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ER Goddess

ER Goddess

Instead of Taking Punches, Let's Take a Stand

Simons, Sandra Scott MD

doi: 10.1097/01.EEM.0000660460.79658.94
    violence in health care

    I was seeing an amiable retired teacher when my not-so-amiable patient in another room punched one of our nurses in the face. I emerged from the room just in time to hear the IT guy, who was troubleshooting my computer, exclaim, “That patient just punched that nurse! The nurse didn't even do anything to her. He just walked into the room, and she hauled off and slugged him in the face. And he didn't even react! He just remained calm and cool, and went about his business.”

    From my desk, the only thing I could see were two blue-uniformed officers working to restrain flailing arms and kicking legs. I marched over and poked my head in. “You guys OK? You need me to order a sedative?” I barely got the words out before my jaw dropped, and the scene rendered me speechless. At the sink in the corner was our charge nurse with a bloody nose, calmly controlling his epistaxis while the police cuffed the patient.

    “She's not getting a sedative. She's getting jail,” one of the other nurses fumed, and off the patient went.

    Even though the entire episode was over in minutes, it viscerally upset me to the point that I nearly burst into tears. After all the gruesome injuries, deaths, and heartache I've seen, a punch in the face shouldn't shake me to my core. Yet this wasn't a typical punch in the face; this was an act of violence against one of our own by one of the people we worked so hard to help.

    All the Feelings

    I felt indignant on the nurse's behalf. He got right back to work with his bloody nose like it was just part of the job. Unless you're a professional boxer, getting punched in the face should not be part of any job. As he carried on worrying about other patients, I wondered whether anyone was worried about him and the rest of our nurses.

    I felt irate at the patient. The punch she threw was an affront to my sense of fairness. I have no delusions that every patient will say thank you or even be nice, but when good-hearted people are trying to help them, how can they not even reciprocate enough respect to refrain from swinging fists at them?

    I feel fearful of the trend of increasing violence in emergency medicine—and elsewhere. Recently I witnessed a patron dragged out of an NFL game for merely mouthing off to security guards. Schools expel students for far less, but EMTALA dictates that we cannot bar anyone from our EDs. The growing resentment from being expected to just take whatever patients dish out, including assault, is palpable. At least in my ED, which is in the middle of a dangerous neighborhood, we are lucky enough to have officers on stand-by. We don't have to call anyone or even press a button because they are already there monitoring the ED, and they respond before we can even react. What happens in places that don't have vigilant officers? How much more of this violence against our own teams can doctors and nurses withstand while still managing to maintain the love of humanity that got us into medicine?

    I can't witness violence like that punch and remain silent. Inaction is an action too. We may not be allowed to raise our fists to defend ourselves physically, but we can, and should, raise our voices. I am more than happy to raise mine about this morally offensive and intolerable issue.

    A Little Respect

    To nurses, I say that they are appreciated more than they know. Calmly and kindly tolerating stuff like that is why nurses go to heaven. Nurses like our charge nurse that day embody the spirit of health care. Thanks and praise to him and those like him.

    To punch-throwing patients, I say, “How dare you?” Nurses are bending over backwards to bring them medicines, blankets, phones, snacks, and reassurance. I understand that patients are in pain, often having the worst day of their life, and frequently dealing with underlying psychiatric issues. Nonetheless, punching someone in the face because you're having an awful day is wrong no matter who you are or the circumstances. Please show some respect.

    To the health care industry, I say it's time to start taking better care of the caretakers in the trenches. When did doctors and nurses become such low priorities that our dignity is sacrificed at the altar of patient satisfaction? There is a reason doctors and nurses are burning out. It's time for a cultural shift in the way people view medicine's front-line warriors. We have given up weekends, holidays, and many, many, many nights of sleep to dodge puke, pee, and punches. We are not replaceable widgets; we are valuable, educated professionals who show compassion 24/7 and drive the entire health care industry. At the very least, we deserve to feel safe in our workplace.

    That same patient came back a few weeks later. Our staff, being the consummate professionals they are, treated her with compassion and courtesy, as if the punch never happened. In what other industry would this occur? The pendulum in medicine has swung too far. We must speak up and spread awareness, so it swings back. Instead of taking punches, let's take a stand. Together we must push for cultural and legal change, so we never see another nurse or doctor take a fist to the face. ED violence is not OK.

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    Dr. Simonsis a full-time night emergency physician in Richmond, VA, and a mother of two. Follow her on Twitter@ERGoddessMD, and read her past columns at

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