July 22, 2015 Celeste Monforton, DrPH, MPH 6Comment

A physician from the Houston area taught me a new phrase: “Code Silver.” Dr. Stella Fitzgibbons had an op-ed in the Austin American-Statesman yesterday about assaults and other violence in US hospitals to healthcare workers. She begins:

“You’ve been waiting in your hospital bed for pain medicine or some ice water, and are starting to get cranky about the nurse’s delay. Then you find out that it happened because another patient tried to strangle her with her stethoscope. Or you hear ‘Code Silver’ on the overhead speakers, and a nursing assistant comes in, wedges the door shut, and helps you get out of your bed and hide behind it. …Hours later, you find out that ‘Code Silver’ means ‘active shooter on hospital property’ and that an intensive-care patient’s relative pulled a gun on the staff.”

Dr. Fitzgibbons goes on:

“Healthcare facilities deal regularly with drug users demanding narcotics and with criminals who need little reason to become violent.  …While we doctors are only rarely targeted…we and our patients depend heavily on the people who keep healthcare running: nurses, therapists, X-ray techs, and the little-noticed people who keep the place clean.”

With her op-ed fresh in my mind, a news report from St. Peter, Minnesota popped up in my email yesterday:

“A 16-year-old patient at the Minnesota Security Hospital in St. Peter, Minn. violently assaulted a female staff member… The male patient bashed her head into a brick wall, then kicked her repeatedly. The woman reportedly began suffering seizures…”

I suspect the image most people have about hospitals are white coats, clean floors and the smell of antiseptics—not nurses aides getting beat up.

An article some months back in Scientific American showed the hodge-podge of requirements and prevention measures across the States to protect healthcare workers. Few states require healthcare employers–or any employers for that matter–to have violence prevention programs. (About half the states, however, focus after the fact with special penalties for offenders who assault nurses and other care providers.)

Fitzgibbons argues that the accrediting body–the Joint Commission –and OSHA should do more to sanction hospitals that fail to protect their employees from workplace violence. OSHA doesn’t have a regulation to address violence. The agency has used its “general duty clause” to cite healthcare employers–with willful violations (e.g., here, here)–for failing to protect its workforce from assaults and other acts of violence. The State of California is considering a regulation specifically on violence against healthcare workers, which would be enforced by Cal/OSHA.

Worker safety and health are rarely the topic for op-eds. That’s probably the reason that Fitzgibbons’ piece caught my attention. Here’s to her for bringing “Code Silver” to our attention.


6 thoughts on ““Code Silver”: Beware of violent hospital patients, visitors

  1. It would be interesting to survey nurses and others who have worked in hospitals over a period of decades, as to what year they can first remember a violent incident in their hospital, that was not clearly a symptom of a patient’s diagnosis.

    I’m inclined to think it’s a relatively recent trend, as in, this century, and correlates with a generalized increase in violence in the culture. Our culture is pathologically violent, as reflected in crime rates and in the media. So it is not surprising to see the violence extend into places that one would have thought were sanctuaries. Such as schools, churches, and hospitals.

  2. G: If you’re talking about time periods as long as centuries then the modern age is the least violent of historical eras. We just talk about the violence more.

    For example: it is no longer acceptable to beat your child in public, or hang a person for a perceived crime, or to whack a churchgoer on the head for the crime of falling asleep (colonial US).
    What’s different is that now that violence is not acceptable, it’s on TV, so there is more awareness.

  3. “…it is no longer acceptable to beat your child in public, or hang a person for a perceived crime, or to whack a churchgoer on the head for the crime of falling asleep ”

    And could this kind of disciplinary softcockery be responsible for falling social standards?

  4. JustaTech @2:

    What I had in mind was a period of decades spanning from the mid 20th century to the present. Clearly some types of violence have decreased, or are less tolerated such as child beating. Just as clearly, other types of violence have increased, such as mass murders (per FBI definition, four or more victims in one incident).

    So: is today’s prevalence of security signage and police officers in hospitals due to an increase in violence in hospitals, or due to a decreased tolerance for violence in hospitals? That’s a choice between two hypotheses, testable even though imperfectly so (survey research and news clippings). Anyone who is alive today to speak to this issue would have worked in a hospital at any time from the 1950s through the present.

    Craig @ 3: We’ll assume you’re being sarcastic rather than supporting brutalism.

  5. Is equating physical negative reinforcement with “brutalism” definitely improving society?
    Why are people attacking nurses and ambulance workers?

  6. Workplace violence is any act or threat of physical violence, harassment, intimidation, or other threatening disruptive behavior that occurs at the work site. It ranges from threats and verbal abuse to physical assaults and even homicide. It can affect and involve employees, clients, customers and visitors.

    According to Bureau of Labor Statistics data, the rate of workplace violence-related nonfatal occupational injuries and illnesses involving days away from work for health care and social assistance workers was 15.1 per 10,000 full-time workers in 2012. For private industry overall, the rate was 4.0. (And please be mindful of the fact that this is only what is reported/captured by the BLS).

    The issue of workplace violence in healthcare settings has been well studied and documented for the better part of 25 years in the United States, and there is no federal OSHA regulation. The General Duty Clause, and in California – the IIPP (CCR 3203), all have their loop holes.

    While Unions and worker advocates are supporting the California Safe Care Standard Campaign, the well funded California Hospital Association has, as anticipated, began a political game to push back on regulating this known hazard. They are doing that by identifying, among other things, that the healthcare industry has accepted, over time, that violence comes with the job. It is a “necessary evil.” Clearly that is not true when the greatest number of violent incidents is preventable. The campaign in California, in fact, leans on the rationale that: If it is predictable — it is preventable.

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