36. And it makes it a felony to criminally threaten a healthcare worker. What it also does is it changes how law enforcement categorizes these crimes. S36, allows our law enforcement partners to actually treat violence against healthcare providers, similar to the way they would treat a domestic violence call, and they can actually take the perpetrator into custody.

 That's not to say that they're going to remove them from the hospital. We will still continue to provide that person medical care just as we would anyone else. And that law actually doesn't apply to just healthcare workers in the hospital, but also our emergency medical specialists out in the community.

Phil Rau (Host): With so much change happening so quickly Matt, Amanda, Dr. Vieth and their colleagues are asking members of the public to be patient and say that everyone's safety continues to be the hospital's top priority.

Matthew Looft, RN: For folks that have lived in Burlington for their whole lives and have accessed care at UVM, it feels like they're going to the big city and, you know, gosh, what are these, why am I being searched when I just come to the hospital?

We still fully support and embrace patient and family centered care, and we want to prioritize getting family members back to the bedside to visit their patients, and we will do so as quickly as possible.

Amanda Young, RN: What we're asking from society is to bear with us while we weather these changes and work hard to keep our staff and the general population as safe as possible. People should know that we're working hard to treat everybody the exact same way we always did. And we are still really dedicated to taking care of folks who need our care.

Phil Rau (Host): If you want to hear from more healthcare workers about their experience with violence while on the job, be sure to check out UVM Medical Center's video op ed with the New York Times, which we'll link in the podcast description. It's absolutely heart wrenching to hear these folks share in their own words what has happened to them while they are providing care to patients.

And if you have your own questions, comments, or ideas for future episodes, be sure to email us at healthtalk@uvmhealth.org. We could end up thanking you for your ideas as we cover them in a future episode. Health Talk is a podcast about all things health and healthcare related. From health and wellness topics and individual profiles to issues like this, which are shaping or reshaping the landscape of healthcare before our eyes.

 Check out our library of existing episodes online at uvmhealth.org/healthtalk. I'm Philip Rau. Thanks for joining us for health talk.