NORWICH — Cynthia Arpin said that when she started working as a nurse in the Emergency Department, she was told that getting assaulted was just “part of the job.”
Now that she’s the Director of Nursing at Three Rivers Community College, she said, she’s not prepared to convey that message to her students.
“I want them to have long, healthy, productive careers,” she said.
Arpin spoke as part of a panel discussion on violence in healthcare settings — the focal point of a piece of federal legislation sponsored by U.S. Congressman Joe Courtney.
The bill requires hospitals, treatment facilities, certain areas of prisons, group homes, mental health clinics, emergency centers and veterans’ facilities to create plans to protect their employees from violence in the workplace. The plans could include security, de-escalation training, surveillance monitors or alarms, procedures for investigating incidents and provisions for medical care for staff members.
According to Courtney, the support for the legislation — introduced first during the 116th Congress — was further spurred by the death of a visiting nurse named Joyce Grayson, from Brooklyn, CT, who was found murdered in the basement of a halfway house for sex offenders in Willimantic in October, after going there to administer medication to one of the residents. Grayson was the mother of six children and had worked for the Department of Mental Health and Addiction Services for 26 years before becoming a visiting nurse.
The murder is currently under investigation by OSHA, the federal Occupational Safety and Health Administration.
But Sherri Dayton, an emergency room nurse at Backus Hospital in Norwich and president of the local union, said that it was a mistake to think that instances of workplace violence were limited to extreme instances like that of Grayson.
“Just this week, I had a patient who brought three knives in,” said Dayton. “I was alone with him for ten minutes. At any point, he could have pulled that out on me and had threatened to hurt himself during that time.”
According to a 2019 New York Times article, as many as 28 percent of nurses will experience PTSD during their career. And Dayton said she thinks that statistic has gotten worse since the pandemic.
Courtney referenced a 2013 report from the Government Accountability Office showing that healthcare workers in hospitals and nursing and residential care facilities experienced non-fatal incidents of violence at a rate five to twelve times higher than workers overall.
“There’s no room in this country for a worker who goes to work and comes home either injured or doesn’t come home at all. It’s just not acceptable,” added Acting Department of Labor Secretary Julie Su, who attended the panel discussion.
OSHA does not currently have a standard for workplace violence — only guidelines, explained Jeffrey Erskine, OSHA Deputy Regional Administrator for the New England Region.
And John Brady, vice president of AFT-CT, the union representing nurses, said that although OSHA had had these guidelines for 20 years, that doesn’t mean that hospitals or healthcare agencies have necessarily adopted them.
“I frankly think it would be a good business decision for them to do it, but they haven’t. And that’s why we need a standard as opposed to just guidelines,” he said.
While it is up to OSHA to draft the rule, Courtney said that having a bill in Congress would accelerate the rule-making process. He likened it to a bill that Congress passed during the AIDS crisis that established a standard to protect healthcare workers from blood-borne pathogens. Courtney said the bill currently has 150 co-sponsors and bipartisan support in the House of Representatives.
Cassandra Esposito, President of the Connecticut Nurses Association said that no one signs up to become a nurse thinking they’re going to get spit on ,kicked and threatened.
“That’s not the point of going into nursing. It’s to help people. And to do that, we need a safe environment,” she said.
Esposito said that the work environment had the potential to cause problems in recruiting new nurses or push veteran nurses out of the field, exacerbating an already existing nationwide nursing shortage.
“Nurses have options now. And it’s really scary to think who is going to be bedside or providing home care to the people that can’t come to the hospital or anything like that,” said Esposito.
Dayton made several suggestions about how to address the issue, including placing security screenings or metal detectors at healthcare facilities to scan for weapons before someone enters the building. She also said that all healthcare professionals should be required to take de-escalation training to understand how to approach people with mental illness.
Courtney said that while people in opposition to the bill cited the potential costs added to an already expensive healthcare system, the bill itself was estimated to cost $70 million over 10 years — a relatively small amount, he said. He added that it could also benefit employers by reducing worker’s compensation costs and improving retention.
“From a cost standpoint, the argument that the system can’t afford this is just totally wrong,” he said.
In the case of home healthcare workers, Erskine said, one possible requirement was to inform workers of any prior violent behaviors before they enter someone’s home.
“From your perspective, I’d like to know what I’d be walking into,” said Erskine.
Dayton said this could also work in hospitals, where a mark could be made on someone’s chart to notify the nurses of a past history of violence.
“We had a violent incident happening at our psych pod, where … there was already five incident reports for this patient in the [Emergency Department]. They went to the psych pod and significant people were injured,” said Dayton. “And it was very sad. And it didn’t have to happen because it just needed to have better communication and plan.”
She also said that in the aftermath of a violent incident, there needed to be a “root cause analysis” follow-up.
Kelly Reardon, an attorney representing Grayson’s family, said that Grayson’s children, three of whom work in the medical field, offered similar suggestions for protections that should be implemented in healthcare settings — like the importance of background checks for patients and good record-keeping.
“It is my understanding, based on what I’ve learned, that a lot of times clients are dismissed because of violent incidents but then they’re taken back, and that there’s no indication in their charts that they actually were engaging in violent behavior with nurses,” said Reardon.
In a statement to CT Examiner, the Connecticut Hospital Association said that Connecticut state statute already has a number of requirements for workplaces, including incident reporting and prevention and response plans, and that the hospitals are improving physical security, identifying at-risk patients and training staff in de-escalation. The association also noted that assaulting a healthcare worker is a Class C Felony in the state.
“The violence that has been experienced by healthcare workers nationwide is unacceptable. We greatly appreciate Congressman Courtney’s steadfast support for caregivers and workplace violence prevention, and we encourage lawmakers and policy leaders to continue supporting the efforts already underway in Connecticut to ensure a safe environment for staff, visitors, and patients to receive the expert, compassionate care they deserve,” the statement read.
But with the proposal of a standard comes the concern about enforcement. Dayton told CT Examiner that it could take OSHA months to respond after a complaint was filed, and that the incident had to be “pretty heinous” to warrant a citation.
“Without a standard, they’re very limited in what they can enforce,” echoed Brady.
Acting Department of Labor Secretary Julie Su told CT Examiner that the department had done “tremendous hiring” under the Biden administration, and that they were working on building up the necessary workforce to address workplace issues.
In the meantime, Arpin said, the six nursing schools that are part of CT State Community College have added a workplace violence component to their curriculum, teaching students how to protect themselves and giving them self-care skills. At Three Rivers, she said, their program is consistently filled to capacity — 96 students per year — and most of the students will stay and work in the area after graduating.
“We hear about the new nurses leav[ing] the field, and we don’t want that,” said Arpin. “We’re working hard to get them out there. We don’t want them to then just leave.”
This story was edited to make clear that the legislation was introduced prior to the death of Grayson and has been a long-standing priority for the congressman